Front-line health managers play a critical role in health systems governance, policy implementation and in accountability processes. However, their decision-making practices are dynamic and complex, and it is difficult to observe and to disentangle the effects of governance issues from other health system dimensions.  

As a consequence, conducting research on governance faces significant challenges. One way of overcoming these challenges is for researchers to work directly with health managers to define research questions, identify appropriate methodologies and generate shared knowledge. This is known as action learning research, and is the approach being used by RESYST at learning sites in Kenya and South Africa to better  understand district-level governance issues.  

What is a health system learning site?  

As well as being located in a specific district and geographical area, learning sites have several distinctive features:  

• They are based on collaboration between researchers and health managers – research is conducted with practitioners rather than about their practice 
• The process of collaboration is long-term, and the range and types of research are constantly developing 
• Research does not start with a pre-defined question. Rather, the overall process of enquiry is emergent 
• Researchers are embedded in the health system; through research activities they come to understand the daily routines and challenges faced by health managers