Table 2 Activities to extend and deepen learnings

Engaging at higher levels of the system

Research team members hold formal and informal policy advisory positions at county and national level, drawing the research findings into wider policy debates and discussions;

for example, EB sits in different national committees that are developing guidelines and guiding the implementation of the national Universal Health Coverage agenda; BT sits in the national health sector planning Thematic Working Group and, in 2018/2019, was invited to support a multi-stakeholder team working on gathering evidence-based lessons for strengthening health sector devolution in Kenya;

within the county, managers shared lessons upwards with more senior managers

Initially, regular meetings were held between researchers and senior provincial and local government managers to feed back insights from the learning site work and secure support for future activities

Subsequently

• Researchers were engaged by senior provincial (and, occasionally, national) managers around specific areas of learning relevant to parallel policy processes (e.g. leadership development, relational governance)

• Learning site managers themselves shared lessons both upwards (with senior managers) and sideways (with colleagues)

Wider researcher–policy-maker engagements in the province also drew on learning site insights and supported the development of shared understandings on governance issues [40]

Challenges experienced in engaging at higher levels of the system;

despite the long-term relationship between the research team and district managers, opportunities to extend this interaction upwards in the health system did not materialise, perhaps due to the district’s internal challenges, which led the collaborative work to focus on supporting sub-district development

Responding to managerial requests for support, within and outside the learning site

Less formal requests included, e.g., requests for transport from managers given lack of funding for supervisory visits to facilities

More formal requests included supporting/chairing the development of the county and regional health plans

Largely informal requests, e.g., to make presentations on health system governance issues to wider groups of managers, facilitate meetings discussing health systems issues and provide advice on specific problems and issues

Informal requests to facilitate budget planning meetings for individual coaching

Involvement of learning site managers in wider activities

Support for managers’ engagement in Africa-wide discussions on leadership development; study visits and short course HPSR training in South Africa and Kenya; nomination of a manager for global award (Heroines of Health)

Support to primary healthcare facility and sub-district managers to attend and report on work in national and international research conferences; support for managerial exchange visit to Kenya

Support for district manager’s participation in short-course health policy and systems research training and conference attendance

Linking research to teaching

Learning site research insights have been drawn into short-course training for managers within Kenya and into a global health masters course in Oxford University

Initial action learning proposal included the specific intention to draw research findings into health management teaching

Direct use of research insights in short course health management training as well as postgraduate health management and systems training (e.g. University of Cape Town post graduate Diploma in Health Leadership and University of Cape Town/University of the Western Cape Masters in Public Health programmes)

Insights from the learning site work are feeding into Centre for Health Policy teaching on the University of the Witwatersrand Master’s in Public Health training programme