Steps towards establishing a learning health system at the sub-district level: Healthy Futures South Africa

Aim A partnership between the University of Cape Town and the Western Cape Government: Department of Health and Wellness received a grant from the Mastercard Foundation under the Africa Health Collaborative to strengthen primary health care by empowering and preparing young people for employment and health entrepreneurship in three sub-districts over eight years. This created the opportunity to co-design and co-develop a learning health system as a joint venture between a health service and a higher education institution. As part of the project, each sub-district has established a ‘learning circle’ comprising representatives from the health services, communities, non-governmental organisations and the university to sustain ongoing conversations aimed at improving health in the three sub-districts. This paper outlines the initial steps in set-up and design, including data from the first two years of operations. Method Using a participatory action research approach, the research team conducted 21 initial interviews after the first six months of the project to explore participants’ understanding and experience with the development of the project. Additionally, the paper reflects on the learning circles and learning forums that were established, to understand the trajectories of learning across the system in the first two years of implementation. Findings Data from key informant interviews, together with reports from the learning circles, are presented to illustrate the issues and lessons that have emerged in the early stages of the project. Conclusion The Healthy Futures South Africa project shows that building a learning health system is an iterative social and political process, not merely a technical one. Learning circles have begun to support inclusive reflection and emerging innovation, particularly through youth engagement and narrative approaches. Long-term sustainability depends on leadership, investment, and embedding learning as core health system infrastructure.