Engaging stakeholders: lessons from the use of participatory tools for improving maternal and child care health services

Background: Effective stakeholder engagement in research and implementation is important for improving the development and implementation of policies and programmes. A varied number of tools have been employed for stakeholder engagement. In this paper, we discuss two participatory methods for engaging with [stakeholders - participatory social network analysis (PSNA) and participatoiy impact pathways analysis (PIPA). Based on I our experience, we derive lessons about when and how to apply these tools. Methods: This paper was informed by a review of project reports and documents in addition to reflection meetings I with the researchers who applied the tools. These reports were synthesised and used to make thick descriptions of the applications of the methods while highlighting key lessons. Results: PSNA and PIPA both allowed a deep understanding of how the system actors are interconnected and how they influence maternal health and maternal healthcare services. The findings from the PSNA provided guidance on how stakeholders of a health system are interconnected and how they can stimulate more positive interaction between the stakeholders by exposing existing gaps. The PIPA meeting enabled the participants to envision how they could expand their networks and resources by mentally thinking about the contributions that they could make to the project. The processes that were considered critical for successful application of the tools and achievement of outcomes included training of facilitators, language used during the facilitation, the number of times the tool is applied, length of the tools, pretesting of the tools, and use of quantitative and qualitative methods. Conclusions: Whereas both tools allowed the identification of stakeholders and provided a deeper understanding of the type of networks and dynamics within the network PIPA had a higher potential for promoting collaboration between stakeholders, likely due to allowing interaction between them. Additionally, it was implemented within a participatory action research project. PIPA also allowed participatoiy evaluation of the project from the perspective of the community. [This paper provides lessons about the use of these participatory tools.