Data, dialogue and differences: multi-stakeholder process at work

Posted on 18 September 2009

Andrew Chetley, Communication and Capacity Strengthening Director MeTA

Multi-stakeholder processes (MSPs) are increasingly being seen in international development as important ways to deal with complex issues and plug gaps in global policy making. They are being hailed by many as a more inclusive and effective tool for complex, ambiguous and dynamic challenges. Although the MeTA national stakeholder processes are still in their formative stages and there is still a great deal to learn, some lessons are beginning to emerge. The right mix of participants, time, clarity of aim and approach, resourcing and facilitation all play key roles in the likelihood of success.

Multi-stakeholder processes are those which aim to bring together all major stakeholders in a new form of communication, decision-finding (and possibly decision-making) on a particular issue. They are also based on recognition of the importance of achieving equity and accountability in communication between stakeholders, involving equitable representation of three or more stakeholder groups and their views. They are based on democratic principles of transparency and participation and aim to develop partnerships and strengthened networks among stakeholders.

MeTA is a country-led initiative. National councils decide to focus on one or more of four main areas to improve information flows: quality, availability, price, promotion. The twin hypotheses that MeTA sets out to test are that:

• No single institution or agency can deal with the complex interventions needed to improve access to medicines.
  
  
• If more information about the quality, availability, pricing and promotion practices of medicine is available in the public domain, the public has more opportunity to understand this information and act on it. This, in turn, can lead to greater public debate about medicines, increased pressure to improve public policy and drive improvements in the procurement, distribution, promotion, sale, prescription, use of and ultimately access to medicines.

The benefits of multi-stakeholder initiatives are that they help to:

• Broaden discussion and identify global public needs;
• Facilitate negotiation;
• Gather and disseminate knowledge;
• Create and correct markets, and
• Broaden participation in global governance.

However much multi-stakeholder initiatives hold promise, they are challenging and their role and relevance – and indeed their likely impact or benefits – are still contested. Some critics doubt that multi-stakeholder cooperation can promote effective and legitimate global policymaking. They argue that the voluntary nature of their agreements or outcomes lack the clout to respond to coordination failures and will only feed new bureaucratic structures, or serve already powerful actors, such as “big business” and “the North”.  Multi-stakeholder initiatives can prove difficult for civil society representatives, who can be left out in the early stages or be overwhelmed. Also challenging is the investment of time and effort required to build the quality working relationships that underpin effective collaboration.

The involvement of the key stakeholders is critical. In several countries taking part in the MeTA pilot, it has become clear that the initial mix of people around the table was missing key players. In the Phillipines, for example, private sector representation was minimal, and missed out any involvement from the key distribution mechanism for some 80 per cent of medicine supply in the country. An analysis of civil society involvement also led to a process where different representatives were selected from among a newly formed coalition of groups that represent a broad spectrum of interests.

Building trust, understanding, respect, confidence and ultimately consensus all takes time – more than is initially anticipated. It also takes time and ongoing dialogue to deal with the issues of sharing power. In Ghana, Jordan and Uganda, the national multi-stakeholder groups have had to grapple with issues of decision-making power and the respective roles and responsibilities of different stakeholder groups. This is helping to transform the process from a consultation around pre-determined (usually government-led) policy conclusions to a more open dialogue around options and possibilities that is owned by all parties.

Clarity of aim and purpose is a real challenge for the MeTA process. MeTA is better described by what it is not – a fund, a service delivery mechanism, a medicines supply mechanism – than by what it is. Its role as a catalyst, a facilitator, a unifier and coordinating mechanism is often perceived as near invisible, particularly in the midst of what is often a strong results-based environment. Not surprisingly, a range of activities have been identified in workplans that attempt to give form to and provide outputs from the engagement process. In several countries, however, there is a worry that these outputs will be owned by the group leading on their development, rather than being a consensus effort. In Uganda, for example, an activity to strengthen the database quality and web presence of information from the National Drug Administration is a clear improvement in transparency, but engagement of the other stakeholders in both the process of doing this and, more importantly, in the analysis of the information and its implications for policy change is that aim and purpose that lies at the heart of MeTA’s added value. The degree to which that happens is what will be important, not only in Uganda, but in all the countries.

Over the next 12 months at both the international and national levels MeTA will be working to:

• Ensure progressive disclosure of data about medicines;
• Develop further and evaluate the multi-stakeholder approach and prepare stakeholders for meaningful engagement;
• Ensure the strong engagement of the private sector; 
• Support efforts to increase the voice of patients and consumers and strengthen capacity and opportunity for their engagement, and
• Document innovation, change and good practice across the programme.

As more lessons emerge across the programme, MeTA will be able to add to the growing evidence about how multi-stakeholder processes can be used to grapple with complex international health and development issues in meaningful ways. Underlying this approach is the fundamental commitment spelled out in the Alma Ata declaration on primary health care that participation of key stakeholders in the determination and implementation of health care was both a right and a responsibility.

Note: This article is compiled of short extracts from a longer article due to be published soon.