Participatory action research to address lack of safe water, a community-nominated health priority in rural South Africa

PLOS ONE · 10 authors, 9 centres

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TL;DR

This study used a participatory action research process to implement a community-developed local action plan for safe water in rural South Africa. Three of seven planned action items were achieved, with success linked to high power and interest among lead stakeholders.

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The study employed a participatory action research (PAR) learning cycle with three iterative phases, engaging communities, government departments, and non-governmental stakeholders in rural South Africa. The process aimed to implement a local action plan addressing safe water, a community-nominated health priority. Results showed partial success: three of seven action items were achieved, three were not achieved, and one was partially achieved. Analysis indicated that high power and high interest were key factors for achievement, with continuous stakeholder interaction creating shifts in power and interest through ownership. Lack of financial support, shifting priorities, and insufficient stakeholder buy-in hindered implementation. The findings suggest that connecting researchers, service providers, and communities as legitimate participants in a learning platform can facilitate power shifts and collective action on local health priorities.

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other

SPECIALTY

public health

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100% · A

ORIGINAL PAPER

PMC10374036

Participatory action research to address lack of safe water, a community-nominated health priority in rural South Africa

PLOS ONE

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ABSTRACT

Abstract Background Despite international evidence supporting community participation in health for improved health outcomes and more responsive and equitable health systems there is little practical evidence on how to do this. This work sought to understand the process involved in collective implementation of a health-related local action plan developed by multiple stakeholders. Methods Communities, government departments and non-government stakeholders convened in three iterative phases of a participatory action research (PAR) learning cycle. Stakeholders were involved in problem identification, development, and implementation of a local action plan, reflection on action, and reiteration of the process. Participants engaged in reflective exercises, exploring how factors such as power and interest impacted success or failure. Results The local action plan was partially successful, with three out of seven action items achieved. High levels of both power and interest were key factors in the achievement of action items. For the achieved items, stakeholders reported that continuous interactions with one another created a shift in both power and interest through ownership of implementation processes. Participants who possessed significant power and influence were able to leverage resources and connections to overcome obstacles and barriers to progress the plan. Lack of financial support, shifting priorities and insufficient buy-in from stakeholders hindered implementation. Conclusion The process offered new ways of thinking and stakeholders were supported to generate local evidence for action and learning. The process also enabled exploration of how different stakeholders with different levels of power and interest coalesce to design, plan, and act on evidence. Creation of safe spaces was achievable, meanwhile changing stakeholders’ level of power and interest was possible but challenging. This study suggests that when researchers, service providers and communities are connected as legitimate participants in a learning platform with access to information and decision-making, a shift in power and interest may be feasible.

CITATION EXPORT

Jennifer Hove, Denny Mabetha, Maria van der Merwe et al.. Participatory action research to address lack of safe water, a community-nominated health priority in rural South Africa. PLOS ONE. (2023). https://doi.org/10.1371/journal.pone.0288524

AUTHORS

10 · 9 CENTRES

Jennifer Hove, Denny Mabetha, Maria van der Merwe, Rhian Twine, Kathleen Kahn, Sophie Witter, Lucia D’Ambruoso, Kamal Gholipour, Kamal Gholipour, Kamal Gholipour

1MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand Johannesburg, Johannesburg, South Africa
2Institute of Applied Health Sciences, Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom
3Cochrane South Africa, South African Medical Research Council (MRC), Cape Town, South Africa
4Maria van der Merwe Consulting, White River, South Africa
5Institute for Global Health and Development, Queen Margaret University, Scotland, United Kingdom
6Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
7Public Health, National Health Service (NHS) Grampian, Scotland, United Kingdom
8Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
9Tabriz University of Medical Sciences, IR Iran, ISLAMIC REPUBLIC OF IRAN