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dc.rights.licenseAttribution 4.0 International (CC BY 4.0)
dc.contributoreditor: Nazif-Munoz, Jose Ignacio
dc.contributor.authorD’Ambruoso, Lucia
dc.contributor.authorMabetha, Denny
dc.contributor.authorTwine, Rhian
dc.contributor.authorvan der Merwe, Maria
dc.contributor.authorHove, Jennifer
dc.contributor.authorGoosen, Gerhard
dc.contributor.authorSigudla, Jerry
dc.contributor.authorWitter, Sophie
dc.contributor.authorOn behalf of the Verbal Autopsy with Participatory Action Research (VAPAR)/Wits/Mpumalanga Department of Health Learning Platform
dc.identifierdoi: 10.1371/journal.pgph.0000323
dc.identifierpublisher-id: pgph-d-21-00979
dc.identifier.citationD’Ambruoso, L., Mabetha, D., Twine, R., van der Merwe, M., Hove, J., Goosen, G., Sigudla, J., Witter, S., and On behalf of the Verbal Autopsy with Participatory Action Research (VAPAR)/Wits/Mpumalanga Department of Health Learning Platform (2022) ‘“Voice needs teeth to have bite”! Expanding community-led multisectoral action-learning to address alcohol and drug abuse in rural South Africa’, PLOS Global Public Health. Edited by J.I. Nazif-Munoz, 2(10), p. e0000323. Available at:
dc.descriptionFrom PLOS via Jisc Publications Router
dc.descriptionHistory: received 2021-11-16, collection 2022, accepted 2022-07-01, epub 2022-10-19
dc.descriptionAcknowledgements: The authors would like to thank community, government, and non-governmental stakeholder participants for agreeing to be part of the process, and for sharing their time, knowledge, and perspectives. Thanks also to the Verbal Autopsy with Participatory Action Research (VAPAR) team and staff of the Medical Research Council (MRC)/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), especially Simon Khoza, Sizzy Ngobeni and Ella Sihlangu. Thanks to Roosamaria Savela for help with literature searches. Finally, thanks to Rene Loewenson for comments on an earlier draft.
dc.descriptionPublication status: Published
dc.descriptionFunder: Medical Research Council; funder-id:; Grant(s): MR/ P014844/1
dc.descriptionSophie Witter - ORCID: 0000-0002-7656-6188
dc.description.abstractThere is limited operational understanding of multisectoral action in health inclusive of communities as active change agents. The objectives were to: (a) develop community-led action-learning, advancing multisectoral responses for local public health problems; and (b) derive transferrable learning. Participants representing communities, government departments and non-governmental organisations in a rural district in South Africa co-designed the process. Participants identified and problematised local health concerns, coproduced and collectively analysed data, developed and implemented local action, and reflected on and refined the process. Project data were analysed to understand how to expand community-led action across sectors. Community actors identified alcohol and other drug (AOD) abuse as a major problem locally, and generated evidence depicting a self-sustaining problem, destructive of communities and disproportionately affecting children and young people. Community and government actors then developed action plans to rebuild community control over AOD harms. Implementation underscored community commitment, but also revealed organisational challenges and highlighted the importance of coordination with government reforms. While the action plan was only partially achieved, new relationships and collective capabilities were built, and the process was recommended for integration into district health planning and review. We created spaces engaging otherwise disconnected stakeholders to build dialogue, evidence, and action. Engagement needed time, space, and a sensitive, inclusive approach. Regular engagement helped develop collaborative mindsets. Credible, actionable information supported engagement. Collectively reflecting on and adapting the process supported aligning to local systems priorities and enabled uptake. The process made gains raising community ‘voice’ and initiating dialogue with the authorities, giving the voice ‘teeth’. Achieving ‘bite’, however, requires longer-term engagement, formal and sustained connections to the system. Sustaining in highly fluid contexts and connecting to higher levels are likely to be challenging. Regular learning spaces can support development of collaborative
dc.publisherPublic Library of Science
dc.rightsLicence for this article:
dc.sourceeissn: 2767-3375
dc.subjectResearch Article
dc.subjectSocial sciences
dc.subjectBiology and life sciences
dc.subjectMedicine and health sciences
dc.subjectPhysical sciences
dc.title‘Voice needs teeth to have bite’! Expanding community-led multisectoral action-learning to address alcohol and drug abuse in rural South Africa
qmu.authorWitter, Sophie
qmu.centreInstitute for Global Health and Development Research Centreen

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Attribution 4.0 International (CC BY 4.0)
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