AIM:
A partnership between the University of Cape Town and the Western Cape Government Department of Health and Wellness has received a generous grant from the Mastercard Foundation under the Africa Health Collaborative, to strengthen primary health care by empowering and preparing young people for employment and health entrepreneurship in three sub-districts over eight years. This created the opportunity to co-design and co-develop a learning health system as a joint venture between a health service and a higher education institution. This chapter outlines the initial steps in setup and design including data from the first two years of operations.

METHODS:
In this project, each of the three sub-districts has established a "learning circle" that includes representatives from the health services, communities, non-governmental organizations and the university. In addition, a "Learning Forum" has been initiated to bring together the reflections from all 3 sites to generate appropriate interventions and research questions. Research methods included initial interviews in the first 6 months that explored participants’ understanding and experience with the development of the project. Secondly, we reflected on the Learning Circles and Learning Forums to understand the trajectories of learning across the system in the first two years of implementation.

RESULTS:
Data from key informant interviews in a participatory action research project, together with reports from the learning circles, are presented to illustrate the issues and learnings that have emerged in the early stages of the project.

CONCLUSIONS:
The HFSA project shows that building a learning health system is an iterative social and political process, not merely a technical one. Learning circles have fostered inclusive reflection and emerging innovation, particularly through youth engagement and narrative approaches. Long‑term sustainability depends on leadership, investment, and embedding learning as core health system infrastructure.