Local Stakeholder Groups Research Articles

Perception of local stakeholder groups about certain invasive alien bee pasture species around Lake Kolon

The apiculture sector in Hungary is currently heavily dependent on invasive alien bee pasture species such as the black locust (Robinia pseudoacacia L.), the common milkweed (Asclepias syriaca L.) and the invasive goldenrod species (Solidago gigantea Ait. and Solidago canadensis L.). Between March and October 2023, semi-structured interviews were conducted around Lake Kolon with representatives of the main stakeholder groups: nature conservationists, beekeepers, foresters and farmers. The main aim of our investigation was to assess the perception of the four stakeholder groups about the invasive alien bee pasture species and reveal the conflicting points. Based on our results the presence of black locusts in the area is only undesirable for the conservation sector, the common milkweed is the most damaging species from both a conservational and agricultural point of view. The invasive goldenrod species are less common but are also unfavourable from a conservation point of you. They play a role in preparing bees for winter Beekeepers mentioned other valuable bee pastures (e.g. protective forest strips, flowering trees and shrubs, wildflower meadows, and native bee pastures such as linden) and some of them could replace the invasive alien species. Agricultural subsidies are essential for local farmers. However, they are reluctant to take advantage of subsidies specifically targeted at indigenous bee pasture species, because for some reason they are not seen as favourable. In terms of conflicts, foresters and farmers consider the regulations and restrictions of the conservation sector too strict. Due to the rich wild bee fauna in the area, the conservationists do not prefer the presence of migratory beekeepers with their hives, which puts extreme competitive pressure on wild bees. Beekeepers have reported conflict cases with farmers about bee poisoning in oilseed rape. Overall, it can be said that the beekeepers interviewed are open to the indigenous bee pasture plant species, but currently, they are dependent on the invasive alien bee pasture species. In addition, there are conflict cases between the stakeholder groups, but most of them can be resolved through discussion.

The Business Practices of a Chinese State-Owned Enterprise in Myanmar’s Kyaukphyu Special Economic Zone: Perspectives of Local Non-State Stakeholders

The Kyaukphyu Special Economic Zone (KSEZ) in Myanmar is part of China’s massive international development strategy known as the Belt and Road Initiative (BRI). To advance the KSEZ, the Chinese state-owned enterprise (SOE) China International Trust and Investment Corporation (CITIC) has asserted its commitment to the principles of corporate social responsibility (CSR). In this paper, we investigate how CITIC’s CSR practices are perceived by two groups of local non-state stakeholders: Myanmar villagers and civil society organizations (CSOs). To this end, we conducted 31 qualitative interviews with non-state stakeholders in Kyaukphyu Township between March 2022 and October 2023. According to our interview results, there is a substantial though not universal local perception that CITIC’s publicly broadcast commitment to CSR has served primarily to advance the KSEZ and left the concerns of local residents largely unaddressed. By examining CITIC’s stated commitment and its actual commitment to CSR as perceived by the local non-state stakeholders, we aim in this study to deepen our understanding of the business practices of Chinese SOEs in overseas investments and to enrich the research on the BRI in Myanmar.

Transition Processes in Dutch Spatial Planning and Water Management: A Shift to the Natural

Climate change is causing more extreme weather conditions in the Netherlands. In response, local governments such as Provinces, Municipalities, and regional Water Boards are encouraged to explore more nature-inclusive ways to keep society safe from flooding and drought. This is considered a transition from the earlier belief that environmental and societal challenges can be solved solely through technical engineering. Instead, landscape-based, climate-adaptive visions offer alternatives on how Dutch regions can maintain water security while also incorporating space for biodiversity, climate mitigation, healthy livelihood and expanding populations. So far, not much is known about the challenges project leaders from different organisations and local governments are facing during the development and implementation of such visions. To address this gap, we used the concept of learning history to build an archive capturing the insider perspective of project leaders tasked with co-creating landscape-based, climate-adaptive visions for future spatial planning and water management across four regions of the Netherlands. By observing and interviewing project leaders, we noticed how co-creating long-term visions enabled more climate-conscious dialogues between local government authorities and civil stakeholder groups. Reflecting on this archive, we gained insights into the strategic challenges associated with adopting biophysical processes as a foundational framework for future spatial development and policy-making. Furthermore, we documented examples of tactical approaches employed by project leaders to navigate these challenges effectively.

Conceptual framework for Information and Communication Technology applications to enhance eco-efficiency

The quality of community decisions about the key characteristics of urban services depends on the level of involvement of local stakeholder groups. The identification of the environmental, economic and social impacts of investments to improve urban services is a critical aspect of the decision preparation phase. Assessment of the main stakeholder groups being affected by the impacts of urban services is required to understand what kind of problems they perceive. Based on their demand, different solutions can be provided to create an Information and Communication Technology (ICT) software system to facilitate environmental cooperations. The aim of this research is to propose an ICT system to support citizens’ active involvement in the transformation of the environment with access to essential information, and enable them to make more effective decisions about the investments. Most of the features of the proposed system have the potential to support eco-effective environmental policy implementations and form part of a sustainable policy toolkit. We explore the different interests and what functions should be provided to make access to information easier and more integrated. Our proposed conceptual framework would fulfill the requirements and gives practical examples how to increase eco-efficiency of products, technologies or investments in urban areas.

Enabling local provision of assistive products in rural South India: an organisational survey of needs, barriers, and facilitators

Objective Access to assistive products (APs) is essential to maximising function, participation, and inclusion of persons with disabilities. Challenges to AP access in low- and middle-income countries include stigma, costs, supply, and rehabilitation capacity gaps. This study aimed to examine AT access in the context of a low-resource setting in rural South India. Objectives were to examine rehabilitation professionals’ perceptions of AP needs, barriers and facilitators of AP provision, and AT knowledge. Methods A descriptive study design with a 2-part online survey methodology was utilized. This study was conducted in April-September 2020 at a non-governmental organization (NGO) serving children and adults with disabilities in 3 districts of rural South India. Purposive sampling of NGO’s multidisciplinary rehabilitation professionals (N=62) was used. The survey was developed based on WHO’s Assistive Products List (APL). Barriers and facilitators were classified according to the principles of AT access. Analyses revealed acceptability, affordability, and availability as the top three barrier themes across disciplines, including poor acceptance by clients/families due to stigma, high AP costs, and a long waitlist for government-provided devices. Acceptability, affordability, and accessibility were the top three facilitator themes, including community awareness, availability of AP funding, client/family education, and AT service provision training. Impact Our study identified key enabling strategies for AT access, aimed at reducing reported barriers. Enabling AP provision was determined to be multi-factorial, aimed at users/ families, service providers, organizations, communities, and policymakers. Local stakeholder groups are crucial to understanding challenges and opportunities to AP provision within a low-resource context.

Proceed with Caution: Social Acceptability of Forestry Practices in Puerto Rico among Members of Local Environmental Organizations, Academia and Professional Associations.

Social acceptability of forestry practices plays a key role in defining sustainable forestry policies and strategies. In this study an online survey was distributed among members of environmental, non-governmental, professional, and academic organizations to assess the acceptability of forestry practices in Puerto Rico among members of civic society interested in environmental management issues. Participants were asked about their perception of forest uses, their preference of tree harvesting technologies, methods that may apply in small scale wood production settings, and trust in organizations providing forest information. We also inquired about attitudes towards economic activity in forests and the impact of such activity on recreation and biodiversity. The results show that even though participants do not place a high priority on economic development through forestry activities, acceptance of forest management for wood harvesting will be possible by considering adherence to particular forestry technologies and methods to safeguard current recreation activities and biodiversity conservation. Social acceptability information would be worthwhile when seeking consensus among a broader group of local stakeholders. As a next step we suggest the creation of a council constituted by diverse forestry sector stakeholders that would engage in a strategic planning exercise to delineate a clear road map that can guide short and long-term sustainable forest management, including wood industry development.

Sociocultural environmental factors and childhood stunting: qualitative studies – a protocol for the Shared Values theme of the UKRI GCRF Action Against Stunting Hub

IntroductionStunting is a significant and growing global problem that is resisting scientific attempts to understand it in terms of direct nutrition-related determinants. In recent years, research included more complex, indirect...

Energy justice: Lessons from offshore wind farm siting conflicts in South Korea

Given the growing salience of energy transition conflicts, policymakers need better tools to explain, prevent, and resolve them. The concept of energy justice highlights the normative direction of the energy system, and therefore, we examined the offshore wind farm siting conflict in Yeonggwang-gun, South Korea, through the lens of energy justice. In this study, we interviewed representatives of local stakeholder groups relevant to offshore wind farms and conducted text-mining analysis to extract the primary opinions of stakeholders. Through text-analysis, four primary factors were identified and discussed in relation to energy justice: gillnet fishing, consultation with the fishing village cooperative, damage by private developers, and a government-led conditional agreement. This mixed-method approach showed that the voices of fishing communities correlate with the four tenets of energy justice—distributional, procedural, recognition, and restorative justice. We discuss how recognition and restorative justice explain energy transition conflict under inadequate policy arrangements in South Korea, where little has been investigated in energy justice literature. By filling the gaps in energy transition conflict, we suggest inclusive policy strategies, revisiting the meaning and utility of participatory planning, scoping methods for Environmental and Social Impact Assessments, and just transition.

Using participatory action research to empower district hospital staff to deliver quality-assured essential surgery to rural populations in Malawi, Zambia, and Tanzania.

In 2017 the SURG-Africa project set out to institute a surgical, obstetric, trauma and anesthesia (SOTA) care capacity-building intervention focused on non-specialist providers at district hospitals in Zambia, Malawi and Tanzania. The aim was to scale up quality-assured SOTA care for rural populations. This paper reports the process of developing the intervention and our experience of initial implementation, using a participatory approach. Participatory Action Research workshops were held in the 3 countries in July-October 2017 and in October 2018-July 2019, involving representatives of key local stakeholder groups: district hospital (DH) surgical teams and administrators, referral hospital SOTA specialists, professional associations and local authorities. Through semi-structured discussions, qualitative data were collected on participants' perceptions and experiences of barriers to the provision of SOTA care at district level, and on the training and supervision needs of district surgical teams. Data were compared for themes across countries and across surgical team cadres. All groups reported a lack of in-service training to develop essential skills to manage common SOTA cases; use and care of equipment; essential anesthesia care including resuscitation skills; and infection prevention and control. Very few district surgical teams had access to supervision. SOTA providers at DHs reported a demand for more feedback on referrals. Participants prioritized training needs that could be addressed through regular in-service training and supervision visits from referral hospital specialists to DHs. These data were used by participants in an action-planning cycle to develop site-specific training plans for each research site. The inclusive, participatory approach to stakeholder involvement in SOTA system strengthening employed by this study supported the design of a locally relevant and contextualized intervention. This study provides lessons on how to rebalance power dynamics in Global Surgery, through giving a voice to district surgical teams.

How does participatory research work: protocol for a realist synthesis

IntroductionParticipatory research science deals with partnerships underlying research, governance and ownership of research products. It is concerned with relationships behind research objectives and methods. Participatory research has gained significant traction...

Local contextual factors of child stunting found via shared values of stakeholder groups: an exploratory case study in Kaffrine, Senegal.

This work aims to demonstrate an original approach to identify links between locally situated shared values and contextual factors of stunting. Stunting results from multi-factorial and multi-sectoral determinants, but interventions typically neglect locally situated lived experiences, which contributes to problematic designs that are not meaningful for those concerned and/or relatively ineffective. This case study investigates relevant contextual factors in two steps: by first facilitating local stakeholder groups (n 11) to crystallise their shared-values-in-action using a specialised method from sustainability studies (WeValue_InSitu (WVIS)). Secondly, participants (n 44) have focus group discussions (FGD) about everyday practices around child feeding/food systems, education and/or family life. Because the first step strongly grounds participants in local shared values, the FGD can reveal deep links between contextual factors and potential influences on stunting. Kaffrine, Senegal, an 'Action Against Stunting Hub' site. December 2020. Eleven stakeholder groups of mothers, fathers, grandmothers, pre-school teachers, community health workers, farmers, market traders and public administrators. Local contextual factors of stunting were identified, including traditional beliefs concerning eating and growing practices; fathers as decision-makers; health worker trust; financial non-autonomy for women; insufficient water for preferred crops; merchants' non-access to quality produce; religious teachings and social structures affecting children's food environment. Local contextual factors were identified. Pre-knowledge of these could significantly improve effectiveness of intervention designs locally, with possible applicability at other sites. The WVIS approach proved efficient and useful for making tangible contextual factors and their potential links to stunting, via a lens of local shared values, showing general promise for intervention research.

A facilitated social innovation: stakeholder groups using Plan-Do-Study-Act cycles for perinatal health across levels of the health system in Cao Bang province, Vietnam

BackgroundUniversal coverage of evidence-based interventions for perinatal health, often part of evidence-based guidelines, could prevent most perinatal deaths, particularly if entire communities were engaged in the implementation. Social innovations may provide creative solutions to the implementation of evidence-based guidelines, but successful use of social innovations relies on the engagement of communities and health system actors. This proof-of-concept study aimed to assess whether an earlier successful social innovation for improved neonatal survival that employed regular facilitated Plan-Do-Study-Act meetings on the commune level was feasible and acceptable when implemented on multiple levels of the health system (52 health units) and resulted in actions with plausibly favourable effects on perinatal health and survival in Cao Bang province, northern Vietnam.MethodsThe Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework guided the implementation and evaluation of the Perinatal Knowledge-Into-Practice (PeriKIP) project. Data collection included facilitators’ diaries, health workers’ knowledge on perinatal care, structured observations of antenatal care, focus group discussions with facilitators, their mentors and representatives of different actors of the initiated stakeholder groups and an individual interview with the Reproductive Health Centre director. Clinical experts assessed the relevance of the identified problems and actions taken based on facilitators’ diaries. Descriptive statistics included proportions, means, and t-tests for the knowledge assessment and observations. Qualitative data were analysed by content analysis.ResultsThe social innovation resulted in the identification of about 500 relevant problems. Also, 75% of planned actions to overcome prioritised problems were undertaken, results presented and a plan for new actions to achieve the group’s goals to enhance perinatal health. The facilitators had significant roles, ensuring that the stakeholder groups were established based on principles of mutual respect. Overall, the knowledge of perinatal health and performance of antenatal care improved over the intervention period.ConclusionsThe establishment of facilitated local stakeholder groups can remedy the need for tailored interventions and grassroots involvement in perinatal health and provide a scalable structure for focused efforts to reduce preventable deaths and promote health and well-being.

Comparing regulatory processes in genome editing and autonomous vehicles: How institutional environments shape sociotechnical imaginaries

AbstractThis study compares the regulation of two emerging technologies, the CRISPR genome‐editing system and Connected and Autonomous Vehicles (CAV) in the United States. The study draws on 33 in‐depth interviews with innovation and governance experts to study the relationship between their regulatory environments and developing beliefs about these technologies. Using sociotechnical imaginaries as a framework, we explore how social actors envision technologically driven futures and the social order that enables them. These imaginaries are essential to emerging technologies, where experts build a framework of potentialities for innovation still underway. While scholarship has documented how sociotechnical imaginaries arise among policymakers, groups of scientists, state and local stakeholders, and public actors in different countries, less has been said about how regulatory organizations and their actors shape expectations around technologies that are in the early and middle stages of development. This article finds that regulatory institutions shape emerging imaginaries along three related axes: the distribution of authority, technological novelty, and risk. Interviewees negotiate these three contingencies differently based on relevant extant regulatory structures and ideologies, resulting in distinct imaginaries around each technology. CRISPR actors envision genome editing as largely diminishing biomedical harm and eventually suitable for health markets, while CAV actors diverge on whether self‐driving cars alleviate or exacerbate risk and how they may enter roads. That organizational structures and practices of regulation inform broadly held sociotechnical imaginaries bears significance for studies of innovation trajectories, suggesting regulators can take an active role in shaping how risks and benefits of emerging technology are defined.

Participatory approaches for planning nature-based solutions in flood vulnerable landscapes

In vulnerable areas, where floods are frequent, decision-making through participatory workshops has proved highly applicable and yielded positive results in integrated management issues. This paper examines Nature-Based Solutions (NBS) to provide flood risk mitigation and proactive adaptation options. The case study concerns the Kalloni river basin (Lesvos Island, Greece) which represents a highly flood-prone area. Participatory methods and community-based approaches according the methodology developed in "Vulnerability and Capacity Assessment (VCA)", are used to evaluate NΒS options and determine their design and implementation framework. As part of this approach, a diverse group of local stakeholders, experts and decision-makers joined a series of interviews and workshops aimed at prioritizing NBS’s proposed practices based on their sustainability at social, economic and environmental level. The small-scale mountainous dams, afforestation and planting measures appeared to be the most acceptable alternatives. After the examination of the digital elevation model and the estimated water and sediment flow, the construction sites of five gabion and three wooden wall dams in river tributaries’ bottlenecks were selected. For every selected site, the slope stability and suitable spillway, as well as the frontage and cross-section were calculated and finally their construction cost was estimated. This solution proved to be the most effective measure that provides environmental and social benefits. Ultimately, NBS strategies can drive the desired sustainable change through a combination of solutions for the wider basin resulting from a complex participatory and modeling approach, strongly depended on stakeholder’s active contribution and government intervention.

Sketching local development: Graphic methods at the intersection of democratic and representational experimentalism

AbstractRecent debates on ‘graphic’ geographies and the reinterpretation of the notion of ‘democratic experimentalism’ in local development suggest the rise of a new ‘representational experimentalism’ that explores graphic methods for place‐based approaches. Graphic methods of research can assist geographers in conducting and presenting the results of place‐based research to wider audiences. Graphic products of research function as tools for storytelling and spatial planning. They can also provide intersubjective dialogue between researchers, local communities, and local governments to create more inclusive place‐based narratives. In this paper, we present a verbo‐visual manifesto and an illustrated fieldwork journal as two empirical examples of possible ways to engage with graphic methods and realise the potential graphic outputs of research. These graphic products are the result of a collaboration between geographers, students in Local Development and Sustainable Territorial Development (at the University of Padua), two professional illustrators, and a group of local stakeholders; they used scribing and observational drawing as place‐based graphic methods during a residential seminar at the Po Delta, in north‐eastern Italy. This paper contributes to both recent debates on creative methods in local development and the study of the use graphic and visual methods in geography. It proposes graphic methods as a way for embracing place‐based approaches to local development in peripheral, fragile, and contested areas, making hidden voices visible.

External Benefits of Irrigation in Mountain Areas: Stakeholder Perceptions and Water Policy Implications

Irrigation contributes to land and ecosystem degradation, especially in intensive farming areas. However, in marginal areas, long-established irrigation systems also supply agroecosystem services. This study aimed to identify and prioritize the external benefits provided by irrigation in extensive grazing farms in an Italian alpine region (Aosta Valley, NW Italy). Three local stakeholder groups (land irrigation consortia members, non-farmer users of the irrigation water service, and non-user citizens) engaged in focus group discussions. The transcriptions were analyzed with an integrated subjective and computer-assisted approach. The main result of the study showed that a convergence of stakeholder opinions led to prioritization of the same four benefits, i.e., hydro-geological and land maintenance, traditional agricultural landscape conservation, biodiversity conservation, and leisure recreational activities provision. Incorporating this information into decision-making processes is relevant in marginal mountain areas, especially in light of the implementation of the water pricing policy laid down in the EU Water Framework Directive. To this end, the economic value of the external benefits should be considered along with the recovery costs for water services. Such information is essential to balance the environmental costs of irrigation and to compare the resource cost of alternative water uses.

Stakeholder Perceptions Can Distinguish ‘Paper Parks’ from Marine Protected Areas

While numerous Marine Protected Areas (MPA) have been created in the last decades, their effectiveness must be assessed in the context of the country’s biodiversity conservation policies and must be verified by local observations. Currently, the observations of local stakeholders, such as those from non-governmental organizations (NGOs), academics, government civil servants, journalists, and fishers, are not considered in any MPA database. The Sea Around Us has added observations from local stakeholders to address this gap, adding their perspectives to its reconstructed fisheries catch database, and to at least one MPA in each country’s Exclusive Economic Zone. It is important to pursue and incentivize stakeholder knowledge sharing to achieve a better understanding of the current level of marine protection, as this information is a valuable addition to the existing MPA databases. To address this gap, we demonstrated that personal emails containing a one-question questionnaire about the fishing levels in an MPA are an excellent way to gather data from local stakeholders, and that this works especially well for respondents in NGOs, academia, and governments. Of the stakeholders who replied to our personalized email, 66% provided us with the fishing level of the MPA that we asked for. The paper also presents how to access this information through the Sea Around Us website, which details in anonymized form the most common fishing levels for each selected MPA, as perceived or observed by different local stakeholder groups. This information is a unique and novel addition to a website that is concerned with marine conservation and contributes to a more accurate and inclusive discourse around MPAs. This information also helps to identify the gaps that need to be addressed to turn ‘paper parks’ (i.e., MPAs that are legally designated but not effective) into effective MPAs, which can contribute to climate-resilient ‘blue economies’.

Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America

ABSTRACT Background Effective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) sought to test the impact of multilevel implementation strategies on rates of primary health care-based measurement of alcohol consumption and identification of depression in Colombia, Mexico, and Peru. Objective To describe the process of development and cultural adaptation of the clinical intervention and training package. Methods We drew on Barrero and Castro’s four-stage cultural adaption model: 1) information gathering, 2) preliminary adaption, 3) preliminary adaption tests, and 4) adaption refinement. The Tailored Implementation in Chronic Diseases checklist helped us identify potential factors that could affect implementation, with local stakeholder groups established to support the tailoring process, as per the Institute for Healthcare Improvement’s Going to Scale Framework. Results In Stage 1, international best practice guidelines for preventing heavy drinking and depression, and intelligence on the local implementation context, were synthesised to provide an outline clinical intervention and training package. In Stage 2, feedback was gathered from local stakeholders and materials refined accordingly. These materials were piloted with local trainers in Stage 3, leading to further refinements including developing additional tools to support delivery in busy primary care settings. Stage 4 comprised further adaptions in response to real-world implementation, a period that coincided with the onset of the COVID-19 pandemic, including translating the intervention and training package for online delivery, and higher priority for depression screening in the clinical pathway. Conclusion Our experience highlights the importance of meaningful engagement with local communities, alongside the need for continuous tailoring and adaptation, and collaborative decision-making.

Impact-Oriented Dialogue for Culturally Safe Adolescent Sexual and Reproductive Health in Bauchi State, Nigeria: Protocol for a Codesigned Pragmatic Cluster Randomized Controlled Trial.

BackgroundAdolescents (10-19 years) are a big segment of the Nigerian population, and they face serious risks to their health and well-being. Maternal mortality is very high in Nigeria, and rates of pregnancy and maternal deaths are high among female adolescents. Rates of HIV infection are rising among adolescents, gender violence and sexual abuse are common, and knowledge about sexual and reproductive health risks is low. Adolescent sexual and reproductive health (ASRH) indicators are worse in the north of the country.ObjectiveIn Bauchi State, northern Nigeria, the project will document the nature and extent of ASRH outcomes and risks, discuss the findings and codesign solutions with local stakeholders, and measure the short-term impact of the discussions and proposed solutions.MethodsThe participatory research project is a sequential mixed-methods codesign of a pragmatic cluster randomized controlled trial. Focus groups of local stakeholders (female and male adolescents, parents, traditional and religious leaders, service providers, and planners) will identify local priority ASRH concerns. The same stakeholder groups will map their knowledge of factors causing these concerns using the fuzzy cognitive mapping (FCM) technique. Findings from the maps and a scoping review will inform the contextualization of survey instruments to collect information about ASRH from female and male adolescents and parents in households and from local service providers. The survey will take place in 60 Bauchi communities. Adolescents will cocreate materials to share the findings from the maps and survey. In 30 communities, randomly allocated, the project will engage adolescents and other stakeholders in households, communities, and services to discuss the evidence and to design and implement culturally acceptable actions to improve ASRH. A follow-up survey in communities with and without the intervention will measure the short-term impact of these discussions and actions. We will also evaluate the intervention process and use narrative techniques to assess its impact qualitatively.ResultsFocus groups to explore ASRH concerns of stakeholders began in October 2021. Baseline data collection in the household survey is expected to take place in mid-2022. The study was approved by the Bauchi State Health Research Ethics Committee, approval number NREC/03/11/19B/2021/03 (March 1, 2021), and by the Faculty of Medicine and Health Sciences Institutional Review Board McGill University (September 13, 2021).ConclusionsEvidence about factors related to ASRH outcomes in Nigeria and implementation and testing of a dialogic intervention to improve these outcomes will fill a gap in the literature. The project will document and test the effectiveness of a participatory approach to ASRH intervention research.Trial RegistrationISRCTN Registry ISRCTN18295275; https://www.isrctn.com/ISRCTN18295275International Registered Report Identifier (IRRID)DERR1-10.2196/36060

Stakeholder engagement in the health policy process in a low income country: a qualitative study of stakeholder perceptions of the challenges to effective inclusion in Malawi

BackgroundInclusive engagement in healthcare policies and decision-making is essential to address the needs of patients and communities, reduce health inequities and increase the accountability of the government. In low income countries such as Malawi, with significant health challenges, stakeholder inclusion is particularly important to improve performance and service delivery. The 2017 National Health Plan II (NHP II) and accompanying Health Sector Strategic Plan II (HSSP II) aimed to improve the functioning of the healthcare system. The Ministry of Health for Malawi intended to involve all key health sector stakeholders in their development. This study explores the extent of stakeholder engagement in the health policy process through local level stakeholders’ perceptions of their involvement in the NHP II and HSSP II.MethodsA qualitative study design was used. Interviews were conducted with 19 representatives of organisations operating at the local level, such as CSOs and local government. Open questions were asked about experiences and perceptions of the development of the NHP II and HSSP II. Inductive content analysis was performed.ResultsStakeholders perceived barriers to inclusive and meaningful engagement in the health policy process. Five categories were identified: tokenistic involvement; stakeholder hierarchy; mutual distrust; preferred stakeholders; no culture of engagement.ConclusionsSerious challenges to the meaningful and equitable engagement of local level stakeholder groups in the health policy process were identified. Issues of trust, accountability and hierarchy in donor-citizen-government relations must be addressed to support stakeholder engagement. Engagement must go beyond tokenism to embed a range of stakeholders in the process with feedback mechanisms to ensure impact from their contributions. Local level stakeholders can be empowered to advocate for and participate in consultation exercises alongside greater top-down efforts to engage stakeholders via diverse and inclusive methods. These issues are not unique to Malawi or to health policy-making.