Background

Engaging stakeholders in deliberations about health policies can help to ensure that:

•    Their concerns are heard and taken into account
•    The problems are analysed, described and perceived correctly
•    Appropriate solutions are identified
•    Important barriers to implementing solutions are considered
•    Effective implementation strategies are identified
•    Appropriate values are used when balancing the pros and cons of options
•    Policy decisions are appropriate, understood and acceptable

Informing and engaging stakeholders effectively can result in better policy decisions, the improved implementation of policies, and better healthcare and better outcomes. The World Health Organization’s Declaration of Alma Ata states that: “The people have the right and duty to participate individually and collectively in the planning and implementation of their health care.”¹ Stakeholder involvement, therefore, can be viewed as a goal in itself by encouraging participative democracy, public accountability, and transparency.

However, engaging stakeholders may not always be helpful. Poorly planned and implemented efforts to engage stakeholders can create mistrust, waste people’s time, and undermine future attempts at engagement.² Engagement without clear objectives may anger participants and fail to add benefit to the policymaking process or outcomes. Care should also be taken not to engage stakeholders for inappropriate reasons. Sometimes, for example, they may be engaged simply to legitimise decisions that have already been made behind closed doors, and their involvement may mislead them into believing they are able to affect the decision. Similarly, stakeholders should not be engaged simply to allow others to avoid responsibility for difficult decisions.

Efforts to engage stakeholders should respect the time they have available and the value of their potential contributions. This means that there should be a clear purpose; that their input is considered; and that the way in which they are able to influence decisions is made clear.

Different circumstances require different levels of engagement and these have been conceptualised in a number of ways. The “spectrum of participation” developed by the International Association for Public Participation (IAP2) emphasises public participation in decisions made by governments or private organisations,³ particularly in situations where the government retains final authority but may choose to inform, consult, involve, or collaborate with others during the process of making decisions. Its deliberate horizontal arrangement indicates that there is a range of options to be considered rather than a hierarchy of choices, and it describes what the public (or stakeholders) can expect at each level. An adaptation of the IAP2 spectrum for decisions about how to involve stakeholders in the preparation and use of policy briefs is shown in Table 8.1.³

Little rigorous evaluation of the effects of different strategies for engaging stakeholders in health policy development is available.^4,5,6 However, substantial experience and anecdotal evidence can be used to inform decisions about how to involve stakeholders in policymaking. To ensure that stakeholders are better informed and effectively engaged, systematic consideration should be given to identifying which stakeholders have an interest in a policy brief, the degree to which they should be engaged in preparing and using the brief, how to inform and engage them, and how their input will be used.

Table 8.1 Degrees of involvement in the preparation and use of a policy brief
	Information	Consultation	Involvement	Collaboration	Delegation
Objectives of stakeholder involvement	To provide stakeholders with information derived from a policy brief in order to help them understand the problem and proposed solutions	To obtain specific types of input from stakeholders, feedback on the policy brief, or input into deliberations about the policy brief, or their views and values related to the decision that the policy brief is intended to inform	To work directly with stakeholders in preparing a policy brief to ensure that their views are understood and considered, or to engage them in deliberations about the problem and the proposed solutions described in a policy brief	To partner with stakeholders throughout the process of preparing a policy brief and its use in the policy development process	To give control over the preparation of some or all of the policy brief and its use in the policy development process
What stakeholders can expect	To be kept informed	To be kept informed, listened to, and provided with feedback on how their input has influenced the policy brief or subsequent deliberations and decisions	To work together in the preparation of the policy brief or subsequent deliberations	To be looked to for advice which will be incorporated as far as possible	To make decisions
Ways of achieving the objective	One-way information dissemination such as: The policy brief itself A website Tailored information Press releases Press conferences Interactive media Presentations	Two-way communication which involves seeking input, listening, and the exchange of views. This may take the form of: Written comments Interactive media Question and answer sessions Open phone lines Interviews Focus groups Surveys Public hearings	Interactive discussion and dialogue which supplement internal decision-making processes: Workshops Working groups A policy dialogue or other deliberative processes	Stakeholder representatives “at the table”, and active as team members in the preparation and use of the policy brief. Stakeholders are not involved in final decisions but will be involved in: Advisory groups Task forces Consensus processes	Decisions by a group or organisation with specific authorisation: Delegation of authority to make decisions about the policy brief or subsequent uses of the policy brief

* Adapted from IAP2 and Bruns.^{3, 7}

Background

Table 8.1 Degrees of involvement in the preparation and use of a policy brief

This page was last updated November 2011.