Stakeholders representing both the private and public health sectors are integral to the assessment. The level of stakeholder involvement may range from minimal to extensive, often as a function of assessment objectives, time frame, and available budget. At a minimum, stakeholders participate as key informants, sharing their perspectives, insights, and even concerns about the private health sector. As the assessment process has evolved, local stakeholders have played a greater role, ranging from providing input and direction to the assessment, to participating in fieldwork, and validating findings and helping to prioritize recommendations.
3.1 Team Discussion: Engagement Approach and Opportunities
Stakeholders represent organizations and individuals that have an interest in the health system. Discussing the team’s approach to engaging stakeholders, as well as engagement opportunities and activities, is a good way to get everyone on the same page regarding rationale and messaging. At this point it’s good to remember that the entire assessment process—especially in-person interviews—provides multiple opportunities to engage stakeholders, raise awareness and dispel myths about the private sector, and lay the foundation for follow-on actions.
Reaching out to stakeholders early on in the assessment process will:
- Facilitate fieldwork by building awareness and credibility (if people know what you’re doing and why it’s important, it will be easier to schedule interviews).
- Gauge level of interest, perceptions of the private sector, and potential role in any public-private partnerships.
- Increase the likelihood of developing actionable recommendations.
- Lay the groundwork for local ownership of the assessment process and recommendations.
TIP ? Connecting with Ministry of Health officials early in the process will shed light on any required protocols or recommended practices. For instance, in some countries the team has had to secure approval from the Ministry of Health prior to starting fieldwork. Even when explicit approval is not required, some informants feel more comfortable being interviewed if they know the assessment has been condoned by the Ministry of Health. A sample letter used in Dominica is available as a resource.
3.2 Identify Key Stakeholders
Typical stakeholders include:
- USAID and other aid agencies or development partners
- Ministry of Health, other ministries (e.g., finance)
- Professional medical and pharmaceutical associations
- Owners of large private health facilities
- Private health practitioners
- NGOs engaged in health
Often the donor can provide insights as to which stakeholders you should reach out to, as well as introductions. Additional stakeholders will emerge from conversations with these individuals (similar to how a snowball sample functions).
RESOURCE ? As the first assessment to focus on HIV and AIDS, our experience in Namibia allowed us to identify new stakeholders in the HIV community and develop a more systematic approach to interviewing them. We developed clear objectives for interviewing each stakeholder group, and this helped to focus the assessment. This table summarizes Namibian stakeholders by sector and demonstrates their relationship to the focus areas of HIV and AIDS and/or orphans and vulnerable children.
3.3 Determine the Level of Stakeholder Engagement
Taking into account the assessment’s objectives, budget, and time frame, consider the following when determining the level and type of stakeholder engagement:
- Is it necessary to engage local stakeholders throughout the process, or focus on certain phases or steps?
- Is it enough to gather ad hoc inputs from key individuals, or would your objectives be better served through the establishment of a formal advisory board?
Engaging stakeholders early on in the process lends credibility to the assessment, and can serve as a foundation for increased public-private communication and an enhanced role for the private sector. In our experience, soliciting stakeholder input to validate findings and prioritize recommendations contributes to local ownership and uptake of recommendations. Other ways that local stakeholders can be involved include:
- Contributing to planning and implementing the assessment
- Participating as a key informant
- Participating as an interviewer (often jointly with one of the international team members)—this is particularly relevant if one of the objectives is to build local capacity to conduct future assessments
- Validating assessment findings and prioritizing recommendations
- Participating in a public-private forum or technical working group to help implement recommendations
TIP ? Be sure to discuss stakeholder engagement with the donor. In some instances, they may be interested in taking the lead on liaising with key stakeholders, and they may be in the best position to do so.