Voice needs teeth to have bite’! Expanding community-led multisectoral action-learning to address alcohol and drug abuse in rural South Africa

Lucia D'Ambruoso* (Corresponding Author), Denny Mabetha, Rhian Twine, Maria Van Der Merwe, Jennifer Hove, Gerhard Goosen, Jerry Sigudla, Sophie Witter

*Corresponding author for this work

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There is limited operational understanding of multisectoral action in health inclusive of communities as active change agents. The objectives were to: (a) develop community-led action-learning, advancing multisectoral responses for local public health problems; and (b) derive transferrable learning. Participants representing communities, government departments and non-governmental organisations in a rural district in South Africa co-designed the process. Participants identified and problematised local health concerns, coproduced and collectively analysed data, developed and implemented local action, and reflected on and refined the process. Project data were analysed to understand how to expand community-led action across sectors. Community actors identified alcohol and other drug (AOD) abuse as a major problem locally, and generated evidence depicting a self-sustaining problem, destructive of communities and disproportionately affecting children and young people. Community and government actors then developed action plans to rebuild community control over AOD harms. Implementation underscored community commitment, but also revealed organisational challenges and highlighted the importance of coordination with government reforms. While the action plan was only partially achieved, new relationships and collective capabilities were built, and the process was recommended for integration into district health planning and review. We created spaces engaging otherwise disconnected stakeholders to build dialogue, evidence, and action. Engagement needed time, space, and a sensitive, inclusive approach. Regular engagement helped develop collaborative mindsets. Credible, actionable information supported engagement. Collectively reflecting on and adapting the process supported aligning to local systems priorities and enabled uptake. The process made gains raising community ‘voice’ and initiating dialogue with the authorities, giving the voice ‘teeth’. Achieving ‘bite’, however, requires longer-term engagement, formal and sustained connections to the system. Sustaining in highly fluid contexts and connecting to higher levels are likely to be challenging. Regular learning spaces can support development of collaborative
Original languageEnglish
Article numbere0000323
Number of pages28
JournalPLOS Global Public Health
Issue number10
Early online date19 Oct 2022
Publication statusPublished - 19 Oct 2022

Bibliographical note

Funding: Joint Health Systems Research Initiative Medical Research Council (MRC)/Department for International Development (DFID)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/P014844/1).

Correction: 'Voice needs teeth to have bite'! Expanding community-led multisectoral action-learning to address alcohol and drug abuse in rural South Africa Lucia D'Ambruoso, Denny Mabetha, Rhian Twine, Maria van der Merwe, Jennifer Hove, Gerhard Goosen, Jerry Sigudla, Sophie Witter, Verbal Autopsy with Participatory Action Research (VAPAR)/Wits/Mpumalanga Department of Health Learning Platform, 2023, vol. 3, issue 7, 2023, p. e0002187. PLOS global public health DOI:http://dx.doi.org/10.1371/journal.pgph.0002187

Data Availability Statement

Data Availability: Data are available from the research team upon reasonable request. A non-author point of contact to field future requests (where authors are not available) is achds@abdn.ac.uk. Public deposition of the dataset would be in breach of the data management plan (DMP) within the study protocol approved by the research ethics boards in South Africa, the UK, and the permission for the study granted by the provincial health research committee, as well as the DMP within the funding proposal and the conditions upon which the research funding was granted.


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