Collective reflections on the first cycle of a collaborative learning platform to strengthen rural primary healthcare in Mpumalanga, South Africa

Abstract

Background Frontline managers and health service providers are constrained in many contexts from responding to community priorities due to organizational cultures focused on centrally defined outputs and targets. This paper presents an evaluation of the Verbal Autopsy with Participatory Action Research (VAPAR) programme—a collaborative learning platform embedded in the local health system in Mpumalanga, South Africa—for strengthening of rural primary healthcare (PHC) systems. The programme aims to address exclusion from access to health services by generating and acting on research evidence of practical, local relevance. Methods Drawing on existing links in the provincial and national health systems and applying rapid, participatory evaluation techniques, we evaluated the first action-learning cycle of the VAPAR programme (2017–19). We collected data in three phases: (1) 10 individual interviews with programme stakeholders, including from government departments and parastatals, nongovernmental organizations and local communities; (2) an evaluative/exploratory workshop with provincial and district Department of Health managers; and (3) feedback and discussion of findings during an interactive workshop with national child health experts. Results Individual programme stakeholders described early outcomes relating to effective research and stakeholder engagement, and organization and delivery of services, with potential further contributions to the establishment of an evidence base for local policy and planning, and improved health outcomes. These outcomes were verified with provincial managers. Provincial and national stakeholders identified the potential for VAPAR to support engagement between communities and health authorities for collective planning and implementation of services. Provincial stakeholders proposed that this could be achieved through a two-way integration, with VAPAR stakeholders participating in routine health planning and review activities and frontline health officials being involved in the VAPAR process. Findings were collated into a revised theory of change. Conclusions The VAPAR learning platform was regarded as a feasible, acceptable and relevant approach to facilitate cooperative learning and community participation in health systems. The evaluation provides support for a collaborative learning platform within routine health system processes and contributes to the limited evaluative evidence base on embedded health systems research.

Burden of mortality linked to community-nominated priorities in rural South Africa

“…HIV/AIDS and tuberculosis) are not fully recognised by policymakers [ 41 , 56 ], but, in contrast, may be better understood among the community. As part of the wider VAPAR programme, mortality data are supplemented with the community’s perceptions, which, we argue, reflects more explicitly the indirect social consequences – not the mere endpoint of life [ 31 , 57 ].…”

Providers' definitions of quality and barriers to providing quality care: a qualitative study in rural Mpumalanga Province, South Africa

“… 41 However, there are ongoing collaborative learning platforms in the study site, such as the Verbal Autopsy Participatory Action Research Programme, which aim to engage local providers and stakeholders in health services research. 42 For quality improvement efforts to be meaningful, there is a need for data literacy education and training at the clinic operational and provider level, involvement in development of indicators, and a clear feedback loop allowing what providers see as critical information to be reflected in the national quality measurement strategy.…”

Moving towards social inclusion: Engaging rural voices in priority setting for health

“…The NHI Bill declares that priority should be given to groups that are in greatest need and experience greatest difficulty in obtaining care. 8,9 This will require prioritising vulnerable groups including rural populations. In the country, the overall disease burden is higher for those living in poverty, 75% of which reside in rural areas, largely due to entrenched structural inequalities and is exacerbated by poor access to services and greater social exclusion.…”

“…This will require prioritising vulnerable groups including rural populations. In the country, the overall disease burden is higher for those living in poverty, 75% of which reside in rural areas, largely due to entrenched structural inequalities and is exacerbated by poor access to services and greater social exclusion 6,10 . These healthcare access challenges are also often greater in rural areas compared to urban areas 11 .…”