Stakeholders Analysis Guidelines

Section 2
Stakeholder Analysis
Guidelines
Kammi Schmeer
Section 2
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Tabl e o f Co nte nts
I n tr odu ct ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 1
Step 1: Pl a n n in g th e Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 3
Step 2: Selectin g a n d Defin in g a Policy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 5
Step 3: I den t ifyin g Key Sta keh older s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 6
Step 4: Ada ptin g th e Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 8
Step 5: Col lecti n g a n d Recor din g th e I n for m a tion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 13
Step 6: Fill in g i n th e St a keh older Ta ble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 15
Step 7: An a lyzin g th e Sta keh ol der Ta ble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 19
Step 8: Usin g th e I n for m a t ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 23
Bibli ogr a ph y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 33
An n ex 2- A: Sa m ple Gen er a l Li st of St a keh older s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 34
An n ex 2- B: Defin ition s of Sta keh older Ch a r a cter istics a n d
I n str u ct ion s for Fil lin g in Sta keh older Ta ble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 35
An n ex 2- C: Sa m ple Sta keh ol der Ta ble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 38
An n ex 2- D: Sa m ple St a keh older I n ter view Qu est ion n a ir e . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 40
An n ex 2- E: Sa m ple I n for m a tion Tr a n sfer Refer en ce Ch a r t . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 43
Li s t o f Bo xe s , Fi gure s , and Tabl e s
Box 2.1. Sa m ple polici es . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 5
Box 2.2. Sa m ple h ea l th refor m pol icy defin ition s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 5
Box 2.3. Poten tia l sta keh older gr ou ps for a
n a tion a l- level h ea lth r efor m policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 6
Box 2.4. Possible secon da r y i n for m a t ion sou r ces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 13
Box 2.5. Sa m ple con clu sion s on t h e decon cen tr a ti on of th e MOH . . . . . . . . . . . . . . . . . 2- 29
Box 2.6. Sa m ple gen er a l str a tegies for in cr ea sin g
su pport for decon cen tr a tion of th e MOH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 30
Figu r e 2.1. Th e Policy Pr ocess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 2
Figu r e 2.2. Spectr u m of Sta keh ol der Positi on s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 16
Figu r e 2.3. Use All Tools i n Fil lin g in th e An a lysis Ta ble
( See An n exes for fu ll ver sion s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 18
Figu r e 2.4. Sa m ple of How to Use Power Poin t to Pr esen t
Power / Lea der sh ip An a lysis Resu lts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 24
Figu r e 2.5. Sa m ple Positi on Ma p . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 25
Figu r e 2.6. Power Poi n t Pr esen t a t ion of Kn owledge Da t a . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 27
Figu r e 2.7. Power Poi n t Pr esen t a t ion of Key All ia n ces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 28
Figu r e 2.8. Sa m ple Pr esen ta tion of St r a tegies in Power Poin t . . . . . . . . . . . . . . . . . . . . . . . . 2- 30
Figu r e 2.9. Ma tr ix for I den tifyin g St a keh older s to
Be Ta r geted by Str a tegi es . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 32
Ta ble 2.1. Sta keh older Ch a r a ct er istics a n d Ta ble Tit les
( fu ll t a bl e in An n ex 2- C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 9
Ta ble 2.2. Referen ce Ch a rt ( qu estion n u m ber s
th a t per ta in to ea ch colu m n on t h e st a keh older t a ble) 2- 12
Ta ble 2.3. Colu m n E of Sta keh older Ta bl e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 15
Ta ble 2.4. Colu m n s H a n d I of Sta keh older Ta bl e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 17
Ta ble 2.5. Exa m ple Resu lts of Power / Lea der sh ip An a lysis . . . . . . . . . . . . . . . . . . . . . . . . . 2- 20
Stake ho l de r Anal ys i s at a
Gl ance
What Is Stake ho l de r Anal ys i s ?
Sta keh older a n a lysis is a pr ocess of system a tica l ly ga th er in g a n d a n a lyzin g qu a li ta tive in for -
m a t ion t o determ in e wh ose in ter ests sh ou ld be ta ken in to a ccou n t wh en developin g a n d/ or
im plem en ti n g a pol icy or pr ogr a m .
Who Is a Stake ho l de r?
Sta keh older s in a pr ocess a r e a ctors ( per son s or or ga n iza t ion s) with a vest ed in ter est in th e pol-
icy bein g pr om oted. Th ese sta keh older s, or i n ter ested pa r ties, ca n u su a l ly be gr ou ped in to th e
followin g ca tegor ies: in ter n a t ion a l/ don or s, n a tion a l pol itica l ( legisla tor s, gover n ors) , pu bl ic
( m in istr y of h ea lth [ MOH] , socia l secu r ity a gen cy, m in i st ry of fin a n ce) , la bor ( u n i on s, m edica l
a ssoci a t ion s) , com m er cia l/ pr iva te for-pr ofit, n on pr ofit ( n on gover n m en ta l or ga n iza ti on s
[ NGOs] , fou n da t ion s) , civil society, a n d u ser s/ con su m er s.
Whi ch Stake ho l de r Characte ri s ti cs Are Anal yz e d?
Th e a n a lysis in clu des su ch sta keh older ch a ra cteristics a s kn owledge of th e policy, in terests rela ted
to th e policy, position for or a ga in st th e policy, poten tia l a llia n ces with oth er sta keh olders, a n d
a bility to a ffect th e policy process ( th rou gh power a n d/ or lea dersh ip) .
Why Is thi s Anal ys i s Us e ful ?
Policym a kers a n d m a n a ger s ca n u se a sta keh older a n a lysis to iden t ity th e key a ctor s a n d to
a ssess th eir kn owledge, i n terest s, positi on s, a llia n ces, a n d im por ta n ce rela ted to th e poli cy. Th is
a llows policym a kers a n d m a n a ger s to in tera ct m or e effectively wi th key sta keh older s a n d to
in crea se su ppor t for a given poli cy or progr a m . Wh en th i s a n a lysis is con du cted before a policy
or pr ogr a m is im plem en ted, pol icym a ker s a n d m a n a ger s ca n detect a n d a ct to preven t poten t ia l
m i su n der sta n din gs a bou t a n d/ or opposition to th e policy or pr ogra m . Wh en a sta keh older
a n a lysis a n d oth er key tools a r e u sed to gu i de th e i m plem en ta tion , th e policy or pr ogra m i s
m or e likel y to su cceed.
What Are the Ste ps i n Stake ho l de r Anal ys i s ?
Th er e a r e eigh t m a jor steps i n t h e pr ocess:
1. Pla n n in g th e pr ocess
2. Selectin g a n d defin i n g a pol icy
3. I den ti fyin g key sta keh older s
4. Ada pt in g t h e tools
5. Collectin g a n d recor din g t h e in for m a tion
6. Fillin g in th e sta keh older t a ble
7. An a lyzin g th e sta keh older ta ble
8. Usin g t h e in for m a tion
What Can Be Achi e ve d wi th Stake ho l de r Anal ys i s ?
Sta keh older a n a lysis yields u sefu l a n d a ccu r a te in form a tion a bou t t h ose per son s a n d or ga n iza -
tion s th a t h a ve a n in t er est in h ea lth r efor m . Th is in for m a tion ca n be u sed to pr ovi de in pu t for
oth er a n a lyses; to devel op a ction pla n s to in cr ea se su ppor t for a r efor m policy; a n d t o gu ide a
pa rt icipa tor y, con sen su s- bu ildin g pr ocess.
To in cr ea se su pport or bu i ld con sen su s for r efor m , policym a kers a n d m a n a ger s m u st ta ke
a ddi tion a l steps foll owi n g t h e st a keh older a n a lysis. I n t h e n ext ph a ses of th e policy pr ocess
con sti tu en cy- bu i ldin g, r esou r ce m obil iza tion , a n d im plem en ta tion policym a kers a n d m a n -
a ger s sh ou ld u se th e in form a tion gen er a ted by th e sta keh older a n a lysis to develop a n d im ple-
m en t str a t egic com m u n ica ti on , a dvoca cy, a n d n egoti a t ion pl a n s. Th e oth er secti on s of th is
toolkit ca n be u sed to gu ide th e developm en t a n d im plem en ta tion of su ch pla n s ( see, for exa m -
ple, Sect ion 3: Advoca cy Gu idelin es, a n d Section 4: Con fl ict Negotia tion Gu i delin es) .
Section 2
Stake ho l de r Anal ys i s
Gui de l i ne s
Intro ducti o n
I n developin g th is docu m en t, Pa r tn ersh ips for Hea l th Refor m ( PHR) a ddr esses on e a spect of
m a n a gi n g t h e poli ticsof th e r efor m pr ocess: th e n eed for in for m a tion on key pla yer s wh o
h a ve a n in vestm en t in pr oposed reform s. Th is is pa r ticu la r ly im por ta n t a t th e policy for m u la -
tion a n d l egitim a tion ph a se of th e poli cy process ( see Figu r e 2.1) . Poli cym a ker s a n d m a n a ger s
ca n u se sta keh ol der a n a l ysis to iden tify th ese key pla yer s or sta keh older s,pr edict wh eth er th ey
m i gh t su ppor t or block t h e im pl em en ta t ion of h ea l th refor m s, a n d develop st ra tegies t o pr o-
m ot e su ppor tive a ct ion s a n d decr ea se opposin g a cti on s b efor e a tt em pt in g t o im plem en t m a jor
r efor m a t t h e n a tion a l , r egi on a l, loca l, or fa ci lity level.
Th e pu rpose of th is docu m en t i s to h elp pol icym a ker s, m a n a ger s, a n d t h eir workin g gr ou ps
follow a n objectivea n d system a ti c pr ocess for col lect in g a n d a n a lyzi n g da ta a bou t key h ea l th
r efor m sta keh older s. I t sh ou ld be n oted, h owever, th a t even t h e a ppli ca tion of t h e system a tic
m eth odology in cor por a ted i n to t h ese gu idel in es ca n n ot pr even t th e in form a tion fr om bein g
som ewh a t su bjective sin ce sta keh older a n a lysis is ba sed on wh a t st a keh older s com m u n ica te to
a n a lysts. Th ese gu ideli n es, h owever, do i n clu de su ggest ion s for ch eckin g th e con sisten cy of
a n swer s a n d oth er m ech a n ism s t o en su r e th a t t h e in for m a tion is obta in ed a n d a n a lyzed a s
objecti vely a s possible.
Th is docu m en t wa s devel oped u si n g a th or ou gh r evi ew of th e l iter a tu r e on sta keh older a n a l-
ysis, pol itica l m a ppin g, a n d policy pr ocess, a s well a s PHR fiel d exper ien ce in con du ctin g sta ke-
h older a n a lyses. ( Hea l th reform st a keh older a n a lyses were con du cted with PHR su ppor t in
Ecu a dor a n d I n di a .) Th e r esu lt in g docu m en t, t h er efor e, in clu des in st ru ction s a n d tool s t h a t a r e
su pport ed by both a ca dem i c t h eor y a n d r ea l- wor ld a pplica t ion .
Th ese gu idel in es in cor por a te a m eth odology t h a t yields u sefu l a n d a ccu r a te in for m a ti on on
h ea l th r efor m st a keh older s ( a n d ca n be followed even wh en con du ctin g a sta keh older a n a lysis
with lim it ed ti m e or resou rces) . Th e in for m a tion r esu lt in g fr om th e a n a lysis ca n be u sed for t h e
followin g:
Pr ovide in pu t for oth er a n a lyses ( i.e., str a tegic pla n n in g, in sti tu ti on a l a ssessm en t, br oa der
politica l a n a lyses)
2-2 Po licy Too lkit fo r Str en gth ening Health Secto r Refor m
Develop a cti on pla n s to i n cr ea se su ppor t for a reform pol icy
Gu ide a pa r ticipa t ory, con sen su s- bu ildin g pr ocess ( by sh a r in g th e in for m a ti on obta in ed
with th e sta keh older s a n d en cou r a gin g discu ssion a bou t h ow to a ddress th e con cer n s of th e
opposit ion ) .
Appl ica tion of th ese gu idelin es is in t en ded to m a ke pol icym a ker s a n d m a n a ger s m ore in for m ed
a bou t th e politi ca l en vir on m en t su r r ou n din g t h eir r efor m s a n d better pr epa red to ta ke a ction to
en su re th e fu ll im plem en t a t ion of h ea lth sector r eform s.
To in cr ea se su ppor t or bu ild con sen su s for r efor m , policym a ker s a n d m a n a ger s m u st ta ke
a ddi tion a l steps foll owi n g t h e st a keh older a n a lysis. I n t h e n ext ph a ses of th e policy pr ocess
con sti tu en cy- bu i ldin g, r esou r ce m obil iza tion , a n d im plem en ta tion ( Figu r e 2.1) policym a k-
er s a n d m a n a gers sh ou ld u se th e in for m a tion gen era t ed by th e sta keh ol der a n a lysi s to develop
a n d i m plem en t st ra tegic com m u n ica tion , a dvoca cy, a n d n egotia tion pla n s. Th e ot h er section s
of th is toolkit ca n be u sed to gu ide th e developm en t a n d im plem en t a t ion of su ch pla n s ( see, for
exa m pl e, Secti on 3: Advoca cy Gu i delin es, a n d Sect ion 4: Con flict Negot ia tion Gu idel in es) .
"Policy, as used in this
document, refers to any na-
tional, regional, local, or in-
stitutional project, program,
law, regulation, or rule.
Fi gure 2 . 1 . The Po l i cy Pro ce s s
Issues
Agendas
Decisions
Policy
Eormulation and
Legitimation
Constituency-
Building
Resource
Mobilization
Implementation
Design and
Organizational
Structuring
Progress/Impact
Monitoring
= primary linkage
= secondary linkage
Politically dominated
Technically led
Issues
Agendas
Decisions
Issues
Agendas
Decisions
Policy
Eormulation and
Legitimation
Constituency-
Building
Resource
Mobilization
Implementation
Design and
Organizational
Structuring
Progress/Impact
Monitoring
= primary linkage
= secondary linkage
Politically dominated
Technically led
Stakeho lde r Analysis Guideline s 2-3
Ste p 1 : Pl anni ng the Pro ce s s
De fi ne the purpo s e o f the anal ys i s , and i de nti fy us e s fo r the
re s ul ts .
Th e fi rst step i n con du ctin g a sta keh older a n a lysis is to defin e th e pu r pose of t h e a n a lysis, iden -
tify th e pot en t ia l u ser s of th e in for m a ti on , a n d devise a pl a n for u sin g th e in for m a tion . A discu s-
sion of th ese i ssu es sh ou l d be led by th e spon sor, or in itia tor, of th e sta keh ol der a n a lysi s.
As n oted a bove, in form a tion gen er a ted from sta keh older a n a l ysis m a y ser ve sever a l pu r -
poses: to provide i n pu t for oth er a n a l yses; to in for m th e developm en t of a ct ion pl a n s to in cr ea se
su pport for a refor m pol icy; or t o gu ide a pa r tici pa t or y, con sen su s- bu ildin g pr ocess.
Oth er a cti vities, su ch a s str a tegic pla n n in g, in stitu tion a l a ssessm en ts, or a pplica ti on of com -
pu terized pr ogr a m s l ike PolicyMa ker,
1
often r equ ir e t h e type of i n for m a t ion pr odu ced by a
sta keh older a n a lysis wh o th e sta keh olders a r e, wh a t th eir positi on s a r e rela ted t o a policy,
h ow im por ta n t th ey a r e, a n d so for th . I t m a y be u sefu l , th er efor e, to con du ct a sta keh older a n a l-
ysis in con ju n ction with t h ese a ctivities.
Policym a kers a n d m a n a ger s m a y u se t h e r esu lts of a sta keh older a n a l ysis to devel op th eir
a ction pla n s. Th ese pl a n s sh ou ld iden tify con cr ete a ction s, a n d possibly beh in d th e scen es
a ctivities, t h a t th e pol icym a ker s a n d m a n a gers will i m plem en t to in crea se st a keh older su pport .
Fin a lly, policym a ker s a n d m a n a gers m a y u se th e r esu l ts in open discu ssi on s with sta keh old-
er s in a n effor t to bu il d con sen su s. Th i s a ll ows sta keh older s t o see wh er e th ey a re rela tive to oth -
er s a n d en cou r a ges discu ssion on h ow to a ddr ess th e opposit ion s con cer n s. Th is m a y be u sefu l
wh en th e n u m ber of sta keh olders is sm a ll a n d m a n a gea bl e a n d wh en con sen su s- bu i ldin g is a
sta ted goa l of th e a n a lysis.
Befor e pr oceedin g wit h t h e n ext steps, th e spon sor sh ou ld en su r e th a t a con sen su s exists
a m on g th e policym a kers a s to th e pu r pose of t h e a n a lysis, its pr oposed u sers, a n d th e in ten ded
u se of th e r esu lts.
Ide nti fy and trai n a wo rki ng gro up.
Th e spon sor of th e a ctivity sh ou ld for m a sm a l l wor kin g gr ou p ( two t o fou r people) wh ose
m em bers will be th e i n terviewer s a n d a n a lyst s for th e sta keh older a n a l ysis. Th e spon sor m a y
gu ide th e pr ocess a n d ser ve a s a poin t of refer en ce, or h e or sh e m a y be a m em ber even th e
lea der of th e worki n g gr ou p.
Wh en ever possible, th e worki n g gr ou p sh ou ld r epr esen t disti n ct in t er ests a n d or ga n i za tion s.
Th is h elps preven t th e t ype of bia ses t h a t ca n occu r wh en a sin gle per son or in stitu tion con du cts
a n a n a lysis. Ha vin g m em bers with differ in g poin t s of view ca n a l so be h elpfu l in i n ter pr etin g
th e qu a lita ti ve a n d, a t tim es, a m bigu ou s da ta th a t em er ge. I f possi bl e, th e gr ou p sh ou ld i n clu de
1. Pol icyMa ker i s a com pu t er pr ogr a m ( desi gn ed by Ha r va r d Un iver si ty) th a t or ga n i zes sta keh ol der in for m a t ion ,
pr ovi des gu ida n ce on st r a t egi es to dea l wi th th e st a keh older s, a n d cr ea tes effect ive visu a ls for pr esen t in g th e
in for m a t ion to poli cym a ker s.
a n eu tr a l person wh o h a s n o politica l or oth er in ter est in th e policy a n d wh o is in depen den t of
th e in st itu t ion pr om otin g th e policy. I t is a lso u sefu l to i n clu de m em ber s wh o a r e kn owl edge-
a ble a bou t th e sector, sta keh ol der s, con text, a n d pol itics rela ted to th e poli cy.
Th e st a keh older a n a lysis pr ocess sh ou ld be pa r ticipa tor y, in vol vin g a ll m em ber s of th e wor k-
in g grou p fr om begin n in g to en d. Th i s wa y, a l l wor kin g gr ou p m em bers will be in tegr a ted in to
th e en tir e process a n d wi ll ga in th e exper ien ce n eeded to con du ct sim ila r effor ts in th e fu tu r e.
I n tegr a tin g a ll workin g gr ou p m em ber s in to t h e process a lso will in cr ea se th eir u n der sta n di n g
of a n d su ppor t for t h e r esu lts a n d h elp t h em a ccu r a tely tr a n sla te th e in terview respon ses in t o
a n a lysis resu lts.
I t is im por ta n t th a t m em ber s of th e wor ki n g gr ou p a r e exper ien ced a s in t er viewer s a n d a r e
a ble to elicit a n swers to t h e sta ted qu estion s with ou t im posin g th eir per son a l bia ses. I f th ey h a ve
n o pr eviou s exper ien ce, a da y or two of tr a in in g m a y be r equ ir ed ( su ch a s pr a ctice in ter viewi n g
th r ou gh r ole pla yin g) . Th e wor kin g gr ou p m em ber s a l so sh ou ld be a ble to r eview a n d a ccu -
r a t ely syn t h esize qu a li ta tive in for m a tion . In a ddition , a l l m em ber s of th e grou p sh ou ld r ea d
th ese sta keh ol der a n a lysi s gu idel in es, r eceive tr a in i n g on th e con ten t of sta keh older a n a lysis,
a n d u n der sta n d th e r ea son for u n dert a ki n g th e a n a lysis.
De ve l o p a pl an and ti me l i ne .
Fin a ll y, th e wor kin g gr ou p sh ou ld iden tify th e specific steps t o be ta ken in con du ctin g th e a n a l-
ysis ( followin g th ese gu i delin es) a n d esta blish a ti m elin e for t h e process. Th e tim elin e sh ou ld
in clu de a ll m a jor steps in th e pr ocess, u p to a n d in clu di n g th e fi n a l pr esen ta tion of con clu si on s
to policym a ker s. Su fficien t tim e sh ou ld be a lloca t ed for settin g u p in terviews a n d r esch edu lin g
th em in ca se of ca n cella t ion s.
Ste p 2 : Se l e cti ng and De fi ni ng a Po l i cy
Se l e ct an appro pri ate po l i cy.
For a sta keh ol der a n a lysi s to be u sefu l, it m u st be focu sed on a specific pol icy or issu e. Aga in ,
policy is u sed in th is docu m en t to r efer to a n y n a tion a l, r egion a l , l oca l, or in sti tu tion a l pr oject,
progr a m , l a w, r egu la ti on , or r u le. I n m ost ca ses, th e spon sor of t h e sta keh older a n a lysis wi ll
h a ve iden tifi ed a poli cy, bu t it i s im por ta n t to en su re th a t th e poli cy in qu estion is a n a ppr opr i-
a te topic for a sta keh ol der a n a lysi s befor e th e process begin s.
Th e fol lowin g a r e som e ba si c cri ter ia for eva lu a tin g th e a ppropr ia ten ess of h ea lt h r eform
policies a s su bjects of a sta keh ol der a n a lysi s:
Th e policy sh ou ld be specific a n d defi n a ble. Policym a ker s
a n d m a n a ger s sh ou ld a voi d con du ctin g a n a n a lysis on a pol i-
cy t h a t h a s n ot been th ou gh t t h r ou gh or i s t oo gen er a l t o be de-
fin ed in con cr ete term s. Th is is i m por ta n t t o en su r e th a t specif-
ic in ter view qu estion s a n d r espon ses ca n be developed a rou n d
th e policy.
Th e policy sh ou ld be socia lly a n d pol itica l ly con tr over sia l so
th a t it m erit s t h e in vestm en t of resou rces requ ir ed to determ in e
wh a t a spects a r e con tr oversia l a n d t o wh om .
Th e policy sh ou ld be key to cu r r en t r efor m efforts a n d im por -
ta n t en ou gh t o ju st ify th e r esou r ces th a t will be n eeded to i m -
plem en t r ecom m en ded a ction s th a t em er ge fr om th e a n a lysis.
De fi ne the po l i cy.
On ce a poli cy is ch osen for th e sta keh ol der a n a lysi s, th e wor kin g
grou p sh ou l d wor k with policym a kers to defi n e th e m a in idea s
a n d con cept s. Th e ba sic idea s, n ot th e det a i ls of th e policy, will
n eed to be expla in ed t o th e sta keh older s la ter in th e pr ocess, a n d
sim ple, con ci se defi n iti on s will be r equ ir ed.
Box 2.1. SampIe poIicies
Appropriate for anaIysis
Deconcentration of the ministry of health (MOH)
Resource allocation based on production
Hospital autonomy/decentralization
New budgeting mechanisms at the hospital level
Not appropriate for anaIysis
Health sector reform (too general)
Modernization of the MOH (too general)
Providing computers for all MOH offices (not a central or
priority health reform topic)
lncreasing national spending on health (may not be a
controversial topic for the health sector)
Box 2.2. SampIe heaIth reform poIicy definitions
Deconcentration of the MOH: the permanent delegation of
decision-making power to provincial directors, area chiefs, and
hospital directors in:
naming and managing personnel
buying equipment and supplies
utilizing funds generated by the facilities.
MOH resource allocation based on results: to provide
resources to ministry facilities based on the volume of services
they provide and whether they meet client needs. The specific
resources that would be allocated based on results include:
facility and general administrative budgets
personnel allocations
equipment distribution.
Ste p 3 : Ide nti fyi ng Ke y Stake ho l de rs
I den ti fyin g th e key sta keh ol ders is ext rem ely i m por ta n t to t h e su ccess of t h e a n a lysis. Ba sed on
th e r esou r ces a va ila ble, th e wor kin g gr ou p sh ou ld decide on th e m a xim u m n u m ber of st a ke-
h older s t o be in terviewed. Th e wor kin g gr ou p sh ou ld th en follow th e steps below to defin e th e
list of sta keh ol der s ( begin n in g with a n open list th a t ca n be r edu ced, if n ecessa r y) .
Co mpi l e and re vi e w e xi s ti ng i nfo rmati o n.
Th e workin g gr ou p sh ou ld ga th er a n d a n a lyze a n y written docu m en ts rela ted to th e selected pol-
icy. Th is will h elp to iden tify poten tia l sta keh older s a n d, perh a ps, th eir con n ection to th e policy.
De ve l o p a l i s t o f al l po s s i bl e s take ho l de rs .
I n iti a l ly, th e wor ki n g gr ou p sh ou ld i den ti fy a l l a ct or s wh o
cou l d h a ve a n in t er est i n t h e selected poli cy, in cl u din g a ctor s
ou tside th e h ea lth sector th a t cou ld a ffect or be a ffected by th e
policy. Speci fic st a keh older s ca n be iden tified fr om th e fol low-
in g sector s: in tern a tion a l/ don or s, n a tion a l politi ca l ( legisla -
tor s, govern ors) , pu blic ( m in istr y of h ea lth [ MOH] , soci a l
secu ri ty a gen cy, m in istr y of fin a n ce) , la bor ( u n ion s, m edica l
a ssoci a tion s) , com m er cia l/ pr iva te for- pr ofit, a n d n on pr ofit
( n on gover n m en ta l or ga n iza t ion s [ NGOs] , fou n da tion s) . Civi l
society is a n i m por ta n t sector t o con si der if th e com m u n it y or
con su m ers h a ve a dir ect in ter est in th e policy. I t is a lso im por -
ta n t to con sider t h e pot en ti a l sta keh ol der s in differen t geo-
gr a ph ic or a dm in istr a tive a r ea s with in on e orga n iza tion .
De ve l o p a l i s t o f pri o ri ty s take ho l de rs wi th
i nput fro m e xpe rts .
Sin ce r esou rces, tim e, a n d fin a n ces for th e a n a l ysis wil l be lim -
ited, th e list of sta keh older s to be in terviewed m u st be pr iori -
tized. Exper ts wh o kn ow t h e sector, policy, a n d pla yers ca n h elp in th i s process.
Th e wor kin g grou p sh ou l d con su lt wi th two to th r ee per son s wh o h a ve ext en sive kn owl edge
of t h e h ea lt h sector, its a ctor s, a n d th e power of th ose a ctor s to in fl u en ce th e policy. Expert s
cou l d be r epr esen ta tives fr om don or or ga n iza tion s, h ea l th refor m projects, a n a t ion a l h ea lth
cou n cil, pr iva te con su ltin g fi rm s th a t h a ve wor ked in h ea lt h , or oth er sector- wide or ga n iza -
tion s. Th ey cou l d a lso be per son s wh o h a ve wor ked in va r iou s posit ion s in th e h ea lt h sector,
su ch a s ex- MOH a u th or iti es. Idea l ly, th ese exper ts sh ou ld n ot be sta keh olders th em selves.
Two wor kin g gr ou p m em ber s sh ou ld m eet with th e exper ts to iden tify pot en t ia l sta keh older s
fr om th e va r iou s sector s. Th e discu ssion sh ou l d focu s on per son s or or ga n iza ti on s th a t m a y be
Box 2.3. PotentiaI stakehoIder groups
For a nationaI-IeveI heaIth reform poIicy
MOH (central, regional, local, facility levels)
Ministry of finance
National institute of social security
National labor unions
Health facility directors
For-profit/nonprofit health organizations
Politicians
lnternational donors
Organized community groups
For a faciIity-IeveI heaIth reform poIicy
MOH central or regional (oversight body)
Ministry of finance (source of funding)
National unions connected with facility
Facility director or manager
Facility board
Facility doctors
Facility nurses
Facility nonmedical staff
Facility labor union representatives
Users/organized community groups
r ela ted to or a ffected by th e pa rt icu l a r policy a n d th a t h a ve th e a bili ty t o a ffect t h e im pl em en ta -
tion of t h e pol icy.
Th e wor kin g grou p a lso sh ou ld a sk exper ts a bou t th e a va ila bility of wr itten in for m a ti on ,
in clu din g specific sta keh older sta tem en ts r ela ted to th e pol icy. Su ch wr it ten docu m en t s m a y n ot
provide t h e workin g gr ou p wi th a l l th e in for m a tion n ecessa r y to i den tify t h e m ost a ppr opr ia te
sta keh older s, bu t th ey wil l m a ke t h e workin g gr ou p sel ecti on s m ore in for m ed.
Usin g t h e exper ts i n pu t, t h e wor kin g gr ou p sh ou ld pr ior itize t h e list of poten tia l sta keh old-
er s to in cl u de on ly th ose in dividu a ls wh o h a ve a dir ect in t er est i n t h e pol icy a n d cou ld a ffect its
im plem en ta t ion . Actor s wh o a re n ot or ga n ized or do n ot h a ve t h e a bility to a ffect th e specific
policy sh ou l d n ot be i n clu ded.
An n ex 2- A lists th e gen er a l gr ou ps fr om wh i ch st a keh older s for a h ea lth fin a n cin g policy
m a y be iden t ified, a s well a s j u stifi ca tion s for th eir in clu si on . Th i s list m a y va r y by cou n tr y a n d
policy, bu t in clu din g a j u stifica tion for th e in clu sion of sta keh olders en su r es th a t on ly th ose
dir ectl y r el a t ed to th e policy a r e select ed.
On ce th e sta keh older s a r e ch osen , t h e wor kin g gr ou p sh ou ld develop a con ta ct li st , wi th th e
sta keh older s n a m es, a ddr esses, a n d ph on e n u m ber s.
Ste p 4 : Adapti ng the To o l s
Gen er a l ly, ver y li ttle secon da ry in for m a tion is a va ila ble on sta keh ol der s. As a r esu lt, th e wor kin g
grou p sh ou ld pla n t o in terview th e pr iori ty sta keh ol der s iden tified to ga in a ccu r a te i n for m a ti on
on th ei r posi tion s, in t er ests, a n d a bilit y t o a ffect t h e process.
Th e fol lowin g tool s ca n be u sed for ga t h er in g a n d a n a lyzi n g th is in for m a ti on :
Defin ition s of sta keh older ch a r a cter istics ( See An n ex 2- B)
Sta keh older ta ble ( See An n ex 2- C)
I n ter view qu estion n a ir e a n d pr ot ocol ( See An n ex 2-D)
Referen ce ch a rt ( See An n ex 2- E)
Th e wor kin g grou p sh ou l d r eview a n d a da pt th ese tools to fi t th e specific policy bei n g a n a -
lyzed a n d th e policym a ker s in for m a tion n eeds.
Adapt s take ho l de r characte ri s ti cs .
Th e wor kin g grou p sh ou l d defin e th e exa ct sta keh older in for m a tion or ch a r a ct er istics t o be
con sider ed. Th e followin g ch a r a ct er istics a r e u su a l ly in cl u ded for ea ch sta keh older ( ea ch of
th ese term s i s defin ed fu r th er in An n ex 2- B) :
I .D. n u m ber ( given to th e sta keh older on th e qu estion n a ir e)
Position a n d orga n iza tion
I n ter n a l / exter n a l: in ter n a l sta keh olders wor k wi th in th e or ga n i za tion th a t is pr om ot in g or
im plem en t in g t h e pol icy; a ll oth er sta keh olders a r e extern a l.
Kn owl edge of poli cy: t h e l evel of a ccu r a te kn owledge t h e sta keh ol der h a s r ega r din g t h e pol -
i cy u n der a n a lysi s, a n d h ow ea ch st a keh ol der defin es t h e pol i cy i n qu est ion . Th i s i s i m por -
t a n t for i den ti fyin g st a keh ol der s wh o oppose th e pol i cy du e to m i su n der st a n di n gs or l a ck of
i n for m a t i on .
Position : wh eth er th e st a keh older su ppor ts, opposes, or is n eu tr a l a bou t th e policy, wh ich is
key to esta bli sh in g wh et h er or n ot h e or sh e will bl ock th e poli cy im plem en ta ti on
I n ter est: t h e st a keh older s in ter est in th e policy, or th e a dva n ta ges a n d disa dva n ta ges t h a t
im plem en t a t ion of th e policy m a y brin g to th e sta keh older or h is or h er or ga n iza tion . Deter -
m i n in g th e sta keh older s vested in ter ests h elps policym a ker s a n d m a n a ger s bett er u n der -
sta n d h is or h er position a n d a ddr ess h is or h er con cer n s.
Allia n ces: orga n iza tion s th a t coll a bor a te to su ppor t or oppose t h e pol icy. Allia n ces ca n m a ke
a wea k st a keh older str on ger, or pr ovide a wa y to in flu en ce sever a l sta keh olders by dea l in g
with on e key sta keh older.
Resou r ces: t h e qu a n t i t y of r esou r ces h u m a n , fi n a n ci a l , t ech n ol ogi ca l , pol i t ica l , a n d
ot h er a va i l a bl e to t h e st a keh ol der a n d h i s or h er a bi l i t y t o m obi l i ze t h em . Th i s i s a n i m -
por t a n t ch a r a ct er i st i c t h a t i s su m m a r i zed by a power i n dex a n d wi l l det er m i n e t h e l evel of
for ce wi t h wh i ch t h e st a keh ol der m i gh t su ppor t or oppose t h e pol i cy.
Power : th e a bi lity of th e sta keh older to a ffect th e im plem en ta tion of th e h ea l th r eform policy.
Lea der sh ip: th e will in gn ess to i n itia t e, con voke, or l ea d a n a ction for or a ga in st th e h ea lth
r efor m policy. Esta blish in g wh eth er or n ot th e st a keh older h a s lea der sh i p will h elp policy-
m a ker s a n d m a n a gers ta r get th ose sta keh olders wh o will be m or e li kely to ta ke a ctive steps to
su pport or oppose th e poli cy ( a n d con vi n ce oth ers to do so) .
Th e wor kin g grou p sh ou l d r eview a n d a da pt th e ch a r a cter istics a n d defin it ion s pr ovided in
An n ex 2- B t o th e policy bei n g a n a l yzed a n d th e pa r ticu la r cu ltu r e of th e cou n tr y. I t is cr u cia l t o
en su re t h a t ea ch m em ber of t h e wor ki n g grou p u n der sta n ds th e m ea n i n g of th e fin a l defin i tion
for ea ch ch a r a cter istic.
On ce th e t er m s h a ve been defin ed, a sta keh older a n a l ysis ta ble ca n be cr ea ted in a wor dpr o-
cessin g a ppl ica tion or in a spr ea dsh eet. ( A sa m ple a n a lysis t a bl e crea t ed in Mi cr osoft Excel i s
provided i n An n ex 2- C.) Th e ta ble sh ou ld l ist sta keh older ch a r a cter istics a cr oss th e top r ow ( see
Ta bl e 2.1) . Th is title r ow m a y va ry depen din g on th e exa ct ch a r a cter istics a n d t h eir defin i tion s.
De ve l o p the i nte rvi e w que s ti o nnai re .
On ce th e wor kin g gr ou p h a s ch osen a n d defin ed key sta keh ol der ch a r a ct er istics, a sta n da r d
qu estion n a ir e sh ou ld be developed for in t er viewi n g sta keh older s. Th e sta keh older s sh ou ld n ot
com pl ete th e qu estion n a i re th em selves, bu t th e in ter vi ewer sh ou ld u se th e qu estion n a ir e t o
gu ide th e con ver sa tion du r in g th e in ter view.
I n developin g th e qu estion n a ir e, th e wor kin g gr ou p sh ou ld decide th e m ost a ppr opr ia te wa y
to obta in th e n ecessa ry in form a tion , given th e cu ltu ra l con text. Askin g direct qu estion s m a y seem
th e m ost efficien t m eth od bu t cou ld resu lt in u n relia ble a n swers beca u se th e sta keh olders m a y
n ot be a ccu stom ed to com m u n ica tin g in su ch a dir ect a n d ca n did m a n n er. Qu estion s sh ou ld be
clea r ly sta ted, specific, a n d open - en ded wh er ever possible, r equ ir in g th e sta keh older to pr ovide
m or e th a n a sim ple yesor n oa n swer. If n ecessa ry, severa l qu estion s m a y be a sked to obta in
in for m a tion on on e ch a r a cteristic, bu t doin g th is repea tedly ru n s th e r isk of exten din g th e in ter -
view beyon d th e idea l 2-h ou r tim e lim it. ( See th e section below on Develop th e in ter view proto-
col.)
Th e qu est ion n a i re a lso sh ou l d in clu de a n in tr odu ctor y section th a t th e in ter viewer ca n r ea d
to ea ch st a keh older ( see An n ex 2-D) . Th is in tr odu ction sh ou ld st a te t h e objecti ve of th e in ter-
view, i den ti fy wh o is coll ecti n g th e in for m a tion , expla in wh a t wi ll be don e wi th th e in form a tion ,
Tabl e 2 . 1 . Stake ho l de r Characte ri s ti cs and Tabl e Ti tl e s
( ful l tabl e i n Anne x 2 - C)
G I J
Alliances Resources Power Leader
1 2 1 Self 3 Final Organizations 2 Ability to Resources Yes
Level Definition S, MS, S, MS, l.D. S, MS, mentioned mobilize average No
3,2,1 N, MO, O N, MO, O # N, MO, O 3, 2, 1 3, 2, 1
Knowledge
D
Quantity
3,2,1
2 Others
E
Position
H
disadvant.
Advant./
lnterests
F
1
a n d a ssu r e th e st a keh older th a t a ll r espon ses wi ll rem a in a n on ym ou s. Th e defin ition of th e pol-
icy u n der a n a l ysis a n d a n y ter m s th a t m i gh t be a m bigu ou s or u n kn own t o th e sta keh ol der
sh ou ld be expl a i n ed du r in g th e in t er view. Su ch defin it ion s a n d cla r ifi ca tion s, h owever, sh ou ld
be pr ovided on ly a fter th e in ter viewer h a s explor ed a n d esta blish ed th e sta keh older s level of
u n der sta n din g a n d kn owledge of th e policy in qu estion .
Th e foll owi n g sect ion on in t er view pr otocol su ggests a few m or e tips for im provin g th e i n ter -
view pr ocess.
De ve l o p the i nte rvi e w pro to co l .
Th e wor kin g grou p sh ou l d discu ss a n d docu m en t t h e protocol to be fol lowed du r in g th e i n ter -
view pr ocess. Th is protocol , a n d a n y oth er r u les th a t th e wor kin g gr ou p con sider s i m por ta n t
to en su r e th e coll ection of con sisten t a n d a ccu r a te da ta , sh ou ld be esta blish ed in a dva n ce. To
en su re con si st en cy a n d object ivity, th e followin g protocol is su ggested:
Two-person in t er view tea m s sh ou ld be u sed, with th e i n ter vi ewer s r epr esen tin g differ en t or -
ga n iza ti on s wh en ever possible.
Both in ter viewer s sh ou l d ta ke n otes, bu t on ly on e sh ou l d lea d th e in t er view.
Qu esti on s sh ou ld be a sked n o m or e th a n twice; if t h e sta keh older st ill does n ot provide a n
a n swer, t h e in terviewer sh ou ld m ove on .
Th e in ter view sh ou ld be term in a ted a t th e sta keh olders requ est, even if qu estion s rem a in .
I m m edia tely followin g th e in ter view, th e i n ter vi ewer s sh ou ld type th eir n otes i n to on e elec-
tr on ic qu esti on n a ir e per sta keh older. ( I n ter viewer s sh ou ld en ter ea ch a n swer u n der its cor r e-
spon din g qu estion in th e electr on ic qu estion n a ir e.)
Th e in for m a ti on sh ou ld be en ter ed i n t h e sa m e words th e sta keh older u sed.
As pa rt of th e pr otocol, ea ch qu esti on n a ir e sh ou ld h a ve a pla ce for th e in t er viewer to fil l ou t th e
n a m e a n d I D n u m ber for t h e st a keh older bein g in terviewed a n d t h e da t e a n d cit y of th e in ter -
view ( see An n ex 2- D) . All in t er viewers sh ou ld be cl ea r on h ow t o a dh er e to t h e protocol befor e
begin n in g th e in ter views.
Te s t the que s ti o nnai re .
Before in ter viewin g th e sta keh older s, th e wor kin g gr ou p sh ou ld pretest th e qu esti on n a ir e by
con du ctin g in ter views with n on pr ior ity sta keh ol der s ( i.e., th ose wh o wer e on a n in itia l list bu t
wer e cu t wh en t h e list wa s sh ort en ed) . Apr etest sh ou ld be con du ct ed to deter m in e wh eth er:
I n ter viewer s a r e com fort a ble wit h t h e qu estion n a ir e
Th e in ter vi ewee u n der st a n ds th e qu estion s
An swer s provi de th e in for m a tion r equ ir ed for fillin g in th e a n a lysi s t a bl e ( th e ta ble sh ou ld be
fill ed in for th e pretest i n ter views)
Th e in ter vi ew does n ot t a ke m or e th a n 2 h ou r s
I n ter viewer s su ccessfu l ly a dh er e t o th e est a bl ish ed pr otocol
Stakeho lde r Analysis Guideline s 2 -1 1
After a n a lyzin g th e r esu lts of th e pretest, t h e qu est ion n a ir e a n d pr otocol sh ou ld be m odified,
if n ecessa r y, befor e pr oceedin g with th e pr ior ity sta keh older in ter views.
De ve l o p the re fe re nce chart.
Th e fi n a l tool n eeded is th e in for m a ti on t ra n sfer r efer en ce ch a r t or r eferen ce ch a r t ( An n ex
2-E) . Th is ch a rt ser ves two pu r poses:
to pr ovide a m ea n s of ch ecki n g th a t a ll th e sta keh older ch a r a cter istics a re cover ed i n t h e in -
ter vi ew qu estion n a i re
to a id th e wor kin g gr ou p in tr a n sfer r in g th e in form a tion fr om th e qu estion n a i re to th e
sta keh older ta ble.
Th e r efer en ce ch a r t sh ou ld be developed a fter th e in ter view qu est ion n a i re a n d th e sta ke-
h older ta ble beca u se it in cor por a t es speci fic in ter view qu estion s a n d th e colu m n tit les u sed in
th e sta keh ol der ta ble ( see Ta ble 2.2) . Th e wor kin g grou p a lso sh ou ld iden tify th e specific in t er -
view qu est ion s t h a t will yiel d th e i n for m a t ion for ea ch col u m n of th e st a keh older a n a lysis ta bl e.
Both th e com pleted i n ter vi ew qu estion n a ir es a n d th e defin ition s sh ou l d be u sed wh en in for m a -
tion is tr a n sfer red to t h e a n a lysis ta ble t o en su r e t h a t t h e sta keh older s respon ses a r e r ecor ded
a ccu ra tely a n d objectively. Th e r eferen ce ch a rt sh ou ld be pretested a lon g wit h t h e in t er view
qu estion n a ir e to en su r e th a t th e cor r ect qu esti on r efer en ce n u m ber s a ppea r ben ea th ea ch col-
u m n on t h e st a keh older ta bl e.
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Ste p 5 : Co l l e cti ng and Re co rdi ng the Info rmati o n
Re vi e w e xi s ti ng i nfo rmati o n.
Before begin n in g th e in ter vi ews, t h e workin g gr ou p sh ou ld ga th er
a n d r eview secon da r y in for m a t ion on th e pr ior ity sta keh ol der s.
Th is in form a tion sh ou l d be m or e deta iled th a n th e i n for m a t ion
th a t wa s r eviewed in Step 3. I t sh ou ld in cl u de a n y wr it ten or spoken
sta tem en t s r ega r din g th e sta keh older s posit ion s on th e policy, a n y
goa l s or object ives of th e or ga n iza tion s t h e sta keh older s r epr esen t,
th e position of t h e st a keh older s wi th in th eir or ga n iza tion s ( with
specifi c r efer en ce to th e sta keh ol der s con tr ol over r esou r ces) , a n d
a n y da t a on th e qu a n tity or type of r esou r ces a va ila ble to th e sta ke-
h older s or th ei r orga n iza tion s.
Make i nte rvi e w appo i ntme nts .
As n oted u n der Step 3, ver y littl e secon da ry in for m a ti on is gen er a ll y a va il a bl e on sta keh ol ders,
a n d t h e workin g gr ou p wil l l ikely h a ve to in terview a l l of th e sta keh ol der s fr om th e fin a l l ist .
Even if t h er e is a n a bu n da n ce of secon da r y in form a tion , t h e workin g gr ou p m a y ch oose to
in t er view a ll sta keh olders to ga i n m or e in si gh t in t o th eir opi n ion s on th e pol icy a n d oth er sta ke-
h older s.
To begin th e pr ocess, i n ter vi ew a ppoi n tm en ts sh ou ld be m a de wit h ea ch sta keh older. I dea ll y,
a ppoin tm en t s sh ou ld be m a de 12 weeks i n a dva n ce by th e wor kin g gr ou p m em ber ( s) with
en ou gh i n flu en ce t o secu re a ppoin tm en ts wit h h igh - level a n d bu sy sta keh olders. I f n ecessa r y,
th e gr ou p sh ou ld seek a ssi st a n ce fr om th e spon sor or policym a ker wh o i s su pport in g t h e pro-
cess.
Th e in ter vi ews sh ou l d be sch edu led a t th e ti m e a n d pl a ce m ost con ven ien t for th e sta ke-
h older. Al l a tt em pt s sh ou ld be m a de to secu r e a n in ter view with th e person in di ca ted a n d n ot h i s
or h er r epr esen ta t ive. Th is in clu des r esch edu li n g ca n cel led a ppoin t m en ts, if n ecessa r y.
To in ter view sta keh olders wh o wor k in a region ou tside th e worki n g gr ou ps ba se city, two
workin g gr ou p m em ber s sh ou ld tr a vel to th e r egion a n d in terview a n y a n d a ll sta keh older s
fr om th a t r egion . Th is tr ip sh ou ld be pla n n ed well in a dva n ce to en su r e th e a va il a bi lity of a ll
sta keh older s. A secon d option , i f th e wor kin g gr ou p does n ot h a ve tr a vel fu n ds, is to m eet with
th e sta keh ol der wh en h e or sh e m a y be i n t h e workin g gr ou ps ba se ci ty. If n eith er tr a vel n or a
sta keh older visit to th e ba se city is possible, t h e workin g gr ou p ca n i n ter vi ew t h e st a keh older by
teleph on e. Th e tel eph on e in ter view sh ou l d be a con fer en ce ca ll i n volvin g t wo in ter viewer s.
Co nduct i nte rvi e ws and re co rd no te s .
Th e in ter vi ewer s sh ou ld foll ow th e pr otocol esta blish ed by t h e gr ou p, wit h on e person a s th e
pri n cipl e in ter vi ewer r espon sible for l ea din g th e con ver sa t ion . Alth ou gh t h e in t er viewer ca n
Box 2.4. PossibIe secondary information sources
Newspapers
lnstitutional reports and publications
Speeches
Political platforms
Organization annual reports, staff size, and/or number of
offices
Expenditure data (National Health Accounts)
Other studies and opinion polls
a ttem pt to cla ri fy th e in ter viewees sta tem en t s, h e or sh e sh ou l d n ot tr y t o su m m a r ize respon ses.
I f th e st a keh older does n ot u n der sta n d a qu estion , th e in ter vi ewer ca n r eph ra se th e qu est ion
sligh tl y, bu t a n y devia tion s fr om th e or igin a l qu estion n a ir e sh ou ld be n ot ed. After t wo a ttem pts
to a sk a n d/ or r eph ra se a qu estion , th e i n ter vi ewer sh ou ld m ove on .
I m m edia tely followin g t h e in ter view, t h e two- per son in terview tea m sh ou ld wor k t ogeth er to
en t er th e sta keh older s a n swer s for ea ch qu estion in to th e com pu ter. A sepa r a te el ectr on i c fi le
sh ou ld be cr ea t ed for ea ch sta keh older th a t con ta in s th e qu esti on n a ir e a n d h is or h er a n swer to
ea ch qu est ion . Th ese a n swer s sh ou ld be r ecorded a s lit er a l ly a s possible, wi th ou t su m m a r izin g
wh a t th e sta keh older wa s tr yin g to sa y. Th e objective of th is follow- u p pr ocess is to recor d th e
in for m a tion a ccu ra t ely, legibly, a n d by qu estion n u m ber for u se in th e a n a lysi s pr ocess.
Ste p 6 : Fi l l i ng i n the Stake ho l de r Tabl e
Th is step of th e pr ocess i n volves ta kin g deta il ed a n d often len gth y a n swers fr om th e in t er views
a n d a r r a n gin g th em in t o a m or e con cise a n d system a ti zed form a t ( for a n on ym ity a n d t o h igh -
ligh t th e m ost sign ifica n t in for m a ti on ) . By doin g th i s, th e wor kin g gr ou p ca n even t u a lly
develop clea r com pa r ison s a m on g th e differ en t sta keh older s a n d con cisely pr esen t th is in for -
m a t ion t o th e policym a kers wh o wi ll u se it ( see Steps 7 a n d 8) . To con du ct su ch com pa r ison s
a n d a n a l yses, th e in ter view r espon ses m u st fir st be tr a n sla ted in t o th e sta keh ol der ta ble. Accu -
r a t ely tra n sfer r in g in ter view r espon ses to th e ta ble requ ir es th a t th e workin g gr ou p u se a ll of th e
tools developed: th e com plet ed in ter view gu i des for ea ch st a keh older, t h e refer en ce ch a r t, th e
defin ition s, a n d th e sta keh older ta ble.
I t is u sefu l to h a ve th ose wor kin g gr ou p m em ber s wh o ser ved a s in ter viewer s pa rt icipa te in
th i s process beca u se th ey ca n gen era ll y r eca ll t h e con text wit h in wh ich cer ta in sta keh olders
sta tem en t s wer e m a de. Grou p m em ber s sh ou ld a n a lyze t h e exa ct respon ses wr itten i n ea ch
sta keh older s qu est ion n a i re, h owever, a n d sh ou ld n ot r ely on th eir m em ory.
Du r in g th e pr ocess of a da ptin g t h e tool, t h e wor kin g gr ou p sh ou ld in clu de, with ea ch defi n i-
tion , a n expla n a tion of h ow t o fill in t h e sta keh older ta ble for ea ch ter m . Th ese in str u ction s a r e
in clu ded in t h e defin i tion s pr ovided in An n ex 2- B, bu t th e pr ocess for tr a n sla t in g th e m or e com -
plex ch a r a cter isti cs, su ch a s posi tion a n d power, is deta il ed bel ow.
De te rmi ne the s take ho l de rs po s i ti o n.
Th e position of ea ch sta keh older ca n be est a bl ish ed by a n a lyzin g th e foll owin g:
I n for m a t ion dir ectly r epor ted by th e sta keh older in th e i n terviews
I n dir ect in form a tion ga th ered th rou gh oth er sta keh older s a n d secon da r y i n for m a t ion ( i.e.,
oth ersper ception s)
I n ter est in form a tion .
To obta in in dir ect i n for m a t ion , ea ch sta keh ol der in ter view m u st in cl u de specific qu est ion s
a bou t t h a t sta keh older s opin ion s of oth er s ( see qu estion s 13 to 17 i n t h e Sa m ple Sta keh older
I n ter vi ew Qu estion n a ir e, An n ex 2- D) . An y su ch opin i on sh ou ld be en ter ed i n t h e st a keh older
ta ble ( An n ex 2- C) in th e r ow r el a tin g to th a t design a t ed sta keh older a n d in th e colu m n for
oth er scol u m n ( colu m n E2, a s sh own in Ta ble 2.3.)
Tabl e 2 . 3 . Co l umn E o f Stake ho l de r Tabl e
1. SeIf 3. FinaI
S, MS, S, MS, I.D. S, MS,
N, MO, O N, MO, O # N, MO, O
2. Others
E
Position
A sta keh ol der s positi on s sh ou ld be cla ssified in colu m n s E1, E2, a n d E3, u sin g th e esta b-
lish ed defi n ition s for position s. Th e fu ll spect ru m of position cl a ssifi ca tion s is pr esen ted i n Fig-
u r e 2.2. I f desir ed, low su ppor ter ( LS) a n d l ow oppon en t ( LO) ca n be a dded, bu t th e i n for m a t ion
ga th er ed u su a ll y does n ot a l low for su ch a deta il ed disa ggr ega tion .
Wh en deter m i n in g th e fi n a l positi on of ea ch sta keh ol der ( col u m n D3) , t h e workin g gr ou p
n eeds to r econ cil e a n y differ en ces between th e positi on th a t is self- r epor ted ( E1) a n d th e posi-
tion th a t is perceived by oth er s ( E2) . Differ en ces ca n be r esol ved in th e followin g m a n n er:
Wh en t h e st a keh older st a t es th a t h e or sh e i s a ga i n st t h e pol icy, th i s is a ssu m ed t o be a ccu -
r a t e, a lbeit su bjective, in for m a tion beca u se th er e is little in cen ti ve for th e sta keh older t o m is-
r epr esen t h i s or h er position . For m oder a te oppon en t s ( MO) or oppon en ts ( O) , self- r epor tin g
sh ou ld deter m in e th e sta keh older s fin a l position .
I n t h e ca se of th e self-r epor ted n eu tr a l or su ppor ti ve sta keh older, i t is im por ta n t to cr oss- r ef-
er en ce th e opin ion s of oth er s beca u se th e sta keh ol der m a y h a ve a n in cen tive to m isr epr esen t
h is or h er posit ion .
Wh en a discr epa n cy exists between th e sta keh older s self- r epor ted positi on a n d th a t per ceived
by oth er s, th e wor ki n g gr ou p m u st con si der th e r ela t ive weigh t of a va ila ble in for m a tion . Th is
in clu des th e n u m ber of oth er sta keh older s wh o disa gree wit h t h e self- r eport ed position , wh eth er
th e sta keh ol der in qu est ion i s per cei ved t o be m oder a tel y or str on gl y opposed to th e policy, a n d
a n y kn owledge of t h e st a keh older s pa st a ct ion s r el a t ive to sim ila r poli cies.
I f con sider ed ca r efu lly, decidin g on t h e ba sis of m a jori ty ru lesis a possi bl e m et h od for
r esolvin g posit ion discrepa n cies. Th er e m u st a lwa ys be a ba la n ce, h owever, so th a t a per son wh o
is in fu ll su ppor t of t h e pol icy is n ot m oved to a n on su ppor tin g posi tion u n l ess th e decision i s
u n a n im ou s on th e pa r t of a ll oth er sta keh ol der s in ter viewed. For exa m ple, if a st a keh older wh o
self- decl a res su pport for a pol icy is per ceived to be a ga in st th e policy by five oth er sta keh ol der s,
a n d on e oth er sta keh older per ceives th e pr in cipa l sta keh ol der a s n eu tr a l, th e wor kin g grou p
cou l d cla ssify th e sta keh ol der in qu est ion a s m oder a tel y opposed ( con sider in g th e 5 to 2 m a jor -
ity a n d th e la ck of u n a n im ity on th e pa r t of oth er st a keh older s) .
Th e in for m a ti on i n t h e in ter ests colu m n of th e sta keh ol der ta ble ( colu m n F) a lso ca n h elp
esta blish th e fi n a l positi on ( pa r ticu la r ly wh en decidin g between a m odera te or fu ll su ppor ter/
oppon en t , or between con flictin g per ception s) . Th e in ter ests colu m n iden t ifies a n y a dva n ta ges
or disa dva n ta ges of th e i m plem en ta tion of th e policy a s sta ted by t h e sta keh older. If a sta ke-
6XSSRUWHU6 0RGHUDWH6XSSRUWHU06 1HXWUDO1 0RGHUDWH2SSRQHQW02 2SSRQHQW2
Fi gure 2 . 2 . Spe ctrum o f Stake ho l de r Po s i ti o ns
h older pr ovides very gen er a l or a m bigu ou s a n swer s to th ese qu est ion s, it m a y in di ca te th a t h e or
sh e is n ot str on gly in vested in th e posi tion st a ted or wa s n ot ca n did i n h is or h er r espon se to th e
qu estion .
Fi l l i n the re s o urce s co l umn and cre ate a po we r i nde x fo r e ach
s take ho l de r.
Sin ce th e m a in sou r ce of a sta keh older s power i s h is or h er resou r ces a n d a bility to u se th em ,
th e power i n dex i s der ived fr om a n a lyzin g th e two r esou rce col u m n s i n t h e st a keh older ta bl e.
Th er efor e, in or der to fill in th e "power " colu m n for ea ch st a keh older, t h e workin g gr ou p m u st
fir st defin e th e r esou r ce col u m n s for ea ch sta keh older a ccor din g to th e defin it ion .
Th e r esou r ce ca t egory is di vided in to two pa r ts: t h e qu a n t ity of r esou r ces th a t a sta keh older
h a s wit h in h i s or h er orga n iza tion or a r ea a n d th e a bili ty to m obilize th ose r esou r ces.
An a l yst s sh ou l d cl a ssi fy t h e qu a n ti t y of r esou r ces a s foll ows: 3 = m a n y, 2 = som e, 1 = few,
a n d i n ser t th e a ppr opr ia te n u m ber i n to col u m n H1 of t h e sta keh ol der t a ble. Th e a bi li t y of t h e
st a keh older to m obi l i ze r esou r ces sh ou l d be qu a n ti fied i n t er m s of t h e fol l owi n g:
3 = th e sta keh older ca n m a ke decision s r ega r di n g th e u se of th e r esou r ces in h is or h er
orga n iza tion or a r ea
2 = th e sta keh ol der is on e of sever a l person s th a t ca n m a ke decision s r ega r din g th e u se of
r esou r ces
1 = th e sta keh older ca n n ot m a ke decision s r ega r din g th e u se of th e r esou rces.
Th is scor e sh ou ld be in ser t ed in to col u m n H2 ( see Ta ble 2.4) .
Sin ce "power " is defin ed h er e a s th e com bin ed m ea su r e of th e a m ou n t of r esou r ces a sta ke-
h older h a s a n d h is or h er ca pa city to m obilize th em , th e two r esou r ce scor es for ea ch sta keh older
sh ou ld be a ver a ged, r esu ltin g in a power in dex between 3 a n d 1: 3 = h igh power, 2 = m ediu m
power, a n d 1 = little power. Th e fin a l ra n kin gs sh ou ld be reviewed to en su re con sisten t scorin g
a m on g a ll of th e sta keh olders.
Power: "the capacity or
ability to accomplish some-
thing.strength, force or
might (Webster). Here,
the ability to affect the im-
plementation of the health
reform policy due to the
strength or force he/she
possesses.
Resources: "a source of
support or aid (Webster).
Resources can be of many
typeshuman, financial,
technological, political, and
other.
Tabl e 2 . 4 . Co l umns H and I o f Stake ho l de r
Tabl e
I
Resources Power
2. AbiIity to Resouces
mobiIize: average
3, 2, 1 3, 2, 1
H
1. Quantity
3, 2 , 1
Fi gure 2 .3 . Us e Al l To o l s i n Fi l l i ng i n the Anal ys i s Tabl e ( Se e Anne xe s fo r ful l ve rs i o ns )
Ste p 7 : Anal yz i ng the Stake ho l de r Tabl e
On ce th e sta keh ol der ta ble i s com pl ete, th e in form a tion n eeds to be "a n a lyzed." Su ch a n a n a ly-
sis sh ou ld focu s on com pa ri n g i n for m a t ion a n d developin g con clu sion s a bou t th e sta keh olders'
r ela tive im por ta n ce, kn owledge, in ter ests, posit ion s, a n d possible a llies rega r din g th e policy i n
qu estion .
From t h e in for m a tion in th e sta keh ol der ta ble, th e wor kin g gr ou p sh ou ld be a ble t o con -
clu de th e followin g:
Wh o a r e th e m ost im por ta n t st a keh older s ( fr om a power a n d lea der sh ip a n a lysis) ?
Wh a t is th e sta keh older s' kn owl edge of th e policy?
Wh a t a re th e sta keh older s' position s on th e specific poli cy?
Wh a t do th e sta keh older s see a s possible a dva n t a ges or disa dva n ta ges of th e poli cy ( in t er est
a n a lysis) ?
Wh ich sta keh older s m igh t for m a llia n ces?
Th e speci fic steps for developin g th ese five a n a lyses a r e deta i led below.
Carry o ut a po we r and l e ade rs hi p anal ys i s .
Alth ou gh th e i n ten t in pr ior itizi n g th e sta keh older list ( see Step 3) wa s to select on ly th ose sta ke-
h older s with power a n d l ea der sh ip, th e fir st a n a lysis i s desi gn ed to u se th e in for m a tion fr om th e
ta ble to fu r th er pr ior it ize th e sta keh olders with i n t h e selected gr ou p in terviewed. Th is secon d
pri orit iza tion , ba sed on a ctu a l da t a a n d a m or e select gr ou p, a llows policym a ker s a n d m a n a g-
er s to focu s resou rces on a ddressin g th e con cern s of t h e m ost im por ta n t of th e pr ior ity st a ke-
h older s.
Th e " im por ta n ce" of sta keh older s is defin ed h ere a s th eir a bi lity to a ffect th e im plem en ta tion
of th e pol icy. Sin ce power a n d lea dersh ip a r e t h e ch a r a cteri st ics t h a t deter m in e a sta keh ol der ' s
a bility to a ffect or block th e im plem en ta tion of a poli cy, th ese two ch a r a cter isti cs a r e th e ba si s
for th e fir st "im por ta n ce" a n a lysis.
For th i s a n a lysis, th e wor kin g grou p sh ou l d divide th e sta keh older s in to th ree gr ou ps ( see
Ta bl e 2.5) :
Gr ou p 1: th ose wh o h a ve lea der sh ip a n d h igh power ( level 3)
Gr ou p 2: th ose wh o h a ve lea der sh ip a n d m ediu m power ( l evel 2)
Gr ou p 3: th ose wh o do n ot h a ve lea der sh i p bu t h a ve h i gh to m ediu m power ( level 2 or 3) .
Power: Quantity of re-
sources and ability to mobi-
lize those resources for or
against the policy.
Leadership: A willingness
to initiate, convoke, or lead
an action for or against the
policy.
Th e a bove gr ou pin g is ba sed on th e pr em ise th a t th ose with lea der sh ip a n d power will be
m ost a ble to a ffect policy im plem en ta tion , a lth ou gh power fu l sta keh ol ders wh o la ck lea der sh ip
m a y still be a bl e t o a ffect t h e im pl em en ta ti on t h r ou gh th eir power a lon e.
I den ti fy th e st a keh older s m a kin g u p t h ese th r ee gr ou ps by or ga n iza tion r a th er th a n by n a m e
in order to pr eser ve th eir a n on ym ity. Ea ch of th e th r ee grou ps sh ou ld h a ve a n a m e ( it cou ld be
sim pl y gr ou p 1, 2, or 3) .
Som e of t h e sta keh older s m a y n ot fit in to a n y of th ese gr ou ps, i.e., th ey m a y h a ve n o lea der -
sh ip a n d low power. Su ch sta keh ol der s m a y be r em oved fr om th e a n a lysis a t th i s poin t so th a t
a tten tion ca n be focu sed on th ose sta keh older s with in th e power / lea der sh ip pr ior ity gr ou ps.
Wh en a sm a ll n u m ber of st a keh older s a r e bei n g a n a l yzed, or if th e wor ki n g gr ou p wa n ts to r ep-
r esen t a ll st a keh older s i n t h e power/ lea der sh ip a n a l ysis, a fou r th gr ou p ca n be a dded for t h ose
with n o lea der sh ip a n d low power ( level 1) .
Anal yz e kno wl e dge data.
Th e sta keh olders' l evel of kn owledge r ela ted to t h e policy is often of in ter est t o pol icym a ker s a n d
m a n a ger s. Th is l evel of kn owledge ca n be pr esen ted a s a gen er a l con clu sion , especia lly if it is
sim i la r for th e m a jor ity of th e sta keh olders, or th e sta keh older s ca n be di vided by th eir level of
kn owledge ( 1, 2, or 3) . Th e la tt er option is u sefu l for t a r get in g a com m u n ica t ion st ra tegy for a
specifi c gr ou p of sta keh ol der s, n a m el y th ose wit h t h e lowest kn owledge of th e poli cy. Th ese
sta keh older s wou ld a ppea r in Gr ou p 1 for kn owl edge l evel .
Th e in for m a ti on fou n d in th e kn owledge da ta ca n be cr ossed with th e power / lea dersh i p
a n a lysis to h igh ligh t th e im por ta n ce l evel of th e sta keh olders with a low kn owledge level. Th i s
cr oss- a n a lysis will r esu lt in a n even sm a ller prior it y gr ou p for ta r getin g com m u n ica tion st ra te-
gies.
Th e kn owl edge da ta a lso ca n be cr oss- r efer en ced with th e position of t h e sta keh older s t o
deter m in e if th ose opposed to t h e pol icy h a ve a con sisten tly low level of kn owledge. Th is wou l d
in dica te t o th e policym a ker or m a n a ger pr om otin g th is poli cy t h a t com m u n ica tin g or a dvoca t-
in g th e objectives a n d ba sic ten ets of th e policy cou ld r edu ce th e opposit ion .
Tabl e 2 . 5 . Exampl e Re s ul ts o f Po we r/ Le ade rs hi p Anal ys i s
Group 1: Leadership &
High (3) Power
Group 2: Leadership & Medium
(2) Power
Group 3: No Leadership, But
Medium or High (2 or 3) Power
Minister of Health Local politicians MOH provincial directors
Minister of Finance Hospital directors in regions A & B MOH central directors
Labor union A Area directors in regions A & B MOH Reform Project
Labor union B Hospital Workers' Association Regional organization
Workers' Association Nurses' Association lnternational donor B
Medical Association lnternational donor A
Anal yz e s take ho l de rs ' po s i ti o ns .
I n a n a lyzin g th e positi on in for m a ti on from t h e ta ble, th e foll owi n g a spect s ca n be deter m in ed:
Tota l n u m ber of su ppor ters
I m por ta n ce of su pport er s ( cr oss-r efer en ce wi th power/ lea der sh ip a n a l ysis)
Kn owl edge of su pport er s ( cross- refer en ce with kn owledge da ta )
Adva n ta ges a n d disa dva n ta ges of policy i m plem en ta tion to th e su ppor ter s ( cross- refer en ce
with in ter est da ta )
Kn owl edge of wh eth er th ese su ppor ter s a r e i n ter n a l or ext er n a l to th e or ga n iza tion devel op-
in g th e policy ( cross- r efer en ce with th e in ter n a l/ ext er n a l cla ssifica ti on )
Su pport "clu ster s": sta keh ol der s in th e sa m e sector wh o su ppor t th e policy ( cr oss- r efer en ce
with or ga n iza tion in for m a ti on )
Tota l n u m ber of oppon en ts
I m por ta n ce of oppon en t s ( cr oss-r efer en ce wit h power/ lea dersh ip a n a lysi s)
Kn owl edge of oppon en t s ( cr oss-r efer en ce wi th kn owledge da t a )
Adva n ta ges a n d disa dva n ta ges of policy i m plem en ta tion to th e oppon en ts ( cr oss- refer en ce
with in ter est da ta )
Kn owl edge of wh eth er th ese oppon en ts a r e i n ter n a l or ext er n a l to th e or ga n iza t ion develop-
in g th e policy ( cross- r efer en ce with th e in ter n a l/ ext er n a l cla ssifica ti on )
Opposit ion "cl u ster s": sta keh ol der s in th e sa m e sector wh o oppose th e poli cy ( cross- refer en ce
with or ga n iza tion in for m a ti on )
Neu t ra l sta keh olders, th eir im por ta n ce, kn owledge, a n d in terest s
Alth ou gh t h e workin g gr ou p ca n i den tify su ch con cl u sion s di rectly fr om th e a n a l ysis ta ble,
th e developm en t of a positi on m a p oft en h elps a n a lysts t o pu ll ou t a n d or ga n i ze th e in for m a -
tion n eeded to m a ke con clu sion s. For exa m ple, su ppor t or opposition "clu ster s" ca n be ea sil y
iden tified on a posi tion m a p. Step 8, Usin g th e I n form a tion , discu sses h ow to develop t h e posi-
tion m a p. Th is m a y be u sefu l to t h e workin g gr ou p i n con du ct in g th e posi tion a n a lysis a s well
a s in pr esen ti n g t h e in for m a tion to policym a kers a n d m a n a ger s.
Anal yz e i nte re s t data.
Th e in terest da t a ca n be u sed eith er in con ju n ction wi th oth er a n a l yses or a lon e a s gen er a l con -
clu si on s. I n cr oss-r efer en cin g th e in t er est da ta with oth er da ta , t h e policy im plem en t a tion
a dva n ta ges a n d disa dva n ta ges iden t ified by t h e sta keh older s ca n be u sed to expl a i n t h eir posi-
tion s or to em ph a size t h eir kn owledge of th e poli cy ( i.e., ir r eleva n t a dva n ta ges a n d disa dva n -
ta ges m a y r epr esen t a m isu n der sta n din g of th e policy) . Th e in t er est da ta a l so ca n be cr oss- r efer -
en ced wit h th e power / l ea der sh ip da ta to in dica te wh a t th e m ost im port a n t st a keh older s m a y
h a ve to lose or ga in fr om policy im plem en ta tion .
Wh en u sed by itself, t h e in ter est da ta ca n be pr esen ted a s a list of th e poten tia l a dva n ta ges
a n d disa dva n ta ges th e policy pr esen ts to th e sta keh ol ders. Th is is m ost u sefu l i f m a n y sta ke-
h older s i den ti fy t h e sa m e a dva n ta ges a n d disa dva n t a ges. I n th i s ca se, th e wor kin g gr ou p ca n
iden tify th e con cer n s of th e m a jor ity of th e sta keh older s r ega r din g policy im plem en ta tion .
Anal yz e al l i ance s .
Possible st a keh older a l lia n ces ca n a lso be iden tified fr om th e ta ble in form a tion . Th e a llia n ces
ca n be i den ti fied in two wa ys:
by r efer r in g t o th e a n a l ysis ta ble to see if sta keh ol der s m en tion ed or ga n iza t ion s t h a t t h ey
wou ld wor k with to dem on str a te for or a ga in st th e policy
by r eferr in g to th e posit ion "clu ster s" ( th e st a keh older s with si m il a r position s a n d with i n th e
sa m e or ga n iza tion or su bsector) . As previou sly sta ted, th e " clu st er s" ca n be ea sily iden tified
with th e developm en t of a posi tion m a p.
Th e a ll ia n ce in form a tion sh ou ld be cr oss- r efer en ced with th e position da ta t o iden tify th ose
a llia n ces t h a t m a y be poten tia l sou r ces of su ppor t, a s well a s th ose th a t m a y wor k toget h er to
oppose th e policy. Th e wor kin g gr ou p ca n su ggest or en cou r a ge policym a ker s to devel op specific
str a t egies ba sed on th ese key a ll ia n ces, ei th er to r ein for ce a poten tia lly su pport ive a llia n ce or t o
sepa ra te a pot en ti a l ly th r ea ten in g a llia n ce.
Th e a ll ia n ce da ta ca n a lso be cr oss-r efer en ced wit h t h e power / l ea der sh ip a n a l ysis r esu l ts to
h igh ligh t th ose a llia n ces t h a t a r e poten t ia lly th e m ost su ppor tive or th r ea ten in g t o th e policy
im plem en t a t ion .
De ve l o p addi ti o nal re s ul ts .
I n a dditi on t o th e in for m a ti on li st ed on th e sta keh ol der ta ble, oth er in for m a ti on ga in ed fr om
th e in ter views ca n be u sed to develop key r esu lts a n d con clu si on s. Wh en tr a n sferr in g th e i n for -
m a t ion from t h e qu estion n a ir es t o th e ta ble, th e worki n g gr ou p sh ou ld n ote th a t th e followin g
in for m a tion m a y be r eleva n t:
Sta keh olders wh o wer e n ot i n cl u ded in th e pr iori ty list bu t were m en tion ed often by th ose in -
ter vi ewed
Sta keh olders' globa l im pr essi on s of oth er st a keh older s or t h eir orga n i za tion s
Su ggestion s for th e i m plem en ta tion of th e policy
An y expect a t ion s t h a t t h e m a jor it y of th e sta keh ol ders h a ve in r ela ti on to th e policy
process.
By a n a lyzin g in for m a tion r ela ted to th ese a r ea s, a s wel l a s t h e five ba sic a n a lysis r esu lts pr e-
viou sl y m en tion ed, t h e worki n g gr ou p ca n develop a list of con clu sion s or r esu lts to be pr esen ted
to t h e pol icym a ker s.
Th e wor kin g grou p sh ou l d th en con sider h ow th is in for m a ti on cou ld be pr esen ted or u sed
with in ot h er a n a lyti ca l fra m ewor ks. Th e n ext secti on pr ovides som e gu ida n ce i n t h is a r ea .
Ste p 8 : Us i ng the Info rmati o n
Usin g th e in form a tion gen era ted by th e precedin g a n a lysis is a n in tegra l pa r t of t h e sta keh older
a n a lysis process. Th e wor kin g grou p, by vir tu e of its r ol e in in for m a tion - ga th er in g a n d a n a lysis,
is r espon sible for or ga n izin g, dissem i n a tin g, a n d expla in in g th e r esu lts in a wa y th a t will
en su re th a t th e spon sor or ot h er poli cym a ker s a n d m a n a ger s ca n u se t h e in for m a tion to ta k e
a ction .
Th e u se of th e in for m a tion gen er a ted by t h e sta keh older a n a lysis sh ou l d be discu ssed du r in g
Step 1, Pla n n in g th e Process, a n d sh ou l d be r eviewed a ga in on ce th e r esu lt s h a ve been a n a lyzed.
As m en ti on ed, th ere a r e va r iou s wa ys to u se th e i n for m a t ion from a st a keh older a n a lysis to
provide in pu t in to oth er a n a lyses, to develop a ction pla n s to in cr ea se su pport for a r efor m policy,
or to gu ide a pa rt icipa tor y, con sen su s- bu ildin g process.
Th is section offer s gu idelin es on h ow to presen t th e resu lts. If th e policym a ker s a n d m a n a ger s
pla n to u se th e r esu lts obta in ed th rou gh th e sta keh older a n a lysis to ta ke con crete, a n d possibly
"beh in d th e scen es," a ction s to in cr ea se sta keh older su ppor t, on ly th ose per son s in volved in
im plem en tin g th e follow- u p a ction s sh ou ld be in clu ded in th e pr esen ta tion a n d discu ssion of th e
resu lts. If th e pu rpose of th e presen ta tion is to sh a r e th e resu lts to bu ild con sen su s a m on g th e
sta keh older s, th en a ll sta keh olders sh ou ld be in vited to a tten d. Alth ou gh th ese gu idelin es a ddr ess
gen era l issu es a bou t pr esen tin g th e r esu lts, if th e spon sor or oth er policym a kers pla n to u se th e
resu lts to bu ild con sen su s, th ey sh ou ld work with profession a l fa cilita tors to gu ide th e discu ssion .
Ge ne ral Re s ul ts Pre s e ntati o n Fo rmat
Two per son s fr om th e wor kin g gr ou p sh ou ld be selected t o m a ke th e pr esen ta tion , a n d th e
r em a i n der of th e gr ou p sh ou ld be a va ila ble to h elp a n swer a n y qu estion s th a t a r ise. A da t e
sh ou ld be set wh en th e spon sor a n d oth er r eleva n t policym a ker s or sta keh older s ca n m eet for a t
lea st a 2- h ou r pr esen ta tion a n d di scu ssion session .
Th e pr esen ta tion m a y in clu de a sh ort in tr odu ction on th e sta keh ol der a n a lysi s, bu t it sh ou l d
focu s on t h e r esu lts of th e a n a lysis, n ot on th e pr ocess. Sin ce poli cym a ker s a n d m a n a gers m u st
pri orit ize a n d focu s on th e m ost i m por ta n t in form a tion , t h e presen ta tion sh ou ld be a con cise
syn th esis, n ot a r eview of a ll t h e in for m a tion obt a in ed or th e en tir e st a keh older ta ble. I f th e
r esu lts will be pr esen ted for a con sen su s- bu ildin g pr ocess, th e key a r ea s th a t th e sta keh older s
will discu ss sh ou ld be pr esen ted.
Th e r em a i n der of t h i s sect i on pr ovi des som e su ggest i on s for pr esen t i n g key i n for m a t i on .
Pre s e ntati o n o f Po we r/ Le ade rs hi p Anal ys i s Re s ul ts
Who is impor tant?
On e wa y t o pr esen t th e m ost im por ta n t con clu sion s is to focu s th e pr esen ta ti on on th e t h r ee
grou ps t h a t em er ged fr om th e power/ lea der sh ip a n a lysis, i.e., t h e fi rst fin din g fr om th e a n a lysi s.
Th e th r ee grou ps ca n be pr esen ted a s or ga n i za tion s th a t h a ve th e poten tia l to a ffect th e su ccess
of th e pol icy.
Micr osoft Power Poin tis a n effective tool for su ch a pr esen ta tion beca u se it h a s color ed
squ a r es th a t ca n be u sed to r epr esen t th e power / l ea der sh ip level of ea ch sta keh ol der con sisten tly
th r ou gh ou t t h e pr esen ta tion . For visu a l em ph a sis, m or e in ten se color s ca n be u sed to r epr esen t
h igh er power/ lea dersh ip i n dexes, a n d, th er efore, h igh er im por ta n ce. For rea son s of a n on ym i ty,
th e boxes sh ou ld be la beled with or ga n iza tion s' n a m es a n d n ot in dividu a l sta keh older s n a m es
or job t itles. ( See Figu re 2.4.) Oth er visu a l a i ds m a y be u sed i f PowerPoin t is n ot a va il a bl e.
Fi gure 2 . 4 . Sampl e o f Ho w to Us e Po we rPo i nt to Pre s e nt Po we r/ Le ade rs hi p
Anal ys i s Re s ul ts
International
Donor A
Local Politicians
Hospital Directors
Area Directors
Hospital Workers`
Associations
Nurses` Association
Group 2:
Leadership/
Medium Power
International
Donor B
Reform Project
Central Directors,
MOH
Regional
Organization
Provincial Directors,
MOH
Group 3:
No Leadership/
Medium-High Power
Who Is Important:
Power and Leadership Analysis
Medical Associations
Minister
of Health
Workers`
Associations
Labor Union A
Group 1:
Leadership/
High Power
Labor Union B
Ministry of
Finance
Pre s e ntati o n o f Stake ho l de rs ' Po s i ti o ns
Wher e is the suppor t/ opposition?
Th e secon d fi n din g th e su ppor tin g, n eu tr a l , or opposin g posi tion s of sta keh olders ca n be
presen ted u sin g a posit ion m a p developed with Power Poi n tor ot h er visu a l a i ds. Th e posit ion
m a p ( see Fi gu r e 2.5) ca n qu ickl y ill u str a te wh ich a ctor s su ppor t or oppose a policy, h ow im por -
ta n t th a t su ppor t or opposition is ( i.e., by col or) to th e su ccess of t h e pol icy, a n d wh er e th ese
sta keh older s a r e by sector. Col or ed boxes r epr esen t in g ea ch a ctor fr om th e th r ee power / lea der -
sh ip gr ou ps sh ou ld be pla ced on th e m a p in a ccor da n ce with th e sector to wh ich t h ey belon g
( vert ica lly) a n d th eir sta keh older posit ion a s est a bl ish ed i n t h e st a keh older t a ble ( h ori zon ta ll y) .
Fi gure 2 .5 . Sampl e Po s i ti o n Mapi n Co l o r
P
o
l
i
t
i
c
a
l
S
e
c
t
o
r
:
I
n
t
e
r
n
a
t
i
o
n
a
l
a
n
d

N
a
t
i
o
n
a
l
E
x
t
e
r
n
a
l
L
a
b
o
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S
e
c
t
o
r
Moderate Moderate
P
u
b
l
i
c
S
e
c
t
o
r

M
O
H
Minister
of Health
Area
Director
Hospital
Director
Local
Politicians
Ministry of
Finance
Hospital Workers`
Associations
Medical
Associations
Nurses`
Associations
Support Neutral Opposition
High High
Central
Directors
Workers` Associations
Labor Union A
Labor Union B

P
r
o
v
i
n
c
a
l
/
L
o
c
a
l

L
e
v
e
l

C
e
n
t
r
a
l
L
e
v
e
l
Provincial
Director
Regional Organizations
International Donor A
International Donor B
Reform Project
Technical Secretariat (policy origin)
Before th e sta keh older s ca n be loca ted on t h e m a p, th e m a p r ows n eed to be l a beled. Th e
orga n iza tion spon sori n g t h e pol icy sh ou ld be pla ced in th e "policy or igin " r ow ( r ow i n t h e cen -
ter of th e below m a p) . Th e oth er r ows sh ou ld be l a beled wi th th e sector ca tegor ies u sed in th e
sta keh older list ( i.e., in t er n a tion a l / don or, n a tion a l politi ca l, pu blic, l a bor, etc.) . Th e r ows
sh ou ld be l a beled i n or der of th e pr oxim ity of th e sector to th e policy or igin . For exa m ple, for a
policy bein g developed by a cen tr a lized gr ou p in th e MOH, th e cen tr a l MOH sect or is cl osest to
th e policy or igin a n d is given t h e r ow im m edia tely a dja cen t t o th e policy or igin r ow. I n th i s
exa m pl e, th e la bor sect or, wh ich i s exter n a l to th e MOH a n d fa r from th e di rect in fl u en ce of th e
policy developer s, i s pla ced fa rt h est fr om th e cen ter row. On ce a ll r ows a re la bel ed, th e sta ke-
h older s ca n be pla ced with in th e r ow th a t repr esen ts th eir sector, or over la ppin g two r ows if th ey
a ct with i n t wo sector s.
In a da ptin g th e m a p, th e colu m n titles, wh ich repr esen t th e position s of th e sta keh olders,
sh ou ld n ot n eed to be ch a n ged. In pla cin g th e colored boxes ( i.e., sta keh olders) on th e m a p,
th ose wh o a re str on g su ppor ter s ( S) sh ou ld be pla ced on th e fa r left of th e fir st colu m n , wh ile
m odera te su pporters ( MS) sh ou ld be on th e righ t side of th e first colu m n with in th e row th a t rep-
r esen ts th eir sector. Th ose wh o a re str on g oppon en ts ( O) sh ou ld be pla ced on th e fa r r igh t of th e
la st colu m n , wh ile m oder a te oppon en ts ( MO) sh ou ld be pla ced on th e left side of th e la st colu m n
with in th eir sector ' s row. An y n eu tra l a ctors ( N) sh ou ld be pla ced in th e m iddle colu m n , in th e
row repr esen tin g th eir sector.
I f col or ed squ a r es a r e u sed, th e followin g con clu si on s ca n be presen ted:
Tota l n u m ber of su ppor ters
I m por ta n ce of su pport er s ( cr oss-r efer en ce wi th power/ lea der sh ip a n a l ysis)
Wh eth er th ese su ppor ter s a r e i n tern a l or ext er n a l to th e or ga n iza tion devel opi n g th e pol icy
( cr oss-r efer en ce wi th th e in t er n a l/ extern a l cla ssifica tion )
Su ppor t "clu sters": sta keh older s in th e sa m e sector wh o su ppor t th e policy
Tota l n u m ber of oppon en ts
I m por ta n ce of oppon en t s ( cr oss-r efer en ce wi th power/ lea dersh ip a n a lysis)
Wh eth er th ese oppon en ts a r e i n ter n a l or ext er n a l to th e or ga n iza tion devel opin g th e poli cy
( cr oss-r efer en ce wi th th e in t er n a l/ extern a l cla ssifica tion )
Opposit ion " clu st er s" : st a keh older s in th e sa m e sector wh o oppose th e policy
Neu t ra l sta keh olders a n d th eir i m por ta n ce.
Sin ce th e kn owledge a n d in ter est da ta ca n n ot be r epr esen ted on th e m a p it self, th e wor kin g
grou p pr esen ter s ca n refer to t h ese da ta wh en expla in in g th e positi on s a s seen on th e m a p. Th ey
ca n a lso develop a ddition a l wa ys of pr esen t in g t h e kn owledge a n d i n ter est da ta a s su ggest ed
below.
Pre s e ntati o n o f Kno wl e dge Data
As su ggested in Step 7, th e kn owledge da ta ca n be pr esen ted in two wa ys: a s a gen er a l con clu -
sion , especi a l ly if t h e level of kn owledge is sim ila r for th e m a jor ity of th e sta keh older s, or a s a
gra ph ic r epr esen ta tion of th e th ree level s of kn owl edge.
Th e gr a ph ic r epr esen t a tion of th e t h r ee kn owledge gr ou ps is pa r ticu la r ly u sefu l i n cross- ref-
er en cin g th e power / lea der sh ip in for m a tion with th e u se of color ed boxes. Usi n g a sl ide sim ila r
to th a t seen in Fi gu r e 2.6, t h e workin g gr ou p pr esen ter s ca n h igh ligh t for th e a u di en ce th e l evel
of kn owl edge of th e m ost im por ta n t st a keh older s.
Fi gure 2 .6 . Po we rPo i nt Pre s e ntati o n o f Kno wl e dge Data
International
Donor A
Local Politicians
Hospital Directors
Area Directors
Hospital Workers`
Associations
Nurses` Associations
Group 2: Medium
International
Donor B
Reform Project
Central Directors,
MOH
Regional
Organization
Provincial Directors,
MOH
Group 3: High
Knowledge Levels
Medical Association
Minister of Health
Workers`
Associations
Labor Union A
Group 1: Low
Labor Union B
Ministry of
Finance
Potential Key Alliances
Workers`
Associations
Hospital
Workers`
Associations
Medical
Associations
Labor
Union A
Labor
Union B
Hospital
Directors
Provincial
Directors
Minister
of Health
Area
Directors
Supporting
Opposing
Pre s e ntati o n o f Ke y Al l i ance s
Who might wor k together ?
Alth ou gh a ll ia n ces ca n be iden ti fied by " clu sters" on th e posi tion m a p, th e wor kin g grou p ca n
iden tify a ddi tion a l a llia n ces t h a t a r e n ot eviden t on t h e posit ion m a p. Sin ce a n a u dien ce often
ca n n ot sim u lt a n eou sly a bsorb a ll of th e in for m a ti on pr esen ted on a m a p, presen ters a lso m a y
wa n t to u se a sli de sim ila r t o th e on e sh own in Figu r e 2.7 t o em ph a size a lli a n ces.
Fi gure 2 . 7 . Po we rPo i nt Pre s e ntati o n o f Ke y Al l i ance s
Pre s e ntati o n o f Othe r Re s ul ts / Co ncl us i o ns
After pr esen tin g th e i n itia l fin din gs, th e gr ou p sh ou ld th en pr esen t key over a ll con clu sion s,
r epea tin g pa r ticu la rl y i m por ta n t con clu sion s dem on str a t ed in th e positi on m a p a n d oth er
gra ph ics. Th i s in for m a tion sh ou l d focu s on wh a t t h e pol icym a ker s a n d m a n a gers n eed to con -
sider wh en im pl em en ti n g th e poli cy. Th ese con clu si on sta tem en ts sh ou ld be con cise a n d cl ea r
a n d m a y be pr esen ted i n a list form a t. ( Box 2.5)
Pre s e ntati o n o f Re co mme nde d Strate gi e s
Fin a lly, th e wor kin g gr ou p pr esen ter s sh ou l d a lwa ys pl a ce t h e r esu lts with in th e con text of rec-
om m en ded a cti on s a n d n ext steps so t h a t th e spon sor a n d oth er policym a kers or m a n a ger s
kn ow h ow to u se t h e r esu lts.
To gu i de t h ese follow- u p a cti on s, th e wor kin g grou p sh ou ld develop st ra tegies t o a ch ieve t h e
followin g five ba sic goa l s:
Ma in ta i n t h e su ppor t of t h ose sta keh older s wh o a re cu r ren tly su ppor ter s
I n cr ea se power a n d lea der sh ip of th e su ppor ter s
Con ver t t h e oppon en ts to su ppor ter s
Wea ken th e power a n d l ea der sh ip of th e oppon en ts
Con ver t t h e n eu tr a l sta keh older s in t o a cti ve su ppor ters ( i.e., con vin ce t h em t o su pport th e
policy a n d in cr ea se th eir power a n d lea der sh i p wh ere n ecessa r y) .
Box 2.5. SampIe concIusions on the
deconcentration of the MOH
All, except one, of the stakeholders in Group 1 (the most
important group) act partially or entirely outside of the MOH.
Most stakeholders have little knowledge of the policy and relate
it to self-financing and privatization.
Stakeholders identified several potential benefits of
implementing the policy:
1) improved quality of service for the user
2) more effective use of collected funds
3) improved personnel training and performance.
Stakeholders identified several possible disadvantages of
implementing the policy
1) diminished local level budget
2) implementation of self-financing and privatization
3) diminished power, status, and function of the central level of
the MOH
4) transfer of corruption to the local level
5) instability within the labor force.
Many of the stakeholders conditioned their future support on
1) the clarity and continuity of the policies
2) the transparency of the policy implementation process
3) their participation in the process.
Two types of str a tegi es ca n th en be i den ti fied to m eet th ose goa ls:
Gen er a l str a t egies: th e wor kin g gr ou p sh ou ld a n a l yze th e in ter est s, con cer n s, a n d m i su n der -
sta n din gs com m on to m ost sta keh older s. ( Box 2.6)
Str a tegies for speci fic sta keh older gr ou ps: th e wor ki n g gr ou p
sh ou ld con sider th e position of ea ch st a keh older, h is or h er
in t er ests ( colu m n F of th e sta keh older ta ble) , a n d th e fi ve
ba si c str a tegy goa ls. Th e wor kin g gr ou p sh ou ld devel op spe-
cific wa ys of a ddr essin g th e con cer n s of th e in dividu a l sta ke-
h older s a n d secu r in g t h ei r a ctiv e su ppor t ( i.e., in cr ea sin g
th eir power a n d lea der sh ip so th ey ca n dem on str a te t h is su p-
port ) . Figu r e 2.8 offers a n exa m ple of h ow to presen t th is in -
for m a ti on i n Power Poin t .
Box 2.6. SampIe generaI strategies for increasing
support for deconcentration of the MOH
Clarify to the stakeholders the vision, objectives, and benefits of
deconcentration, as well as its relation to the modernization of
the MOH, with the aim of strengthening their knowledge.
Communicate the definitions and consequences of
deconcentration, decentralization, self-financing, and
privatization.
lnform stakeholders regularly on achieved tangible results from
the implementation of deconcentration.
Develop new forms of participation in developing and
implementing deconcentration for actors within and external to
the MOH.
Fi gure 2 . 8 . Sampl e Pre s e ntati o n o f Strate gi e s i n Po we rPo i nt
Provincial
Directors
P/L 1 Supporters
INTERESTS STRATEGIES POSITION
More decision-making
power; guidance Irom
central level; attention to
local priorities
Increase their leadership by
requesting their participation in
deIining and promoting local level
implementation.
P/L 2&3 Neutrals
Participation in
process; increased
salaries
Medical
Associations
DeIine speciIic means Ior involving
them in policy design and
implementation. Consistently inIorm
them oI progress. Address salary issue
iI possible, or provide other
incentives.
Workers`
Associations
Improved working
conditions; payment on
time; appropriate
supplies in Iacilities;
participation in process
Demonstrate how policy addresses
working condition issues. Involve local
workers` association members in deIining
policy at the local level to address their
issues. Negotiate with upper levels oI
association.
P/L 3 Opponents
Priority Strategies
Th e wor kin g grou p sh ou l d pr esen t th ese str a tegies to th e spon sor a n d oth er policym a kers or
m a n a ger s presen t, wit h t h e followin g ca vea t s:
To be m ost effective, cer ta in str a tegies m a y n eed to r em a i n con fiden tia l, kn own on l y by a se-
lect gr ou p of policym a ker s i m plem en tin g th e policy.
Th e str a tegies sh ou l d be developed in fu r th er det a il t h r ou gh con cr ete a ction pla n s, com -
m u n ica tion pla n s, a n d n egotia tion pa ck a ges.
Th e i m plem en ta tion of th e str a tegies will r equ i re t h e com m it m en t of a dditi on a l t im e a n d r e-
sou r ces from t h e spon sor.
Th e im plem en t a t i on of t h e st r a t egi es wi l l r equ i r e t h e devel opm en t of a sel ect gr ou p of pr o-
fessi on a l s t r a i n ed i n com m u n i ca t i on , fa ci l i ta t i on a n d m edi a t i on , a n d n egot i a t i on t ech -
n iqu es.
It is n ot a lwa ys n ecessa ry or fea sible to im plem en t a ll of th e stra tegies im m edia tely. In presen t-
in g th e stra tegies, th e wor kin g gr ou p sh ou ld iden tify a few, select priorities for im m edia te a ction
( i.e., n ext steps) by th e spon sor or oth er policym a ker s or m a n a gers. Depen din g on th e resu lts, th e
wor kin g gr ou p m a y r ecom m en d im plem en ta tion of on e key str a tegy for a ll sta keh older s, or
im plem en ta tion of sever a l str a tegies to a ddr ess th e n eeds of sever a l sta keh older s. I n th e la tter
ca se, th e workin g grou p sh ou ld recom m en d wh ich sta keh olders sh ou ld be ta rgeted for str a tegy
im plem en ta tion , given th e lim ited resou rces gen er a lly a va ila ble for im plem en ta tion . Th e grou p
ca n recom m en d th a t th e followin g sta keh older s be ta rgeted for th e first sta ge of str a tegy im ple-
m en ta tion :
Su pport er s with li ttle power a n d lea der sh ip: focu s on wa ys of in cr ea sin g th e power a n d lea d-
er sh ip of th ese sta keh older s.
Neu t ra l sta keh olders with m ediu m to h igh power a n d lea der sh i p: focu s on con vin cin g th e
sta keh older s t o su ppor t th e poli cy a n d in cr ea sin g th eir power a n d lea der sh ip wh er e n eces-
sa r y.
Oppon en t s wi th h igh power a n d lea dersh ip: focu s on n egot ia tin g for t h e oppon en ts' su ppor t
a n d decr ea sin g t h eir power a n d lea der sh ip if t h ey r em a in opposed.
Figu r e 2.9 il lu str a tes a visu a l pr iori tiza tion of st a keh older s to be t a r get ed for t h e in it ia l str a t-
egy im pl em en ta ti on .
On ce th e sta keh older gr ou ps a r e pri or it ized, th e wor kin g gr ou p sh ou ld pr esen t th e sta ke-
h older s' in terest s a n d th e specifi c str a tegi es for a ddr essin g th ei r n eeds. Th is ca n be don e eit h er
in a list or in a t a bl e, cr ea ted in a wor dpr ocessin g a pplica t ion or in a Power Poi n tfigu r e,
h igh ligh ti n g t h e power a n d l ea der sh ip i n dex of th e pr ior ity sta keh older with th e col ored boxes
( e.g., a s in Figu r e 2.9) .
Followin g th e pr esen t a t ion , th e wor kin g grou p sh ou ld be a va i la ble to a n swer qu estion s
r ega rdin g th e pr ocess, r esu lt s, a n d r ecom m en ded st ra tegies. If possi bl e, th e m em ber s of t h e
grou p sh ou l d be in vol ved i n fu r th er developin g t h e stra t egies i n to a ction pla n s. I f th a t is n ot
possible, t h e workin g gr ou p sh ou ld fol low u p with th e spon sor a n d th e oth er policym a ker s a n d
m a n a ger s wh o a t ten ded th e pr esen ta tion to ch eck on th e sta tu s of th e i m plem en ta tion of th e
str a t egies.
Policym a ker s a n d m a n a ger s ca n u se th e gu ideli n es a n d tools fou n d in th e su bsequ en t sec-
tion s of th is t ool ki t to develop a n d im plem en t th e str a tegies i den ti fied h ere r ela ted to com m u n i-
ca tion , a dvoca cy, a n d con flict m a n a gem en t a n d n egotia t ion .
Fi gure 2 . 9 . Matri x fo r Ide nti fyi ng Stake ho l de rs To Be Targe te d by Strate gi e s
Level of Support
Opponent Supporter
2
=

m
e
d
i
u
m
3
=

h
i
g
h
P
o
w
e
r
/
L
e
a
d
e
r
s
h
i
p

(
P
/
L
)
Opponent
P/L 2
Neutral
P/L 2
Supporter
P/L 2
Neutral
1
=

l
o
w
Supporter
P/L 1
Neutral
P/L 1
Opponent
P/L 1
Neutral
P/L 3
Opponent
P/L 3
Supporter
P/L 3
Stakeholders targeted for initial strategy
implementation
Bi bl i o graphy
Br in kerh off, Der ick. Ju n e 1998. Fr om Design to Im plem en ta tion : Sta k ehold er An a ly sis in a
PHC Pr oject in In d ia . Beth esda , MD: Abt Associa tes In c.
_ _ _ _ _ . Apr il 1997. PHR Tr ip Repor t: Sta k ehold er An a ly sis in In d ia . Beth esda , MD: Abt Asso-
cia tes I n c.
Cr osby, Ben ja m in L. Ma r ch 1992. "Sta keh older An a lysis: A Vit a l Tool for St ra t egic Ma n a ger s."
Techn ica l Notes, n o. 2. Wa sh in gton , DC: I m pl em en tin g Policy Ch a n ge Pr oject for th e US
Agen cy for I n ter n a tion a l Developm en t ( USAI D) .
_ _ _ _ _ . Apr il 1992. "Ma n a gem en t a n d th e En vi ron m en t for I m plem en ta tion of Policy
Ch a n ge: Pa r t On e." Techn ica l N otes, n o. 4. Wa sh in gton , DC: I m plem en tin g Policy
Ch a n ge Pr oj ect for th e US Agen cy for I n tern a tion a l Developm en t ( USAID) .
_ _ _ _ _ . Apr il 1992. "Ma n a gem en t a n d th e En vi ron m en t for I m plem en ta tion of Policy
Ch a n ge: Pa r t Two." Techn ica l N otes, n o. 5. Wa sh in gton , DC: I m plem en tin g Policy
Ch a n ge Pr oj ect for th e US Agen cy for I n tern a tion a l Developm en t ( USAID) .
Lin den ber g, Ma r c, a n d Ben ja m i n Cr osby. 1981. Ma n a gin g Dev elopm en t: The Politica l
Dim en sion . Ha r tfor d, CT: Ku m a r ia n Pr ess.
Reich , Mich a el R. Ma r ch 1993. "Politica l Ma ppin g of Hea lth Policy: Dr a ft Gu ideli n es." Boston ,
MA: Ha r va r d Sch ool of Pu bl ic Hea lth .
Reich , Mich a el R., a n d Da vi d M. Cooper. 1996. Policy Ma k er : Com pu ter-Aid ed Politica l An a l-
y sis: Im pr ov in g the Ar t of the Fea sib le. Br ooklin e, MA: PoliMa p. ( To order, con t a ct Poli-
Ma p, 74 Ar m or y St., Br ookli n e, MA 02446- 3909 USA.)
Sch m eer, Ka m m i. Septem ber 1998. Pr ocess for Developin g a n In ter est Ma p in Ecu a dor, Tech-
n ica l Repor t n o. 23. PHR Project. Beth esda , MD: Abt Associa tes I n c.
Web ster ' s II N ew Riv er sid e Diction a r y. 1984. Boston : Hou gh ton Mifflin Com pa n y.
Anne x 2 - A
Sampl e Ge ne ral Li s t o f Stake ho l de rs
Th e fol lowin g t a bl e i llu str a tes gen er a l in for m a tion on pr ior ity sta keh ol der s to be in ter viewed,
with a ju stifica tion for ea ch gr ou p' s i n clu sion in th e a n a lysis.
Sector Sub-Sector InternaI/
ExternaI
to the
MOH
# to be
inter-
viewed
Reason chosen/reIation to poIicy
lnternational
Agencies/
Donors
USAlD
PAHO
World Bank
lDB
External 4 External support, in both economic and political terms, has been
very influential in determining the direction of health reform
efforts.
National
Political
Provincial
Congressional
Representatives
External 3 The provincial representatives have significant impact on
implementation of health reform efforts in the regions and
represent the provinces' views to the Congress; those to be
interviewed are involved in the issues related to this topic.
Provincial Governors External 2 The provincial governors are responsible for implementing the
executive plans and are the coordinators of public institutions at
the provincial level.
Public Entities:
MOH
Central level (executive,
planning, finances,
human resources,
operations)
lnternal 8 The central level of the MOH will be responsible for planning and
implementing the policy being analyzed. They also will be
affected by this process, mainly in terms of the redistribution of
power from the central level to the provincial and local levels, and
will be held to the new results budgeting.
Provincial and local
levels (directors of
provinces, areas and
hospitals)
lnternal 12 Since the process being analyzed includes deconcentration, the
provincial and local levels of the MOH will be responsible for
implementing many of these changes. ln addition, they will be
held to new standards for receiving budget, personnel, and
supplies from the central level.
Public Entities:
other than MOH
Ministry of Finance External 1 Since the policy deals with resource allocation, and the Ministry
of Finance currently controls this allocation, support from these
officials for the new policy is required to implement the change.
Modernization
Committee
External 1 The modernization committee has chosen the MOH as its pilot
institution to begin public sector modernization efforts; this entity
is very involved in planning the specific modernization efforts.
Labor Sector Medical Associations
Nurses' Associations
Hospital Workers'
Associations
National Labor Unions
lnternal and
External
10 The labor sector in the country is very powerful, and through their
protests, labor groups are able to stop political efforts they
consider threatening to their interests. ln the health sector alone
there are numerous organized labor groups, both inside and
outside the MOH, from doctor and nurse associations to hospital
and MOH labor unions. These groups may be able to stop
implementation if they do not support the policy.
Anne x 2 - B
De fi ni ti o ns o f Stake ho l de r Characte ri s ti cs and
Ins tructi o ns fo r Fi l l i ng i n Stake ho l de r Tabl e
A. I. D. Numbe r
Th e distin ct n u m ber gi ven to ea ch sta keh older on t h e qu estion n a ir e.
B. Po s i ti o n and Organi z ati o n
Th e position th e sta keh older h a s a n d t h e orga n i za tion for wh ich h e or sh e wor ks.
C. Inte rnal / Exte rnal
I n ter n a l ( I ) sta keh olders wor k wi th in th e or ga n i za tion th a t is pr om ot in g or im pl em en ti n g th e
policy; a ll oth er sta keh olders a re con si der ed exter n a l ( E) .
D. Kno wl e dge o f Po l i cy
Th is colu m n is di vided in to two pa r ts. Th e fir st pa r t, D1, is t h e level of a ccu ra t e kn owl edge t h e
sta keh older h a s r ega r din g th e policy u n der a n a lysis. Th is kn owledge sh ou ld be r a ted fr om 3 to
1: 3 = a lot; 2 = som e; 1 = n on e. Fi n a l r a n kin gs sh ou ld be r evi ewed to en su r e con sisten t scor in g
a m on g a ll of th e sta keh older s.
Th e secon d pa r t of th e col u m n , D2, is to r ecor d h ow ea ch sta keh older defin es th e poli cy in
qu estion . Th e in for m a ti on ga th er ed in qu estion #3 of th e qu estion n a ir e sh ou ld be n oted h er e in
th e sta keh ol ders own wor ds.
E. Po s i ti o n: Suppo rts / Oppo s e s / Ne utral
Position r efers to th e sta keh older s sta tu s a s a su ppor ter or oppon en t of th e policy. Th e position
of t h e sta keh older ca n be obta in ed by ga th eri n g in for m a tion dir ectl y fr om th e sta keh older ( i.e.,
self- r epor tin g) a n d t h r ou gh in for m a tion ga th er ed i n dir ect ly from oth er sta keh ol ders or secon d-
a ry in for m a ti on ( i.e., ot h er s perception s) . Th u s, th e repor ti n g in th is col u m n r epr esen ts t h e
self- r epor ted cla ssi fica tion ( colu m n E1) , th e cla ssifica tion by oth er s ( colu m n E2) , a n d a fi n a l
cla ssifica t ion con si deri n g both ( colu m n E3) . Th e position of th e sta keh ol der sh ou ld be r epor ted
fr om th is fin a l cla ssifi ca tion ( colu m n E3) .
Sta keh older s wh o a gr ee wit h th e im pl em en ta ti on of th e poli cy a r e con si dered su ppor ters ( S) ;
th ose wh o disa gr ee with th e policy a r e con sidered oppon en ts ( O) ; a n d th ose wh o do n ot h a ve a
clea r opi n ion , or wh ose opin ion cou ld n ot be di scer n ed, a r e con sider ed n eu t ra l ( N) . Th ose wh o
expr ess som e, bu t n ot tota l, a gr eem en t with th e policy sh ou ld be cla ssified a s m oder a te su ppor t-
er s ( MS) . Fi n a lly th ose wh o express som e, bu t n ot tota l, opposi tion to th e poli cy sh ou ld be cla s-
sified a s m oder a te oppon en t s ( MO) . Th u s, in colu m n E1, t h e posit ion of th e sta keh older a s t h ey
sta te it i n t h e in ter view sh ou ld be en ter ed ( S, MS, N, MO, or O) .
I n colu m n E2, th e posi tion of th e st a keh older a s per cei ved by ot h er sta keh ol der s a n d/ or fr om
secon da r y in for m a tion sh ou ld be en ter ed with a r efer en ce t o th e I D n u m ber of th e per son wh o
sta ted th a t opin ion . For exa m pl e, S 32 wou ld m ea n th a t sta keh older n u m ber 32 st a ted in h is or
h er in ter view th a t th e sta keh ol der u n der a n a lysis wou ld su ppor t th e policy. I n colu m n E2, th e
posi tion of th e sta keh older a s ot h er s per ceive it sh ou ld be en ter ed ( S, MS, N, MO, or O) with t h e
I D n u m ber for ea ch opin ion .
La st ly, i n colu m n E3, th e fin a l deter m i n a tion for th e posit ion of th e sta keh older sh ou ld be
en t er ed ( a fter en teri n g da ta from a l l in ter views) . Th i s posi tion sh ou ld ta ke in to a ccou n t th e
self- r epor ted positi on a s well a s ot h er st a keh older s opin ion s. S, MS, N, MO, a n d O ca n be
en t er ed i n t h is colu m n .
F. Inte re s t
Th e in ter est th e sta keh ol der h a s i n th e policy, or th e a dva n ta ges a n d disa dva n ta ges t h a t i m ple-
m en ta ti on of th e poli cy m a y bri n g to th e st a keh older or h is or h er or ga n i za tion . Adva n ta ges a n d
disa dva n ta ges m en tion ed by ea ch of t h e sta keh older s sh ou ld be en ter ed i n to th is colu m n in a s
m u ch deta il a s possible, sin ce th e i n for m a ti on wil l be u sed pr im a r il y in developin g con clu si on s
a n d str a tegi es for dea l in g with th e sta keh olders con cer n s.
G. Al l i ance s
A u n ion or r ela tion sh ip( Webster, 1984) . Allia n ces a r e for m ed wh en t wo or m ore or ga n iza -
tion s colla bor a te to m eet th e sa m e objective, in th is ca se to su pport or oppose th e policy in qu es-
tion . An y or ga n iza t ion s th a t a r e m en tion ed by th e sta keh older in th e qu estion s rela ted to th is
item sh ou ld be en ter ed in th is colu m n .
H. Re s o urce s
A sou r ce of su ppor t or a i d( Webster, 1984) . Resou r ces ca n be of m a n y types h u m a n , fi n a n -
cia l, t ech n ologica l, poli tica l, a n d oth er. Th e a n a l ysts sh ou ld con sider th e sta keh older s a ccess to
a ll of th ese r esou rces.
Th e r esou r ce ca t egory is di vided in to two pa r ts: th e qu a n t ity of r esou r ces th a t a sta keh older
h a s wit h in h i s or h er or ga n iza tion or a r ea , a n d t h e a bility to m obili ze th ose resou rces. Th e
qu a n t ity of r esou r ces sh ou ld be cla ssi fied by th e a n a lysts a s 3 = m a n y, 2 = som e, 1 = few a n d
in ser ted in to colu m n H1 of th e sta keh older t a ble. Fi n a l ra n ki n gs sh ou ld be r eviewed to en su r e
con sisten t scori n g a m on g a ll sta keh ol ders.
Th e a bility of th e sta keh older to m obilize resou r ces sh ou ld be qu a n tified in term s of:
3 = th e sta keh older ca n m a ke decision s r ega r di n g th e u se of th e r esou r ces in h is or h er
orga n iza tion or a r ea
2 = th e sta keh older is on e of sever a l person s th a t m a kes decision s rega r din g th e u se of
r esou r ces
1 = th e sta keh older ca n n ot m a ke decision s r ega r din g th e u se of th e r esou rces.
Th is scor e sh ou ld be in sert ed in to col u m n H2. For exa m ple, if th e sta keh older h a s per son n el
th a t work for h im or h er, it ca n be con clu ded th a t th e st a keh older h a s th e a bili ty t o m obi lize
th ese r esou r ces beca u se h e or sh e h a s dir ect in flu en ce over t h em .
I. Po we r
Th e ca pa cit y or a bility to a ccom pli sh som eth in g;str en gth , force or m igh t( Webster, 1984) .
Her e, power r efer s to th e a bi lity of t h e st a keh older to a ffect t h e im plem en t a t ion of th e h ea lth
r efor m policy du e to t h e str en gth or for ce h e or sh e possesses.
Sin ce power is defin ed h er e a s th e com bin ed m ea su re of th e a m ou n t of r esou r ces a sta ke-
h older h a s a n d h is or h er ca pa city to m obilize t h em , th e two resou rce scor es im pl ied sh ou ld be
a ver a ged, r esu ltin g in a power in dex between 3 a n d 1: 3 = h igh power, 2 = m edi u m power, a n d
1 = little power. Th e fin a l r a n kin gs sh ou ld be r eviewed to en su r e con sisten t scor in g a m on g a ll
sta keh older s.
J. Le ade rs hi p
To dir ect th e a ct ivity;to st a r t, begin ;fr on t , forem ost( Webster, 1984) . Lea der sh i p is spe-
cifi ca lly defin ed h er e a s th e will in gn ess to in itia te, con voke, or l ea d a n a ction for or a ga in st th e
h ea l th r efor m pol icy. Th e sta keh ol der ei th er h a s th is ch a r a cter istic ( " yes") or la cks i t ( "n o") .
Th is is r epr esen ted with "yes" or " n o."
Anne x 2 - C
Sampl e Stake ho l de r Tabl e
( On r ever se side of th i s sh eet.)
B
C
G
I
J
P
o
s
i
t
i
o
n
l
n
t
e
r
n
/
A
l
l
i
a
n
c
e
s
R
e
s
o
u
r
c
e
s
P
o
w
e
r
L
e
a
d
e
r
&
E
x
t
e
r
n
1
2
1

S
e
l
f
3

F
i
n
a
l
O
r
g
a
n
i
z
a
t
i
o
n
s
2

A
b
i
l
i
t
y

t
o
R
e
s
o
u
r
c
e
s
Y
e
s
r
g
a
n
i
z
a
t
i
o
n
l
L
e
v
e
l
D
e
f
i
n
i
t
i
o
n
S
,

M
S
,
S
,

M
S
,
l
.
D
.
S
,

M
S
,
m
e
n
t
i
o
n
e
d
m
o
b
i
l
i
z
e
a
v
e
r
a
g
e
N
o
E
3
,
2
,
1
N
,

M
O
,

O
N
,

M
O
,

O
#
N
,

M
O
,

O
3
,

2
,

1
3
,

2
,

1
A
d
v
a
n
t
.
/
l
n
t
e
r
e
s
t
s
F
1
K
n
o
w
l
e
d
g
e
D
Q
u
a
n
t
i
t
y
3
,
2
,
1
2

O
t
h
e
r
s
E
P
o
s
i
t
i
o
n
H
d
i
s
a
d
v
a
n
t
.
Anne x 2 - D
Sampl e Stake ho l de r Inte rvi e w Que s ti o nnai re
Da te: _ _ _ / _ _ _ / _ _ _ _ _ I D #: _ _ _ _ _
Cit y: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Intro ducti o n:
We a r e from ( or ga n iz a tion n a m e) a n d we a re con du ctin g a stu dy on beh a lf of ( spon sor n a m e
if a ppr opr ia te) to explore th e opin ion s of severa l im porta n t a ctors wh o a re in terested in th e
im proved m a n a gem en t of th e Min istr y of Hea lth . As a n im porta n t a ctor in th e h ea lth sector, it is
cru cia l for u s to obta in you r opin ion a n d th a t of you r orga n iza tion .
We pla n to con du ct a bou t 35 to 40 i n ter views to produ ce a gen era l r epor t on th e opin ion s of
th e m a jor h ea l th sector a ct ors. Th e i n for m a t ion obta i n ed th r ou gh th ese in ter vi ews will be for
th e dir ect u se of th e con su lta n ts on t h e a n a lysis t ea m , a n d will be pr esen ted in a gen er a l r epor t
to ( in ser t or ga n iz a tion for whom r epor t is d on e if a ppr opr ia te) with ou t i den ti fyin g in di vid-
u a l opi n ion s.
We wou ld n ow li ke to a sk you a few specific qu estion s a bou t you r opin i on r ega r din g th e
im plem en ta t ion of decon cen tr a t ion of th e MOH.
Yo ur Opi ni o n:
1. Ha ve you h ea r d of th e Min istr y of Hea lth policy on "decon cen tr a tion "?
2. I f so, h ow did you h ea r of it?
3. Wh a t do you u n der st a n d " decon cen tr a tion of th e MOH" to m ea n ?
Th e Mi n istr y of Hea lt h h a s defin ed " decon cen t ra ti on " a s "per m a n en tly delega tin g con tr ol over
r esou r ces t o th e Provin ci a l Dir ector s, Hospita l Dir ector s a n d Area Ch iefs." Th e deci sion s th a t
th ese levels wou ld h a ve con tr ol over i n clu de 1) n a m in g a n d m a n a gin g per son n el, 2) bu yin g
equ i pm en t a n d su pplies, a n d 3) u sin g a n y fu n ds ea rn ed a t ea ch fa cility.
4. Wh a t a re th e poten tia l ben efits to you a n d you r or ga n iza tion of th e decon cen tr a tion of
th e MOH a s th e Min istr y h a s defin ed i t?
5. Wh a t a re th e poten tia l disa dva n ta ges to you a n d you r or ga n iza tion of th e decon cen tr a -
tion of t h e MOH a s th e Min istr y h a s defin ed it?
6. Wh ich of th ese ca tegor ies best descr ibes you r opin i on on th e decon cen tr a tion of t h e MOH
a s th e Min istr y h a s defi n ed it? ( Rea d the option s a n d cir cle the a n sw er giv en . )
a ) I st ron gly su ppor t it
b) I som ewh a t su ppor t i t
c) I do n ot su ppor t n or oppose it
d) I som ewh a t oppose it
e) I str on gly oppose it
I f sta keh older a n swer s a , b, or c, con tin u e below. I f st a keh older a n swer s d or e, pa ss to qu estion
#10.
For th ose wh o a n swer "a ,""b," or " c" to qu est ion #6:
7. Wh ich of th e t h r ee a spects of decon cen t ra t ion do you su ppor t?
a ) Decon cen tr a ted con t rol over n a m i n g a n d m a n a gin g person n el
b) Decon cen tr a ted con t r ol over bu yin g equ ipm en t a n d su pplies
c) Decon cen tr a t ed con tr ol over th e u se of fu n ds gen er a ted a t ea ch fa cil ity
8. For th ose a spects of decon cen t ra t ion t h a t you do su pport,
a ) I n wh a t m a n n er wou ld you dem on st ra te th is su ppor t?
b) Wou ld you t a ke th e i n iti a t ive in su pport in g decon cen tr a tion , or wou ld you wa it for
oth ers to do so?
c) Do you h a ve fin a n cia l or h u m a n r esou r ces a va ila ble to su ppor t th i s policy?
d) Wh ich r esou r ces a r e a va ila ble a n d h ow qu ickly ca n th ey be m obilized?
e) Wou l d th i s su pport be pu blic?
f) Wh a t con dit ion s wou l d h a ve to exist for you to expr ess t h is su ppor t?
g) Wou ld you a l ly wi th a n y oth er per son s or or ga n iza tion s in th ese a ction s? Wh ich per -
son s/ or ga n iza tion s?
9. Un der wh a t con dition s wou ld you ch oose NOT t o su pport decon cen tr a tion ?
For th ose wh o a n swer ed "d" or "e" t o qu est ion #6:
10. Wh ich of th e fol lowin g a spects of decon cen tr a ti on do you oppose:
a ) Decon cen tr a ted con t rol over n a m i n g a n d m a n a gin g person n el
b) Decon cen tr a ted con t r ol over bu yin g equ ipm en t a n d su pplies
c) Decon cen tr a t ed con tr ol over th e u se of fu n ds gen er a ted a t ea ch fa cil ity
11. For th ose a spects t h a t you oppose:
a ) I n wh a t m a n n er wou ld you dem on st ra te th is opposi tion ?
b) Wou ld you t a ke th e i n iti a t ive in opposin g decon cen tr a tion , or wou l d you wa it for oth -
er s to do so?
c) Do you h a ve fin a n cia l or h u m a n resou rces a va ila ble to su pport th is policy?
d) Wh ich r esou r ces a r e a va ila ble a n d h ow qu ickly ca n th ey be m obilized?
e) Wou l d th i s opposit ion be pu bli c?
f) Wh a t con diti on s wou l d h a ve to exist for you to expr ess t h is opposition ?
g) Wou ld you a l ly wi th a n y ot h er per son s or or ga n iza tion s in th ese a ct ion s? Wh ich per -
son s/ or ga n iza tion s?
12. Un der wh a t con dition s wou ld you com e to su pport decon cen tr a t ion ?
We wou ld n ow li ke to a sk you a few specific qu estion s a bou t you r opin i on r ega r din g oth er s'
opin ion s of th e im pl em en ta ti on of decon cen t ra t ion of th e MOH.
Othe r Suppo rte rs :
13. Wh a t ot h er or ga n i za t i on s, depa r t m en t s wi t h i n a n or ga n i za t i on , or per son s do you
t h i n k wou l d su ppor t decon cen t r a t i n g t h e MOH? ( Pr ob e for MOH a n d n on - MOH
sta k ehold er s)
14. Wh a t do you th in k t h ese su pport er s wou ld ga i n from t h e decon cen t ra ti on of th e MOH?
15. Wh ich of th ese su ppor ter s wou ld ta ke th e in itia ti ve to a ct ively su ppor t decon cen tr a tion ?
Othe r Oppo s o rs :
16. Wh a t oth er orga n iza tion s, depa r tm en t s with in a n or ga n iza t ion , or per son s do you t h in k
wou ld oppose decon cen tr a tin g th e MOH? ( Pr ob e for MOH a n d n on - MOH sta k ehold er s)
17. Wh a t do you th in k t h ese oppon en t s wou ld ga in fr om pr even ti n g th e decon cen tr a tion of
th e MOH?
Anne x 2 - E
Sampl e Info rmati o n Trans fe r Re fe re nce Chart
C
G
I
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A
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a
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e

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