Fostering a learning health system: emerging insights from the Western Cape, South Africa

Aim This case study describes efforts to foster a learning health system in four metropolitan and rural sub-districts of the Western Cape, South Africa, during 2023–2026 as part of the Scaling Use of Health Data project. It examines how learning behaviours, organisational structures, and data uptake developed over time and identifies key enablers and challenges in strengthening data-informed decision-making. Method A mixed-methods case study approach was used, combining descriptive analysis of operational metrics from the provincial health information platform with thematic review of implementation documentation. Findings were synthesised through three interdependent foundational pillars: people, organisation, and data. Findings Data systems enable learning but depend on human and organisational capacity to translate information into action. Thus, integrated information systems can accelerate learning but are not a prerequisite for a learning health system. Learning was most directly translated into service improvement at facility level, supported by sub-district structures that coordinated, translated, and shared learning across the health system. Progress was incremental as staff gained access to data tools, developed confidence in using them, and participated in structured reflection and quality improvement. Uneven digital literacy, competing demands, reliance on manual data capture, and sustainability remain challenges. Conclusion Fostering a learning health system is a long-term process of embedding collective learning within routine health-system practice by strengthening the interdependent pillars of people, organisation, and data. In resource-constrained settings, its development can build on existing data, governance structures, and local capacity, with sustained investment across health-system levels. Future work should assess how learning capabilities are sustained over time, how they contribute to service and patient outcomes, and how patient perspectives can be more meaningfully incorporated.