A complexity theory-informed COPC approach to evaluation of mining health programmes

Area of Science:

• Public Health
• Health Systems Research
• Community Health Interventions

Background:

• Conventional evaluation methods fail to capture the non-linear dynamics of complex community health interventions, particularly in fragmented settings like mining-affected communities.
• Health projects in these areas often lack coordination and responsiveness to socio-ecological realities, hindering effectiveness.

Purpose of the Study:

• To describe and reflect on a complexity-informed assessment methodology.
• To evaluate the coherence and contextual alignment of health and wellness projects in mining-affected communities.

Main Methods:

• A complexity-informed, mixed-methods design was employed.
• Data collection included document review, field observation, and 12 key informant interviews.
• Community-Oriented Primary Care (COPC) principles and complexity theory guided iterative analysis, supported by digital tools.

Main Results:

• Fragmented implementation, limited household engagement, and weak data systems were identified.
• Lack of integration and adaptive strategy limited systemic effectiveness despite widespread activity.
• Transdisciplinary engagement, adaptive iteration, and co-production facilitated institutional learning and context-sensitive proposals for change.

Conclusions:

• Sustainable health system change in complex settings necessitates integrated, reflexive, and locally grounded approaches beyond project-based interventions.
• Complexity theory, transdisciplinarity, and COPC principles provide a viable framework for adaptive evaluation and systemic learning in community health.
• This methodological framework is applicable to primary care and community health systems operating in dynamic contexts.