Karumba K
Oluoch D
Mutua E
Gathara D
Fuller S
English M
Were F
Molyneux S
Maina M
High- QStakeholder Representative Group
NIHR Open Res. 2024;473
BACKGROUND: Engaging relevant stakeholders throughout the research cycle is increasingly recognised as critical to conducting quality health systems research. There are few descriptions and analyses of stakeholder engagement in practice for embedded health systems research especially those that must navigate multi-level decentralised health systems. We describe and reflect on the stakeholder engagement activities of an international multi-disciplinary programme of research focused on newborn care in hospitals in Kenya. METHODOLOGY: Our experienced project stakeholder engagement group coordinated engagement activities across multiple stakeholders ranging from those close to the intervention to those further away. with differing interests in the research. We conducted a stakeholder mapping and analysis using an engagement matrix to include national and county-level policymakers, professional communities, associations and regulators, health managers, frontline healthcare workers, patients, families and patient representative groups. Our engagement group maintained a log of engagement activities and had regular programme feedback meetings. Our analysis of stakeholder engagement drew on Programme's documents and meeting minutes, and on a conceptual framework which distinguishes between the moral, strategic and practical dimensions of stakeholder engagement. RESULTS: We engaged a wide range of stakeholders based on our understanding of their needs, interests and concerns. We drew on the International Association for Public Participation model on encompassing 'inform', 'consult,' 'involve,' 'collaborate', and 'empower' to inform strategies of engaging stakeholders and the need to balance moral, strategic and pragmatic components of engagements. Although we had significant prior engagement experience and relationships at the hospitals and the counties, introducing new staff into Newborn Units triggered complexities that required careful consultation along the bureaucracies at the counties. Despite the counties having similar hierarchical architectures, engagement processes varied and achieved different research approval, recruitment of additional workforce and outcomes across counties. There were also multiple officeholder transitions over the research period, occasioned by factors in our external environment, often necessitating engaging afresh. CONCLUSION: Even with a carefully developed stakeholder engagement plan, an experienced team, and a landscape backed by long-term relationships and embeddedness, health research stakeholder engagement can be complex and unfold in unexpected ways and requires continuous effort, resources, and adaptability. Meeting the moral, strategic, and practical potential of engagement requires flexibility, responsiveness, and commitment, including adequate resources.
Talking to relevant stakeholders throughout the research process is getting more recognised as important to conducting exceptional health systems research. Even with this recognition, there is limited practical guidance on how to approach stakeholders, especially in studies involving layered, dynamic autonomous sub-national or local health systems. This paper describes the experiences of our research project focused on newborn care in hospitals in Kenya. The study involved interviews, observations across eight public sector newborn units and an intervention to increase staffing in four of these units. The Project assembled a team to coordinate engagement activities involving diverse groups, including national and county policymakers, healthcare professionals, hospital staff, patients, and families. The project team adopted a stakeholder mapping approach to ensure inclusion and maintained a log of activities to adapt to emerging challenges. The inquiry into engagement activities was based on project records and a framework addressing the moral, strategic, and practical aspects of engagement. Engaging stakeholders was key but challenging, especially with the involvement of new project staff getting integrated to work alongside existing hospital staff, which required careful coordination across various levels of the health system. These processes varied between the sub-national governance structures. Engagement was repeated and sustained especially where there were frequent changes in leadership, such as those due to elections. These experiences led us to conclude that despite careful planning and experience, stakeholder engagement in health research often unfolds unpredictably and requires ongoing effort, resources, and adaptability to achieve meaningful outcomes.
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