Stakeholder analysis for a maternal and newborn health project in Eastern Uganda

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Study Justification:
– The study was conducted to assess and map stakeholders’ interests, influence/power, and position in relation to proposed maternal/newborn care interventions in Eastern Uganda.
– The goal was to understand stakeholders’ views on the success and sustainability of the interventions and how the research could influence policy formulation in the country.
Study Highlights:
– Stakeholders at the district and community level were supportive of the proposed interventions but not drivers.
– Mothers, spouses, and transporters at the community level had limited influence due to limited funds.
– National and district stakeholders believed the interventions were costly and could not be affordably scaled up.
– Stakeholders recommended mobilizing and sensitizing communities to contribute financially from the start to enhance sustainability.
– Stakeholders believed the interventions would influence policy by improving the quality of maternal/newborn health services, promoting male involvement, and improving accessibility of services.
Study Recommendations:
– Mobilize and sensitize communities to contribute financially from the start to enhance sustainability beyond the study period.
– Address supply side barriers that influence access to maternal and child healthcare by using locally available human and financial resources.
– Foster mutual trust, continued dialogue, and engagement between researchers, implementers, and policy makers to enable scale up.
Key Role Players:
– Ministry of Health representative
– Member of Parliament
– Development partners
– District health team members
– Community leaders
– Administrators
Cost Items for Planning Recommendations:
– Mobilization and sensitization activities
– Training and capacity building for community health workers
– Communication and awareness campaigns
– Monitoring and evaluation activities
– Infrastructure and equipment for health facilities
– Financial incentives for community health workers
– Research and data collection expenses

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a stakeholder analysis conducted in Uganda in 2011. The analysis involved interviews and focus group discussions with stakeholders at the national, district, and community levels. The findings reveal that stakeholders were generally supportive of the proposed maternal and newborn care interventions, but had concerns about cost and sustainability. The evidence is based on qualitative data collected through appropriate methods. However, the abstract does not provide details on the sample size or selection process for the stakeholders interviewed. To improve the strength of the evidence, future studies could include a larger and more diverse sample of stakeholders, ensuring representation from different sectors and perspectives. Additionally, quantitative data could be collected to complement the qualitative findings and provide a more comprehensive analysis of stakeholder interests and attitudes.

Background: Based on the realization that Uganda is not on track to achieving Millennium Development Goals 4 and 5, Makerere University School of Public Health in collaboration with other partners proposed to conduct two community based maternal/newborn care interventions aimed at increasing access to health facility care through transport vouchers and use of community health workers to promote ideal family care practices. Prior to the implementation, a stakeholder analysis was undertaken to assess and map stakeholders’ interests, influence/power and position in relation to the interventions; their views regarding the success and sustainability; and how this research can influence policy formulation in the country. Methods: A stakeholder analysis was carried out in March 2011 at national level and in four districts of Eastern Uganda where the proposed interventions would be conducted. At the national level, four key informant interviews were conducted with the ministry of health representative, Member of Parliament, and development partners. District health team members were interviewed and also engaged in a workshop; and at community level, twelve focus group discussions were conducted among women, men and motorcycle transporters. Results: This analysis revealed that district and community level stakeholders were high level supporters of the proposed interventions but not drivers. At community level the mothers, their spouses and transporters were of low influence due to the limited funds they possessed. National level and district stakeholders believed that the intervention is costly and cannot be affordably scaled up. They advised the study team to mobilize and sensitize the communities to contribute financially from the start in order to enhance sustainability beyond the study period. Stakeholders believed that the proposed interventions will influence policy through modeling on how to improve the quality of maternal/newborn health services, male involvement, and improved accessibility of services. Conclusion: Most of the stakeholders interviewed were supporters of the proposed maternal and newborn care intervention because of the positive benefits of the intervention. The analysis highlighted stakeholder concerns that will be included in the final project design and that could also be useful in countries of similar setting that are planning to set up programmes geared at increasing access to maternal and new born interventions. Key among these concerns was the need to use both human and financial resources that are locally available in the community, to address supply side barriers that influence access to maternal and child healthcare. Research to policy translation, therefore, will require mutual trust, continued dialogue and engagement of the researchers, implementers and policy makers to enable scale up. © 2013 Namazzi et al; licensee BioMed Central Ltd.

The stakeholder analysis was carried out in March 2011 at the national and district level in Uganda. Local level participants came from four districts of Buyende, Kamuli, Iganga, and Pallisa where the study projects will be conducted. The stakeholder analysis was undertaken through three major phases 1) Identification of stakeholders, 2) Assessing and mapping out their interests and attitudes, power/influence, position in relation to the political resources they possess [22], and 3) Development of an appropriate strategy on how best to interact and engage these stakeholders. This step involved brainstorming amongst the research team members to identify categories of stakeholders, how they may be affected, who were likely to be direct beneficiaries, the potential impact of the project upon stakeholders, and their numbers. A list of categories of stakeholders was then prioritized based on: potential to benefit, weaken or strengthen the intervention; at national, district, and community level (Table 1) within 11 major categories. Stakeholders identified and interviewed for the Uganda project FGDs = Focus group discussion, IDIs = Key informant interviews. Data were collected from the respondents indentified in Table 1. Data collection techniques involved mainly qualitative methods and these included: Focus group discussions with mothers and their spouses, and transporters; Key informant interviews with national level participants, community leaders, district health team members and administrators; and a stakeholders’ workshop with 12 representatives from the district health teams from the districts of Buyende, Kamuli, Iganga, and Pallisa. Data were collected by researchers with experience in qualitative data collection techniques. National and district level interviews were conducted in English while at the community level the interviews and discussions were in Lusoga, the local language. Two Lusoga speakers independently translated interviews into English. All interviews were digitally recorded and transcribed. Key informants were purposively selected and key informant interview guides were used to collect data from 4 national, 8 district and 4 community level representatives as shown in Table 1. Questions and discussions focused on topics such as factors affecting utilization of maternal child health services, strengths and weaknesses of the proposed study, how integration into existing health and community services can be accomplished, challenges, potential solutions, and sustainability strategies. Focus group discussions (FGDs) were conducted to explore opinions, attitudes and perceptions on the feasibility of implementation, and sustainability of a maternal/newborn care research project at the community and household levels [23,24]. Participants included mothers and their spouses (men). Four FGDs of women and four FGDs for men in the intervention areas of Buyende and Pallisa, and the comparison areas of Kibuku and Kamuli were conducted. The discussion with mothers who are the program’s primary beneficiaries focused on barriers to service utilization [25,26], opinions regarding the proposed intervention, how the intervention can successfully be integrated into existing structures, potential implementation challenges and sustainability strategies. Transporters (motorcycle riders) were also interviewed to seek their views, the challenges they face and possible solutions for the use of transport vouchers for maternal and newborn services. Two focus group discussions were held with transporters in the intervention area and two focus group discussions with those in the comparison area. The participants in all the FGDs were purposively selected. The groups were homogenous in composition (mothers aged 18–35 years, men aged 18–35 years, and transporters aged 35 – 50 years). The discussions were guided by an FGD guide and focused on challenges in transporting mothers, information the transporters would like to share, means of communication and possible community contributions for sustaining the scheme. Ethical approval to conduct the study was provided by the Institutional Review Board at the Makerere University School of Public Health and Uganda National Council for Science and Technology (UNCST). Voluntary informed consent was then individually obtained from all the study participants. Assessing and mapping the power/influence of the stakeholders involved identifying who owns what resources (tangible or intangible), who possesses privileges, and who can directly or indirectly take action for or against the project or be able to mobilize for or against it. This assisted in the organization of stakeholders according to their likely influence over decisions to be made, and the likely impact of project decisions upon them. During this phase a stakeholder analysis grid was formulated and the stakeholders were characterized according to the following pre-existing categories as predicted in Figure 1. The categorization was based on the interview findings, the positions they held, and previous roles they played in the pilot studies. Stakeholder analysis grid. Ref: FHS2/Stakeholder Analysis/Hyder et al.[27]. Drivers: A person or group that has high influence and champions the cause Blockers: A person or group that has high levels of power, but opposes the proposal Supporters: Those that support the proposal, but whose influence may be limited (on their own) Bystanders: Those with low influence and support. Abstainers: Those who are neutral to the proposal, but may or may not have influence. The classification of the stakeholders was further categorized as high, moderate or low, considering their varied levels of alignment and influence. A table was used to present the findings since most of the stakeholders were supporters (same category of the grid), secondly this allowed the inclusion of other results and strategies to deal with the stakeholder. Such strategies were classified into: (1). Empowerment: Strategies that would economically empower communities, encourage saving or raise awareness (2). Continuous engagement: Keep the stakeholders updated of the implementation process in order to take action (3). Involve further: Engage in planning or implementation (4). Consult further: Agree on working relations Thematic analysis of interviews and mapping of stakeholders by their level of power, influence, and level of agreement was conducted. The researchers, who are considered internal analysts [21] led this process. Although we used a framework that highlighted the key areas of investigation, we also looked out for new themes emerging outside this framework [28,29]. The themes identified were in line with the key issues that the research sought to address, such as concerns and interests of stakeholders, sustainability challenges and suggestions for promoting sustainability and uptake of the research findings.

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Based on the information provided, here are some potential innovations that could be recommended to improve access to maternal health:

1. Transport vouchers: The use of transport vouchers can help address the barrier of limited funds for transportation to health facilities. By providing vouchers that cover the cost of transportation, pregnant women can have easier access to maternal health services.

2. Community health workers: Engaging community health workers can help promote ideal family care practices and increase awareness about maternal health services. These workers can provide education, support, and referrals to pregnant women and their families, ensuring they receive the necessary care.

3. Mobilization and sensitization of communities: To enhance sustainability beyond the study period, it is important to involve and engage the communities from the start. This can be done through mobilization and sensitization efforts, encouraging community members to contribute financially and actively participate in improving access to maternal health services.

4. Integration into existing health and community services: To ensure the success and sustainability of the interventions, it is crucial to integrate them into existing health and community services. This can help leverage existing resources and infrastructure, making the interventions more effective and accessible.

5. Male involvement: Promoting male involvement in maternal health can have a significant impact on improving access. Engaging men in discussions, decision-making, and support for maternal health services can help break down barriers and increase utilization of services.

These innovations can help address the challenges identified in the stakeholder analysis and improve access to maternal health services in Eastern Uganda.
AI Innovations Description
The stakeholder analysis conducted in Uganda aimed to assess and map stakeholders’ interests, influence/power, and position in relation to maternal and newborn health interventions. The analysis revealed that district and community level stakeholders were high-level supporters of the proposed interventions but not drivers. Mothers, their spouses, and transporters at the community level had low influence due to limited funds. National level and district stakeholders believed that the interventions were costly and could not be affordably scaled up. They advised the study team to mobilize and sensitize communities to contribute financially from the start to enhance sustainability beyond the study period. Stakeholders believed that the proposed interventions would influence policy through modeling on how to improve the quality of maternal and newborn health services, male involvement, and improved accessibility of services. The stakeholder analysis highlighted the need to use both human and financial resources that are locally available in the community to address supply-side barriers that influence access to maternal and child healthcare. The analysis also emphasized the importance of mutual trust, continued dialogue, and engagement of researchers, implementers, and policymakers for successful research to policy translation and scale-up.
AI Innovations Methodology
Based on the information provided, the stakeholder analysis conducted in Eastern Uganda aimed to assess and map stakeholders’ interests, influence/power, and position in relation to two community-based maternal/newborn care interventions. The analysis involved three major phases: identification of stakeholders, assessing and mapping their interests and attitudes, and developing an appropriate strategy to engage these stakeholders.

The methodology used for the stakeholder analysis included qualitative data collection techniques such as key informant interviews, focus group discussions, and a stakeholders’ workshop. Key informants at the national, district, and community levels were interviewed to gather their perspectives on factors affecting utilization of maternal and child health services, strengths and weaknesses of the proposed interventions, integration into existing health and community services, challenges, potential solutions, and sustainability strategies.

Focus group discussions were conducted with mothers, their spouses, and motorcycle transporters to explore opinions, attitudes, and perceptions on the feasibility of implementation and sustainability of the research project. The discussions focused on barriers to service utilization, opinions regarding the proposed interventions, integration into existing structures, implementation challenges, and sustainability strategies.

The power/influence of stakeholders was assessed and mapped by identifying who owns tangible or intangible resources, who possesses privileges, and who can directly or indirectly take action for or against the project. Stakeholders were categorized as drivers, blockers, supporters, bystanders, or abstainers based on their level of influence and support. Strategies to engage stakeholders were developed, including empowerment, continuous engagement, involvement in planning or implementation, and consultation.

The data collected through interviews and discussions were analyzed thematically, and stakeholders were mapped based on their level of power, influence, and agreement. The findings of the stakeholder analysis were used to inform the final project design and to address stakeholder concerns. The analysis also highlighted the need for mutual trust, continued dialogue, and engagement of researchers, implementers, and policymakers to enable scale-up and translation of research into policy.

Overall, the stakeholder analysis provided valuable insights into the interests, attitudes, and positions of stakeholders involved in the maternal and newborn care interventions in Eastern Uganda. The findings can be used to guide the implementation of the interventions and to inform policy formulation in the country.

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