[spotlight] Not so long ago, in mid 2017, I was part of a team evaluating a system-wide initiative in Nelson Mandela Bay Metropolitan (NMBM) health district to improve the quality and accountability of its primary health care services and district hospitals. Our independent assessment was overwhelmingly positive. We documented an integrated system of problem analysis and response in frontline health services, engaging providers and their immediate supervisors in a manner that was both generative and meaningful to them