Synergising community participation and quality improvement in primary health care: An action-learning case study in the Western Cape, South Africa

Abstract

Introduction: Health committees and the Ideal Clinic Realisation and Maintenance Framework (ICRMF) are mandated community participation and quality improvement (QI) systems, respectively. While both systems hold potential for improving the quality of primary health care, they have largely developed as parallel programmes and have not been deliberately connected in routine practice. Set in the Western Cape province of South Africa, this study explores whether and how health committees and the ICRMF could be synergised, through an embedded action learning process. Methods: We used an action-learning case study consisting of three linked steps: 1) situation appraisal, 2) action and 3) learning. Data included a focus group discussion with one relatively active clustered health committee, written inputs from managers on an integration guide, author debriefing notes, and subsequent learning and reflection workshops with health committee members, managers and other stakeholders. Results: The situation appraisal showed that health committee participation in the ICRMF was constrained by resource limitations, limited training and knowledge of QI, weak communication, mistrust, unequal power relations and lack of recognition. These findings shifted the action from developing a technical training manual for health committees to developing a practical guide for managers on how to collaborate with health committees through the ICRMF cycle. The learning step demonstrated emerging synergies and early system changes, including greater visibility of community participation in planning and review processes, while also showing that full integration remained incomplete. Conclusion: This case study demonstrates emerging synergies between health committees and the ICRMF, including opportunities for health committees to contribute community knowledge to QI and for the ICRMF to provide a structured route for strengthening community participation. However, empirical piloting of the guide was disrupted, and full integration remains future work. Leveraging such synergies requires sustained facilitation, attention to system hardware and software, and routine spaces where managers and health committees can jointly plan, act and learn.