Learning in the district health system: How can meetings become spaces of reflection?
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i6.2094Keywords:
District health system, Learning health systems, Meeting managementAbstract
To fulfil its role, the District Health System (DHS) must enable and lead learning in the South African (SA) health system. Meetings are a core routine that can be leveraged to encourage learning in the DHS. In this article, we draw from existing experiences in SA to present practical steps that can be implemented to transform meetings into spaces of learning.
References
South Africa. National Health Act No. 61 of 2003.
Owen P. District health system development. In: Harrison D, Nielson M, editors. South African Health
Review. Durban: Health Systems Trust, 1995.
Choonara S, Goudge J, Nxumalo N, Eyles J. Significance of informal (on-the-job) learning and
leadership development in health systems: Lessons from a district finance team in South Africa. BMJ
Glob Health 2017;2(1). https://doi.org/10.1136%2Fbmjgh-2016-000138
Engelbrecht B, Gilson L. Governance, leadership and management. In: Matsoso MP, Chikte U,
Makubalo L, Pillay Y, Fryatt R, eds. The South African Health Reforms 2015 - 2020. Johannesburg:
Trackstar Trading, 2022:291-312.
Kawonga M, Blaauw D, Fonn S. The influence of health system organisational structure and culture on
integration of health services: The example of HIV service monitoring in South Africa. Health Policy
Plan 2016;31(9):1270-1280. https://doi.org/10.1093/heapol/czw061
Mathole T, Lembani M, Jackson D, Zarowsky C, Bijlmakers L, Sanders D. Leadership and the
functioning of maternal health services in two rural district hospitals in South Africa. Health Policy
Plan 2018;33(Suppl 2): ii5-15. https://doi.org/10.1093/heapol/czx174
Gilson L, Elloker S, Olckers P, Lehmann U. Advancing the application of systems thinking in health:
South African examples of a leadership of sensemaking for primary health care. Health Res Policy Syst
;12(30):1-13. https://doi.org/10.1186/1478-4505-12-30
Fusheini A, Eyles J. Achieving universal health coverage in South Africa through a district health
system approach: Conflicting ideologies of health care provision. BMC Health Serv Res 2016;16.
https://doi.org/10.1186/s12913-016-1797-4
GilsonL,BarasaE,NxumaloN,etal.Everydayresilienceindistricthealthsystems:Emerginginsights from the front lines in Kenya and South Africa. BMJ Glob Health 2017;2(2). https://doi.org/10.1136 %2Fbmjgh-2016-000224
Schneider H, Masilela T, Mndebele J, et al, South African Learning Alliance on the District Health System. Special series on the District Health System. S Afr Med J 2023;113(11):1468.
Gilson L, Motshweneng OS. The District Health System must become a learning health system. S Afr Med J 2024;114(6):e2085. https://doi.org/10.7196/SAMJ.2024.v114i6.2085.
Barron P, Mahomed H, Masilela TC, Vallabhjee K, Schneider H. District Health System performance in South Africa: Are current monitoring systems optimal? S Afr Med J 2023;113(12):1515-1521. https://doi.org/10.7196/SAMJ.2023.v113i12.1614
Witter S, Sheikh K, Schleiff M. Learning health systems in low-income and middle-income countries: Exploring evidence and expert insights. BMJ Glob Health 2022;7:e008115. https://doi.org/10.1136/ bmjgh-2021-008115
SheikhK,AbimbolaS,eds.Learninghealthsystems:Pathwaystoprogress.FlagshipreportoftheAlliance for Health Policy and Systems Research. Geneva: World Health Organization, 2021. https://ahpsr.who. int/publications/i/item/learning-health-systems-pathways-to-progress (accessed 10 January 2024).
Mukinda FK, van Belle S, George A, Schneider H. The crowded space of local accountability for maternal, newborn and child health: A case study of the South African health system. Health Policy Plan 2020;35(3):279-290. https://doi.org/10.1093/heapol/czz162
Hall W, Ford-Ngomane T, Barron P. The Health Act and the district health system: Cross-cutting health systems issues. In: Ijumba P, Barron P, eds. South African Health Review. Durban: Health Systems Trust, 2005:44-57.
The Western Cape HPSR Journal Club Team. “Not just a journal club – it’s where the magic happens”: Knowledge mobilisation through co-production for health system development in the Western Cape Province, South Africa. Int J Health Policy Manag 2022;11(3):323-333. https://doi. org/10.34172%2Fijhpm.2020.128
Orgill M, Marchal B, Shung-King M, Sikuza L, Gilson L. Bottom-up innovation for health management capacity development: A qualitative case study in a South African health district. BMC Public Health 2021;21:1-9. https://doi.org/10.1186/s12889-021-10546-w
Nkomazana O, Mash R, Wojczewski S, Kutalek R, Phaladze N. How to create more supportive supervision for primary healthcare: Lessons from Ngamiland district of Botswana: Co-operative inquiry group. Glob Health Action 2016;9(1):31263. https://doi.org/10.3402/gha.v9.31263
Renggli S, Mayumana I, Mboya D, et al. Towards improved health service quality in Tanzania: Contribution of a supportive supervision approach to increased quality of primary healthcare. BMC Health Serv Res 2019;19(1):1-6. https://doi.org/10.1186/s12913-019-4648-2
SchneiderH,GeorgeA,MukindaF,TabanaH.Districtgovernanceandimprovedmaternal,neonataland child health in South Africa: Pathways of change. Health Syst Reform 2020;6(1):e1669943. https://doi.or g/10.1080/23288604.2019.1669943
Baedke L, Lamberton N. The Emerging Healthcare Leader: A Field Guide. 2nd ed. Chicago: Health Administration Press, 2018.
Kruk ME, Gage AD, Arsenault C, et al. High-quality health systems in the Sustainable Development Goals era: Time for a revolution. Lancet Glob Health 2018;6(11):e1196-1252. https://doi.org/10.1016/ S2214-109X(18)30386-3
Aberese-AkoM,AgyepongIA,vanDijkH.LeadershipstylesintwoGhanaianhospitalsinachallenging environment. Health Policy Plan 2018;33(suppl_2): ii16-26. https://doi.org/10.1093/heapol/czy038
Okello DRO. The leadership trinity: examining the interplay between healthcare organisational context,
collective leadership and leadership effectiveness in the health sector - a multiple case study of district hospitals in the Western Cape province, South Africa. [PhD thesis]. University of Cape Town, 2021. https://open.uct.ac.za/handle/11427/36030 (Accessed 10 January 2024).
Gilson L, Ellokor S, Lehmann U, Brady L. Organisational change and everyday health system resilience: lessons from Cape Town, South Africa. Soc Sci Med 2020;266:e113407. https://doi.org/10.1016/j. socscimed.2020.113407
Downloads
Published
Issue
Section
License
Copyright (c) 2024 O Motshweneng, L Gilson, S Elloker

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.





