Health Policy & Planning: Rethinking collaboration

1 July, 2019

Interesting new paper on local collaboration in Social Science and Medicine. Citation, abstract and a comment from me below.

CITATION: Rethinking collaboration: developing a learning platform to address under-five mortality in Mpumalanga province, South Africa

Lucia D’Ambruoso Maria van der Merwe Oghenebrume Wariri Peter Byass Gerhard Goosen Kathleen Kahn Sparara Masinga Victoria Mokoena Barry Spies Stephen Tollman et al.

Health Policy and Planning,

Published: 26 June 2019


Following 50 years of apartheid, South Africa introduced visionary health policy committing to the right to health as part of a primary health care (PHC) approach. Implementation is seriously challenged, however, in an often-dysfunctional health system with scarce resources and a complex burden of avoidable mortality persists. Our aim was to develop a process generating evidence of practical relevance on implementation processes among people excluded from access to health systems. Informed by health policy and systems research, we developed a collaborative learning platform in which we worked as co-researchers with health authorities in a rural province. This article reports on the process and insights brought by health systems stakeholders. Evidence gaps on under-five mortality were identified with a provincial Directorate after which we collected quantitative and qualitative data. We applied verbal autopsy to quantify levels, causes and circumstances of deaths and participatory action research to gain community perspectives on the problem and priorities for action. We then re-convened health systems stakeholders to analyse and interpret these data through which several systems issues were identified as contributory to under-five deaths: staff availability and performance; service organization and infrastructure; multiple parallel initiatives; and capacity to address social determinants. Recommendations were developed ranging from immediate low- and no-cost re-organization of services to those where responses from higher levels of the system or outside were required. The process was viewed as acceptable and relevant for an overburdened system operating ‘in the dark’ in the absence of local data. Institutional infrastructure for evidence-based decision-making does not exist in many health systems. We developed a process connecting research evidence on rural health priorities with the means for action and enabled new partnerships between communities, authorities and researchers. Further development is planned to understand potential in deliberative processes for rural PHC.


1. Despite progressive health policy, implementation challenges limit progress in reducing health inequalities in rural South Africa. The introduction of a ‘learning platform’ connecting stakeholders from provincial and district health systems with researchers can promote co-production and use of research evidence to inform policy and programmes.

2. Structured spaces for dialogue and deliberation in local policy and planning can extend the potential of research to inform service organization and delivery. Sustaining such platforms via integration into routine activities, including key stakeholders within and beyond the health system, and shared planning, design, learning and adaption are key to realizing potential.

COMMENT (NPW): The authors conclude: 'As the process continues, we will explore integrating into routine activities for collaborative problem-solving, developing and analysing data with those who organize, provide and use services, and working at different levels to understand and enable change.' From a communications perspective, these levels of collaboration are both downstream (local/communities) and upstream (national/global). Such communication/collaboration would have been unimaginable as we started the 21st century, but have huge potential as connectivity becomes more and more ubiquitous. A future where there is equitable engagement and participation on health policy (and other development issues) at (and across) local, national and global levels would be profoundly transformative - and is readily achievable.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: