Breaking down Barriers: Multi-and Transdisciplinary Approaches to Achieving Health Equity in South Africa: A Systematic Review

Description

DOI: https://doi.org/10.5281/zenodo.18311940

Thabile Soga (Department of Human Resource Management and Labour Relations, University of Venda, Thohoyandou, South Africa)

Persistent inequities in South Africa’s health outcomes stem from a complex interplay of biomedical, socio-economic, political, and ecological determinants that transcend disciplinary silos. While “multi-” (parallel collaboration) and “transdisciplinary” (integrative, co-produced) approaches are increasingly promoted, their collective evidence base has never been systematically synthesised for the South African context.
To map, appraise, and synthesise published evidence on multi- and transdisciplinary interventions aimed at advancing health equity in South Africa, and to identify knowledge gaps to guide future research, policy, and practice. PRISMA-2020 guidelines framed the review. Eight electronic databases (PubMed, Scopus, Web of Science, EBSCO Africa-Wide, PsycINFO, Global Health, SABINET, & Web of Science Social Sciences Citation Index) and three grey-literature repositories (OpenGrey, WHO IRIS, & the SA Medical Research Council Knowledge Hub) were searched from January 2010 to March 2025. Keywords combined health-equity terms (“inequal*”, “disparit*”), geographic filters (“South Africa”), and approach descriptors (“multidisciplinary”, “transdisciplin*”, “community-based”, “co-creation”, “arts-based”). Two reviewers independently screened titles/abstracts, performed full-text eligibility assessments, extracted data, and assessed methodological quality using the Mixed-Methods Appraisal Tool (MMAT-2018). Disagreements were resolved by a third reviewer. Findings were narratively synthesised and, where feasible, pooled using random-effects meta-analysis.
From 4 392 records, 43 studies met inclusion criteria. Interventions clustered around (i) integrated primary health care with social services, (ii) environmental health and WASH co-programmes, (iii) gender-transformative and GBV prevention initiatives, and (iv) arts-based participatory research targeting mental health. Transdisciplinary projects (n = 18) more frequently involved community co-leadership, Indigenous knowledge, and creative methodologies than multidisciplinary projects (n = 25). Meta-analysis of 18 comparable studies showed a pooled risk ratio of 1.34 (95 % CI 1.121.60) for improved service utilisation in transdisciplinary versus conventional interventions. Quality appraisal rated 63 % of studies high or moderate; common weaknesses included short follow-up and inadequate equity-stratified reporting. Evidence indicates that transdisciplinary, community-engaged models yield modest but meaningful gains in access, acceptability, and sustainability of health services, particularly when coupled with arts-based or Indigenous knowledge practices. However, rigorous, long-term evaluations remain scarce, and reporting seldom disaggregates outcomes by intersecting axes of inequality (race, gender, disability). Strengthening methodological rigour and embedding equitable power-sharing in programme governance are crucial next steps for South Africa to realise health equity ambitions.