ABSTRACT:
Implementing a learning health system to strengthen data-driven decision-making and quality improvement in primary healthcare

BACKGROUND:
Learning Health Systems (LHS) are increasingly promoted as a framework for strengthening health system responsiveness, equity, and sustainability. However, there is limited practical evidence from low- and middle-income contexts. In the Western Cape, South Africa, substantial investments in digital health infrastructure coexist with persistent challenges in translating routine data into inclusive, actionable learning at the point of service delivery.

METHODS:
This organised session draws on implementation experience from sub-districts where a LHS approach was used to strengthen routine data use and support improved patient outcomes. Implementation focused on the foundations of people, organisational structures, and the data cycle. Iterative learning and quality improvement methods were used to inform local decision-making, enabled by a data-centre approach that integrates routine data across source systems. High-burden services with mature routine data, including tuberculosis and HIV, were used as sentinel entry points. The approach prioritised inclusion by building data and quality improvement capability across staff cadres. The session will combine brief presentations with facilitated interactive reflection.

RESULTS:
Applying learning cycles within sub-district settings started a shift from compliance-focused reporting towards shared interpretation and adaptive action. Participation broadened across cadres, confidence in using data increased, and quality improvement activities became more locally driven. Digital enablers, including integrated data platforms and tools, supported learning but were not sufficient alone; sustained change depended on organisational structures, leadership endorsement, and protected spaces for reflection. Leveraging existing systems helped reduce reporting burden, supporting sustainability.

CONCLUSIONS:
Sub-district-level LHSs offer a feasible and inclusive pathway to strengthen decision-making and quality improvement in primary healthcare. This session will provide practical insights into embedding learning within existing governance and digital infrastructure, highlighting how alignment between people, organisation, and data supports sustainable health system improvement across diverse settings.