Working in partnership with communities to improve health and research outcomes. Comparisons and commonalities between the UK and South Africa

Realising radical potential: building community power in primary health care through Participatory Action Research

BACKGROUND

While community participation is an established pro-equity approach in Primary Health Care (PHC), it can take many forms, and the central category of power is under-theorised. The objectives were to (a) conduct theory-informed analysis of community power-building in PHC in a setting of structural deprivation and (b) develop practical guidance to support participation as a sustainable PHC component.

METHODS

Stakeholders representing rural communities, government departments and non-governmental organisations engaged through a participatory action research (PAR) process in a rural sub-district in South Africa. Three reiterative cycles of evidence generation, analysis, action, and reflection were progressed. Local health concerns were raised and framed by community stakeholders, who generated new data and evidence with researchers. Dialogue was then initiated between communities and the authorities, with local action plans coproduced, implemented, and monitored. Throughout, efforts were made to shift and share power, and to adapt the process to improve practical, local relevance. We analysed participant and researcher reflections, project documents, and other project data using power-building and power-limiting frameworks.

RESULTS

Co-constructing evidence among community stakeholders in safe spaces for dialogue and cooperative action-learning built collective capabilities. The authorities embraced the platform as a space to safely engage with communities and the process was taken up in the district health system. Responding to COVID-19, the process was collectively re-designed to include a training package for community health workers (CHWs) in rapid PAR. New skills and competencies, new community and facility-based alliances and explicit recognition of CHW roles, value, and contribution at higher levels of the system were reported following the adaptations. The process was subsequently scaled across the sub-district.

CONCLUSIONS

Community power-building in rural PHC was multidimensional, non-linear, and deeply relational. Collective mindsets and capabilities for joint action and learning were built through a pragmatic, cooperative, adaptive process, creating spaces where people could produce and use evidence to make decisions. Impacts were seen in demand for implementation outside the study setting. We offer a practice framework to expand community power in PHC: (1) prioritising community capability-building, (2) navigating social and institutional contexts, and (3) developing and sustaining authentic learning spaces.

Using Curriculum Mapping as a Tool to Match Student Learning Outcomes and Social Studies Curricula

The interest in program- and colleges of education- level evaluation and alignment of student learning outcomes to course content has been increasing over the past several decades. Curriculum mapping establishes the links between content and expected student learning outcomes. Curriculum map is an overview of what is taking place in the classroom; and it includes evaluation tools and activities. Social Studies Department, Federal Capital Territory (FCT) College of Education Zuba, Abuja, recently completed an accreditation exercise by National Commission for Colleges of Education Abuja, Nigeria. The audit reported that there was no match between the student learning outcomes and Social Studies curricula. The purpose of this paper was to align the Nigeria Certificate in Education (NCE) (Social Studies) minimum standards with student learning outcomes to determine gaps and redundancies. The paper also looked at how virtual education enhances curriculum mapping during COVID-19 pandemic. Minimum standards learning outcomes were modified from existing learning outcomes to better align with college learning outcomes and the Social Studies Core and Elective Competencies. All NCE Social Studies courses were mapped to the Social Studies Core and Elective Competencies and assessed to determine the gaps and redundancies. The study used the documentary research method. The purposeful sampling strategy was used to select the research site. Potential gaps were defined as coverage for each competency in about ≤20% of the courses and potential redundancies was considered as coverage of ≥80% of the courses. The mapping exercise revealed gaps; and no redundancies in course content. The findings of the mapping exercises should be used to improve the content provided to NCE Social Studies students at FCT College of Education Zuba, with the overall objective of enhancing the quality of the education provided to those students and helping them to be better students that are prepared for a successful career in Social Studies.