Navigating political dilemmas: collaborative efforts between a health trust and municipalities, before and during the COVID-19 pandemic in Norway

Purpose The Norwegian Government expects collaboration between health trusts and municipalities to promote sustainable, coordinated health services. The coordination reform (2012) introduced various instruments. This article analyses how these instruments created dilemmas, affecting collaboration differently before and during the COVID-19 pandemic. Design/methodology/approach This article applies a comparative qualitative case study design with a theoretical interpretative focus. The material includes public documents, cooperation agreement and individual interviews covering experiences from formal collaboration structures before the pandemic and more informal ad hoc collaboration during the pandemic. Findings Before the pandemic, collaboration involved power imbalances and discussions over resources and financing. During the pandemic, actors appeared equal and focused on tasks and solutions. This article highlights how a better balance between instrumental and communicative rationalities supported this change. Practical implications The findings suggest that collaboration is more effective when policy design supports both instrumental clarity and communicative engagement. Clear goals, mutual recognition of local perspectives and flexible structures, where relevant actors are entrusted with decision-making authority, can strengthen policy support and enable local mobilization. Originality/value This article illustrates how collaboration between a health trust and municipalities represents both multi-actor collaboration and multi-level governance. The findings contribute to the academic discussion on how balancing hierarchical control with communicative approaches may foster collaborative outcomes. They underscore the need for context-sensitive governance approaches that may support adaptive and sustainable collaboration across diverse policy areas.