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dc.contributor.authorD’Ambruoso, Lucia
dc.contributor.authorvan der Merwe, Maria
dc.contributor.authorWariri, Oghenebrume; orcid: 0000-0002-7432-8995
dc.contributor.authorByass, Peter
dc.contributor.authorGoosen, Gerhard
dc.contributor.authorKahn, Kathleen
dc.contributor.authorMasinga, Sparara
dc.contributor.authorMokoena, Victoria
dc.contributor.authorSpies, Barry
dc.contributor.authorTollman, Stephen
dc.contributor.authorWitter, Sophie; orcid: 0000-0002-7656-6188
dc.contributor.authorTwine, Rhian
dc.identifierdoi: 10.1093/heapol/czz047
dc.identifier.citationHealth Policy and Planning, volume 34, issue 6, page 418-429
dc.descriptionFrom Crossref via Jisc Publications Router
dc.descriptionHistory: epub 2019-06-26, issued 2019-06-26, ppub 2019-07-01
dc.descriptionArticle version: VoR
dc.descriptionFunder: Department for International Development, UK Government; FundRef: 10.13039/501100002992
dc.descriptionFunder: Department for International Development; FundRef: 10.13039/501100000278
dc.descriptionFunder: Medical Research Council Canada; FundRef: 10.13039/501100007155
dc.descriptionFunder: Wellcome Trust; FundRef: 10.13039/100010269
dc.descriptionFunder: Economic and Social Research Council; FundRef: 10.13039/501100000269; Grant(s): MR/N005597/1, MR/P014844/1
dc.descriptionFunder: University of the Witwatersrand, Johannesburg; FundRef: 10.13039/100009467
dc.descriptionFunder: South African Medical Research Council; FundRef: 10.13039/501100001322
dc.descriptionFunder: Foreign and Commonwealth Office; FundRef: 10.13039/501100000617
dc.descriptionFunder: Health Systems Research Initiative
dc.descriptionFunder: MRC
dc.descriptionFunder: Umeå Centre for Global Health Research
dc.descriptionFunder: FORTE: Swedish Council for Health, Working Life and Welfare; Grant(s): 2006–1512
dc.descriptionFunder: The School of Public Health
dc.descriptionFunder: Wits Rural Public Health and Health Transitions Research Unit and Agincourt HDSS; Grant(s): 058893/Z/99/A, 085477/B/08/Z, 069683/Z/02/Z, 085477/Z/08/Z
dc.descriptionFunder: FCO
dc.description.abstractAbstract 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.
dc.publisherOxford University Press (OUP)
dc.rightsLicence for VoR version of this article starting on 2019-06-27:
dc.sourcepissn: 0268-1080
dc.sourceeissn: 1460-2237
dc.subjectHealth Policy
dc.titleRethinking collaboration: developing a learning platform to address under-five mortality in Mpumalanga province, South Africa

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