District In South Africa Research Articles

Substantial but spatially heterogeneous progress in male circumcision for HIV prevention in South Africa

BackgroundVoluntary medical male circumcision (VMMC) reduces the risk of male HIV acquisition by 60%. Programmes to provide VMMCs for HIV prevention have been introduced in sub-Saharan African countries with high HIV burden. Traditional circumcision is also a long-standing male coming-of-age ritual, but practices vary considerably across populations. Accurate estimates of circumcision coverage by age, type, and time at subnational levels are required for planning and delivering VMMCs to meet targets and evaluating their impacts on HIV incidence.MethodsWe developed a Bayesian competing risks time-to-event model to produce region-age-time-type specific probabilities and coverage of male circumcision with probabilistic uncertainty. The model jointly synthesises data from household surveys and health system data on the number of VMMCs conducted. We demonstrated the model using data from five household surveys and VMMC programme data to produce estimates of circumcision coverage for 52 districts in South Africa between 2008 and 2019.ResultsNationally, in 2008, 24.1% (95% CI: 23.4–24.8%) of men aged 15–49 were traditionally circumcised and 19.4% (18.9–20.0%) were medically circumcised. Between 2010 and 2019, 4.25 million VMMCs were conducted. Circumcision coverage among men aged 15–49 increased to 64.0% (63.2–64.9%) and medical circumcision coverage to 42% (41.3–43.0%). Circumcision coverage varied widely across districts, ranging from 13.4 to 86.3%. The average age of traditional circumcision ranged between 13 and 19 years, depending on local cultural practices.ConclusionSouth Africa has made substantial, but heterogeneous, progress towards increasing medical circumcision coverage. Detailed subnational information on coverage and practices can guide programmes to identify unmet need to achieve national and international targets.

Examining the Implementation and Lessons Learnt from the Annual National Assessment in a South African Education District

In the pursuit of enhancing educational practices and systems, this study delved comprehensively into examining the implementation and lessons learned from the Annual National Assessment (ANA) within an educational district in South Africa. A stratified random sampling technique was used to pick up schools from different tiers. A sample of 108 teachers from 22 schools within the UMkhanyakude education district, situated in the KwaZulu Natal province of South Africa participated in the study. The study examined the effects of the ANA on schools and its impact on teaching and learning. Data was collected using a questionnaire and were analyzed with SPSS software version 26. The findings indicate that teachers received sufficient training on the administration procedures of the assessment and recognized its positive influence on schools in general. However, a majority of the teachers disagreed with the notion that the assessment had positive effects on teaching and learning. They expressed a lack of confidence in the assessment, both in themselves and in their students, and also raised concerns about parental involvement. Therefore, this study suggests the inclusion of a comprehensive consultative approach and the involvement of stakeholders in future assessment administration and implementation processes. Additionally, it advocates for the importance of aligning assessments with the curriculum to prevent teachers from solely teaching to the test in most situations. This study will contribute to knowledge on test construction as well as the different approaches to assessment. Keywords: Administration, Annual National Assessment, Assessment, High Stakes, Management, Parental Involvement, Standardized Testing.

Investigation of the challenges in online formative assessment faced by Grade 10 Physical Sciences teachers in South African schools

Formative assessment is crucial for teachers to gauge students’ understanding of subject content, and applying formative assessment in an online context is more challenging than in a traditional Physical Sciences classroom. This study examines challenges experienced by Grade 10 Physical Sciences teachers when enacting online formative assessment as per the research question. The empirical investigation adopted a generic qualitative design in which three purposively selected Grade 10 Physical Sciences teachers from three different schools and quintiles within the Tshwane North District in South Africa. Data were collected through individual and focus group interviews. Interviews were video recorded, transcribed and thematically analysed using grounded theory to construct a thematic framework for supporting the study. Technological, pedagogical, and content knowledge (TPACK) was utilised as a theoretical framework underpinning the study to identify challenges experienced by Grade 10 Physical Sciences teachers when enacting online formative assessment. Challenges identified in this study include the enforced utilisation of Annual Teaching Plans, lack of technological knowledge, lack of internet connectivity, and poor digital infrastructure at schools, and in towns and cities in South Africa. The study aims to show that the Department of Basic Education faces the key imperative to provide continuous teacher professional development and concomitant online learning materials that can facilitate meaningful enactment of online formative assessment in various educational settings while policy is needed to ensure that every student has access to data and internet resources.

Collaborative teaching strategies used to enhance learning of accounting concepts

Collaborative teaching strategies that teachers use to enhance learning of accounting concepts were explored in schools located in the Pinetown education district in South Africa. The study employed a qualitative case study within the interpretivist paradigm. A purposive sample of five Grade 10 Accounting teachers from five secondary schools was selected to participate in the study. Individual semi-structured interviews and focus group interviews were used to generate data that was analyzed through thematic analysis. The study found that accounting teachers emphasize the necessity of using diverse collaborative strategies to teach accounting concepts. A questioning approach to the teaching of accounting was used to ascertain learners’ experiences and prior knowledge. Infusing technology and group discussions were utilized to encourage learner involvement and participation in the teaching of accounting concepts. The study emphasizes the need for accounting teachers to strengthen learners’ understanding of concepts in Grade 10 by actively engaging them during the process of teaching and learning.

Effect of implementation strategies on pre-exposure prophylaxis persistence among female sex workers in South Africa: an interrupted time series study

A disproportionate number of new HIV infections in South Africa are among female sex workers; pre-exposure prophylaxis (PrEP) for HIV prevention is freely available to female sex workers in the country, but unique barriers challenge PrEP persistence. TB HIV Care, a large South African non-profit organisation that provides daily oral PrEP (tenofovir disoproxil fumarate and emtricitabine), has implemented multiple strategies to improve PrEP persistence. We aimed to evaluate the effect of different implementation strategies on PrEP persistence in a large-scale real-world setting. In this interrupted time series study, we estimated level changes in 1-month oral PrEP persistence associated with roll-out of various implementation strategies among female sex workers across nine districts in South Africa. We used routinely collected data from TB HIV Care programme files from June 7, 2016, to April 30, 2021. Poisson regression of 1-month persistence was used to assess the effect of these strategies. In secondary analyses, we tested the association between each of the strategies and 4-month persistence. The median 1-month PrEP persistence for female sex workers was 33% (IQR 27-40). SMS support and refill reminders were associated with an 11% relative increase in 1-month persistence (risk ratio [RR] 1·11, 95% CI 1·02-1·26) and clinical mentoring for PrEP providers was associated with a 127% relative increase (RR 2·27, 95% CI 1·94-2·66) among female sex workers. The loyalty rewards programme was negatively associated with 1-month persistence (RR 0·71, 95% CI 0·67-0·83). Although clinical mentoring improved 4-month persistence, SMS support text messages had no significant effect. Identification and subsequent use of clinical mentoring for PrEP providers and SMS support and refill reminders might improve the usefulness of PrEP overall to prevent new HIV infections among female sex workers. PrEP persistence remains an important issue, and strategies to build on our findings are needed. National Institute of Mental Health and National Institute of Allergy and Infectious Diseases.

The missing links in climate services for health and heat-health services: Examining climate-heat services in peri-urban districts in South Africa

Climate services for health can facilitate health resilience and adaptation to climate change, particularly if they are well-calibrated to promote wellness and save lives. In this study, the status of climate services for health in South Africa’s Agincourt sub-district, Mpumalanga province, was assessed. A qualitative case study methodology encompassing multiple methods of data collection was used. The results show that climate services for health in the Agincourt sub-district, albeit essential, are fragmented and underdeveloped. Scientifically informed heat-health services are non-existent. Notwithsatnding this gap, healthcare and allied professionals are aware of the importance of climate services for health. The main barrier to climate services delivery is the paucity of interagency coordination; for example, coordination to plan and respond to climate-health information between the South African Weather Services and the Departments of Health and Education is lacking. Inclusive climate services for health are essential for positive prevention and treatment outcomes. Future studies must provide an investment case for climate services for health, demonstrating the benefits of acting and the costs of inaction.

Factors Associated with COVID-19 Vaccine Uptake among Schoolgoing Adolescent Girls and Young Women in South Africa.

(1) Background: By October 2022, vaccination rates with at least one dose of a COVID-19 vaccine were low among adolescent girls aged 12-17 (38%) and young women aged 18-34 (45%) in South Africa. This study aimed to measure and identify barriers to and facilitators of motivation to take up, access to, and uptake of COVID-19 vaccines among schoolgoing adolescent girls and young women in two districts in South Africa. (2) Methods: Using the theory of the HIV prevention cascade, we conceptualised the relationship between motivation, access, and uptake of COVID-19 vaccines, and associated barriers. Potential barriers and facilitators were identified using bivariate and multivariable Poisson regression. (3) Results: Among all 2375 participants, access was high (69%), but motivation (49%) and vaccination with at least one COVID-19 vaccine (45%) were lower. Fear of injections was a barrier to vaccine uptake (aRR 0.85 95% CI 0.82-0.88), while being tested for COVID-19 (aRR 2.10 95% CI 1.85-2.38) and believing that the COVID-19 vaccine was safe (aRR 1.31 95% CI 1.18-1.44) and would prevent you from getting very sick (aRR 1.11 95% CI 1.04-1.19) were facilitators. (4) Conclusions: The controversy about the value of vaccinating adolescents and the delay in vaccine rollout for adolescents and young adults may have contributed to fears about the safety and efficacy of COVID-19 vaccines, as well as a lack of motivation to get vaccinated.

Enhancing linkage to HIV care in the “Universal Test and Treat” era: Barriers and enablers to HIV care among adults in a high HIV burdened district in KwaZulu-Natal, South Africa

Ending AIDS by 2030 would depend on how successful health systems are in linking people living with HIV (PLHIV) into care. The World Health Organization recommended the ‘Universal Test and Treat’ (UTT) strategy – initiating all individuals testing positive on antiretroviral therapy (ART) irrespective of their CD4 count and clinical staging. This study aimed to explore the enablers and barriers to linkage to HIV care among adults with a new HIV diagnosis in a high-HIV prevalent rural district in South Africa. A qualitative study was undertaken to explore patients’ perceptions of enablers and barriers of linkage-to-care, using a life-story narration and dialogue approach. In-depth interviews were conducted with 38 HIV-positive participants sampled from a cohort of 1194 HIV-positive patients recruited from December 2017 to June 2018. Participants were selected based on whether they had been linked to care or not within 3 months of positive HIV diagnosis. Interviews were thematically analysed using a general inductive approach. Of the 38 participants, 22 (58%) linked to care within three months of HIV-positive diagnosis. Factors that facilitated or inhibited linkage-to-care were found at individual, family, community, as well as health systems levels. Enablers included a positive HIV testing experience, and assistance from the fieldwork team. Support from family, and friends, as well as prior community-based education about HIV and ART were also noted. Individual factors such as acceptance of HIV status, previous exposure to PLHIV, and fear of HIV progressing, were identified. Barriers to linkage included, denial of HIV status, dislike of taking pills, and preference for alternative medicine. Negative experiences with counselling and health systems inefficiency were also noted as barriers. Perceived stigma and socio-economic factors, such as lack of food or money to visit the clinic were other barriers. Community-based and health system-level interventions would need to focus on clinic readiness in providing patients with necessary and effective health services such as proper and adequate counselling. This could increase the number of patients who link to care. Finally, interventions to improve linkage-to-care should consider a holistic approach, including training healthcare providers, community outreach and the provision of psychological, social, and financial support.

Learners’ Graphical Efficacy When Solving Trigonometric Problems

This study explored grade 12 learners’ graphical efficacy when solving problems involving trigonometric graphs. A structured test consisting of five trigonometric problems, with variations in context and structure, was administered to a purposefully selected group of 25 Grade 12 learners from the Sekhukhune District in South Africa. Insights into learners' graphing efficacy were obtained through task-based interviews. Data were analysed using direct interpretation which involved deductive thematic analysis of the task-based interviews and content analysis of the test scripts to match learners’ responses to the themes drawn from the Meta-Representational Competence (MRC) framework. The results showed that most learners lack invention and functioning, critiquing and reflection efficacies and hence this affected their drawing and interpretation of the graphs and consequently lead to incorrect solutions. Furthermore, the results show most learners have critiquing efficacy. This indicates that learners lack graphical efficacy for solving trigonometric problems involving trigonometric functions. This finding has pedagogic implications: the apparent lack of graphical efficacy in graphical solutions may suggest inadequate mastery of the concept. Therefore, this study recommends that the teaching and learning of trigonometric graphs should consider the development of invention, functioning, critiquing and reflection efficacies.

Factors that Parents in South Africa Consider in Support of their Children’s Continuous Use of Online Learning

One of the lessons learnt during the COVID-19 pandemic is the need for technology to connect and communicate. Schools learnt to use technology as tools of teaching and learning, as well as connecting with parents. Such gains need not be discarded now that the pandemic has subsided. The purpose of this study was to investigate factors that parents in South Africa consider significant in allowing their children to continue using online learning. The extended expectation-confirmation model, with eight constructs, was used to explain this phenomenon using a sample of 358 participating parents. The model was analysed using partial least squares structural equation modeling, while SmartPLS3 was employed in the analysis of the data. The results showed that the factors that parents in South Africa consider significant in allowing their children to continue using online learning were statistically significant. The seven factors (constructs) identified in the model explained 74.6% of the variance in support of continuous use of online learning. This was an overwhelming support for continuance to use online learning by their children, based on its benefits. This work contributed to the body of knowledge by developing a model for predicting the continued use of educational technologies (online learning), especially in developing countries. One of the shortcomings of the study is that it only included parents of learners in one district of South Africa. As a result, generalising the findings to other high schools elsewhere should be done with caution.

Leadership Issues: Investigation of the Etiology of Curriculum Delivery in Rural Institutions of Learning

This study explored the factors affecting curriculum delivery as well as the way in which subject advisors deliver curriculum changes in selected rural schools in a selected education district in South Africa. Quantitative research was adopted for data collection. Questionnaires were administered to 17 educators, 35 school management team (SMT) members, and 165 subject advisors, who were purposively selected. The findings of the study show that non-involvement of educators in the curriculum planning phase, political instability, poor infrastructure, workload of educators, among other things, affect curriculum delivery, leading to curriculum change. The study recommends that educators be involved in and consulted during curriculum planning, and that political instability of the state not interfere with the planned curriculum guiding teaching and learning activities in the state. Adequate infrastructure should be provided to enhance teaching and learning activities, while more educators are recruited to reduce their workload.

Evaluation of the efficiency in delivery of government services to ameliorate the COVID-19 pandemic in the King Cetshwayo District in South Africa: Recipients’ perspectives

Evaluation of the efficiency in delivery of government services to ameliorate the COVID-19 pandemic in the King Cetshwayo District in South Africa: Recipients’ perspectives

Instructional Design to Promote Translingual Practices in an English First Additional Language Context

Languages are not set, autonomous, bounded entities whose nature cannot be disrupted; they are flexible entities that can be reformed, re-arranged and recreated to fit into new contexts of communication. This study was driven by the need to explore the instructional design used to promote translingual practices in an English first additional language context in the Further Education and Training phase. For this qualitative study, eight (8) English first additional language teachers in the Further Education and Training phase were used as respondents. These teachers were stationed at four (4) high schools in one district of South Africa, meaning two (2) teachers per school were selected. The researchers used telephone interviews to collect data. The results revealed that translanguaging can be used in conjunction with collaborative activities like co-teaching, peer tutoring and group work in the English first additional language classroom. Besides, all learners have prior knowledge gained from schooling and life experiences and English first additional language teachers can build on those experiences. Also, based on the findings, it is indispensable to take advantage of modern technological facilities like WhatsApp in aiding the task of teaching English first additional language.

A qualitative exploration into the presence of TB stigmatization across three districts in South Africa

BackgroundTuberculosis (TB) stigma is a barrier to active case finding and delivery of care in fighting the TB epidemic. As part of a project exploring different models for delivery of TB contact tracing, we conducted a qualitative analysis to explore the presence of TB stigma within communities across South Africa.MethodsWe conducted 43 in-depth interviews with 31 people with TB and 12 household contacts as well as five focus group discussions with 40 ward-based team members and 11 community stakeholders across three South African districts.ResultsTB stigma is driven and facilitated by fear of disease coupled with an understanding of TB/HIV duality and manifests as anticipated and internalized stigma. Individuals are marked with TB stigma verbally through gossip and visually through symptomatic identification or when accessing care in either TB-specific areas in health clinics or though ward-based outreach teams. Individuals’ unique understanding of stigma influences how they seek care.ConclusionTB stigma contributes to suboptimal case finding and care at the community level in South Africa. Interventions to combat stigma, such as community and individual education campaigns on TB treatment and transmission as well as the training of health care workers on stigma and stigmatization are needed to prevent discrimination and protect patient confidentiality.

Teachers’ Experiences on Stress during COVID-19: A South African Case Study

COVID-19 posed an obstacle to many teachers as they tried to master online teaching. This study sought to investigate teachers stress experiences in primary schools in South Africa during COVID-19. The study adopted the interpretivism paradigm in which thematically analysed data was collected through interviews. Fifteen (15) participants were selected purposely from primary schools of Chris Hani East District in South Africa for the interview. In the study, teachers attributed their stress to the lack of protective resources, lack of proper plans for remote teaching, and lack of skills. Students were not co-operating with the teachers during online lessons. The study recommends that the necessary protective resources be provided by the Department of Education to protect teachers from being infected with Covid-19 and provide teaching assistants so that teachers can find it easier to teach with less burden. Schools must be equipped with digital technology and train teachers on how to use digital technology to ease the burden on them. It is important for teachers and motivational speakers to meet with students to raise students’ interest and curiosity about learning and in the same vein boosting the students’self-confidence. Keywords: anxiety, burnout, COVID-19, frustration, pressures, stress, and workload

The effect of Regulatory Compliance on SMMEs’ Access to Government Support during Covid 19 Lockdown: the Case of King Cetshwayo District in KwaZulu Natal

This paper analyzes the impact of non-compliance on distribution of government support to SMMEs in the King Cetshwayo district in South Africa during the Covid 19 lockdown. We use qualitative data from semi-structured interviews and thematic content analysis to analyze the experiences and perceptions of government employees and political representatives who were involved in distributing the goods or services. Our findings show that compliance and negative attitudes towards compliance requirements were a hindrance to government interventions to ameliorate the Covid 19 pandemic induced recession. The top-down structure of the compliance system also contributed to challenges as local, national, and regional regulators were not coordinated with each other. We therefore recommend alignment of compliance requirements across the distinct levels of government (regulators), and improvement in efficiency of the regulatory system. A complete online system can be used and made accessible to local regulators to improve service delivery. In addition, compliance requirements can be relaxed during times of crises to enable access to government support by SMMEs.

Exploring Threats to Novice Teachers’ Development in Selected Secondary Schools in South Africa

Newly appointed teachers in the profession encounter challenges that impact their professional development possibilities and potential. The first five years in the teaching profession are delicate and fragile. This is the era where growth and development are gathered through classroom practices. This article seeks to explore any potential threats to these teachers’ development prospects. This can be incomplete without perusing related literature and teacher development theories. This study is qualitative and interpretive in nature and involved 23 participants who were novice teachers, school management team members and school principals. The theories of teacher change and social learning theory were used as the theoretical framework. Teacher change theory argues that change can happen when teachers come across valuable experiences and knowledge in the course of life. Empirical evidence was authenticated through interviews from purposively selected schools in the Mopani district in South Africa. This paper was authored to help education authorities, teacher unions, and school management hierarchies with relevant teacher development practices that can mitigate threats to novice teacher development. One compelling finding was that most of the difficulties accompanying novice teachers’ development were beyond the novice teachers’ control while in certain instances; teachers’ attitudes need to improve. The participants affirmed the need to introduce school-based development programmes that are unique to individuals. The need to regularly monitor and support schools cannot be over-emphasised. The study recommended that the Circuits and the Districts need to take control of their responsibilities for novice teacher development programmes. They should ensure that all programmes are regularly monitored, and schools are allowed to introduce programmes that address their unique professional development needs. Recommendations for future research on the subject are made.

The Changes That Occur in the Immune System During Immune Activation in Patients With Prediabetes From All Ethnicities, Aged 25-45 Years: Protocol for a Systematic Review and Meta-analysis.

Prediabetes is an asymptomatic, intermediate state between normoglycemia and the onset of type 2 diabetes mellitus. Recent reports indicate that during prediabetes, there are subclinical changes to immune cells and inflammatory markers. Therefore, this systematic review will provide a synthesis of the available data on the changes in the concentration of immune cells and selective inflammatory markers. It will also give evidence of a demographic impact on changes or complications in the prediabetes state. The objectives of this study are to create a protocol that will be used to analyze the collected data of previously published research based on immune cells such as neutrophils, lymphocytes, monocytes, eosinophils, and basophils, as well as inflammatory markers such as C-reactive protein, tumor necrosis factor-alpha, interleukin-6, P-selectin, cluster of differentiation 40 ligand, and fibrinogen. Additionally, an impact of demographics will be determined using the previously published data collected. This protocol was prepared through adhering to the PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analysis) 2015 guidelines for reporting protocols. Published clinical studies that involve observational (cross-sectional, comparative cross-sectional, case-control, or cohort) study designs that include normal or nondiabetic and prediabetes reports will be used in this systematic review and meta-analysis. This will be accomplished by using clinical Medical Subject Headings to search on MEDLINE, Cochrane library, and African Journal Online. Reviewers (NCM, AMS, and AK) will screen all the results and select the studies that meet the eligibility criteria. Downs and Black Checklist will be used to check the risk of bias, and then a Review Manager v5.4 forest plot will be used for meta-analysis. Additionally, the forest plot will also be used for sensitivity analysis. The strength of evidence will then be assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Since July 5, 2020, there are no participants recruited. Publicly available data will be used in the review and will be collected after this protocol publication. No ethics approval is required as no subjects will be used, and analysis will be based on reported data. Authors will be contacted if there was a misunderstanding related to reading their reported data. The findings will clarify changes that might be observed in a study of interest based in the eThekwini district in South Africa. International Prospective Registry of Systematic Reviews (PROSPERO) CRD42020184828; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=184828. PRR1-10.2196/31619.

An Investigation of the Role the School Library Space Plays in Promoting Reading Habits in Foundation Phase Learners in Vhembe District in South Africa

The school library space is of utmost importance in the school community as a whole. A library space provides, both teachers and their learners, with a space, which is safe and conducive to learning. The aim of this paper is to explore the role the school library space plays in promoting reading habits of the foundation phase learners in Vhembe District. The paper employed or followed a qualitative research method based on the nature of the study. The population of the study is the teacher librarians who are responsible for school libraries in the foundation phase. Purposive sampling was used to select eight schools from Vhembe District. Eight participants were sampled by virtue of their being teacher librarians serving in the Foundation Phase school libraries. Data was collected by means of individual interviews. The finding revealed that although they have a separate building for the library, the sitting space for learners is not sufficient because there are many learners. Secondly, the finding was concerned with the capacity of the school libraries in as far as the space to accommodate bookshelves, computers and other library facilities required in the library. The third finding was concerned with the challenges like overcrowding due to the lack of enough space in the school library. The fourth finding was concerned with the school libraries being used for purposes other than library activities. The study recommended that the library should also provide both teacher and learners with a space that encourages individual study, group cooperation and big group exhibition.

'Voice needs teeth to have bite'! Expanding community-led multisectoral action-learning to address alcohol and drug abuse in rural South Africa.

There is limited operational understanding of multisectoral action in health inclusive of communities as active change agents. The objectives were to: (a) develop community-led action-learning, advancing multisectoral responses for local public health problems; and (b) derive transferrable learning. Participants representing communities, government departments and non-governmental organisations in a rural district in South Africa co-designed the process. Participants identified and problematised local health concerns, coproduced and collectively analysed data, developed and implemented local action, and reflected on and refined the process. Project data were analysed to understand how to expand community-led action across sectors. Community actors identified alcohol and other drug (AOD) abuse as a major problem locally, and generated evidence depicting a self-sustaining problem, destructive of communities and disproportionately affecting children and young people. Community and government actors then developed action plans to rebuild community control over AOD harms. Implementation underscored community commitment, but also revealed organisational challenges and highlighted the importance of coordination with government reforms. While the action plan was only partially achieved, new relationships and collective capabilities were built, and the process was recommended for integration into district health planning and review. We created spaces engaging otherwise disconnected stakeholders to build dialogue, evidence, and action. Engagement needed time, space, and a sensitive, inclusive approach. Regular engagement helped develop collaborative mindsets. Credible, actionable information supported engagement. Collectively reflecting on and adapting the process supported aligning to local systems priorities and enabled uptake. The process made gains raising community 'voice' and initiating dialogue with the authorities, giving the voice 'teeth'. Achieving 'bite', however, requires longer-term engagement, formal and sustained connections to the system. Sustaining in highly fluid contexts and connecting to higher levels are likely to be challenging. Regular learning spaces can support development of collaborative.