Towards institutionalising participatory learning for community mobilisation in primary health care: evidence from community health worker training in rural South Africa

Aim Community participation is essential for equitable primary health care but remains inconsistently implemented, particularly in rural settings. This study evaluates a participatory learning intervention designed to strengthen community health workers’ community mobilisation competencies as a pathway for supporting community participation and institutionalisation within primary health care. Method The Verbal Autopsy with Participatory Action Research programme, in partnership with Mpumalanga Department of Health, delivered structured community mobilisation training across all provincial health districts in 2024. Using a training-of-trainers model and learning cycles combining facilitated sessions with field application, trainees applied participatory tools to priorities including HIV/TB treatment adherence, stigma, and loss to follow-up. A cross-sectional evaluation triangulated project outputs, semi-structured interviews with trainees, and a policy/strategy desk review. Findings Key informants described the intervention as practical, relevant, and confidence building. Reported changes included improved facilitation and problem solving, stronger collaboration between community health workers, outreach team leaders and facility teams, and greater capacity to engage patients and community actors around locally identified service challenges. The training strengthened community health worker-led mobilisation capabilities by helping frontline workers surface local concerns, organise them through participatory tools, and link them to primary health care action. A key finding was rapid peer-to-peer diffusion of tools and learning beyond primary trainees, suggesting a potential multiplier effect. There were also clear signals of institutional uptake by provincial leadership, and movement towards aligning the programme with regional training requirements. Operational constraints included transport and equipment gaps, uneven foundational skills/literacy, workload pressures, and limited formal recognition. Conclusion Participatory learning can support relational and community-oriented primary health care strengthening by building community health worker capabilities to convene actors, surface local concerns, and translate tacit community and service knowledge into collective problem solving across communities and facilities. Scaling will require supervision, mentoring, minimum resources, and systems to document and quality-assure peer diffusion.