Stakeholder Engagement Approach Research Articles

PROSPECTS OF STAKEHOLDER ENGAGEMENT IN PUBLIC POLICY: A CASE OF INDIA

The shift from government to governance necessitated the role of multiple stakeholders in policy process and called for an approach that could optimally facilitate the process. Resulting adoption of the stakeholder engagement approach in public policy from the domain of corporate governance has come as a mainstay as one of the most sought after diagnostic technique for the achievement of good governance in the realm of public delivery. Although the concept of stakeholder engagement possesses an imported character, it is being widely practiced across all kinds of public and private organizations whereby the various stakeholders enjoy the opportunity to influence decision-making in a desired manner. Public policy process has also acknowledged and made use of this concept as a tool, both formal and informal, for policy development, monitoring and evaluation realizing and admiring the intertwined interests of the two domains, as also the stakeholders getting increasingly involved into the process of public policy thereby enabling better alignment of the public policy with their needs and aspirations than ever before. Public policy and governance are closely interwoven and interdependent for their efficiency and efficacy. It is due to the shift experienced in both these spheres as a clear impact of the global changes of neo-liberalism and globalization that enhanced role has been assigned to informed, aware and proactive stakeholders. Stakeholders hold a substantial position in terms of institutional framework as well as achievement of the established goals. Stakeholder engagement, an effort towards collaborative partnerships and proactive involvement towards the exchange of information, ideas and resources critically important for a contextual policy perspective, therefore, forms an integral part of present times policy process and is a significant determining factor in policy development right from identifying priorities to drafting a blueprint, from formulation to implementation, for decision-making and monitoring at all levels. The present paper attempts to understand the prospects, significance and challenges of stakeholder engagement in public policy sphere of India. It intends to draw inference on the basis of document analysis as regards some of the current Indian government’s development initiatives, like Swachh Bharat Abhiyan, Namami Gange Programme, Smart City Mission and assess the status of stakeholder engagement therein. The prerequisites of stakeholder engagement are many and complex calling for a continuum across the multiple stakeholders associated with a project in varying capacities and differing levels of engagement as per the authority or power they wield to influence decisions. Although the concept of stakeholder engagement is gaining increased acceptance and significance across various domains, there are yet no established normative frameworks and practices of the stakeholder engagement method courtesy the varying social, economic and political conditions across settings. Besides, being a direct human dimension, engagement of stakeholders is difficult to be quantitatively measured. Public policy demands a long-term, persistent and non-manipulative commitment on the part of the policy-makers and stakeholders to optimally reap the benefits of stakeholder engagement. Nonetheless, appropriate and effective stakeholder engagement in itself is not a guarantee to the success of a project or policy.

Perspectives and Experiences with Engaging Youth and Families in Research

Engaging youth with disabilities and families in research is critical in facilitating knowledge utilization to impact processes and outcomes of services and interventions. Organizations such as INVOLVE in the United Kingdom, the Canadian Institutes of Health Research and the Patient-Centered Outcomes Research Institute in the United States advocate for engaging stakeholders in all aspects of the research process. Despite these efforts, there is a need for research to identify best practices and approaches for stakeholder engagement in research as current descriptions around processes are lacking. In this perspective paper, we share our insights and experiences with engaging youth with disabilities and families as members of the research team. We offer considerations and strategies for stakeholder engagement, as well as identify relevant frameworks to facilitate stakeholder engagement in research. We encourage researchers to share and document their experiences with stakeholder engagement in research to provide guidance for others with shared interests. We hope this paper will initiate conversations among researchers about best practices to maximize the full potential of stakeholders’ time and input.

A Novel Stakeholder Engagement Approach for Patient-centered Outcomes Research.

The engagement of patients and other stakeholders is a critical element in the design of patient-centered outcomes research studies. However, methodology for scalable engagement in research management particularly activities such as operationalization of principles and setting of priorities is not well-developed. The objective of this study is to describe a novel approach for scalable stakeholder engagement in research aligned with the Patient-Centered Outcomes Research Institute (PCORI) engagement principles, which was evaluated in a national clinical data research network. Patient, patient advocate, clinician, and researcher stakeholders were recruited from clinical sites, as well as social media sites related to the 3 conditions of focus, heart failure, obesity, and Kawasaki disease. The engagement strategy was designed, implemented, and mapped to the PCORI engagement principles. Evaluation included internal assessment and quantitative measures of online engagement. We operationalized the PCORI principles with 12 stakeholder engagement strategies and convened stakeholder advisory boards and online research prioritization panels to determine research priorities in a rigorous, deliberative process. A total of 46 advisors (20 patients) and 339 panelists (159 patients) actively participated. There were not significant differences between patients and clinicians in level of online engagement. Nonetheless, while patients reported a slightly greater challenge with following online discussion, they overall had a more favorable opinion about use of the online format. An efficient way to engage large numbers of representative stakeholders in research is a necessary first step to assure the public of trustworthy use of data networks for health research. This paper describes a comprehensive approach to engagement in patient-centered outcomes research management that informs ongoing development of rigorous methodologies in this area.

Mitigating Election Violence and Intimidation: A Political Stakeholder Engagement Approach

Political parties and candidates are key stakeholders in the election process. They compete for public office using campaigns through party-based platforms to convince electorates for their votes. Thus, parties and candidates could potentially be destructive in the election process. Drawing on the stakeholder theory and stakeholder engagement literature, this paper develops a political stakeholder engagement framework to create, communicate, deliver and exchange sustainable political strategies to political stakeholders to mitigate election violence and intimidation. The paper outlines a definition, the process of political stakeholder engagement and the application of the developed framework to the fiercely contested US 2016 presidential election. The analysis and lessons from the US case suggests the importance of the political stakeholder engagement process as an integral part of sustainable election governance.

A Latino Patient-Centered, Evidence-Based Approach to Diabetes Prevention.

Cultural tailoring of evidence-based diabetes prevention program (DPP) interventions is needed to effectively address obesity and its related chronic diseases among Latinos in primary care. This article describes the patient-centered process used to adapt the DPP and reports cultural adaptations. We used a 2-stage formative research process to culturally adapt an evidence-based DPP intervention in the context of primary care. The first stage involved 5 focus groups of Latino patients and interviews with 5 stakeholders (3 with primary care physicians and 2 with medical directors) to inform a first round of adaptations. The second stage included pretesting the stage I-adapted intervention with a Latino patient advisory board to complete a second round of adaptations. Key stakeholders involved in this 2-stage adaptation process included 34 Latino patients who participated in 5 focus groups and 5 physicians and medical directors who participated in key informant interviews during stage I and 11 patients who attended the 16 advisory board meetings and their family members who attended 1 of the meetings during stage II. Using this patient-centered stakeholder-engaged approach, we found the original intervention was largely congruent with the cultural values of the study population. To further strengthen the cultural relevance of the intervention, salient cultural values emphasized by patients and stakeholders underscored the importance of family and community support for behavior change. Accordingly, key adaptations were made to (1) invite family members to the orientation session and at 2 other key timepoints to facilitate family support, (2) provide participants support from the coach and each other via smartphone applications, and (3) provide healthy, easy, low-cost culturally appropriate meals at each group session. The 2-stage approach actively engaging patients, family members, providers, and health care system leaders reinforced the cultural congruence of the existing intervention while further strengthening it with adaptations promoting Latino family and community support.

Developing an Integrative Treatment Program for Cancer-Related Fatigue Using Stakeholder Engagement - A Qualitative Study.

Background: Although cancer-related fatigue (CRF) has gained increased attention in the past decade, it remains difficult to treat. An integrative approach combining conventional and complementary medicine interventions seems highly promising. Treatment programs are more likely to be effective if the needs and interests of the people involved are well represented. This can be achieved through stakeholder engagement. Objectives: The aim of the study was to develop an integrative CRF treatment program using stakeholder engagement and to compare it to an expert version. Method: In a qualitative study, a total of 22 stakeholders (4 oncologists, 1 radiation-oncologist, 1 psycho-oncologist, 5 nurses/nurse experts, 9 patients, 1 patient family member, 1 representative of a local Swiss Cancer League) were interviewed either face-to-face or in a focus group setting. For data analysis, qualitative content analysis was used. Results: With stakeholder engagement, the integrative CRF treatment program was adapted to usual care using a prioritizing approach and allowing more patient choice. Unlike the expert version, in which all intervention options were on the same level, the stakeholder engagement process resulted in a program with 3 different levels. The first level includes mandatory nonpharmacological interventions, the second includes nonpharmacological choice-based interventions, and the third includes pharmacological interventions for severe CRF. The resulting stakeholder based integrative CRF treatment program was implemented as clinical practice guideline at our clinic (Institute for Complementary and Integrative Medicine, University Hospital Zurich). Conclusion: Through the stakeholder engagement approach, we integrated the needs and preferences of people who are directly affected by CRF. This resulted in an integrative CRF treatment program with graded recommendations for interventions and therefore potentially greater sustainability in a usual care setting.

Integrated Knowledge Transfer and Exchange: An Organizational Approach for Stakeholder Engagement and Communications

Knowledge transfer and exchange (KTE) is a process of making relevant research information available and accessible for use in practice or policy. Integrated KTE, where knowledge users are engaged in the research process, is considered to better facilitate uptake and use. The objective of this paper is to describe a fully integrated KTE approach developed over the past 20 years. Key concepts related to knowledge user engagement as well as the integration of communications within KTE are described. The organizational KTE approach is flexible and can be adapted to a variety of research areas.

A five-step approach for stakeholder engagement in prioritisation and planning of environmental evidence syntheses

Systematic reviews and systematic maps, regarded as a gold standard for syntheses of documented research evidence, are increasingly used to inform decisions in environmental management. To increase their relevance and uptake, systematic reviews and maps can be planned with the help and engagement of stakeholders, i.e. organisations and individuals involved in and affected by environmental policy-making and practice. We report on the emprically tested five-step approach that the Mistra Council for Evidence-based Environmental Management (EviEM) is using to engage stakeholders and incorporate their views and opinions in the prioritisation and planning of reviews, including (1) stakeholder identification; (2) identification of policy- and practice-relevant topics; (3) framing and prioritisation of review questions; (4) establishment of the specific scope of a review; and (5) a public review of a draft review protocol. We provide examples from EviEM’s reviews and describe various challenges and valuable lessons learnt from the engagement process, hoping that this will be useful reading not only for reviewers, but also for stakeholders who plan to participate in the engagement process.

Expert Consensus to Examine the Cross-Cultural Utility of Substance Use and Mental Health Assessment Instruments for Use with Indigenous Clients

Evaluation of minority-culture specific treatment centres for substance use and mental health is challenging. The challenge is compounded by a paucity of validated instruments for assessing substance use and mental ill health. In the field of Australian Indigenous alcohol and other drug service provision there are few guidelines to determine which instruments should be targets for validation for use with Indigenous clients. As such, reliable, validated, evaluable data on the client population is limited, posing multifaceted concerns for clinicians and service providers as well as evaluators. The aim of this study was to pilot the use of a participatory expert consensus approach to evaluate, rate and select suitable majority-culture substance use and mental health assessment instruments for use with their clients. Eight practitioners of an Indigenous-specific substance misuse residential treatment centre participated. The findings reinforce the value of consensus approaches for stakeholder engagement and to provide a sense of ownership of the results. In this setting, consensus on the implementation of an agreed set of Indigenous-specific and non-Indigenous specific instruments improved the ownership of the instruments by clinicians allowing for the use of valid and/or reliable instruments that also had good face validity. This makes it more probable that reliable client wellbeing data will be collected. This is crucial to program evaluation at a later point in time. This study was a novel approach to generating evidence to inform practice in the absence of normative practice guidelines.

Advanced Trajectory Modeling: Stakeholder Needs and Expectations

Advanced air traffic control techniques require accurate predictions of aircraft trajectories. Such predictions rely on complex aircraft parameters which typically are unknown and must be estimated. These estimates can be improved with aircraft-to-ground data exchange methods. The Advanced Trajectory Modeling project is exploring such methods, and how they can improve the aircraft data available to the air traffic control trajectory models used by controller and traffic management decision support tools. The project has identified aircraft data, including current state and intent, which could be downlinked to ground automation systems. The project is exploring emerging technologies onboard the aircraft—such as Internet Protocol Data Link, Aircraft Interface Devices, and Electronic Flight Bags—that could be used to extract and downlink these data to ground automation systems. The project is evaluating advanced trajectory models to enable future synchronization of various ground automation trajectory models with aircraft-generated models to support Trajectory Based Operations, an effort that affects a wide range of stakeholders. Here we use a two-phase stakeholder engagement approach to insure the feasibility of the proposed concept.

Use of stakeholder engagement to support policy transfer: A case of contaminated land management in Nigeria

Transfer of environmental policy from one country to another without consideration for the contextual differences (e.g. socio-cultural, economic) between the countries can be a barrier that prevents adoption, or limits the implementation and effectiveness of that policy. In this study, we investigate the socio-cultural preferences of stakeholders in the Niger Delta to understand how different stakeholder groups value socio-cultural differences. We used a modified, mixed-methods stakeholder engagement approach to capture this information, combining stakeholder workshops and interviews. Community groups, regulators, experts in contaminated land management, and oil exploration operators participated in this study, and our results revealed a general consensus concerning the ranked priority of issues. Top issues included water quality, soil quality for agriculture, food production, and human health and wellbeing. Despite this consensus, differences in how stakeholder groups arrived at their rankings might pose a challenge for policy makers. Other potential barriers to effective policy transfer identified in this study include political and cultural differences, regulatory structure, and corruption. In sum, this study provides insights about the socio-cultural preferences of stakeholders from the Niger Delta; information that could be used by policy makers to contextualise contaminated land management policy transfer.

Socio-Technical Drivers for Community Renewable Energy Systems – Analysis of Case Studies from India

Renewable energy sector of India has the potential to be a credible alternative for households and communities. The sector accounts for approximately 13 per cent of the national energy capacity, including technologies such as solar grid/ off – grid generation, wind power, small hydro power, biomass/ biogas, and waste to energy. Statistics related to implementation illustrate the scope of tapping the renewable energy sector comprehensively, esp. for decentralized, household and community level applications. This paper analyses on – ground case studies and projects from various renewable energy categories, specifically the socio – technical and community aspects that play a significant role in successful Renewable Energy Technologies (henceforth RET) implementation. The distilled positive and negative drivers include technical, economic considerations, policy and regulatory, environmental aspects, market/ business models, and social/ community linked aspects. Case studies describe the need for a system based and stakeholder engagement approach where all possible stakeholders and their issues are envisaged and taken into account. Use of an evaluating framework is suggested to ensure successful community models of RETs and mass adoption of renewable technologies.

Three approaches to glucose monitoring in non-insulin treated diabetes: a pragmatic randomized clinical trial protocol

BackgroundFor the nearly 75% of patients living with type 2 diabetes (T2DM) that do not use insulin, decisions regarding self-monitoring of blood glucose (SMBG) can be especially problematic. While in theory SMBG holds great promise for sparking favorable behavior change, it is a resource intensive activity without firmly established patient benefits. This study describes our study protocol to assess the impact of three different SMBG testing approaches on patient-centered outcomes in patients with non-insulin treated T2DM within a community-based, clinic setting.Methods/DesignUsing stakeholder engagement approach, we developed and implemented a pragmatic trial of patient with non-insulin treated T2DM patients from five primary care practices randomized to one of three SMBG regimens: 1) no testing; 2) once daily testing with standard feedback consisting of glucose values being immediately reported to the patient through the glucose meter; and 3) once daily testing with enhanced patient feedback consisting of glucose values being immediately reported to the patient PLUS automated, tailored feedback messaging delivered to the patient through the glucose meter following each testing. Main outcomes assessed at 52 weeks include quality of life and glycemic control.DiscussionThis pragmatic trial seeks to better understand the value of SMBG in non-insulin treated patients with T2DM. This paper outlines the protocol used to implement this study in fifteen community-based primary care practices and highlights the impact of stakeholder involvement from the earliest stages of project conception and implementation. Plans for stakeholder involvement for result dissemination are also discussed.Trial registrationClinicalTrials.gov NCT02033499, January 9, 2014.

Methods guiding stakeholder engagement in planning a pragmatic study on changing stroke systems of care.

The Comprehensive Post-Acute Stroke Services (COMPASS) Study is one of the first large pragmatic randomized-controlled clinical trials using comparative effectiveness research methods, funded by the Patient-Centered Outcomes Research Institute. In the COMPASS Study, we compare the effectiveness of a patient-centered, transitional care intervention versus usual care for stroke patients discharged home from acute care. Outcomes include stroke patient post-discharge functional status and caregiver strain 90 days after discharge, and hospital readmissions. A central tenet of Patient-Centered Outcomes Research Institute-funded research is stakeholder engagement throughout the research process. However, evidence on how to successfully implement a pragmatic trial that changes systems of care in combination with robust stakeholder engagement is limited. This combination is not without challenges. We present our approach for broad-based stakeholder engagement in the context of a pragmatic trial with the participation of patients, caregivers, community stakeholders, including the North Carolina Stroke Care Collaborative hospital network, and policy makers. To maximize stakeholder engagement throughout the COMPASS Study, we employed a conceptual model with the following components: (1) Patient and Other Stakeholder Identification and Selection; (2) Patient and Other Stakeholder Involvement Across the Spectrum of Research Activities; (3) Dedicated Resources for Patient and Other Stakeholder Involvement; (4) Support for Patient and Other Stakeholder Engagement Through Organizational Processes; (5) Communication with Patients and Other Stakeholders; (6) Transparent Involvement Processes; (7) Tracking of Engagement; and (8) Evaluation of Engagement. In this paper, we describe how each component of the model is being implemented and how this approach addresses existing gaps in the literature on strategies for engaging stakeholders in meaningful and useful ways when conducting pragmatic trials.

The Austrian Way: Sozialpartnerschaft as Means to Curb the Falling Rate of Profit

Economic crises are inherent in all market systems. The leap from long boom to long downturn is attributed to the lack of advanced capitalist economies to achieve and sustain high profit rates. Economic historians vividly outline overaccumulation and overheating leading to a squeeze of profits as underlying to great booms, recessions and depressions by the historical examples of Italy, France, Germany and Japan. Overaccumulation is based on the capital account being run down due to a demand for labor, which leads to rising wages and capital flight and ultimately to unprofitable economies. Tightening labor markets during long boom phases lead eventually to class conflict, which is the starting point of the profit squeeze and eventually busts and recessions and depressions. Overheating occurs in the wake of strike waves and subsequent wage explosions, such as in Europe between 1968 and 1970 in France, Germany, Netherlands, Italy and the United Kingdom, when workers backed their claims with strike action. Capitalists were forced to concede wage rises, which eventually lowered their rate of profit. Strikes stem out of frustration over moderation of growth of real wages, reduction in labor's share and increase in the share of profits, erosion of differentials, and increased work load. Manifold conventional monetary, fiscal and social intervention strategies as counter-cyclical means to avert booms and busts are described in international examples of the past. This paper aims at adding to the existing literature the case of describing the Austrian Sozialpartnerschaft. This stakeholder engagement means practiced in Austria is shown to avert social imbalances leading to economically inefficient worker uprising, protests and strikes. Since the post-World War II era, the Austrian Wirtschaftswunder (economic miracle) is attributed to the Sozialpartnerschaft breeding economic growth alongside social stability in Austria. The relative low economic fluctuations of the Austrian economy are grounded in the model of Sozialpartnerschaft to solve class struggles and worker rights movements elegantly through self-determination, participation and compromise. The unique Austrian model of the voluntary Sozialpartnerschaft is captured to implicitly curb the falling rate of profit phenomenon. In the Sozialpartnerschaft model, the citizenry, that undermines the profit rate in many other countries, gains access to board meetings to discuss national claims. Rather than partially illegal and counterproductive, risky strike movements, the Sozialpartnerschaft forms an institutionalized relationship between the government, political parties and certain interest groups in the field of labor, social, and economic policy. While it is widely recognized as a key element in Austrian politics since the end of World War II, social partnership is neither anchored in the Austrian constitution nor laid down in any specific legal act. The insights gained from the Austrian way to structure economic growth are discussed alongside granting an international and future perspective of Sozialpartnerschaft as means to avert negative consequences in the wake of economic fluctuations. While the influence of the Sozialpartnerschaft may be decreasing in the eye of the European Union integration and in times of globalization, other countries with fairly less developed stakeholder engagement approaches may learn from the positive example of the Austrian way to gracefully social partner in reaching common economic, industrial and societal endeavors together.

An approach for effective stakeholder engagement as an essential component of the ecosystem approach

An approach for effective stakeholder engagement as an essential component of the ecosystem approach

Using a stakeholder-engaged approach to develop and validate electronic clinical quality measures.

To describe the stakeholder-engaged processes used to develop, specify, and validate 2 oral health care electronic clinical quality measures. A broad range of stakeholders were engaged from conception through testing to develop measures and test feasibility, reliability, and validity following National Quality Forum guidance. We assessed data element feasibility through semistructured interviews with key stakeholders using a National Quality Forum-recommended scorecard. We created test datasets of synthetic patients to test measure implementation feasibility and reliability within and across electronic health record (EHR) systems. We validated implementation with automated reporting of EHR clinical data against manual record reviews, using the kappa statistic. A stakeholder workgroup was formed and guided all development and testing processes. All critical data elements passed feasibility testing. Four test datasets, representing 577 synthetic patients, were developed and implemented within EHR vendors' software, demonstrating measure implementation feasibility. Measure reliability and validity were established through implementation at clinical practice sites, with kappa statistic values in the "almost perfect" agreement range of 0.80-0.99 for all but 1 measure component, which demonstrated "substantial" agreement. The 2 validated measures were published in the United States Health Information Knowledgebase. The stakeholder-engaged processes used in this study facilitated a successful measure development and testing cycle. Engaging stakeholders early and throughout development and testing promotes early identification of and attention to potential threats to feasibility, reliability, and validity, thereby averting significant resource investments that are unlikely to be fruitful.

Ideal and reality of multi-stakeholder collaboration on sustainability problems: a case study on a large-scale industrial contamination in Phoenix, Arizona

Multi-stakeholder collaboration among industry, government, the public, and researchers is widely acknowledged as a critical success factor for resolving sustainability problems. Proponents argue that pooling capacities and resources is necessary to cope with such wicked problems. Despite good intentions and attempts to follow best practices, the reality of multi-stakeholder collaboration is often flawed. We demonstrate this mismatch between the ideal and reality with a case study of a multi-stakeholder collaboration centered on a large urban area affected by industrial contamination (superfund site) in Phoenix, Arizona. The study indicates deficits in the collaborative process due to the lack of trust, power asymmetry, and other factors. Efforts have recently been undertaken to enhance the multi-stakeholder collaboration through novel engagement approaches. The study uses insights from stakeholder engagement approaches to demonstrate how the quality of multi-stakeholder collaboration on sustainability problems could be appraised and how common obstacles to such collaboration could be overcome, while reflecting on the role of transdisciplinary research in this process.

Managing stakeholders’ influence on embracing business code of conduct and ethics in a local pharmaceutical company

Purpose This paper aims to avail a soft approach to embracing the process of creating a business code of conduct and ethics and make it work for a pharmaceutical company [player] which wants to remain relevant before stakeholders and society, amidst escalating inducements to go against the acceptable pharmaceutical behaviour. Design/methodology/approach Data collection was guided by qualitative methodologies. A four stepwise process was followed: data collection at the case company – Kampala Pharmaceutical Industries (KPI), Uganda; validation of data collected at KPI; data collection from external stakeholders of KPI; and re-validation of KPI data based on data collected from external stakeholders. In all this, combination of semi-structured and informal interviews with CEOs, senior staff managers, non-participant observation of ethical related activities plus organizing a stakeholder engagement workshop on business code of conduct and ethics was achieved. This workshop helped document what ought to be an ideal design process to secure stakeholder buy-in of the code of business ethics. A local pharmaceutical company in Uganda, KPI was used, which, for continuous five years since its adoption of the business code of conduct and ethics, registered commercial viability without any record of unethical practices. Triangulation was used to ensure credibility and validity of the results. For data analysis, a three-stepwise process was followed, which helped develop a framework within which the collected data revealed themes which were later analyzed. For generalization of the findings, the “adaptive theory approach” was used. Findings When poorly introduced in an organization, the business code of conduct and ethics can work against the company simply because it will be received with “intentional rebellion” from stakeholders, notably staff. However, when a soft stakeholder engagement and consultative approach is used and followed during the business code of ethics and conduct’s design process, multiple stakeholders feel proud and are much willing to live by the promise spelt out in it. Cited notable benefits of living by the code include reputational enhancement, strategic competitiveness and increased possibilities of wining cross-border cooperation among like-minded pharmaceutical players. In the efforts to reap from the code of ethics, communication was observed as an indispensable activity. Refresher trainings to remind the stakeholders about the promises in the code are also needed as time passes by, otherwise they forget. Needless to say, rewarding those who live an exemplary life in embracing and living by the code was cited as key in sustaining the ethical agenda. Lastly, managing multiple stakeholders influences is a curvilinear fashion and involves back and forth consultations. Practical implications The lessons learnt from KPI can be borrowed and used by both global pharmaceutical players and national/local players, especially those that face challenges living by the promise of their existing codes or those without business code of conduct and ethics. That is, both players can use the suggested process to help participants in their medicine supply chain to come up with working business codes of conduct, as well as guide the stakeholder consultative process which results in stakeholder buy-in. Originality/value For many years, issues surrounding bioethics have dominated priorities of World Health Organization (WHO), UNESCO and many international and national development allies. However, there is an escalating violation of medical codes of conduct and ethics. Hence, this publication is a step toward the implementation of the principles and objectives of the UNESCO Universal Declaration on Bioethics and Human Rights which is currently challenged with a difficult question posed by life sciences – How far can we go given the dented medical relationship between ethics, medical science and freedom?

Conducting a Systematic Literature Review on Water-related Attitudes, Behaviors, and Stakeholder Engagement Approaches in Florid: Strategies and Tools

Conducting a Systematic Literature Review on Water-related Attitudes, Behaviors, and Stakeholder Engagement Approaches in Florid: Strategies and Tools