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The aim of this paper is to present the LOOPER participatory co-creation methodology and platform developed in the Learning Loops in the Public Realm (LOOPER) project to demonstrate ‘learning loops’ i.e. new ways of decision-making which bring together citizens, stakeholders and policy-makers to iteratively learn how to address urban challenges. The methodology and platform are demonstrated in three Living Labs with different spatial, cultural and thematic contexts. The main issues are traffic and mobility in Brussels; traffic and green space in Manchester; and air and noise pollution in Verona. The paper discusses the LOOPER approach to support finding solutions to urban problems in a participatory co-creation process. The experiences from the LOOPER Living Labs show that combining offline and online participation tools is often necessary in co-creation and that online tools should have a low entry threshold. Furthermore, formal evaluation methods can be effective tools in ensuring stakeholder participation.

Background Access to adequate antenatal care (ANC) is critical in ensuring a good maternal health and in preventing maternal and neonatal morbidity and mortality. South Sudan has one of the world’s poorest health indicators due to a fragile health system and a combination of socio-cultural, economic, and political factors. This study was conducted to identify barriers to utilisation of ANC services in Rumbek North County. Methods Using a qualitative design, data were collected through 14 focus group discussions with 169 women and 45 men and 12 key informant interviews with community leaders, staff working in health facilities, and the staff of the County Health Department. Data were analysed using inductive content analysis. Results The perceived barriers to ANC utilisation were categorised as follows: 1) Issues related to access to health facilities and lack of resources. These included long distance to health facilities, lack of means of transportation to the health facilities, floods and poor roads, and demand for payment for health care at some health facilities; 2) The influence of the socio-cultural context and conflict including heavy burden of domestic chores, the negative influence of husbands who were reluctant to allow their wives to attend ANC, and insecurity; 3) Perceptions about pregnancy including misperceptions about the benefits of ANC and low perceived risk of pregnancy-related complications; and 4) Perceptions about the quality of care and the efficacy of medical treatment. Conclusions This study identified a myriad of factors deeply entrenched in the society, which prevent women from utilising ANC services. It also elicits broad aspects of interconnectedness among the barriers. To ensure effectiveness, strategies to improve utilisation of ANC in the study area and in similar contexts need to take into account the barriers identified by this study. Electronic supplementary material The online version of this article (doi:10.1186/s12978-017-0327-0) contains supplementary material, which is available to authorized users.

Objective To assess provision of emergency obstetric care (EmOC) in Greater Yirol, South Sudan, after implementation of a hospital-centered intervention with an ambulance referral system. Methods In a descriptive study, data were prospectively recorded for all women referred to Yirol County Hospital for delivery in 2012. An ambulance referral system had been implemented in October 2011. Access to the hospital and ambulance use were free of charge. Results The number of deliveries at Yirol County Hospital increased in 2012 to 1089, corresponding to 13.3% of the 8213 deliveries expected to have occurred in the catchment area. Cesareans were performed for 53 (4.9%) deliveries, corresponding to 0.6% of the expected number of deliveries in the catchment area. Among 950 women who delivered a newborn weighing at least 2500 g at the hospital, 6 (0.6%) intrapartum or very early neonatal deaths occurred. Of 1232 women expected to have major obstetric complications in 2012 in the catchment area, 472 (38.3%) received EmOC at the hospital. Of 115 expected absolute obstetric indications, 114 (99.1%) were treated in the hospital. Conclusion A hospital-centered approach with an ambulance referral system effectively improves the availability of EmOC in underprivileged remote settings.

Effective from May 2014, community-based traditional birth attendants (TBAs) in Yirol West County, South Sudan, were directed to start referring all women in labour to health facilities for childbirth instead of assisting them in the villages. This study aimed to understand the degree of integration of TBAs in the health system, to reveal the factors influencing the integration, and to explore the perceived solutions to the challenges faced by TBAs. A qualitative study utilising 11 focus group discussions with TBAs, 6 focus group discussions with women, and 18 key informant interviews with members of village health committees, staff of health facilities, and staff of the County Health Department was conducted. Data were analysed using qualitative content analysis. The study found that many TBAs were referring women to health facilities for delivery, but some were still attending to deliveries at home. Facilitators of the adoption of the new role by TBAs were: acceptance of the new TBAs’ role by the community, women and TBAs, perceptions about institutional childbirth and risks of home childbirth, personal commitment and motivation by some TBAs, a good working relationship between community-based TBAs and health facility staff, availability of incentives for women at health facilities, and training of TBAs. Challenges of integrating TBAs in the health system included, among others, communication problems between TBAs and health care facilities, delays in seeking care by women, insecurity, lack of materials and supplies for TBAs, health system constraints, insufficient incentives for TBAs, long distances to health facilities and transportation problems. This study has revealed encouraging developments in TBAs’ integration in the formal health system in Yirol West. However, there is need to address the challenges faced by TBAs in assuming their new role in order to sustain the integration.

The public realm is a place where urban stakeholders interact and come into conflict. Symptoms such as traffic congestion, safety and pollution are difficult to tackle as they involve multiple stakeholders. Planning and implementation to improve public space can be enhanced through co-creation, but examples of co-creation approaches overarching the full planning cycle are rare. The aim of this paper is to present the LOOPER participatory co-creation methodology and platform developed in the Learning Loops in the Public Realm (LOOPER) project to demonstrate ‘learning loops’ i.e. new ways of decision-making which bring together citizens, stakeholders and policymakers to iteratively learn how to address urban challenges. A loop starts with collective debate on topical issues, then frames the problem and collects data. The LOOPER platform visualizes the data and enables the co-design and evaluation of solutions. The selected solutions are then implemented, and the results are monitored with a second loop learning from the first. The LOOPER prototype platform integrates online and offline tools to facilitate learning in each stage of the co-creation process such as visualisation of participatory sensing data, a geotagging tool to collect citizens’ qualitative input about urban space and an idea generation tool to contribute to the co-design. The methodology and platform are demonstrated in three Living Labs with different spatial, cultural and thematic contexts. The main issues being solved are traffic and mobility in Brussels; traffic and green space in Manchester; and air and noise pollution in Verona. LOOPER will enable policy makers to improve their decision-making in a participatory manner. The paper will discuss the overall approach and methodology developed in the LOOPER project to support finding solutions to urban problems in a participatory co-creation process.