As part of an ongoing effort to create agreed-upon principles for stakeholder engagement in the priority-setting process for implementation science and research, a tool which would ensure all stakeholders had a voice in agenda setting, the 11th East, Central and Southern African Health Community’s (ECSA-HC) Best Practices Forum (BPF) and Directors Joint Consultative Committee (DJCC) featured the rollout of a survey to assess the need and utility of such principles. With broad representation from government, non-government organizations, and multilateral organizations, the participating global health leaders from 18 Sub-Saharan African Countries and India presented a unique opportunity to survey opinions and experiences with multi-stakeholder research collaborations. Findings from the survey will inform the developing Principles moving forward.

 

Background on the Emerging Need for Principles of Stakeholder Engagement in Global Health Implementation Science

The need for principles for stakeholder engagement stood out during the process of establishing the Implementation Science Collaborative (ISC) which is set to launch in Fall 2018. The ISC will seed-fund implementation science partnerships in low and middle-income countries as the means of responding to, and successfully overcoming, the challenges with achieving the use of evidence in the design and improvement of public health policies and programs in real time. During the conceptualization of the ISC, broad consultations engaging a wide range of stakeholders were held. Through this process, LMIC leaders identified meaningful stakeholder engagement in the agenda-setting process as an overarching problem due to the asymmetric power funders and researchers tend to hold. That power often gives funders disproportionate influence in setting research and implementation science priorities compared with local policy makers, implementers, advocates, and other stakeholders.

 

Panelists from the in-depth discussion hosted by Georgetown University’s O’Neill Institute

 

Stakeholders proposed the need for the creation of principles that all members of the ISC would agree to as a means of overcoming this inherent problem. A discussion among global health leaders organized at the Center for Global Development in March 2018 affirmed the need for such principles to ensure inclusivity in priority setting processes within and beyond the ISC. A follow-on June 2018 in-depth discussion hosted by Georgetown University’s O’Neill Institute explored how such principles could assist global health stakeholders in managing power relationships that undermine partnered collaboration, specifically noting the role that funders play in driving priorities.

 

Findings from the Survey of Stakeholders Opinions and Experiences at the ECSA-HC BPF and DJCC

The survey of ECSA-HC BPF and DJCC participants represented an important step in the ISC consultative process. The survey instrument—comprised of 23 questions on opinions and experiences with multi-stakeholder research collaborations in global health as well as the process of setting and advancing implementation science and research priorities—was completed by 41 of 86 conference participants (48% response rate). Overall, findings documented among respondents the perceived need for and importance of principles for stakeholder engagement. Findings point to near-unanimous consensus on the need to involve the following stakeholders in determining research priorities and questions: national policy makers, program implementers, academic researchers, advocacy groups/community-based organizations, donors and beneficiaries. They also highlight the perception among LMIC stakeholders that a) they do not have an equal voice in determining the focus of research and b) those who will use research findings often are not engaged until the end of research-to-use process.

 

Moving forward with the development of Principles

The involvement of stakeholders at ECSA-HC’s BPF and DJCC represents an important part in the process to develop the Principles framework that will be used to provide guidance and a roadmap for the more efficient management of asymmetric power relationships, which can potentially undermine collaboration.  The guiding framework will be developed in conjunction with other frameworks that promote fairness and equity in global health and development more broadly, such as the GIPA Principles, Research Fairness Initiative, as well as the SDGs and other development frameworks. The eventual uptake of these principles by the full range of stakeholders that partner around implementation science and research in global health will ultimately strengthen such collaborative efforts globally.