“Not Just a Journal Club – It’s Where the Magic Happens”: Knowledge Mobilization through Co-Production for Health System Development in the Western Cape Province, South Africa

Document Type: Original Article

Author

A list of The Western Cape HPSR Journal Club Team is provided in the Acknowledgments.

Abstract

Background
The field of Health Policy and Systems Research (HPSR) views researchers as active participants in processes of knowledge mobilization, learning and action. Yet few studies examine how such processes are institutionalized or consider their health system or wider impacts. This paper aims to contribute insights by presenting a South African experience: the Western Cape (WC) HPSR Journal Club (JC).

 
Methods
The paper draws on collective reflection by its authorial team, who are managerial and academic JC participants; reflective discussions with a wider range of people; and external evaluation reports. The analysis has been validated through rounds of collective engagement among authors, and through comparison with the wider sets of data, documentation and international literature. It considers impacts using a framework drawn from the co-production literature.

 
Results
Since 2012, the JC has brought together provincial and local government health system managers and academics to discuss complex systems’ and social science perspectives on health system development. The JC impacts encompass the trusting relationships (group micro-level) that have not only strengthened personal confidence and leadership skills (individual micro level), but also led to organizational impacts (meso level), such as practice and policy changes (practitioner organizations) and strengthened research and post-graduate teaching programs (academic organizations). Macro-societal impacts are, finally, judged likely to have resulted from new health system practices and policies and from academic post-graduate training activities. This set of impacts has been enabled by: the context of the JC; aspects of the JC design that underpin trusting relationships and mutual learning; the sustained participation of senior health system managers and academic managers who are able to translate new ideas into practice in their own organizational environments; and our individual and collective motivations – including the shared goal of health system development for social justice. Our challenges include risks and costs to ourselves, and the potential exclusion of challenging voices.

 
Conclusion
The principles and practice of the JC approach, rather than the JC as a model, offer ideas for others wishing to mobilize knowledge for health system development through embedded and co production processes. It demonstrates the potential for productive human interactions to seed long lasting systemic change.

Highlights

 

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Keywords


  1. Mills A. Health policy and systems research: defining the terrain; identifying the methods. Health Policy Plan. 2012;27(1):1-7. doi:10.1093/heapol/czr006
  2. Sheikh K, Gilson L, Agyepong IA, Hanson K, Ssengooba F, Bennett S. Building the field of health policy and systems research: framing the questions. PLoS Med. 2011;8(8):e1001073. doi:10.1371/journal.pmed.1001073
  3. De Savigny D, Adam T. Systems Thinking for Health Systems Strengthening. Geneva: World Health Organization; 2009.
  4. Sheikh K, George A, Gilson L. People-centred science: strengthening the practice of health policy and systems research. Health Res Policy Syst. 2014;12:19. doi:10.1186/1478-4505-12-19
  5. Green A, Bennett S. Sound Choices: Enhancing Capacity for Evidence-Informed Health Policy. Geneva: World Health Organization; 2007.
  6. World Health Organization (WHO). Strategy on Health Policy and Systems Research: Changing the Mindset. Geneva: WHO; 2012.
  7. Gilson L, Orgill M, Shroff ZC. A Health Policy Analysis Reader: The Politics of Policy Change in Low- and Middle-Income Countries. Geneva: World Health Organization; 2018.
  8. El-Jardali F, Lavis J, Moat K, Pantoja T, Ataya N. Capturing lessons learned from evidence-to-policy initiatives through structured reflection. Health Res Policy Syst. 2014;12:2. doi:10.1186/1478-4505-12-2
  9. Zida A, Lavis JN, Sewankambo NK, Kouyate B, Ouedraogo S. Evaluating the process and extent of institutionalization: a case study of a rapid response unit for health policy in Burkina Faso. Int J Health Policy Manag. 2018;7(1):15-26. doi:10.15171/ijhpm.2017.39
  10. Ongolo-Zogo P, Lavis JN, Tomson G, Sewankambo NK. Assessing the influence of knowledge translation platforms on health system policy processes to achieve the health millennium development goals in Cameroon and Uganda: a comparative case study. Health Policy Plan. 2018;33(4):539-554. doi:10.1093/heapol/czx194
  11. Sriram V, Bennett S, Raman VR, Sheikh K. developing the national knowledge platform in India: a policy and institutional analysis. Health Res Policy Syst. 2018;16(1):13. doi:10.1186/s12961-018-0283-3
  12. Nguyen T, Graham ID, Mrklas KJ, et al. How does integrated knowledge translation (IKT) compare to other collaborative research approaches to generating and translating knowledge? learning from experts in the field. Health Res Policy Syst. 2020;18(1):35. doi:10.1186/s12961-020-0539-6
  13. Beckett K, Farr M, Kothari A, Wye L, le May A. Embracing complexity and uncertainty to create impact: exploring the processes and transformative potential of co-produced research through development of a social impact model. Health Res Policy Syst. 2018;16(1):118. doi:10.1186/s12961-018-0375-0
  14. Langley J, Wolstenholme D, Cooke J. 'Collective making' as knowledge mobilisation: the contribution of participatory design in the co-creation of knowledge in healthcare. BMC Health Serv Res. 2018;18(1):585. doi:10.1186/s12913-018-3397-y
  15. Best A, Holmes BJ. Systems thinking, knowledge and action: towards better models and methods. Evid Policy. 2010;6(2):145-159. doi:10.1332/174426410x502284
  16. Koon AD, Windmeyer L, Bigdeli M, et al. A scoping review of the uses and institutionalisation of knowledge for health policy in low- and middle-income countries. Health Res Policy Syst. 2020;18(1):7. doi:10.1186/s12961-019-0522-2
  17. Oliver K, Kothari A, Mays N. The dark side of coproduction: do the costs outweigh the benefits for health research? Health Res Policy Syst. 2019;17(1):33. doi:10.1186/s12961-019-0432-3
  18. Ostrom E. Crossing the great divide: coproduction, synergy, and development. World Dev. 1996;24(6):1073-1087.
  19. Gilson L, McIntyre D. The interface between research and policy: experience from South Africa. Soc Sci Med. 2008;67(5):748-759. doi:10.1016/j.socscimed.2008.02.005
  20. Greenhalgh T, Raftery J, Hanney S, Glover M. Research impact: a narrative review. BMC Med. 2016;14:78. doi:10.1186/s12916-016-0620-8
  21. Engelbrecht B. CHESAI Blog: In search of health system strengthening algorithms; 2018 http://www.chesai.org/index.php/about-us/blog/108-in-search-of-health-system-strengthening-algorithms.  Accessed December 18, 2019.
  22. Schneider H, Zulu JM, Mathias K, Cloete K, Hurtig AK. The governance of local health systems in the era of Sustainable Development Goals: reflections on collaborative action to address complex health needs in four country contexts. BMJ Glob Health. 2019;4(3):e001645. doi:10.1136/bmjgh-2019-001645
  23. Gilson L, Barasa E, Nxumalo N, et al. Everyday resilience in district health systems: emerging insights from the front lines in Kenya and South Africa. BMJ Glob Health. 2017;2(2):e000224. doi:10.1136/bmjgh-2016-000224
  24. Western Cape Government Health. Healthcare 2030: The road to wellness; 2014 https://www.westerncape.gov.za/assets/departments/health/healthcare2030_0.pdf.  Accessed December 18, 2019.
  25. Gilson L, Pienaar D, Brady L, et al. Development of the health system in the Western Cape: experiences since 1994. S Afr Health Rev. 2017;2017(1):59-69.
  26. Olivier J, Scott V, Molosiwa D, Gilson L. Embedded systems approaches to health policy and systems research. In: De Savigny D, Blanchet K, Adam T, eds. Applied Systems Thinking for Health Systems Research: A Methodological Handbook. London: Open University Press; 2017:14-52.
  27. Barasa EW, Cloete K, Gilson L. From bouncing back, to nurturing emergence: reframing the concept of resilience in health systems strengthening. Health Policy Plan. 2017;32(suppl 3):iii91-iii94. doi:10.1093/heapol/czx118
  28. Schneider H, van der Merwe M, Marutla B, Cupido J, Kauchali S. The whole is more than the sum of the parts: establishing an enabling health system environment for reducing acute child malnutrition in a rural South African district. Health Policy Plan. 2019;34(6):430-439. doi:10.1093/heapol/czz060
  29. Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham ID. Evolution of Wenger's concept of community of practice. Implement Sci. 2009;4:11. doi:10.1186/1748-5908-4-11
  30. Lavis JN, Ross SE, Hurley JE, et al. Examining the role of health services research in public policymaking. Milbank Q. 2002;80(1):125-154. doi:10.1111/1468-0009.00005
  31. Stewart R, Dayal H, Langer L, van Rooyen C. The evidence ecosystem in South Africa: growing resilience and institutionalisation of evidence use. Palgrave Commun. 2019;5(1):90. doi:10.1057/s41599-019-0303-0
  32. Aronson JK. Journal Clubs: 2. Why and how to run them and how to publish them. Evid Based Med. 2017;22(6):232-234. doi:10.1136/ebmed-2017-110861
  33. Deenadayalan Y, Grimmer-Somers K, Prior M, Kumar S. How to run an effective journal club: a systematic review. J Eval Clin Pract. 2008;14(5):898-911. doi:10.1111/j.1365-2753.2008.01050.x
  34. Williamson A, Tait H, El Jardali F, et al. How are evidence generation partnerships between researchers and policy-makers enacted in practice? a qualitative interview study. Health Res Policy Syst. 2019;17(1):41. doi:10.1186/s12961-019-0441-2
  35. Flinders M, Wood M, Cunningham M. The politics of co-production: risks, limits and pollution. Evid Policy. 2016;12(2):261-279. doi:10.1332/174426415x14412037949967