Using multistakeholder dialogues to assess policies, programmes and progress for women’s, children’s and adolescents’ health

Abstract

Stakeholders from a range of sectors --including health, finance, planning, water and sanitation, nutrition and education--and from diverse constituencies --including government, nongovernmental organizations, private sector and academic institutions --all contribute to the improvement of women's, children's and adolescents' health. Multistakeholder dialogues are structured processes used to bring stakeholders together to develop a shared understanding of issues, evidence and plans of action. (1) The sustainable development goals (SDGs) and the Global strategy for womens, childrens and adolescents' health (2016-2030) emphasize the importance of multistakeholder and cross-sector collaboration. (2,3) Multistakeholder dialogues can facilitate these processes, and their benefits and challenges have been shown in a variety of sectors and contexts. (1) Few multistakeholder dialogues have been systematically documented and evaluated, which is required to understand how they can be most effectively undertaken to support implementation and evaluation. This paper describes multistakeholder dialogues conducted as part of the Success factors for women's and children's health studies. (4,5) When the studies started in 2012, only 10 low- and middle-income countries were on track to meet both millennium development goals (MDGs) 4 and 5A, to reduce the under-five mortality rate by two-thirds and reduce the maternal mortality ratio by three quarters, respectively. These countries were Bangladesh, Cambodia, China, Egypt, Ethiopia, the Lao People's Democratic Republic, Nepal, Peru, Rwanda and Viet Nam. (5) Between 2014 and 2015, these countries conducted dialogues to understand which policies or programmes, both within and outside the health sector, contributed to progress. They then documented the results in country policy reports. (4) The policy and programme findings across the country multistakeholder dialogues are published elsewhere. (6) Here, we describe the processes, identify strengths and challenges and highlight key lessons for future efforts, by drawing on the perspectives of those who participated in the design and implementation of the dialogues. In total, 407 stakeholders across the 10 countries engaged in the dialogues. While initiated by international study partners, the dialogues in each country were led by health ministries and convened by World Health Organization (WHO) country teams (or an organization identified by WHO) with key development partners. (4) National consultants in most countries, three international consultants and international partner organizations provided technical support. The dialogues followed three phases (Table 1). Phase 1 was preparatory. International partners contacted national conveners and provided a background literature and data review. In most countries, the convening organization contracted a national consultant to facilitate the dialogues and update the background information. A first draft report, on the policies and programmes potentially associated with mortality reductions, was distributed to participants. Phase 2 was conducting the multistakeholder meetings. (4) Participants agreed on four plausibility criteria to determine which policy and programme inputs were likely to be associated with mortality reductions (Box 1). In most countries the meetings were held over two days. In one country, individual interviews replaced the meeting because of contextual constraints. In two countries, follow-up meetings were convened to ensure participation from sectors outside health. Phase 3 was dissemination of findings and follow up. Findings were further validated using key informant interviews in some countries. The final country policy reports were prepared by the international consultants, reviewed by national stakeholders, and signed-off by health ministries. (4) Plans for dissemination and follow-up action varied in each country. The phases, timing and costs associated with the multistakeholder dialogues are detailed in Table 1. …