Navigating context, power and politics
A qualitative case study of co-designing gender integration in South Africa
Bibliographic Data
| ID | 24143252 |
|---|---|
| Authors | Ulla Walmisley (0000-0002-0588-1383, University of the Western Cape, corresponding author), Olagoke Akintola (0000-0002-2137-1906, University of the Western Cape), Anam Nyembezi (0000-0003-4799-405X, University of the Western Cape), Brighton Khumalo (Power+Energy (United States)), Colleen Wagner (0000-0002-6704-5014, Network of AIDS Researchers of Eastern and Southern Africa), Nichola Schaay (University of the Western Cape), Tanya Jacobs (0000-0002-8566-4767, University of the Western Cape), Asha George (0000-0002-5968-1424, University of the Western Cape), Asha S George (University of the Western Cape) |
| Year | 2026 |
| Volume | 21 |
| Issue | 1 |
| Pages | 2716997-2716997 |
| Publication date | 2026-12-31 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Global Public Health (JOURNAL) |
| Journal identifiers | ISSN: 1744-1692 • E-ISSN: 1744-1706 |
| Publisher | Informa UK Limited (PUBLISHER • GB) |
| DOI | 10.1080/17441692.2026.2716997 |
| PMID | 42695623 |
| OpenAlex | W7208775930 |
| Language | EN |
| References cited | 41 |
Gender is an intersectional determinant of health that remains insufficiently integrated in programmes and policies. Sustained processes of dialogue and collaboration, including participatory approaches such as co-design, are needed to effect gender integration. However, the contexts and power dynamics through which co-design may support gender integration are not well understood. This qualitative case study examined a co-design partnership that undertook gender integration within an established adolescent sexual and reproductive health programme in South Africa from 2022-2025, drawing on (n = 37) project documents, (n = 36) post-meeting reflections, (n = 2) annual project group reflections, and (n = 12) key informant interviews. Analysis was deductive–inductive and informed by theories of context, organisational logics, gender, and power. Three interlinked contextual levels influenced the partnership. Macro-level funding arrangements and accountability structures created hierarchical pressures that constrained participatory and gender-responsive work. Meso-level organisational logics differed across partners, creating misalignment with the reflective co-design approach and between partner organisations. At the micro-level, boundary-spanning individuals enabled trust-building and adaptation. Interactions across levels revealed how institutionalised power shaped feasible forms of participation and gender integration. Co-design partnerships can strengthen gender integration in programmes but require macro-level enabling systems, institutional support, and navigation of meso-level organisational logics alongside sustained micro-level action.
Accountability · Citizen journalism · Doing gender · General partnership · Participatory action research · Power (physics) · Qualitative research · Reproductive health · Adolescent Sexual and Reproductive Health · Gender Roles and Identity Studies · Sex and Gender in Healthcare
The concept of mechanism from a realist approach
Co-creation, co-design, co-production for public health – a perspective on definitions and distinctions
Consolidated criteria for reporting qualitative research (Coreq)
Boundary workers and the management of frustration
Health systems as human systems
Power analysis in health policy and systems research
Learning health systems in low-income and middle-income countries
Conducting co-creation for public health in low and middle-income countries
Democratic South Africa at 25 – a conceptual framework and narrative review of the social and structural determinants of adolescent health
Participatory design partnerships for gender and health in low- and middle-income countries
Adaptation of a gender-transformative sexual and reproductive health intervention for adolescent boys in South Africa and Lesotho using intervention mapping
Stigma in the health clinic and implications for PrEP access and use by adolescent girls and young women
Power dynamics and intersectoral collaboration for health in low- and middle-income countries
Qualitative Case Study Methodology
Turning notions of cross-sector partnerships into practice
Document analysis in health policy research
Tackling HIV and gender-based violence in South Africa
Handbook of Contemporary Sociological Theory
Participation in Practice
Innovative methods to analyse the impact of gender norms on adolescent health using global health survey data
Gender norms and social norms
| Citation velocity | historical |
|---|---|
| Highly cited | No |