The study aimed to analyze actors and their relationships, spaces and challenges faced in the governance of actions and services of medium complexity health in a health region. A qualitative study, developed through interviews with public health managers, a representative of the State Health Manager, the regional supporter of Paraná and the director of the Intermunicipal Health Consortium. The results allowed to classify the actors in government and market. The meetings of the regional interagency commissions were highlighted as possible spaces for actions and services of medium complexity health governance. Among the challenges, are: the lack of solidarity and sharing of responsibilities between federative entities; the fragility of the municipal entity, in relation to the other actors involved in governance; the political interference of deputies, with the State Manager. Actions and services of medium complexity health governance presents itself as a great game, permeated by competitive relationships and conflicts.
Governance; Regional health planning; Secondary care