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

Abstract

BACKGROUND : Conventional evaluation approaches are often designed for predictable, linear systems and fail to capture the non-linear dynamics of complex community health interventions. Health projects in mining-affected communities are typically fragmented, with limited coordination or responsiveness to socio-ecological realities. This study applied complexity theory, community-oriented primary care (COPC) principles, and used a transdisciplinary approach to assess a health and wellness project in such a setting. AIM : To describe and reflect on the methodology of a complexity-informed assessment of the coherence and contextual alignment of a health and wellness project in mining-affected communities. SETTING : Health and wellness projects funded by the Sishen Iron Ore Company Community Development Trust (SIOC-CDT) and implemented across five municipalities in the Northern Cape and Limpopo provinces, South Africa. METHODS : A complexity-informed, mixed-methods design was used. Data were gathered through document review, field observation, and 12 key informant interviews with implementing agents, health officials and traditional healers. Community-oriented primary care principles and complexity theory guided iterative analysis and were supported by digital tools. RESULTS : The study identified fragmented implementation, limited household engagement and weak data systems. Despite widespread activity, the lack of integration and adaptive strategy limited systemic effectiveness. However, transdisciplinary engagement, adaptive iteration and co-production of knowledge and reflection facilitated institutional learning and practical proposals for change that are integrated and context sensitive, responding to complexities. CONCLUSION : Sustainable health system change in complex settings requires integrated, reflexive and locally grounded approaches that move beyond project-based interventions. CONTRIBUTION : This study demonstrated how complexity theory, transdisciplinarity, and community-oriented primary care principles offer a viable methodological framework for adaptive evaluation and systemic learning in community health and development, contributing to the journal’s focus on primary care and community health systems in dynamic contexts.