Policy For Public Sector Reform

Policy Toolkit for
Str engthening Health

Sector Refor m
Policy Toolkit for
Strengthening Health
Sector Reform
September 2000
%,-0 41 4390398
1 . I ntroduction to the Toolkit and the Policy Process
by Susan Scr ibner and Der ick Br inker hoff
Th e Pol itica l Pr ocess a n d Hea lt h Sector Refor m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- 1
Wh o Sh ou ld Use th i s Toolkit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- 2
How To Use th is Toolkit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- 2
Tips for Va r iou s User s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- 5
Bibli ogr a ph y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- 8
2. Stakeholder Analysis Guidelines
by Kammi Schmeer
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
3. Advocacy Guidelines
by Susan Scr ibner and Bar bar a OHanlon
I n tr odu ct ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 1
Developin g a n Advoca cy Str a tegy: Com pon en t I Lookin g Ou twa r d . . . . . . . . . . . . . . . . . . 3- 5
Step 1: Un dersta n d th e Pol itica l Deci si on - Ma ki n g Process . . . . . . . . . . . . . . . . . . . . . . . . . 3- 6
Step 2: Select a n d Defin e a Hea lt h Refor m Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 7
Step 3: Set Advoca cy Object ives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 10
Step 4: I den t ify a n d An a l yze Au dien ces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 12
Developin g a n Advoca cy Str a tegy: Com pon en t II Looki n g I n wa r d . . . . . . . . . . . . . . . . . 3- 16
Step 5: Select Advoca cy Activi ties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 17
Step 6: I m pl em en t Advoca cy Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 27
Developin g a n Advoca cy Str a tegy: Com pon en t II I Lookin g Ah ea d . . . . . . . . . . . . . . . . . . 3- 28
Step 7: Eva lu a te a n d Adju st Str a tegy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 29
Con clu sion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 30
Bibli ogr a ph y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 32
An n ex 3- A: Au di en ce I den tifica tion Wor ksh eet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 3
An n ex 3- B: Au dien ce Kn owl edge, Position , a n d I n ter est s Worksh eet . . . . . . . . . . . . . . . . . . . 3- 35
An n ex 3- C: Allies a n d Opposition Ma tr ix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 37
An n ex 3- D: Messa ge Con t en t Wor ksh eet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 39
An n ex 3- E: Selectin g a Messen ger Wor ksh eet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 41
An n ex 3- F: Com m u n ica tion s Pla n Wor ksh eet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 43
4. Conflict Negotiation Guidelines
by Kathleen Novak and Chr istianne Hall
I n tr odu ct ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 1
Un der sta n din g Con flict . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 5
Developin g Effective I n terperson a l Com m u n ica tion Ski lls
a n d Bu ildi n g Wor kin g Rela tion sh ips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 11
Ma n a gin g th e Negotia ti on Process: An I n terest -Ba sed Approa ch . . . . . . . . . . . . . . . . . . . . . . 4- 17
Resu lt s of Effective Con flict Negotia ti on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 26
Bibli ogr a ph y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 27
An n ex 4- A: Negot ia tion Style Assessm en t a n d Scor i n g Sh eet . . . . . . . . . . . . . . . . . . . . . . . . . 4- 29
An n ex 4- B: Self- I n ven tor y Wor ksh eet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 39
An n ex 4- C: Negotia tion Prepa r a tion Wor ksh eet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 41
5. I ntroduction to Strategic Management
by Susan Scr ibner
Figu r e 5.1. Fa cets of Str a tegic Ma n a gem en t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5- 2
Figu r e 5.2. Str a tegic Ma n a gem en t of On e St a ge of t h e Policy Process . . . . . . . . . . . . . . . . . 5- 4
Ta ble 5.1. Five Fa cets of Str a tegic Ma n a gem en t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5- 3
Bibli ogr a ph y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5- 5
An n ex 5- A. Str a tegic Pla n n in g a n d Str a tegi c Ma n a gem en t . . . . . . . . . . . . . . . . . . . . . . . . . . 5- 6
List of Boxes
Box 1.1. Polit ica lly dom i n a ted a r en a of th e policy pr ocess . . . . . . . . . . . . . . . . . . . . . . . . 1- 3
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 si n g
su pport for decon cen tr a tion of th e MOH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- 30
Box 3.1. Discu ssion qu esti on s: How pol icy decision s a r e m a de . . . . . . . . . . . . . . . . . . . . . 3- 6
Box 3.2. Hea lth r eofr m policy defi n iti on #1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 8
Box 3.4. Discu ssion qu esti on s: Deter m in in g if a policy is poli tica lly vi a bl e . . . . . . . . . . . 3- 9
Box 3.5. Discu ssion qu esti on s: Set tin g a dvoca cy objecti ves . . . . . . . . . . . . . . . . . . . . . . . 3- 11
Box 3.6. Advoca cy object ive #1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 11
Box 3.8. Discu ssion qu esti on s: En su r in g th a t a dvoca cy object ives a r e SMART . . . . . . . . 3- 11
Box 3.9. Discu ssion qu esti on s: I den tifyin g t a r get a u dien ces . . . . . . . . . . . . . . . . . . . . . . 3- 13
Box 3.10 Au dien ces for h ea lt h r eform i n Ecu a dor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 13
Box 3.11. Th e ben efit s of n etwor ks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 18
Box 3.12. Types of coa li tion s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 19
Box 3.13. Colla bor a tion to str en gth en com m u n i ty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 20
Box 3.14. Equ i ty a s a h ea l th sector objective in Ecu a dor . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 20
Box 3.15. Discu ssion qu esti on s: Developin g a n d deliveri n g policy m essa ges . . . . . . . . . . 3- 22
Box 3.16. Decen tr a lizin g h ea lth ser vices. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 23
Box 3.17. Differen t form a ts for n a tion a l h ea lth a dvoca cy in Ecu a dor . . . . . . . . . . . . . . . 3- 25
Box 3.18. Usin g m a ss m edia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 27
Box 3.19. Lobbyin g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 27
Box 3.20. Discu ssion qu esti on s: Mon itor in g you r pr ogr ess . . . . . . . . . . . . . . . . . . . . . . . . 3- 30
Box 3.21. Discu ssion qu esti on s: Eva lu a t in g you r r esu lt s . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 31
Box 4.1. Str a tegic qu estion s to a sk wh en you a r e defin in g
th e issu e a n d decidin g to n egotia te . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 18
Box 4.2. Br a in stor m in g tech n iqu es . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 23
Box 4.3. Som e object ive cr iter ia for h ea l th sector r efor m issu es . . . . . . . . . . . . . . . . . . . 4- 23
List of Figures
Figu r e 1.1. Th e Pol icy Pr ocess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- 3
Figu r e 2.2. Spectr u m of Sta keh ol der Position 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
Figu r e 3.1. Policy Sta ges, Tech n ica ll y Dom in a ted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 3
Figu r e 3.2. Com pon en ts of a n Advoca cy Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 10
Figu r e 3.3. Exa m ple of a Per son a l Net wor k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 18
Figu r e 3.4. Th e SEE Meth od . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 23
Figu r e 4.3. Th e Policy Pr ocess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 4
Figu r e 4.4. Con flict Negotia ti on Styles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 7
Figu r e 4.5. Con flict Sca le . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 10
Figu r e 5.1. Fa cets of Str a tegic Ma n a gem en t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5- 2
List of Tables
Ta ble 1.1. Policy Sta ges a n d Rel a ted Ta sks i n t h e
Tech n ica lly Led Dom a in of th e Policy Pr ocess . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- 4
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
Ta ble 3.1. Exa m ple of Costs a n d Ben efit s of a Hea lth Refor m Poli cy: I n cr ea sed Effi cien cy in
Use of MOH Resou r ces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 8
Ta ble 3.2. Possible Key Actor s a n d Sta keh older s i n Hea l th Refor m . . . . . . . . . . . . . . . . . . 3- 14
Ta ble 3.3. Adva n ta ges a n d Disa dva n t a ges of Coa l ition s . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 19
Ta ble 3.4. Da ta Sou r ces for Hea lt h Sector Refor m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 21
Ta ble 4.1. Assessin g th e Rel a tive Power of Negotia ti n g Tea m s . . . . . . . . . . . . . . . . . . . . . . 3- 19
Acronyms
DDM
Da ta for Decision Ma kin g
FPMD
Fa m ily Pla n n in g Ma n a gem en t Developm en t
LAC HSR
La tin Am er ica n a n d Ca r ibbea n Region a l Sector Refor m I n itia t ive
MOH
Mi n istr y of Hea lt h
NGO
Non gover n m en t a l Or ga n iza t ion
PAHO
Pa n Am er ica n Hea l th Orga n i za tion
PHR
Pa rt n er sh ip for Hea lth Reform
USAID
Un ited Sta tes Agen cy for I n tern a tion a l Developm en t
Section 1
Intr oduction
Susan Scr ibner
Der ick Br inker hoff
Section 1
I ntroduction to the Toolkit
and the Policy Process
Table of Contents
Th e Pol itica l Pr ocess a n d Hea lt h Sector Refor m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- 1
Wh o Sh ou ld Use th i s Toolkit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- 2
How To Use th is Toolkit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- 2
Tips for Va r iou s User s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- 5
Bibli ogr a ph y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- 8
List of Boxes, Figures, and Tables
Box 1.1. Polit ica lly dom i n a ted a r en a of th e policy pr ocess . . . . . . . . . . . . . . . . . . . . . . . . 1- 3
Ta ble 1.1. Policy Sta ges a n d Rel a ted Ta sks i n t h e
Tech n i ca lly Led Dom a in of th e Policy Pr ocess . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- 4
Section 1
I ntroduction to the Toolkit
and the Policy Process
The Political Process and Health Sector Reform
1
Ma n y La t in Am er ica n cou n tr ies h a ve begu n to refor m t h eir h ea lth sector s. In th ese cou n tr ies, a
lot of deba te, a n a l ysis, a n d a ssi st a n ce h a s been dir ected towa r d th e tech n ica l con ten t of t h e
r efor m s. Often , th e gover n m en t deter m in es th e dir ect ion a n d ou t lin e of h ea lt h sector r efor m s.
On ce th er e is con cu r r en ce on th e gen er a l di rection of reform , r espon sibilit y i s tr a n sfer r ed from
th e pol iticia n s to h ea lth sector refor m t ea m s or oth er gr ou ps of t ech n ica l exper ts with i n th e gov-
er n m en t, u su a lly in th e m in istr y of h ea l th . Alth ou gh th ese tech n i ca l exper ts a r e oft en ski lled
a n a lysts, th ey m a y la ck th e ski lls a n d exper ien ce n eeded to n egoti a te t h e com pl ex polit ica l pr o-
cess t h a t i s a t t h e cor e of h ea l th sector r efor m . I n fa ct, u n t il r ecen tly, few h a ve pa id m u ch a tten -
tion to t h e pol itica l fea sibil ity of r efor m s.
Now, a gr owin g n u m ber of obser ver s a n d pa rt icipa n t s h a ve begu n t o a ckn owledge a n d
becom e i n terest ed in th e poli tica l process th a t u n der lies h ea lt h sector r efor m . Despi te th is
in crea si n g r ecogn ition of th e r ole of politics, h owever, h ea lt h sector tech n ica l exper ts m a y n ot
r ecogn ize t h a t pol icy refor m is a pr ocess th a t ca n be m a n a ged or con sider m a n a gi n g th a t pr o-
cess t o be pa r t of th eir j ob. Fu rth er m or e, t h ey m a y n ot u n der sta n d howto m a n a ge th e politica l
en vir on m en t a n d in flu en ce th e policy pr ocess in or der to in crea se th e fea si bility a n d su ccess of
proposed r eform s.
Th is toolkit wa s design ed specifica lly to h elp h ea lt h sector r efor m tea m s better u n der sta n d
th e n a t u r e of th e polit ica l pr ocess a n d develop skill s to a ctively m a n a ge th a t pr ocess.
Th e rem a in der of th is in tr odu ctor y sect ion pr esen ts a con ceptu a l fra m ewor k for u n der sta n d-
in g t h e va ri ou s sta ges of th e policy pr ocess a s well a s for u sin g th e gu i delin es a n d tools in clu ded
in th i s toolkit.
1. Th e a ppr oa ch t o h ea lt h r efor m ou tl in ed i n t h is i n tr odu cti on dr a ws h ea vil y on th e ea r li er con cept pa per for th i s
tool kit ( Br in ker h off et a l ., 1999) .
1-2 Po licy Too lkit fo r Str en gth ening Health Secto r Refor m
Who Should Use this Toolkit
Th is toolkit is in ten ded for h ea lt h sect or r efor m tea m s a n d oth er s in volved in m a kin g a n d in flu -
en cin g h ea lt h poli cy decision s. Hea lt h sector r efor m tea m s m a y in cl u de m i d- level a n d h igh -
level officia ls i n t h e m in istr ies of h ea lt h , pla n n i n g, or fin a n ce; in - cou n tr y h ea lt h pr ofession a ls;
m em bers of pr ofession a l a ssocia t ion s; a n d h ea lth econ om i st s. Oth er s a lso m a y fin d th e toolkit
u sefu l, in clu din g n on gover n m en t a l or ga n iza t ion s ( NGOs) , don or s, or m a n a ger s of h ea lth
fa cil ities. In sh or t, ever yon e with a n in ter est i n th e pr ocess a n d ou tcom es of h ea lth sector r efor m
will ben efit fr om u sin g th is pol icy toolkit beca u se it h el ps th em pri or it ize a n d m a n a ge th eir
in t er ests a n d in fl u en ce th e h ea lth r efor m process. ( Th e fin a l section of t h is i n tr odu cti on
descr ibes h ow va r iou s u ser s m igh t a pply th e gu idel in es a n d tools.)
Th e gu ida n ce in th is tool kit will be especia lly u sefu l t o policy ch a m pion s per son s or tea m s
willi n g a n d a ble to lea d a n d m a n a ge th e policy pr ocess. Policy ch a m pi on s pr oa ctively prom ote
policy r eform s, pu blicly su ppor t th e poli cies, a n d foster th e su ppor t of ot h er s. Th ey fr a m e discu s-
sion of th e i ssu e, bu ild con sen su s, a tt ra ct r esou r ces, a n d seize a n d cr ea te oppor tu n iti es to m ove
th e r efor m for wa r d. I dea ll y, m em ber s of a ll h ea lth sect or r efor m tea m s will a ct a s policy ch a m -
pion s.
How To Use this Toolkit
Understand the Policy Process
Th e fi rst step i n u sin g th is tool kit i s to r eview a n d u n der sta n d t h e policy pr ocess. Hea lth sector
r efor m is a n in h er en tly politica l pr ocess th a t i n volves th e r ea ll oca tion of li m i ted r esou r ces
with in a n ever-ch a n gin g politi ca l en vir on m en t. Th e con cept u a l fra m ewor k pr esen ted i n
Secti on 2 ( see Figu re 1.1) descr ibes th e sta ges of th e pr ocess a n d is a gu ide for determ in in g
wh er e you a r e a n d wh ere you n eed t o be. Ta ble 1.1 ou t lin es th e ta sks th a t m u st be com plet ed a t
ea ch sta ge if t h e h ea lt h sector r efor m s a r e t o be clea r ly defin ed a n d effecti vely im plem en ted
( Crosby 1996) .
Rea lit y, h owever, is a lwa ys m or e com plex th a n m odels. Th e sta ges of th e poli cy pr ocess a re
iter a ti ve, n ot str ictly sequ en ti a l . Th er efore, com pletion of on e sta ge does n ot gu a r a n tee m ove-
m en t to th e n ext ( Porter and Hicks1994) . Nor i s pr ogr ess i n on e sta ge depen den t on com ple-
tion of a ll th e t a sks in th e pr eviou s sta ge. By sim plifyin g r ea lity, h owever, th e m odel ca n h elp you
deter m in e wh er e you a n d you r refor m a gen da a r e with in th e policy pr ocess a n d focu s you r
a tten tion on th e ta sks you m u st com plet e a t ea ch sta ge. Th is is cr itica l , sin ce th e ta sks will n ot
be com pleted with ou t you r a t ten tion a n d in terven t ion . It is you r job, a s a m em ber of t h e h ea lth
sector r efor m tea m a n d a s a policy ch a m pion , to r ecogn ize th e n ecessa r y ta sks a n d con t ri bu te to
th eir com pleti on . Th e con ceptu a l fr a m ewor k ca n h elp you a ssess you r politica l r ea lit y, develop
str a t egies to a ch ieve you r r efor m object ives, a n d st ra tegica lly m a n a ge t h e r efor m process by
a n a lyzin g th e situ a t ion wi th in th e m in istr y of h ea l th ( or oth er or ga n iza ti on r espon sible for
r efor m ) , a ssessin g wh a t i s h a ppen i n g beyon d th e m in istr y, a n d deter m in i n g th e best str a tegy for
a ch i evin g you r lon g- ter m h ea lth r efor m goa ls.
Policy champions: persons
or teams who are willing
and able to lead and man-
age the policy process
A conceptual framework of
the policy process can
guide your efforts by help-
ing you determine where
you are and where you
need to be.
Intr o duction to the Too lk it and the Policy Pr o cess 1-3
Th e policy pr ocess is la u n ch ed wh en poli cy issu es, a gen da s, a n d decision s com e togeth er,
a n d t h e dir ection is set for h ea lt h sector r efor m . Th is is a poli tica l process th a t sh ou l d be
in for m ed by tech n i ca l in pu t. On ce th e poli cy dir ection is set, policym a ker s h a n d th e policy over
to tech n ica l h ea l th sector r efor m tea m s for im plem en t a t ion , a n d t h e process goes fr om bei n g
politica l ly led t o bein g tech n i ca lly dr iven .
Th er e a r e fi ve t ech n ica ll y dr iven sta ges of th e pr ocess, wh ich gen er a lly occu r in th e followin g
order:
Policy for m u l a t ion a n d legi tim a tion
Con sti tu en cy- bu i ldin g
Resou r ce m obil iza tion
I m plem en ta tion design a n d or ga n iza tion a l str u ctu r in g
Pr ogress/ im pa ct m on itor in g.
Th is toolkit is m ea n t to be u sed a fter th e policy pr ocess h a s been la u n ch ed, h ea lt h sector
r efor m h a s been a gr eed u pon , th e gen er a l dir ection of r efor m h a s been deter m in ed, a n d th e pol-
icy h a s m oved fr om bein g politica lly dri ven to bein g tech n ica l ly dom in a t ed. Th e toolkit is pr i-
m a r ily for m a n a gin g th e five tech n ica lly dri ven policy sta ges, wh en you a r e workin g to im pl e-
m en t a n i den ti fied poli cy, a s descr ibed in Ta ble 1.1.
Box 1.1.
PoIiticaIIy Dominated Arena
of the PoIicy Process
lssues Agendas Decisions
When issues and agendas come
together, policymakers make
decisions. These political
decisions often result in new
policies but rarely specify the
details of implementation.
Issues
Agendas
Decisions
Policy Formulation
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
Policy Formulation
and
Legitimation
Constituency-
Building
Resource
Mobilization
Implementation
Design and
Organizational
Structuring
Progress/Impact
Monitoring
= primary linkage
= secondary linkage
Issues
Agendas
Decisions
Policy Formulation
and
Legitimation
Constituency-
Building
Resource
Mobilization
Implementation
Design and
Organizational
Structuring
Progress/Impact
Monitoring
= primary linkage
= secondary linkage
Issues
Agendas
Decisions
Policy Formulation
and
Legitimation
Constituency-
Building
Resource
Mobilization
Implementation
Design and
Organizational
Structuring
Progress/Impact
Monitoring
Issues
Agendas
Decisions
Issues
Agendas
Decisions
Policy Formulation
and
Legitimation
Constituency-
Building
Resource
Mobilization
Implementation
Design and
Organizational
Structuring
Progress/Impact
Monitoring
= primary linkage
= secondary linkage
Technically led
Figure 1 .1 . The Policy Process
TabIe 1.1. PoIicy Stages and ReIated Tasks in the TechnicaIIy Led Domain of
the PoIicy Process
PoIicy Stages ReIated Tasks
PoIicy FormuIation and
Legitimation
Once politicians have decided to reform the health sector, policy managers need to:
Formulate the technical content of the policy. Use someone with technical knowledge to detail
policy goals and objectives, an operational framework of programs, and a statement of required
resources. These elements are often included in initial reform plans but without sufficient detail.
Make the policy legitimate. Encourage key individuals and groups to take ownership of the policy,
especially when health reform efforts are supported by external multilateral donors or international
financial institutions. This is the time to identify and/or consolidate the support of policy champions
and help ensure that the policy is considered necessary and important.
Constituency-BuiIding Moving health sector reform forward will depend on your ability to:
Generate active support from individuals and groups who see the changes created by health sector
reform as desirable and beneficial. ldentify and mobilize supporters. This is more than gaining
legitimacy; it is inciting supporters to action. Convince interest groups that they will benefit from
health sector reform and that the benefits are worth the costs of change.
Reduce or deflect opposition from those who consider the reform measures to be undesirable or
harmful. Acknowledge opponents of health sector reform and explore their positions. By
understanding opposing perspectives, you can develop messages and strategies that will convince
adversaries not to work against reform.
Resource MobiIization lmplementation of health sector reform demands financial, technical, and human resources. Getting off
to a good start requires accumulating a sufficient supply of these resources, and successful
implementation demands an ongoing flow. Yet these resources often are inaccessible (allocated to
someone else's budget), unavailable (assigned to other priorities and programs), or nonexistent (no
appropriately skilled staff). This is more than an internal management task of proper budgeting and
programming workflow. A policy champion must exercise leadership to:
Galvanize constituencies to lobby for resources
Create performance incentives to use existing resources efficiently or develop new resources
Achieve and publicize successes along the way to ensure a continuous flow of resources.
ImpIementation Design
and OrganizationaI
Structuring
Health sector reform assigns new objectives and new tasks to organizations that are used to
functioning differently. New implementation partners may be introduced into the process by reform
efforts, including nongovernmental organizations (NGOs), community groups, commercial health
providers, and professional associations. Staff may resist giving up old procedures, routines, and
patterns of communication. Given these challenges, policy managers will need to:
Design new implementation arrangements and structures, or modify existing ones, and ensure that
the arrangements and structures function effectively
Engage a wide range of implementation partners to create and nurture partnerships that can work
together
Help individuals and groups manage their transitions so they can adapt and function effectively in
the changing environment.
Progress/impact
Monitoring
Managing the reform process over time requires feedback, which should be used to make adjustments
and adapt to changing conditions. Health sector reform typically involves many organizations and
ministries. lndividual agencies may be paying attention to their own activities, but often no one is
paying attention to the overall progress and impact of the reform. Policy managers need to:
Create and position analytic and monitoring capacity to collect and analyze data for the entire
reform effort and make recommendations to decision-makers
Design monitoring and evaluation systems and set up procedures for "hearing and heeding"
feedback to ensure that analysis and recommendations reach the intended audience, i.e., decision-
makers who have the capacity to act on the information
Base ongoing reform efforts on lessons learned and a willingness to adapt so that strategies can be
modified as needed.
Use the Guidelines and Tools to Manage the Policy Process
After reviewi n g th e va ri ou s sta ges of th e policy pr ocess a n d th e a ccom pa n yin g ta sks, u se th e
gu idel in es a n d tools to develop cr iti ca l skills in t h e a r ea s of sta keh older a n a l ysis, a dvoca cy, con -
flict n egotia tion , a n d str a tegic m a n a gem en t:
Th e Sta keh older An a l ysis Gu i delin es ( Section 2) h elp you iden t ify th e in ter ested pa r ti es a n d
a ssess th ei r su pport for a pa r ti cu la r pol icy, th eir u n der lyin g in ter ests, a n d i f a n d wh y th ose
in t er ests sh ou ld be ta ken in to a ccou n t.
Th e Advoca cy Gu idelin es ( Section 3) h el p you determ in e you r a dvoca cy objectives; iden tify
ta r get a u dien ces; ta ke stock of a va i la bl e su ppor t a n d in for m a ti on r esou r ces; deter m i n e a
str a t egy th a t m a kes th e best u se of you r resou rces to a ch ieve you r obj ective; a n d develop, ta r -
get, a n d deliver m essa ges th a t provide r el eva n t a n d tim ely in form a tion a n d per su a de policy-
m a ker s to ta ke th e desir ed a ction s.
Th e Con flict Negot ia tion Gu idel in es ( Sect ion 4) h elp you , with ca r efu l pr epa r a tion , a n t ici-
pa te, con t a i n , a n d r esolve dispu tes th a t a r ise wh en pa r ties with differ en t in terest s n eed to
work towa rd m u tu a ll y a ccepta ble solu tion s.
Th e I n t rodu ction to Str a tegic Ma n a gem en t ( Section 5) h elps you a ch ieve you r policy goa ls
by system a tica lly eva lu a ti n g opport u n i ties a n d th r ea ts in you r exter n a l en vi ron m en t; a ssess-
in g st ren gth s a n d wea kn esses in you r str u ct u r e a n d r esou r ce ba se; a n d developin g, im ple-
m en tin g, a n d m on itor in g a str a tegy th a t effect ivel y a pplies you r resou rces to a ddr ess you r
ch a l len ges. Th is i s n ot a h ow-to gu ide, bu t r a th er a n in t rodu ction to a wa y of th in kin g a bou t
or ta ckli n g pr oblem s. I t r equ ir es th a t you u n dersta n d th e con text of t h e pol icy process a n d
a ppl y t h e gu ideli n es a n d tools i n cl u ded i n t h is t ool ki t.
Ea ch of th e gu idelin es a n d t ool s is closely a ssocia ted with on e or m or e sta ges of th e poli cy
pr ocess. Beca u se th e n a tu r e of th e pol icy pr ocess is i ter a tive, h owever, th e tools sh ou ld be u sed in
th e or der a n d m a n n er m ost a ppr opri a te for th e r efor m pr ocess a n d sh ou ld be m odified in
r espon se to u n for eseen cir cu m sta n ces. Th r ou gh ou t th e process, you m u st con tin u a lly a ssess th e
exten t of su ppor t for a n d opposit ion to you r r efor m s, develop str a tegies to a dvoca te a n d com m u -
n ica te effectively wi th you r t a rget a u dien ces, a n d n egot ia te th e m yr ia d of con fli cts, la r ge a n d
sm a ll, t h a t you en cou n ter a lon g t h e wa y.
Tips for Various Users
As n oted, t h e prim a r y in ten ded u ser s for th e tool kit a r e m em bers of h ea lth sector reform tea m s.
However, oth er s wi th a n i n ter est in r efor m ca n a lso pr ofit fr om u sin g th e tools a n d a pproa ch es
presen ted h ere. Th ese in clu de NGOs th a t pr ovide com m u n it y h ea lth ser vices, don ors wh ose
r esou r ces con tr ibu t e t o fu n din g r efor m s, or fa cility m a n a ger s wh ose oper a tion s m a y be ch a n ged
a s a r esu lt of th e r efor m s. Th is section pr ovides tips for ea ch of t h ese gr ou ps on u sin g th e toolkit.
Health Reform Teams
For m em bers of a h ea lth sector r efor m tea m , th e toolkit h elps, fi rst of a ll , u n der sta n d a n d m a s-
ter th e policy pr ocess, wh ich is cr itica l for effectivel y m a n a gin g r efor m . As a ch a m pion for
r efor m , you n eed t o devel op a n effective str a tegy for ch a n ge. Depen din g on you r position with in
th e h ea lth sector, you m a y be fa m il ia r with som e or a ll of t h e pol icy pr ocess, bu t th er e m a y be
ga ps in you r kn owledge a n d/ or u n dersta n di n g.
Sta keh older a n a lysis ( Sect ion 2) h elps you iden tify th e key pla yer s. Beca u se you a r e a m em -
ber of th e r efor m tea m a n d h a ve been workin g in th e h ea lth sector in you r cou n tr y for a lon g
tim e, you ca n pr oba bly r ea dily iden tify th e people im por ta n t to th e pr ocess. Bu t sta keh older
a n a lysis, by syst em a tizin g a n d deepen in g you r l ist of key pl a yer s, h elps you a lso di scover wh o
h a s wh a t in t er est in th e r efor m , wh o will win a n d wh o wil l lose, a n d wh a t sta keh olders m igh t do
to h elp or h a r m th e r efor m ' s pr ogress a n d pr ospects.
Advoca cy ( Section 3) h elps you bet ter persu a de key people th a t th e r efor m is wor th wh il e.
Th is tool h elps you r r efor m t ea m cr a ft st ra tegies t o collect da t a a n d i n flu en ce decision - m a ker s
to su ppor t th e r efor m . I t h el ps th e tea m develop th e m ost con vin cin g set of m essa ges for a dvo-
ca tin g th e r eform a n d its va r iou s com pon en ts. Th i s tool h elps you pa cka ge in for m a tion to
in flu en ce th e va r iou s grou ps iden tified by you r sta keh older a n a lysis.
Con flict n egot ia tion ( Sect ion 4) h elps th e t ea m dea l with grou ps or in di vidu a ls th a t h a ve
con flicti n g in ter ests. For exa m ple, m a n y reform s ca ll for m ea su res th a t will ch a n ge h ow h ea lth
sector wor ker s a r e pa i d a n d/ or eva l u a ted. Th is ca n ca u se ser iou s con flicts, pa r ticu la r ly i f th ese
grou ps a r e u n ion i zed. Th ese gu idelin es h elp you m a n a ge su ch con flicts a n d n egotia t e a ccept-
a ble solu tion s.
Nongovernmental Organizations
You r NGO m a y h a ve exper ien ce wi th h ea lth ser vi ces delivery a n d com m u n ity m obi liza ti on bu t
m a y be rela tively n ew to h ea lth sect or r efor m . Th is t oolki t h elps you gr a sp th e im por ta n t fea -
tu r es of t h e policy cycle t h a t lea d to r efor m design a n d im plem en ta ti on . Sin ce m a n y h ea lth sec-
tor r efor m s in clu de n ew r oles for n on govern m en ta l a ctor s, it i s im por ta n t th a t you u n der sta n d
you r pl a ce in th e policy pr ocess a n d h ow you ca n exer t in flu en ce.
Sta keh older a n a lysis ( Section 2) h elps you iden tify you r n ew pa r tn er s, lea rn wh a t th eir i n ter -
ests a r e, a n d a ssess wh a t r esou r ces th ey ca n m u st er. Th is in for m a ti on h elps you m a n a ge you r
n ew r ole a n d m eet you r n ew pa rt n er s' expecta tion s for you r per for m a n ce. Sta keh older a n a lysis
a lso ca n a ssi st you in developin g a m ore in -dept h m a p of key sta keh older s i n t h e com m u n iti es
wh er e you r NGO is cu r r en t ly wor kin g or m a y wor k i n t h e fu tu r e, in clu din g iden tifyi n g sta ke-
h older s wh o m a y be u n fa vor a bly di sposed t owa r d you .
Advoca cy ( Section 3) i s a tool NGOs ca n u se with a n u m ber of pot en ti a l ly im por ta n t sta ke-
h older s i n t h e h ea lt h sector. For exa m ple, you m a y n eed to con vin ce m in istr y of h ea lth deci-
sion - m a kers th a t NGOs ca n be effective pa r tn er s for im pl em en ti n g r eform s or t h a t t h e n eeds of
loca l com m u n iti es sh ou l d figu re m ore pr om i n en tly in th e r efor m pa cka ge. You m a y wa n t to
a dvoca te with don or s on you r beh a lf. Or you m a y wa n t to tr a in com m u n it y lea der s to becom e
effective a dvoca tes for r efor m a m on g loca l polit icia n s or h ea lth ser vi ce pr ovider s. You will li kely
n eed severa l kin ds of m essa ges to fit va ri ou s a u dien ces, fr om com m u n i ty m em ber s t o sen i or
m i n istr y offici a l s.
Con flict n egot ia tion ( Sect ion 4) is im por ta n t to NGOs beca u se th ey often ser ve a s m edia tor s
between com m u n ities a n d pu blic sector officia ls, u su a l ly wh en th ese gr ou ps do n ot a gr ee on
pri orit ies, a ction s, or r esu lts. NGOs m a y wish to t ra in com m u n i ty gr ou ps in con fl ict n egoti a t ion ,
a s in a dvoca cy, a n d th is tool a ssists in su ch ca pa city- bu il di n g effor ts.
Donors
You r don or a gen cy pr oba bl y h a s worked exten sivel y wi th sen ior officia ls to el a bor a te a n d/ or
r eview th e tech n ica l com pon en ts of th e r efor m pa cka ge. You r a gen cy m a y be fu n din g th e en ti re
r efor m , or i t m a y be pa r t of a don or con sort iu m th a t is fu n din g on e or m or e com pon en ts of
r efor m . You r a gen cy i s a lso likel y t o be pr ovi di n g som e t ech n ica l a ssi st a n ce to th e r efor m tea m
a n d oth er pa r tn er s in th e r efor m , su ch a s NGOs or pr iva te-sector pr ovider s. Wh il e you a r e
a lr ea dy fa m il ia r with th e policy desi gn a n d for m u la tion steps i n r efor m , you m a y be less fa m il-
ia r with th e m a n a gem en t- in t en sive steps of th e poli cy pr ocess. Th e toolkit' s focu s on th e poli cy
process h elps you focu s on poli cy m a n a gem en t ta sks th a t m a y r equ ir e tech n ica l a ssista n ce.
Sta keh older a n a lysis ( Section 2) h elps you cla r ify th e key pla yer s in th e r efor m . Beca u se you
likel y pa r tici pa t ed in th e reform design , you proba bly a lr ea dy kn ow th e sen ior decision - m a kers
a n d t h e m em ber s of th e cou n tr y r efor m tea m . You m a y be less fa m ilia r, h owever, with r efor m
pa rt n er s wh o will be i n volved in i m plem en ta tion or societa l gr ou ps th a t h a ve a n i n ter est in
h ea l th reform . As a don or, you m a y be a ble to h el p th e r efor m tea m in fl u en ce bot h th e su pport -
er s a n d oppon en ts of r efor m iden tified th r ou gh th e sta keh older a n a lysis.
Advoca cy ( Section 3) is a tool th e r efor m tea m m u st kn ow a n d u se, a n d you ca n pr ovide
tech n ica l a ssista n ce to en su re th a t th is ca pa ci ty i s cr ea ted a n d r ein for ced.
Con flict n egot ia tion ( Sect ion 4) is u sefu l in th e l ikely even t th a t ten sion s a n d con flicts a rise
a m on g th e va r iou s sta keh older s or between t h e st a keh older s a n d th e r efor m tea m . I n m a n y
r efor m efforts, don or s a r e ca ll ed u pon t o ser ve a s n eu t ra l m edia tor s, a n d t h e con flict n egot ia tion
gu idel in es h el p you fu l fill th i s r ol e.
Facility Managers
You a n d you r fa cilit y m a y be a ffected by h ea l th sect or r efor m . Th e toolkit h elps or ien t you to th e
policy pr ocess a n d h elps you bet ter u n der sta n d a n d m a n a ge t h e ch a n ges goin g on a r ou n d you .
For exa m pl e, you m a y be ca lled u pon to str en gth en you r focu s on cu stom er sa tisfa ction . You
m a y be a sked to dissem in a t e in for m a ti on a n d pa rt icipa te in socia l m a r keti n g ca m pa ign s to
m odify people' s per cept ion s of h ea lth a n d h ea lt h ca r e. Or, you m a y fin d you r self in n ew pa rt n er -
sh ips wit h pu blic a gen ci es, NGOs, th e pr iva t e sector, or com m u n it y gr ou ps for ser vice deli ver y.
Sta keh older a n a lysis ( Section 2) h elps you i den tify a ll th e a ctor s im por ta n t to you r fa cili ty a t
a ll level s of th e h ea lth syst em , in clu din g som e you m a y n ot kn ow. I t a lso h elps you ga th er in for -
m a t ion on th e feeli n gs of you r cu r r en t cli en ts a n d col la bor a tor s a bou t th e ch a n ges t h a t h ea lth
r efor m will bri n g a n d a bou t h ow th ey m igh t respon d. Th is h elps you dea l m or e effect ivel y wit h
th ose of you r cl ien t s wh o wi ll n ot ben efi t fr om th e ch a n ges ( th e l osers) a n d wh o m a y t h er efor e
oppose n ew pr a ctices. I t a lso h elps you en cou r a ge t h ose wh o will ben efit ( th e win n er s) t o con -
tin u e th eir su ppor t for r eform . Th e sta keh older a n a l ysis a lso wil l h elp you better u n der sta n d
a n d wor k wi th a key grou p of st a keh older s you r own sta ff.
Developin g a n a dvoca cy str a tegy ( Section 3) ca n h elp you con vi n ce key a ctor s th a t th e
r efor m - in du ced ch a n ges in you r fa ci lity a r e desir a ble a n d wor th th e cost . Th is tool h elps you r
sta ff develop a str a tegy to edu ca te a n d i n flu en ce you r cu stom ers a n d h elps you r ser vice deliver y
tea m develop t h e m ost a ppr opr ia te m essa ges. Aga i n , you r st a ff m a y be th e fir st ta r get for th ese
effor ts, given t h e exper ien ce in m a n y cou n tr ies th a t h ea lth ser vice pr ovider s t h em selves do n ot
a lwa ys h a ve com plete in for m a tion a bou t r efor m objectives, com pon en ts, a n d a ctivi ties.
Con flict n egot ia tion ( Sect ion 4) will be a n essen tia l tool i f you con fr on t la bor issu es r esu lt-
in g fr om h ea lt h r eform m ea su r es su ch a s ch a n ges i n h ea lth wor ker sa la r ies, wor ki n g con di-
tion s, a n d pr ocedu r es for per for m a n ce a ssessm en ts. Con flict n egot ia tion h el ps you dea l wi th
dispu tes ( i.e., fr om a n gr y u n i on s or u pset fa cilities u ser s) in wa ys th a t a void disru ptin g you r
fa cil ity' s opera t ion s.
Bibliography
Br in kerh off, Der ick W., Ba r ba r a O' Ha n lon , a n d Su sa n Scr ibn er. Ja n u a r y 1999. "Str en gth en i n g
Hea lth Refor m Policy in La tin Am eri ca : A Con cept Pa per." Beth esda , MD: Abt Associa tes
I n c.
Br in kerh off, Der ick W. 1994. " Lookin g Ou t , Lookin g in , Lookin g Ah ea d." PATimes. Vol. 17, No.
12, p. 11.
Cr osby, Ben ja m in L. 1996. "Pol icy I m plem en ta tion : Th e Or ga n iza tion a l Ch a llen ge." World
Development. Vol. 24, No. 9, pp. 1403- 1417.
Por ter, Robert W., a n d I r vin Hicks. October 1994. "Kn owledge Utiliza tion a n d th e Pr ocess of
Policy For m a tion : Towa rd a Fr a m ewor k for Afri ca ." Wa sh in gton , DC: Su ppor t for An a ly-
sis a n d Resea rch in Afri ca Pr oject a n d Hea lt h a n d Hu m a n Resou r ces An a l ysis for Afr ica
Pr oject, for US Agen cy for In ter n a t ion a l Developm en t.
Section 2
Stakeholder Analysis
Guidelines
Kammi Schmeer
Section 2
Guidelines
Table of Contents
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
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
Stakeholder Analysis at a
Glance
What I s Stakeholder Analysis?
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 I s a Stakeholder?
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.
Which Stakeholder Characteristics Are Analyzed?
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 I s this Analysis Useful?
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 beforea 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 Steps in Stakeholder Analysis?
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 Achieved with Stakeholder Analysis?
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
Guidelines
I ntroduction
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 beforea 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)
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.
Figure 2.1 . The Policy Process
Issues
Agendas
Decisions
Policy
Eormulation and
Legitimation
Constituency-
Building
Resource
Mobilization
Implementation
Design and
Organizational
Structuring
Progress/Impact
Monitoring
= primary linkage
= secondary linkage
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
Technically led
Stakeho lde r Analysis Guideline s 2-3
Step 1 : Planning the Process
Define the purpose of the analysis, and identify uses for the
results.
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.
I dentify and train a working group.
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.
Develop a plan and timeline.
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.
Step 2: Selecting and Defining a Policy
Select an appropriate policy.
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.
Define the policy.
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.
Step 3: I dentifying Key Stakeholders
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) .
Compile and review existing information.
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.
Develop a list of all possible stakeholders.
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 .
Develop a list of priority stakeholders with
input from experts.
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.
Step 4: Adapting the Tools
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 stakeholder characteristics.
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.
Develop the interview questionnaire.
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 ,
Table 2.1 . Stakeholder Characteristics and Table Titles
(full table in Annex 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.
Develop the interview protocol.
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.
Test the questionnaire.
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.
Develop the reference 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 after 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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Step 5: Collecting and Recording the I nformation
Review existing information.
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 interview appointments.
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.
Conduct interviews and record notes.
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.
Step 6: Filling in the Stakeholder Table
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.
Determine the stakeholders position.
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.)
Table 2.3. Column E of Stakeholder Table
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-
Supporter (S) Moderate Supporter (MS) Meutra| (M) Moderate Cpponent (MC) Cpponent (C)
Figure 2.2. Spectrum of Stakeholder Positions
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 .
Fill in the resources column and create a power index for each
stakeholder.
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.
Table 2.4. Columns H and I of Stakeholder
Table
I
Resources Power
2. AbiIity to Resouces
mobiIize: average
3, 2, 1 3, 2, 1
H
1. Quantity
3, 2 , 1
Figure 2.3. Use All Tools in Filling in the Analysis Table (See Annexes for full versions)
Step 7: Analyzing the Stakeholder Table
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 out a power and leadership analysis.
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) .
Analyze knowledge 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 .
Table 2.5. Example Results of Power/Leadership Analysis
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
Analyze stakeholders' positions.
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.
Analyze interest 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 .
Analyze alliances.
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 .
Develop additional results.
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 .
Step 8: Using the I nformation
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 take
action.
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 .
General Results Presentation Format
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 .
Presentation of Power/Leadership Analysis Results
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.
Figure 2.4. Sample of How to Use PowerPoint to Present Power/Leadership
Analysis Results
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
Presentation of Stakeholders' Positions
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) .
Figure 2.5. Sample Position Mapin Color
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Moderate Moderate
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M
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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

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Provincial
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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.
Presentation of Knowledge 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.
Figure 2.6. PowerPoint Presentation of Knowledge 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
Presentation of Key Alliances
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.
Figure 2.7. PowerPoint Presentation of Key Alliances
Presentation of Other Results/Conclusions
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)
Presentation of Recommended Strategies
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 activesu 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.
Figure 2.8. Sample Presentation of Strategies in PowerPoint
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 action plans, com-
munication plans, a n d negotiation packages.
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 .
Figure 2.9. Matrix for I dentifying Stakeholders To Be Targeted by Strategies
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
Bibliography
Br in kerh off, Der ick. Ju n e 1998. FromDesign to Implementation: Stakeholder Analysisin a
PHCProject in India. Beth esda , MD: Abt Associa tes In c.
_ _ _ _ _ . Apr il 1997. PHR TripReport: Stakeholder Analysisin India. 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."
Technical 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." Technical Notes, 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." Technical Notes, 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. ManagingDevelopment: ThePolitical
Dimension. 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 Maker: Computer-Aided Political Anal-
ysis: ImprovingtheArt of theFeasible. 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-
nical Reportn o. 23. PHR Project. Beth esda , MD: Abt Associa tes I n c.
Webster'sII NewRiversideDictionary. 1984. Boston : Hou gh ton Mifflin Com pa n y.
Annex 2-A
Sample General List of Stakeholders
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.
Annex 2-B
Definitions of Stakeholder Characteristics and
I nstructions for Filling in Stakeholder Table
A. I .D. Number
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. Position and Organization
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. I nternal/External
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. Knowledge of Policy
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. Position: Supports/Opposes/Neutral
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. I nterest
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. Alliances
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. Resources
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 . Power
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. Leadership
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."
Annex 2-C
Sample Stakeholder Table
( On r ever se side of th i s sh eet.)
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Annex 2-D
Sample Stakeholder I nterview Questionnaire
Da te: _ _ _ / _ _ _ / _ _ _ _ _ I D #: _ _ _ _ _
Cit y: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
I ntroduction:
We a r e from (organization name) a n d we a re con du ctin g a stu dy on beh a lf of (sponsor name
if appropriate) 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 (insert organization for whomreport isdoneif appropriate) 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.
Your Opinion:
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? ( Read theoptionsand circletheanswer given.)
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.
Other Supporters:
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? ( Probefor MOH and non-MOH
stakeholders)
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 ?
Other Opposors:
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? ( Probefor MOH and non-MOH stakeholders)
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?
Annex 2-E
Sample I nformation Transfer Reference Chart
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Section 3
Advocacy Guidelines
Susan Scr ibner
Bar bar a OHanlon
Section 3
Advocacy Guidelines
Table of Contents
I n tr odu ct ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 1
Developin g a n Advoca cy Str a tegy: Com pon en t I Lookin g Ou twa r d . . . . . . . . . . . . . . . . . . 3- 5
Step 1: Un dersta n d th e Pol itica l Deci si on - Ma ki n g Process . . . . . . . . . . . . . . . . . . . . . . . . . 3- 6
Step 2: Select a n d Defin e a Hea lt h Refor m Policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 7
Step 3: Set Advoca cy Object ives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 10
Step 4: I den t ify a n d An a lyze Au dien ces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 12
Developin g a n Advoca cy Str a tegy: Com pon en t I I Looki n g I n wa r d . . . . . . . . . . . . . . . . . 3- 16
Step 5: Select Advoca cy Activi ties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 17
Step 6: I m pl em en t Advoca cy Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 27
Developin g a n Advoca cy Str a tegy: Com pon en t II I Lookin g Ah ea d . . . . . . . . . . . . . . . . . 3- 28
Step 7: Eva lu a te a n d Adju st Str a tegy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 29
Con clu sion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 30
Bibli ogr a ph y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 32
An n ex 3- A: Au di en ce I den tifica t ion Wor ksh eet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 3
An n ex 3- B: Au dien ce Kn owl edge, Position , a n d I n ter ests Worksh eet . . . . . . . . . . . . . . . . . . . 3- 35
An n ex 3- C: Allies a n d Opposition Ma tr ix. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 37
An n ex 3- D: Messa ge Con t en t Wor ksh eet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 39
An n ex 3- E: Selectin g a Messen ger Wor ksh eet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 41
An n ex 3- F: Com m u n ica tion s Pla n Wor ksh eet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 43
Box 3.1. Discu ssion qu esti on s: How pol icy decision s a r e m a de . . . . . . . . . . . . . . . . . . . . . 3- 6
Box 3.4. Discu ssion qu esti on s: Deter m in in g if a policy is poli tica lly vi a bl e . . . . . . . . . . . 3- 9
Box 3.5. Discu ssion qu esti on s: Set tin g a dvoca cy objecti ves . . . . . . . . . . . . . . . . . . . . . . . 3- 11
Box 3.8. Discu ssion qu esti on s: En su r in g th a t a dvoca cy object ives a r e SMART . . . . . . . . 3- 11
Box 3.9. Discu ssion qu esti on s: I den tifyin g t a r get a u dien ces . . . . . . . . . . . . . . . . . . . . . . 3- 13
Box 3.10 Au dien ces for h ea l th r eform i n Ecu a dor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 13
Box 3.11. Th e ben efit s of n etwor ks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 18
Box 3.12. Types of coa l ition s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 1 9
Box 3.13. Colla bor a tion to str en gth en com m u n i ty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 20
Box 3.14. Equ i ty a s a h ea l th sector objective in Ecu a dor . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 20
Box 3.15. Discu ssion qu esti on s: Developin g a n d deliveri n g policy m essa ges . . . . . . . . . . 3- 22
Box 3.16. Decen tr a lizin g h ea lth ser vices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 23
Box 3.17. Differen t for m a ts for n a tion a l h ea lth a dvoca cy in Ecu a dor . . . . . . . . . . . . . . . . 3- 25
Box 3.18. Usin g m a ss m edia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 27
Box 3.19. Lobbyin g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 27
Box 3.20. Discu ssion qu esti on s: Mon itor in g you r pr ogr ess . . . . . . . . . . . . . . . . . . . . . . . . 3- 30
Box 3.21. Discu ssion qu esti on s: Eva lu a t in g you r r esu l ts . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 31
Figu r e 3.1. Policy Sta ges, Tech n ica ll y Dom in a ted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 3
Figu r e 3.2. Com pon en ts of a n Advoca cy Objective . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 10
Figu r e 3.3. Exa m ple of a Per son a l Net wor k . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 18
Figu r e 3.4. Th e SEE Meth od . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 23
Ta ble 3.1. Exa m ple of Costs a n d Ben efit s of a Hea lth Refor m Poli cy: I n cr ea sed Effi cien cy in
Use of MOH Resou r ces . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 8
Ta ble 3.2. Possible Key Actor s a n d Sta keh older s i n Hea l th Refor m . . . . . . . . . . . . . . . . . . 3- 14
Ta ble 3.3. Adva n ta ges a n d Disa dva n t a ges of Coa l ition s . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 19
Ta ble 3.4. Da ta Sou r ces for Hea lt h Sector Refor m . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3- 21
Advocacy at a Glance
What I s Advocacy?
Th er e a r e m a n y defin it ion s of a dvoca cy.
Advoca cy is in flu en cin g decision - m a ker s.
Advoca cy is ch a m pi on in g a n i ssu e, dra win g a tten tion to it, a n d gettin g it on t h e a gen da .
Advoca cy is iden tifyin g a pr oblem , recom m en din g a solu tion , a n d pu t tin g problem a n d so-
lu tion togeth er.
Advoca cy is ch a n gin g th e policies, posi tion s, progr a m s, or bu dgets of a n y in stitu tion .
Advoca cy is ch a n gin g a n orga n iza tion or system .
Advoca cy is edu ca tin g lea ders, policym a ker s, policy im plem en ter s, a n d oth er s.
Advoca cy is bu ildin g su pport for a n issu e.
For th e pu r poses of th is Policy Tool kit, a dvoca cy is a set of ta r geted a ction s dir ected a t decision -
m a ker s a n d oth er key sta keh olders in su ppor t of a specifi c policy i ssu e.
Why I s Advocacy I mportant to Health Reform?
Th e com m on t h r ea d a m on g t h ese defin ition s of a dvoca cy i s th a t [ w] h er ever ch a n ge n eeds t o
occu r, a dvoca cy h a s a r ole to pla y ( Sh a r m a n .d.) . I m pl em en ti n g h ea lth sect or r efor m is a ll
a bou t ch a n ge, h en ce t h e im por ta n ce of a dvoca cy.
Advoca cy is a tool for h ea lth r efor m t ea m s, pr ovidin g a str a tegic a pproa ch to bu ildi n g a n d
m a i n ta in in g su ppor t for im plem en t in g h ea lth r efor m s. Devel opin g a n a dvoca cy str a tegy
in volves lookin g ou twa r d to determ in e you r goa ls, objectives, a n d a u dien ces; looki n g i n wa r d to
a ssess you r r esou r ces for i n for m a ti on a n d in flu en ce; a n d lookin g a h ea d t o m on itor t h e effec-
tiven ess of you r st r a t egy a n d a dju st th e str a tegy a s n eeded t o a ch i eve you r r efor m goa l s a n d
objecti ves.
Ma n y exper ien ced pol icy a dvoca tes descr ibe a dvoca cy a s pa r t scien ce a n d pa r t a r t. Th er e is
n o u n iver sa l scien tifi ca lly proven form u l a or m eth od for effective a dvoca cy, bu t experien ce su g-
gests th a t a dvoca cy str a tegi es a r e m or e likely to su cceed wh en th ey a r e ba sed on solid a n a lysis
a n d ca refu l pla n n in g. Design in g a n d im plem en ti n g a n effect ive a dvoca cy str a t egy a l so gen er-
a lly in vol ves qu a lita tive r esea r ch , com m u n ica t ion , n egoti a tion , a n d pol itics skills a n d
kn owledge th a t a r e oft en la ckin g a m on g m em ber s of h ea lth r efor m tea m s.
Advoca cy i s a lso pa rt a r t. Su ccessfu l a dvoca tes i n spir e a n d m ot iva te a wide r a n ge of peopl e to
ta ke a ction . Th ey a r e a lso cr ea tive a n d seek a lt er n a tive, in n ova tive wa ys t o dr a w a tten tion to
th eir issu e. Th ey h a ve well- h on ed poli tica l in stin cts a n d tim in g, str a tegica ll y ch oosi n g wh en to
figh t a n d wh en to la y l ow a n d a l wa ys keepi n g a n eye on th e u ltim a te vict or y a ch ievin g th eir
r efor m goa l .
Most of th ese skills ca n be lea rn ed a n d r efin ed t h r ou gh pra ct ice, a n d both su ccessfu l a n d
fa iled a dvoca cy efforts a re in st ru ctive. With ti m e, effor t, a n d experi en ce, you ca n bu ild th e con -
fiden ce to pr a ctice t h e a rt a s wel l a s t h e scien ce of a dvoca cy.
What Are the Steps in Developing an Advocacy Strategy?
Figu r e 3.1 il lu str a tes a str a tegic a ppr oa ch to a dvoca cy, wh i ch com pr ises th r ee com pon en ts:
lookin g ou twa r d, l ookin g in wa r d, a n d looki n g a h ea d. Ea ch step i n di scu ssed in det a i l in th e
a dvoca cy gu idelin es.
Com pon en t I Looki n g Ou twa rd
Step 1. Un der st a n d th e poli tica l decision -m a kin g process
Step 2. Sel ect a n d defin e a h ea lth r efor m policy
Step 3. Set a dvoca cy objectives
Step 4. I den tify a n d a n a lyze a u dien ces
Com pon en t I I Lookin g I n wa r d
Step 5. Ar ticu la te a dvoca cy a cti vities
Step 6. I m plem en t a dvoca cy a cti vities
Com pon en t I I I Lookin g Ah ea d
Step 7. Eva lu a te a n d a dj u st str a tegy
Figure 3.1 . A Strategic Approach to Advocacy
Strategic Approach Strategic Action Advocacy Steps
Looking Outward
Looking Inward
Looking Ahead
Analyze policy environment
Policy process
Policy actors
Health reform policies and
strategies
Analyze resources
Information and data
Resources
Influence
Analyze impact on reform
policy
Understand the policy decision-
making process
Select and define a health
reform policy
Set advocacy objectives
Identify and analyze audiences
Articulate advocacy activities
Implement advocacy activities
Evaluate and adjust strategy
Section 3
Advocacy Guidelines
I ntroduction
Ma n y cou n tr ies, both devel oped a n d developin g, h a ve u n dert a ken som e type of h ea lth sector
r efor m over t h e pa st deca de, r a n gin g fr om ta r geted in t er ven tion s a i m ed a t i m pr ovin g th e effec-
tiven ess of th e h ea lth m in istr y to r a dica l r estr u ct u r in g of th e en tir e h ea l th sector. Th is collective
in t er n a tion a l exper ien ce h a s dem on st ra ted th a t r efor m is tech n ica l ly com plex a n d difficu lt to
im plem en t a n d, th ou gh t h e r ea son s for u n even im pl em en ta t ion h a ve va r ied, som e com m on
con str a in ts h a ve em er ged:
Polit ica l con str a in t s: Beca u se of t h e h igh ly com plex a n d tech n ica l n a tu r e of h ea l th refor m ,
th e pr ocess is often dom i n a ted by tech n icia n s, a n d th ese tech n ica l exper ts oft en n eglect to
seek bu y- in fr om key sta keh older s a n d oth er s wh o a r e di rectly a ffected by r efor m . More-
over, i n flu en t ia l polit icia n s a n d poli cym a ker s fr equ en tly h esita te to su ppor t reform s t h ey do
n ot fu ll y u n der sta n d or th a t m a y pr ove con tr oversia l.
Resou r ce- r ela t ed con st ra in ts: Even wi th poli tica l su pport fr om th e top, h owever, som e h ea lth
r efor m s fa il beca u se of a la ck of r esou r ces in su fficien t fu n din g, sta ff, or t ech n ica l skil ls to
im plem en t or su sta in r efor m over tim e.
Or ga n iza tion a l con stra i n ts: Key in st itu t ion s m a y n eed to be r eor ga n ized or r estr u ctu r ed be-
for e t h e proposed ch a n ges ca n be a ppr opr ia t ely im pl em en ted. Even th en , key sta ff m em bers
m a y be resista n t to ch a n ge a n d m a y obstr u ct i m plem en ta tion of th e r efor m s.
Why is advocacy important to health reform?
To be effective, a h ea l th refor m tea m m u st a ddr ess a n d over com e th ese con st ra i n ts t o im ple-
m en ta ti on . I n cr ea sin gly, th i s requ ir es th a t tea m m em ber s becom e a dvoca tes for h ea lth refor m .
A wel l- pl a n n ed a n d ca refu ll y t h ou gh t -ou t a dvoca cy str a tegy ca n m a xim i ze effor ts t o:
Sh a pe th e poli cy deba te su r r ou n di n g h ea lt h r efor m : Advoca cy ca n h elp defin e h ow h ea l th r e-
for m s a r e per cei ved a n d u n der stood by key sta keh older s. Usin g fa ct s a n d figu r es t o m a ke a
per su a sive a rgu m en t for you r r efor m policies h elps bu il d su pport a m on g key gr ou ps. In tr o-
du ci n g sou n d a n d relia ble pol icy a n a lysis a lso foster s a m or e a ccu r a te a n d obj ective di scu s-
sion of h ea lth r efor m issu es.
Advocacy is a set of
targeted actions directed
at decision-makers and
other key stakeholders in
support of a specific
policy issue.
3-2 Polic y Toolkit for Str engthen ing Health Car e Secto r Refor m
Bu ild su ppor t a n d m in i m ize opposition : Th e a n a lysis requ ir ed to design a n d im plem en t a
su ccessfu l a dvoca cy st ra t egy i den ti fies poten tia l a llies for su ppor t a n d in di vidu a ls a n d/ or
grou ps wh o m a y oppose you r h ea lt h r eform i n iti a t ives. Th e a n a lysis a lso su ggest s str a tegies
to con solida te a n d m a in ta i n su ppor t, wh i le a t th e sa m e t im e, a ddr essin g you r opposition .
Motiva te a ct ion : Su ccessfu l a dvoca cy effor ts n ot on ly provide i n for m a ti on , r a i se a wa r en ess,
a n d bu ild su ppor t for h ea l th refor m effor ts, th ey a lso focu s on th e actionsrequiredby th e
ta r get a u dien ces to im plem en t r efor m s. Advoca cy a ct iviti es m a ke expl icit th e decision s to be
m a de, t h e ch a n ges in opin i on desir ed, th e l evel of pol itica l com m i tm en t n eeded, a n d th e
tech n i ca l, h u m a n , a n d fin a n cia l r esou r ces requ ir ed t o su ccessfu lly im plem en t h ea lth r e-
for m in i tia tives.
What comprises an effective advocacy strategy?
Th ese a dvoca cy gu idelin es h elp you syst em a t ica lly develop a n a dvoca cy str a tegy th a t bu ilds
su pport a n d pol itica l com m i tm en t for you r pr iori ty h ea lth r efor m s a n d m i n im izes th e opposi -
tion to r eform . Th ese gu idelin es in tr odu ce th e con cept of a dvoca cy with a str a tegic focu s on
developi n g a dvoca cy ca m pa ign s, foll owed by a stepby- step descri ption of th e pr ocess n eeded to
design a n d im pl em en t a n a dvoca cy str a tegy. Th e pr ocess ou tlin ed in th ese gu idel in es h elps you
Art icu la te wh a t you wa n t to a ch ieve th r ou gh a dvoca cy
I den ti fy a n d u n der sta n d wh om you n eed to i n flu en ce
Select a ppr opri a t e a ctivit ies to im plem en t you r a dvoca cy str a t egy.
Th ese gu idelin es a lso dem on st ra te th e cri tica l r ol e of a dvoca cy in su ppor tin g im pl em en ta t ion
of h ea lth r efor m , tea ch ba sic a dvoca cy skil ls, pr ovide wor ksh eets for con du ctin g th e n ecessa r y
a n a lyses a n d developin g a system a tic a ppr oa ch ( see An n exes) , a n d bu i ld con fiden ce for u n der -
ta kin g a dvoca cy a ctivities th a t effectively su pport r efor m .
Th e gu i delin es h a ve been a da pted from tools a n d m eth odologies devel oped for oth er h ea l th -
r ela ted a cti vities ( see bibliogr a ph y) a n d th er efor e bu il d on t h e gr owin g exper ien ce in a dvoca cy,
policy com m u n ica ti on , a n d m a n a gem en t of th e policy pr ocess. Th ey h a ve been field- test ed a n d
a re or ga n ized t o cr ea te a n a ppr oa ch a ppr opr ia te to th e com plexit y a n d diver si ty of h ea lth sector
r efor m s.
Where does advocacy fit into the policy process?
Developin g a th or ou gh u n der sta n din g of th e oppor tu n ities th a t exist for in flu en ci n g th e poli cy
pr ocess is cri tica l to t h e su ccess of you r a dvoca cy effor t s beca u se it focu ses you r a dvoca cy a ctivi-
ties on wh a t is a tta in a ble. Th is requ ir es a ssessin g h ow t h e pol icy pr ocess wor ks in you r cou n t ry.
Th e I n t rodu ction to th is toolkit presen ts a m odel for th e policy pr ocess t h a t i n clu des five sta ges:
policy for m u la tion a n d legiti m iza tion ; con st itu en cy-bu ildin g; r esou r ce m obi liza ti on ; im pl e-
m en ta ti on design a n d or ga n i za tion a l str u ctu r in g; a n d pr ogr ess/ im pa ct m on it orin g ( see Fi gu r e
3.1) .
Advoc acy Guide lines 3-3
Refor m s a re la u n ch ed wh en issu es a n d a gen da s com e togeth er a n d policym a ker s decide to
r efor m th e h ea lth sector a n d set th e dir ection of r efor m . Th i s politica l ly dr iven process is wh a t
m ost peopl e a ssocia te with a dvoca cy a n d, i n fa ct, wh er e t h ey ten d to focu s th eir a dvoca cy effor ts.
Exper ien ce dem on str a tes, h owever, th a t a dvoca cy is n eeded in a ll sta ges of th e h ea l th refor m
policy pr ocess a n d th a t a dvoca cy ca n be pa r ticu la r ly effecti ve du r in g con stitu en cy- bu ildi n g a n d
r esou r ce m obili za tion .
Constituency-Building
You m u st con vin ce key con sti tu en cies th a t th ey wi ll ben efit fr om th e pr oposed r eform s a n d th a t
th e ben efit s will ju stify th e cost s. A gen er a l per ception of legitim a cy is im por ta n t t o h ea lth sect or
r efor m , bu t it is n ot su fficien t to en su r e im pl em en ta ti on . Moreover, ben efi cia r ies m u st a ctively
su pport h ea lth sector r eform , n ot sim ply give th eir ta cit a ppr ova l. Su ccessfu l ly im plem en tin g
h ea l th sector r efor m r equ ir es br oa d su ppor t a t differen t levels, in cl u din g fr om pr opon en ts in side
a n d ou tside gover n m en t. I t is essen tia l to h a ve th e pa r ti cipa tion of sta keh older s wh o pu blicl y
su pport h ea lth sector r eform a n d lea d by exa m ple by ch a n gin g th eir own beh a vi or s a n d
orga n iza tion a l n or m s. Advoca cy is cr iti ca l for bu ildin g con st itu en ci es a n d m obili zin g th em to
becom e a ctive su ppor ter s.
Resour ce Mobilization
I m plem en tin g h ea lth sector r eform r equ ir es su bsta n tia l fin a n cia l, h u m a n , a n d tech n i ca l
r esou r ces. Accu m u la tin g a n d m obilizin g t h ese r esou r ces i s a n oth er cr iti ca l a dvoca cy ch a llen ge.
Con sti tu en cies a n d n etwor ks ca n h elp you lobby for r esou r ces. Th ey m a y a lso h elp you develop
in cen ti ves or con diti on s th a t a llow existin g r esou r ces to be u sed m or e efficien tly or to be r ede-
ployed. However, you ca n n ot becom e com pla cen t on ce you h a ve su ccessfu lly m obilized r equ i red
r esou r ces to im pl em en t key h ea lth r efor m s, sin ce th ese r esou r ces ca n la ter be rea lloca ted or lost
to com peti n g u ses a n d u ser s. As a m em ber of th e h ea lth sect or r efor m tea m , you n eed to r ecog-
n ize a n d dea l with th e opposi tion th a t is cr ea t ed wh en resou r ces ch a n ge h a n ds a n d con tin u e
you r a dvoca cy effor ts t o m a i n ta in th e r esou rces r equ i red to im plem en t h ea lt h r eform poli cies.
Figure 3.1 . Policy Stages, Technically Dominated
Policy Formulation
and
Legitimation
Constituency-
Building
Resource
Mobilization
Implementation
Design and
Organizational
Structuring
Progress/Impact
Monitoring
= primary linkage
= secondary linkage
= Policy stages where
advocacy is most
useful
Advocacy can be
particularly important
during constituency-
building and resource
mobilization.
How do the Advocacy Guidelines relate to the other guidelines in
this toolkit?
Th ese gu idelin es a r e design ed to com plem en t a n d bu il d on th e oth er m eth odologies in th e Pol-
icy Toolkit. As a r esu lt, th e r ea der i s en cou r a ged to r efer to th e oth er gu idelin es a n d tools a s
n eeded. For exa m ple, som e of th e t ech n iqu es to i den ti fy a n d a n a lyze key pol icym a ker s a n d
oth er i n flu en t ia l politi ca l a ctor s bu il d on a ppr oa ch es a n d exer cises descr ibed in th e Sta keh older
An a lysis Gu idel in es. Sim ila r ly, con fl ict r esol u tion a n d n egoti a t ion a r e im por ta n t t o a dvoca cy,
a n d t h e Con flict Negotia tion Gu idelin es pr ovide su bsta n tia l , deta iled di rection on h ow a n d
wh en to u n der ta ke n egotia tion . Alt h ou gh ea ch tool ca n be u sed in depen den tly, you a r e en cou r-
a ged to lea r n th e con cepts a n d skills i n clu ded i n a ll a n d to u se th em to fu r th er you r r efor m
effor ts.
Developing an Advocacy Strategy: Component I Looking
Outward
Th is com pon en t of th e pr ocess com pr ises fou r steps: u n dersta n di n g t h e pol itica l deci si on - m a k-
in g pr ocess, selectin g a n d defin in g a h ea l th r efor m pol icy, set tin g a dvoca cy obj ecti ves, a n d i den -
tifyin g a n d a n a lyzin g a u dien ces. Th e fir st th r ee steps a r e oft en th e m ost diffi cu lt a n d ch a ll en g-
in g a spects of devel opi n g a n a dvoca cy str a tegy. Th ey r equ ir e a n a lyzin g a n d u n der sta n din g
com pl ex poli cy processes a n d rela tion sh ips, syn th esi zin g h igh ly tech n ica l a n d m u lti fa ceted pol-
icy issu es, pr ior itizi n g th e releva n t r efor m policies, a n d clea r ly defin in g a dvoca cy obj ecti ves.
Ta ki n g th e tim e t o com plete th e exer cises a n d ca r r y ou t th e a n a lyses r equ ir ed for th ese steps i s
ver y ben efici a l in th e l on g r u n . Th e r esu lt s of t h ese th r ee steps di rectly a ffect a l l th e su bsequ en t
steps in th e a dvoca cy pr ocess iden tifyin g a n d a n a l yzin g ta r get a u dien ces, a r ticu la tin g a n d
im plem en ti n g a dvoca cy a ctivities, eva lu a tin g a n d a dju stin g you r str a tegy a n d th er efor e h a ve
a dir ect bea r in g on th e effecti ven ess of you r a dvoca cy effort . With ou t a fu n da m en ta l u n der -
sta n din g of th e pol itica l deci si on - m a kin g pr ocess a n d pol itica l con t ext, a cl ea r a n d specific
sta tem en t of you r reform policy, a n d well- defin ed a dvoca cy objectives, you r u n th e r isk of losin g
focu s a n d wa stin g pr eciou s r esou r ces a n d en er gy.
Step 1 : Understand the Political Decision-Making Process
Effecti ve a dvoca cy st r a tegies begi n wi th st u dy a n d r esea r ch . To effect ch a n ge in th e decision -
m a kin g or policy- im pl em en ta t ion a r en a s of h ea lth r efor m , you m u st iden tify a n d u n dersta n d
th e processesth r ou gh wh i ch policy deci si on s a r e m a de a n d im plem en ted.
Th ese pr ocesses in vol ve m a n y a ctors a n d m a n y steps. Ea ch a ctor is a pot en ti a l sou rce of su p-
port or opposi tion , a n d ea ch step is a poten tia l poin t of a ccess in to th e poli cy pr ocess. By disa g-
grega tin g, a n a lyzin g, a n d u n dersta n din g t h e process, you ca n bet ter i den tify t h e im por ta n t
a ctor s a n d deter m in e wh ere to in ter ven e. It is equ a lly im port a n t t o iden tify, on on e h a n d, th e
for m a l ru les a n d pr ocedu r es of gover n m en t a n d, on t h e ot h er, th e u n wr itten r u l es of policym a k-
in g th a t a ffect th e roles, r el a t ion sh ips, a n d ba la n ce of power a m on g in stit u tion s a n d key a ct ors.
Fir st , a ssem ble a gr ou p of collea gu es, a n d br a in stor m toget h er t o a n a lyze h ow policy deci-
sion s a r e m a de. An swer th e qu est ion s in Box 3.1. Cr ea ti n g a flow ch a r t or m a ppin g th e policy
process ca n a lso be h el pfu l.
Box 3.1. Discussion questions: How poIicy
decisions are made
How are ideas or issues generated for a new or revised
policy?
How is the proposed issue introduced into the formal
decision-making process?
What is the process for discussing, debating, and altering
the proposal?
Who are the actors involved?
How is the proposal approved or rejected?
What is the timeframe for discussing and approving the
proposal?
lf approved, what are the steps to implement the policy?
(Boyd et al. 1999)
Step 2: Select and Define A Health Reform Policy
Now t h a t you h a ve a ba sic u n der sta n din g of th e poli cy pr ocesses in you r cou n tr y, you m u st a n a -
lyze th e di ffer en t h ea lth r efor m policies a n d select on e t o be t h e focu s of you r a dvoca cy effort s.
Th is is oft en th e m ost diffi cu l t pa r t of design in g a n a dvoca cy str a tegy. Hea lth r efor m is com -
pri sed of m u ltiple com plex a n d h i gh ly tech n i ca l policies a n d str a tegies, a n d you m u st select
a n d defin e you r r efor m policy in ter m s th a t a r e pol itica l ly fea sible a n d u n der sta n da ble to
policym a ker s a n d oth er key st a keh older s.
Step 2 is br oken down i n to fou r ta sks: 1) selectin g a h ea lth r efor m policy, 2) defin in g you r
policy, 3) a n a lyzin g th e con sequ en ces of im plem en tin g you r policy, a n d 4) eva lu a ti n g its pol iti-
ca l fea sibilit y.
Select a Health Reform Policy.
For a dvoca cy t o be effect ive, it m u st be focu sed on a specific h ea lth r efor m pol icy. Th e cr iteri a for
selectin g a pr ior ity h ea lt h r eform poli cy for you r a dvoca cy effor ts in cl u de th e followin g:
Th e policy dir ectly su ppor ts cu rr en t h ea lth r efor m s.
Th e policy i s cr itica l to im plem en t a t ion of you r h ea l th reform s.
Th e policy i s politica lly via ble.
Th e ti m e is oppor tu n e t o bu il d su ppor t for t h e policy or m a ke decision s a n d ta ke a ction r e-
ga rdin g th e poli cy.
Refer to th e st a keh older a n a lysis gu idelin es in Section 2 for a m or e in - depth discu ssion of h ow
to sel ect a n d defin e a policy.
Define the health reform policy.
On ce you h a ve sel ected a pr ior ity policy, you m u st defin e it con cr etel y a n d clea r l y to en su r e a
com m on u n der st a n din g of it a m on g policym a kers, oth er sta keh olders, a n d pot en ti a l su ppor t-
er s. Advoca cy is a bou t con vin cin g oth er s of t h e m er it s of you r h ea lt h r efor m policy, a n d h ow you
a rt icu l a te th e poli cy h elps sh a pe th e deba te th a t su r rou n ds i t. You m u st a lso specify wh a t a ction s
th e gover n m en t m u st ta ke to im plem en t t h e refor m pol icy. As th e exa m ples i n Boxes 3.2 a n d 3.3
dem on str a te, better defin ition s m a ke it is ea sier to i den ti fy wh o h a s a u th or it y to in flu en ce th e
policy a n d wh o wil l su ppor t or oppose it, th ereby i m pr ovin g th e effect iven ess of you r a dvoca cy
effor ts ( see a l so th e sta keh older a n a l ysis gu ideli n es in Section 2) . To en su r e t h a t you defin e you r
policy in a wa y th a t is a ccu r a te a n d com pr eh en sible, be su r e to:
Use clea r a n d n on t ech n ica l la n gu a ge.
Be a s specific a s possible.
Be a ction -or ien ted.
High li gh t positi ve a spects of th e policy.
I dentify the advantages and disadvantages of implementing the
policy.
Th er e a r e a dva n ta ges a n d disa dva n t a ges for a n y h ea lth r efor m
policy. Sta keh ol der s will decide wh eth er to su ppor t a policy ba sed
on th e a dva n ta ges a n d disa dva n t a ges th a t a r e pr esen ted to th em .
Good a dvoca tes u n der sta n d a ll possible con sequ en ces of th eir pol-
icy a n d develop a dvoca cy objectives th a t h igh li gh t th e a dva n t a ges
a n d down pl a y th e di sa dva n ta ges.
Con du ct a qu ick a n a lysis of th e a dva n ta ges a n d disa dva n ta ges
by iden tifyin g th e grou ps a n d in dividu a ls a ffected by th e proposed
policy goa l a n d bra in storm in g with you r collea gu es on th e reform
tea m to deter m in e wh ich in dividu a ls a n d grou ps will ben efita n d
wh ich will lose( see Ta ble 3.1) . First, list th e a dva n ta ges of im ple-
m en tin g you r proposed policy. For ea ch a dva n ta ge, iden tify a n d list
th ose in dividu a ls a n d grou ps th a t will win ( m a rk with a + ) . Fol-
low th e sa m e process with th e poten tia l disa dva n ta ges, by listin g th e
disa dva n ta ges a n d iden tifyin g th ose in dividu a ls a n d grou ps th a t
will lose ( m a rk with a ) . I f you h a ve con du cted a sta keh older
a n a lysis, th en you ca n u se you r sta keh older list a n d/ or sta keh older
a n a lysis in form a tion .
Box 3.2. HeaIth reform poIicy definition #1
Definition for the general health reform policy of
"Deconcentration of the Ministry of Health.
Deconcentration of the MOH is the permanent delegation of
decision-making power to provincial directors, area chiefs,
and hospital directors in the areas of:
naming and managing personnel
buying equipment and supplies
utilizing funds generated by the facilities.
Box 3.3. HeaIth reform poIicy definition #2
Definition for the general health reform policy of "MOH
resource allocation based on results.
Allocating MOH resources based on results is the provision of
resources to Ministry facilities based on the services they
provide (according to the number of services produced). The
specific resources that would be allocated based on results
include:
facility and general administrative budgets
personnel allocations
equipment distribution.
Table 3.1 .
Example of Costs and Benefits of a Health Reform Policy: I ncreased Efficiency in Use of MOH Resources
Advantages Disadvantages StakehoIder affected
Decreased costs of service provision +MOH authorities
+Clients
lncreased work load by MOH
personnel
MOH personnel in facilities
Labor unions
Decreased wait time +Clients
+MOH authorities (through better institutional
reputation)
New administrative and budgeting
systems
Ministry of Finance
MOH budgeting at central and facility levels
MOH facility directors
MOH more competitive provider More competition Private sector providers
+MOH authorities and facilities
Possible shut downs of inefficient or
unnecessary facilities Clients
Facility personnel
Labor unions
Changes in personnel Labor unions
Facility personnel
Allows MOH to continue to provide
services
+Clients
+MOH personnel
Evaluate the policys political viability.
Now you r tea m wil l n eed to deter m in e i f th e pol icy is polit ica lly via ble ( see Box 3.4) . For exa m -
ple, in r evi ewin g th e a n a lysi s in Ta bl e 3.1, t h e h ea lt h r eform t ea m ca n qu ickly deter m in e th a t
th ere a r e m or e oppon en ts th a n su pport er s for th eir poli cy of in cr ea sin g th e efficien cy of MOH
r esou r ces. Th e n ext step is to dig fu rt h er in to th e a n a lysis to determ in e if th e opposi tion is str on -
ger th a n t h e su pport . You ca n qu ickly see th a t th is h ea lt h r eform t ea m ca n a n ti cipa te st ron g
oppositi on fr om key a n d in flu en tia l politica l a ctor s like th e Min istry of Fin a n ce, MOH tech n ica l
sta ff a t th e cen tr a l a n d clin i c levels, MOH di rector s, pr iva te sector pr ovider s a n d la bor u n ion s.
Given th e opposi tion , th e tea m m a y wa n t to con sider selectin g a n oth er policy th a t is m or e fea si-
ble or r eor ien tin g th e ch osen poli cy. Th e ben efit of th is a n a lysis is th a t in sh or t or der, th e h ea l th
r efor m tea m ca n qu ickly deter m in e if th eir r efor m policy i s politica lly fea sible, n eeds to be r efo-
cu sed, or sh ou ld be a ba n don ed for a n ot h er on e less con tr over sia l befor e developin g a n a dvoca cy
str a t egy t h a t will be m isgu ided fr om th e sta r t.
Box 3.4. Discussion questions: Determining if a
poIicy is poIiticaIIy viabIe
Are there more supporters than opponents?
Are the supporters more influential than the opponents?
Are there undecided and neutral groups that can be
converted to supporters?
ls there is more opposition than support for your policy? lf
yes, should you: a) continue? b) refocus the policy? c)
choose another, less controversial policy?
Step 3: Set Advocacy Objectives
On ce you h a ve selected a n d defin ed you r policy, you a r e a ble to begin sh a pin g you r a dvoca cy
str a t egy by iden tifyin g you r a dvoca cy objectives. An a dvoca cy str a tegy a im s to ch a n ge th e
beh a vior or opin ion s of poli cym a ker s, or ga n iza t ion s, or key in dividu a ls r ega r din g you r reform
policy a n d to m otiva te th em t o ta ke a cti on in su ppor t of you r policy. An a dvoca cy objective st a tes
wh a t you wa n t to ch a n ge, wh o wil l m a ke th e ch a n ge, a n d by wh en . You r a dvoca cy str a tegy m a y
en com pa ss m ore th a n on e objective; m a n y a dvoca t es sim u lt a n eou sly wor k on m u ltiple a dvo-
ca cy objectives to im plem en t t h eir pol icy a n d a ch ieve t h eir lon g- ter m r efor m goa ls.
Ma n y a dvoca cy object ives fa ll in to th e followin g th r ee ca tegor ies:
1. Ma i n t a i n a n d m ob i l i ze cu r r en t su p po r t er s Ma i n t a i n a n d m ob i l i ze cu r r en t su p po r t er s Ma i n t a i n a n d m ob i l i ze cu r r en t su p po r t er s Ma i n t a i n a n d m ob i l i ze cu r r en t su p po r t er s of you r h ea l th r efor m pol icy: Not ever yon e
wh o su ppor ts you r h ea lth r efor m policy wil l wor k a ct ively for its pa ssa ge or im plem en ta -
tion . You r su ppor ter s m a y n eed t o be a sked or, perh a ps, con vin ced to do som et h in g to fu r -
th er policy im plem en ta tion . You m a y n eed to per su a de th em th a t th e ben efits of a ct ion
ou tweigh t h e costs, a n d you m u st be speci fic a bou t h ow th ey ca n h elp.
2. Mi n i m i ze a ct i ve op po si t i o n Mi n i m i ze a ct i ve op po si t i o n Mi n i m i ze a ct i ve op po si t i o n Mi n i m i ze a ct i ve op po si t i o n to you r h ea lth r efor m poli cy: Th er e i s a cost to a ct ion for
you r su ppor ters, bu t you r oppon en ts in cu r a cost for a ction a s well. You m a y be a ble to
con vin ce you r oppon en ts to lim it t h eir effor ts t o obst ru ct you r poli cy, even i f you ca n n ot
ch a n ge t h eir opi n ion s a bou t th e m eri ts of t h e policy. For exa m ple, it m a y be di fficu lt for
Min i st ry of Hea lth officia ls to a rgu e a ga in st a poli cy decen tr a l izin g r espon sibilit y a n d r e-
sou r ces for h ea lt h ser vices if t h e policy en joys widespr ea d pu blic su ppor t.
3. Con ver t n eu t r a l pa r t i es a n d o pp o si t i on Con ver t n eu t r a l pa r t i es a n d o pp o si t i on Con ver t n eu t r a l pa r t i es a n d o pp o si t i on Con ver t n eu t r a l pa r t i es a n d o pp o si t i on t o su ppor ter s for you r h ea lth r eform policy: Of-
ten , th e views of oppon en ts or n eu t ra l pa rt ies a bou t a poli cy a r e ba sed on in com plete or
in a ccu r a te in for m a tion . By pr ovidin g cl ea r a n d com pellin g evi den ce to su pport you r po-
sition , you m a y swa y a ddition a l sta keh olders to you r view.
Br a in stor m wit h you r coll ea gu es on t h e h ea lt h r eform t ea m to i den ti fy a com pr eh en si ve list
of a dvoca cy objectives ( see Boxes 3.5, 3.6, a n d 3.7) . Beca u se you h a ve lim ited tim e a n d
r esou r ces to ca rr y ou t th e a ctivities n ecessa ry t o a ch ieve th ese object ives, you m u st pr ior itize t h e
list. I n a ddit ion , ea ch a dvoca cy objective sh ou ld con ta in th e foll owi n g th r ee com pon en ts ( see
Figu r e 3.2) : a ta r get a u dien ce, t h e desir ed policy a ct ion or decision to be ta ken by th e ta r get
a u dien ce, a n d th e tim el in e a n d degree of ch a n ge.
Figure 3.2. Components of an Advocacy Objective
Target audience Desired poIicy
action or decision
to be taken by
target audience
TimeIine and
degree of change
+
+
Advoc acy Guide lines 3 -1 1
Fin a lly, sou n d objectives a re Specific, Mea su r a bl e, Rea listic, a n d Tim e- bou n d ( SMART) . Use
th e discu ssion qu est ion s in Box 3.8 t o en su r e t h a t you r a dvoca cy objectives a r e SMART.
Box 3.5. Discussion questions: Setting advocacy
objectives
Whose opinion or behavior do you want to change?
To what should their opinion or behavior be changed?
What actions or steps do you want them to take?
What is the timeframe?
Box 3.6. Advocacy objective #1
Advocacy objective for decentralizing health services:
Create support and better understanding of the benefits of
decentralization among Ministry of Health leadership before
policy is approved by Prime Minister.
Box 3.7. Advocacy objective #2
Advocacy objective for rationalizing health facilities:
Minimize political opposition to closing 50 percent of public
health posts by informing key stakeholders such as local
politicians, provincial advisory council members, and
community leaders about how services will improve with more
resources dedicated to fewer clinics.
Box 3.8. Discussion questions: Ensuring that
advocacy objectives are SMART
S Specific: ls the objective specific enough that your
supporters understand what you are trying to achieve?
M Measurable: ls the objective measurable, enabling
you to assess whether your advocacy activities succeed or
fail?
A Achievable: ls the objective achievable given the
resources (financial, political, and technical) available to
your health reform team?
R Realistic: ls the objective realistic given your
resources, expectations, and timing?
T Time-bound: Have you specified a timeframe in which
to achieve the objective?
Step 4: I dentify and Analyze Audiences
I dentify target audiences
Effecti ve a dvoca cy i s ba sed on a n a u dien ce-cen ter ed a pproa ch th a t ta r gets in stitu tion s a n d peo-
ple cr itica l for su ccess, r a t h er th a n a ttem ptin g to rea ch a l l a ct ors or decision -m a ker s. Th e
a u dien ce- cen tered a pproa ch :
Distin gu ish es th e ta r get a u dien ces
An a lyzes th eir positi on s a n d in ter ests
Com m u n ica tes policy m essa ges to th em
Motiva tes th em to ta ke a ct ion .
Th e sta keh older a n a l ysis gu ideli n es in th is toolkit ( Sect ion 2) pr ovide on e m eth od for iden ti-
fyin g ta r get a u dien ces by iden tifyin g key st a keh older s. An oth er m eth od is to br a in st orm wi th
you r collea gu es to iden t ify a ll or ga n iza t ion s, grou ps, a n d in dividu a ls wi th a vested in ter est a n d
st a kein you r cou n tr ys h ea l th r efor m ( see Box 3.9) .
Wh il e t h er e m a y be va r ia tion s a m on g cou n tr ies, th e ta r get a u dien ces for h ea lt h r efor m poli -
cies gen era ll y i n clu de r epr esen ta tives fr om th e fol lowin g sector s: i n ter n a tion a l, gover n m en t,
politica l , com m er cia l, n on gover n m en ta l , a n d socia l . Ta ble 3.2 pr ovides a com pr eh en sive li st of
possible ta r get a u dien ces, a n d Box 3.10 lists th e ta r get a u di en ces of a h ea lth r eform in itia ti ve in
Ecu a dor.
Aft er you h a ve i den t i fi ed t h e st a keh ol der s, sepa r a t e t h em i n t o pr i m a r y a n d secon da r y
a u di en ces:
Pr im a r y a u di en ces h a ve th e a bi lity a n d a u th or ity to di rectly a ffect you r a dvoca cy objectives.
Th ese gr ou ps m a ke decision s, ta ke a ction , a n d cr ea te ch a n ge. Th ey sh ou ld be t h e pri m a r y
ta r gets for you r a dvoca cy str a tegy. I n th e ca se of h ea lth sect or refor m , pr im a ry a u dien ces
m a y in clu de m in i st er s of Hea l th , Pl a n n in g, a n d Fin a n ce, va r iou s levels of cen tr a l a n d loca l
gover n m en ts, sta ff a t th e h ea l th fa cili ties, a n d pr iva te sector ser vice pr oviders.
Secon da r y a u dien ces a r e people a n d gr ou ps wh o in flu en ce you r pr im a r y a u dien ces. To th e
exten t t h a t th ey a ffect th e deci si on s a n d a ction s of pr im a ry a u dien ces, th ey a lso sh ou l d be
ta r gets of a dvoca cy a ction s. Opposition m a y be in clu ded a m on g you r secon da r y a u dien ces.
Key secon da r y a u dien ces for h ea l th sect or r efor m i n cl u de doctor s syn dica t es a n d ot h er a sso-
cia ti on s of h ea lth pr ofession a ls, th e m edia , a n d, possi bl y, n on gover n m en ta l or ga n i za tion s
( NGOs) a n d th e pu blic. ( Th e pu blic is u su a lly con si der ed a secon da r y a u di en ce beca u se it
a ffects ch a n ge by rea ctin g t o t h e in cen tives crea t ed by policies or r efor m ed syst em s, n ot by di-
r ectl y in flu en cin g t h e policies or system s.)
Th e Au di en ce I den tifica tion Wor ksh eet ( see An n ex 3- A) h elps you l ist you r pr im a r y a u di-
en ces a ccor din g to obj ecti ve a n d you r secon da r y a u dien ces a s th ey r el a t e t o pr im a r y a u dien ces.
Primary audiences have
the ability and authority to
directly affect your
objectives. They make
decisions, take action, and
create change. Secondary
audiences are people and
groups who influence your
primary audiences.
Th is wor ksh eet will h el p you iden tify a ll ta r get a u dien ces a n d see
clea r ly wh i ch grou ps or in di vidu a ls a r e listed m u lti pl e t im es.
I den tifyin g key politica l a ctor s a n d sta keh olders is a n im por ta n t
step i n developin g you r a dvoca cy str a t egy. Hea lth r efor m tea m s fr e-
qu en tly focu s sol ely on th ei r own i n stitu tion s a n d th eir im m edia te
cir cl es of in flu en ce, bu t it is essen tia l t o look ou twa rd to iden tify
poten t ia l a llies and pot en ti a l oppon en ts. I n deed, th e in tr odu ction of
h ea l th sector r efor m s often elici ts dir ect a n d open opposition fr om
im por ta n t gr ou ps, su ch a s str ike th r ea ts fr om h ea lth wor ker u n ion s
a n d n ega tive pu bl ic r el a tion s ca m pa ign s fr om m edica l a ssocia ti on s
a n d pr iva t e sector h ea lth orga n iza tion s. Wh eth er th e opposition is
m i ld or str on g, you m u st be pr epa red to a ddr ess it in wa ys th a t ben e-
fit you r st a t ed policy:
Be ca r efu l to iden t ify a n d in clu de poten tia l opposi tion in you r a d-
voca cy effor t s.
Be in form ed a bou t th e opposition s specific issu es a n d ba se of
su pport .
An ticipa te t h e opposition s r espon se, a n d i n clu de th em wh en ever
possible in th e poli cy deba t e.
Pr epa r e m essa ges to r efu t e t h e oppon en ts a r gu m en ts a s th ey a ri se.
Th e u n deci ded or n eu tr a l pa r ties a r e oft en over looked by h ea lth r efor m tea m s. Ma n y
u n decided gr ou ps m a y becom e fu ll su pport er s of you r r efor m policy with on ly a m in im a l effor t
beca u se m a n y si m ply la ck in for m a tion or n eed on l y t o be a sked to becom e a ctively in volved in
h ea l th refor m effor ts. Ma n y poli cym a ker s a n d key sta keh olders a re h esita n t t o voice a n opin ion
on h ea lth r eform issu es th ey fea r m a y be con tr oversia l , bu t you r a dvoca cy effor ts m a y effectively
con ver t th ese ta r get a u di en ces fr om n eu tr a l to su ppor tive.
Collect I nformation about Your Audiences
Collectin g in form a tion a bou t you r ta rget a u di en ces is cri tica l for ta il or in g effect ive m essa ges
a n d i den tifyin g a ppr opr ia te a dvoca cy str a tegies. You n eed to lea r n you r a u dien ces kn owledge
of, a ttitu des towa r d, a n d in ter ests i n t h e r efor m policy, a s wel l a s th e ot h er issu es a bou t wh ich
you r a u dien ces ca r e deepl y.
Kn owl edge: Wh a t is th eir l evel of kn owledge a bou t you r r efor m policy? Ar e th ey con ver sa n t
with key h ea l th refor m issu es? Do t h ey u n der st a n d th e con sequ en ces of i m plem en tin g th e
policy?
Attitu des a n d/ or per ception s: Wh a t do th ey rea lly th in k a n d feel a bou t you r refor m pol icy?
Are th ey in fa vor ? Opposed? Wh a t is th eir officia l posi tion ? u n officia l posit ion ?
Box 3.9. Discussion questions: Identifying target
audiences
Who or what groups have direct decision-making
authority, influence, or power over my reform policy?
Who or what groups influence these individuals or groups?
What organizations or individuals are affected by my
reform policy? Are they affected negatively? Positively?
What organizations or individuals are interested or
potentially support my reform policy?
Box 3.10. Audiences for heaIth reform in Ecuador
Before the Ministry of Health (MOH) in Ecuador proposed
specific health reform policies and related constitutional
amendments, it researched and consulted a wide range of
groups to enhance the political feasibility of its proposals. The
MOH identified more than 15 groups, including:
Central and provincial-level employees of the MOH
Doctors
Nurses
Private sector service providers
Nongovernmental organizations (NGOs)
lndigenous groups
Women's groups
Universities
I n ter ests: Do t h ey ca r e a bou t h ea lth r efor m in gen er a l? th is policy in pa r ticu la r ? Wh y? How
does th e poli cy a ffect th em ?
Oth er issu es: Wh a t oth er issu es do you r ta r get a u dien ces ca r e deeply a bou t ( th ey ca n be u n r e-
la ted to you r policy goa l a n d h ea lth r efor m ) ?
Th is a u dien ce-cen ter ed da ta m en tion ed a bove is key to th e effectiven ess of you r effor t. For
exa m pl e, if you r pr im a r y a u di en ce h a s littl e or n o in for m a ti on a bou t you r r efor m policy, you r
a dvoca cy obj ecti ve m a y be to pr ovide th em i n for m a t ion a n d ra ise th eir a wa ren ess. Kn owin g th e
issu es you r ta r get a u dien ces ca r e a bou t h elps you lin k you r r efor m policy to th ei r politica l
a gen da , in crea si n g t h e likeli h ood th a t you will ga in th eir su ppor t. Sim i la r ly, u n der sta n din g
h ow you r r efor m poli cy a ffects you r a u dien ces pa r ticu la r ly wh a t th ey sta n d to losefr om th e
policy h elps you cra ft m essa ges th a t dir ectly a ddr ess t h eir con cer n s.
Th er e a r e sever a l m eth ods for collectin g in for m a tion on t a r get a u dien ces. Th e sta keh older
a n a lysis gu ideli n es ( Secti on 2) in clu des u sefu l t ool s for com pilin g, a n a lyzi n g, a n d pr esen tin g
Table 3.2. Possible Key Actors and Stakeholders in Health Reform
Sectors Actors
InternationaI lnternational agencies (World Health Organization, Pan American Health Organization, etc.)
lnternational financial institutions (World Bank, African Development Bank, lnterAmerican
Development Bank, etc.)
Bilateral donors (US Agency for lnternational Development, etc.)
lnternational private voluntary organizations (PVOs)
Government Executive branch
Legislative branch
Government ministries (health, finance, education, etc.)
Military
Regional and local government
PoIiticaI Political parties (in power)
Political parties (in opposition)
Other political organizations
Social movements
CommerciaI Private entities (private hospitals, private provider networks, etc.)
Commercial private sector (pharmaceutical companies, insurance schemes, etc.)
NongovernmentaI Health activists
Religious groups, leaders
Nongovernmental organizations (NGOs), PVOs
Professional Associations (doctors, nurses, midwives, health workers, etc.)
Media
SociaI Voters
Community leaders
lndigenous and other community groups
Labor unions/groups
th i s in for m a tion . I f you do n ot con du ct a sta keh older a n a lysis, you ca n ga th er in for m a tion by
ta lkin g to people fa m i lia r with you r a u dien ces, r ea din g speech es or docu m en ts wr itten by th em ,
a n d a tt en din g m eeti n gs wh er e t h ey a r e spea kin g or pa r ticipa ti n g. Th e foll owi n g m eth ods a r e
a lso u sefu l:
I n fo r m a n t i n t er vi ews: I n fo r m a n t i n t er vi ews: I n fo r m a n t i n t er vi ews: I n fo r m a n t i n t er vi ews: I n terviews pr ovide in -dept h i n for m a t ion on key ta r get a u dien ces
feelin gs a n d beliefs r ega rdin g you r r efor m pol icy. You ca n u se in for m a ti on a l in terviews wi th
a lim it ed n u m ber of i n flu en t ia l or kn owl edgea ble in dividu a ls ( wh o a r e represen ta ti ve of key
grou ps) to better a ssess h ow secon da r y a u dien ces i n ter a ct a n d in flu en ce pr im a r y a u dien ces.
I n for m a n t i n ter vi ews a r e pa r ticu la r ly h elpfu l wh en th e a u dien ce is a sin gle person or a
gr ou p sm a l l en ou gh to be in ter viewed toget h er. Be ca r efu l , h owever, n ot to con si der a n swer s
fr om a sin gl e in dividu a l to be r epr esen ta tive of a n en tir e a u dien ce.
Fo cu s gr ou p s: Fo cu s gr ou p s: Fo cu s gr ou p s: Fo cu s gr ou p s: Th ese a r e sem i- str u ctu r ed session s wh er e sm a ll gr ou ps fr om you r t a r get pop-
u la ti on r espon d to qu estion s a n d discu ss issu es of in ter est. Th ey pr ovide a n in - depth per spec-
tive a n d th e oppor tu n ity to gen er a te discu ssion a n d va lida te opin ion s from r epr esen ta tives of
th e ta r get a u dien ces. Fin d som eon e you r a u dien ce con si der s n eu tr a l t o lea d th e focu s
grou ps.
Su r veys/ po l l s: Su r veys/ po l l s: Su r veys/ po l l s: Su r veys/ po l l s: Su r veys a n d polls a r e h el pfu l for lea r n i n g a bou t la r ge a u dien ces su ch a s
voter sor com m u n iti es.Su r veys ca n be i m por ta n t for testin g th e wa ter for key r efor m s by
ga u gin g h ow differ en t gr ou ps wil l r ea ct to a pa rt icu la r policy. Sin ce su rveys a r e expen si ve to
con du ct, h owever, fi rst r eview existi n g su r vey da ta .
You ca n com pi le a n d pr esen t th e i n for m a t ion you ga th er in t h e Au dien ce Kn owledge, Posi-
tion , a n d I ssu es Wor ksh eet ( see An n ex 3- B) . Use on e worksh eet for ea ch a dvoca cy objective. Li st
th e pr im a r y a n d secon da r y a u dien ces in th e fir st col u m n . Ba sed on th e da ta you collect, list
wh a t you kn ow a bou t th eir kn owledge, a t titu de a n d posi tion s, in t er est i n t h e pol icy, a n d oth er
key issu es of con cer n . I f you a r e u n su re a bou t a n y of t h ese, en ter r esea r ch n eeded in th e
a ppr opr ia te box a n d fill in th e in form a tion a s it becom es a va i la ble.
Developing an Advocacy Strategy: Component I I Looking
I nward
Th e secon d com pon en t of th e str a tegic a ppr oa ch to a dvoca cy is l ookin g i n wa r d. By lookin g ou t-
wa rd in Steps 14, you h a ve bu i lt a sol id fou n da tion for a n a dvoca cy str a tegy. You n ow m u st
in j ect som e r ea lism in to you r policy a n d a dvoca cy objecti ves by lookin g in wa r d t o a ssess
wh et h er you h a ve th e r esou r ces n ecessa r y to a ch ieve you r objectives. Resou rces a r e defin ed a s:
I n fl u en ce: I n fl u en ce: I n fl u en ce: I n fl u en ce: You r a l lia n ces with oth er in dividu a l s a n d or ga n iza tion s a r e you r pr im a r y re-
sou r ces for in flu en ce. Alli es ca n dem on str a te th eir su ppor t th r ou gh th ei r n u m ber s i n l etter-
wr itin g ca m pa i gn s or r a llies. I n flu en tia l in dividu a ls ca n lobby decision - m a ker s, deliver a d-
voca cy m essa ges, or ot h er wise per su a de you r ta r get a u dien ces t h r ou gh differen t ch a n n els.
Bu ildin g a n d str en gth en in g a llia n ces a r e cr itica l to th e su ccess of you r a dvoca cy str a tegy.
I n fo r m a t i o n : I n fo r m a t i o n : I n fo r m a t i o n : I n fo r m a t i o n : In for m a ti on su ch a s st a t istics, test im on ia ls, a n d a n a lyses ca n be u sed t o h igh -
ligh t a pr oblem , iden tify or eva l u a te a lter n a t ive sol u tion s, or a ssess th e effectiven ess of cu r -
r en t pr ogr a m s or polici es. Fa ct s a n d figu r es a r e cr itica l to cr a ftin g per su a sive a rgu m en ts a n d
a dvoca cy m essa ges. Speci fic types of in for m a tion a r e m or e com pellin g to specific a u dien ces
( e.g., sta tistics ver su s testim on ia ls) . Ga th er in g in for m a tion a n d/ or con du ctin g r esea r ch
h el ps en su re th a t you h a ve t h e n ecessa r y in form a tion to su ppor t you r ot h er a dvoca cy a ctivi -
ties.
Ot h er Reso u r ces: Ot h er Reso u r ces: Ot h er Reso u r ces: Ot h er Reso u r ces: You n eed fu n din g a n d tech n ica l exper ti se to im plem en t you r a dvoca cy
a ctivities. Typica l a dvoca cy a ct iviti es worksh ops, tr a in in g even ts, a n d pol icy sem in a r s
a ll requ ir e fin a n cia l su ppor t. You a lso m a y n eed to h ir e con tr a ctor s or con su lta n ts to devel -
op, pr odu ce, a n d im plem en t a dvoca cy m a teria l s a n d a ctivit ies, su ch a s policy br iefs, pu bl ic
r ela tion s a ctivities, a n d m edia ca m pa ign s. You n eed to i den ti fy r esou rces, a ssess wh o h a s
con t rol of t h em , a n d det er m i n e h ow t o m obi lize th em in su pport of you r a dvoca cy effor ts.
Looki n g in wa rd to a ssess wh a t r esou r ces a re a va ila ble to you h elps you ba l a n ce you r a dvo-
ca cy objectives a ga i n st t h e a dvoca cy a ctivities you ca n rea listica ll y i m plem en t. On ce you h a ve
a ssessed you r resou rces, you m a y n eed to retu r n to St eps 14 a n d m odify you r a dvoca cy objec-
tives in a ccor da n ce wit h you r a va il a bl e r esou r ces.
Step 5: Select Advocacy Activities
Advocacy Activity 1 : I dentify and Develop Potential Allies,
Networks, and Coalitions
As a n a dvoca te for h ea l th sector r efor m , you n eed to bu ild su ppor t a n d con sen su s for h ea lth
r efor m a n d for you r r eform poli cy. Effective a dvoca t es bu i ld n etwor ks to a cqu ir e a grea ter n u m -
ber of a llies a n d diver si fy th ei r ba ses of su ppor t. Th ey a lso for m or pa r ticipa te in coa li tion s
a m on g or ga n iza tion s to cr ea t e politica l m om en tu m a n d a m a ss pu bli c su pport . Below is a br ief
over view of th e differen t str a tegies you ca n u se to m obilize su ppor t th r ou gh a llia n ces, n etwor ks,
a n d coa l ition s. ( Th is section dr a ws fr om two excellen t resou rces on th is topic: Introduction to
Advocacypu bli sh ed by th e USAI D- fu n ded Su ppor t for An a lysis a n d Resea r ch in Afr ica ( SARA)
Pr oject ( Sh a rm a n .d.) , a n d Networkingfor Policy Change: An Advocacy TrainingManual,
pu blish ed by USAI Ds POLI CY Pr oject ( Boyd et a l. 1999) ) .
Identify potential allies.
Th e fi rst step i n expa n din g you r ba se of su ppor t i s to iden tify poten tia l a llies. Th e Allies a n d
Opposit ion Ma t ri x ( An n ex 3- C) h elps you displa y su pporter s, poten tia l su ppor ter s, a n d oppo-
n en ts. Th is pr esen ts a n oth er opport u n i ty to u se th e r esu lts of you r sta keh older a n a lysis ( Section
2) . Ta ke th e followin g st eps to iden ti fy pot en ti a l a lli es:
St a r t wi t h you r cor e su p po r t er s. t a r t wi t h you r cor e su p po r t er s. t a r t wi t h you r cor e su p po r t er s. t a r t wi t h you r cor e su p po r t er s. Wh o a r e th e people wor ki n g m ost closely with you ot h er
m em bers of th e h ea lth sect or r efor m tea m , th e m in ister of h ea lth , key sta ff m em ber s a t t h e
m i n istr y of h ea l th , a n d oth er colla bora tor s? Work with you r cor e su ppor ters to r ea ch con sen -
su s on goa ls a n d objectives.
I d en t i fy o t h er p ot en t i a l su p po r t er s. I d en t i fy o t h er p ot en t i a l su p po r t er s. I d en t i fy o t h er p ot en t i a l su p po r t er s. I d en t i fy o t h er p ot en t i a l su p po r t er s. Wh o a m on g you r pri m a r y a n d secon da ry a u di en ces
ca n be brou gh t on boa r d? Wh a t oth er gr ou ps or in di vidu a ls sh a r e you r position a n d h a ve r e-
sou r ces t o u se a s in flu en ce? Sol icit th eir pa r tici pa t ion a n d a cti on .
I d en t i fy t h e op p osi t i o n . I d en t i fy t h e op p osi t i o n . I d en t i fy t h e op p osi t i o n . I d en t i fy t h e op p osi t i o n . Assess t h e con stitu en ci es of you r oppositi on . How do t h ey com pa r e
to you r s? If you r ba se of su ppor t is wea k by com pa r ison , r ea ch ou t to a broa der a u dien ce.
Con sider in clu din g a n yon e wh o m a y be con vin ced t o su pport you r posi tion .
Build r elationships thr ough networ king.
n etwor ks a re u n iversa l. Wh eth er a ckn owledged a s su ch or n ot, m ost people belon g to
for m a l or in form a l gr ou ps n etwor ks or ga n ized a r ou n d fa m i ly, jobs, r eli gi ou s a cti viti es
or r ecr ea ti on a l a ctivit ies. ( Boyd et a l. 1999)
Networkin g is sim ply a process for in itia tin g a n d m a in ta in in g con ta ct with in dividu a ls a n d
orga n iza tion s th a t sh a re a com m on goa l a n d a gree to wor k togeth er to a ch ieve th a t goa l. Devel-
opin g a n d m a in ta in in g n etworks ca n h elp you a ch ieve you r a dvoca cy objectives ( see Box 3.11) ,
bu t doin g so ta kes tim e a n d en ergy beca u se it in volves bu ildin g r ela tion sh ips a n d tru st a m on g
people. Fu r th erm ore, n etworks requ ire or ga n iza tion a n d str u ctu re in order to brin g togeth er th e
resou r ces, en ergy, a n d ta len ts of differen t in dividu a ls a n d orga n iza tion s a n d work efficien tly.
Allies are people and
organizations who
support your advocacy
efforts.
Networks are loose
associations of
individuals and
organizations that share
your goals and can help
you achieve them.
You ca n begin by developin g you r own person a l n etwork:
select i n dividu a ls a n d or ga n i za tion s th a t you kn ow a n d a re a sso-
cia ted with h ea lth r efor m a n d/ or you r policy. Th in k of people
both wi th in a n d ou tside you r or ga n iza ti on . Displ a y you r con ta cts
u sin g a dia gr a m sim i la r to th e on e in Figu r e 3.3. You m a y fin d
th a t you a lr ea dy h a ve a n exten si ve n etwor k of in flu en tia l politi-
ca l a ctor s th a t you ca n poten tia lly in volve in you r a dvoca cy
effor ts. To solidify a n d str en gth en you r n et wor k, it i s im por ta n t to
bu ild open a n d tr u st in g rela tion sh i ps. Her e a r e a few st ra tegies:
colla bor a te on pr ojects of m u tu a l in terest; h elp bri n g a tt en ti on t o th eir wor k; a ssist th em with
specia l projects; sh a r e i n for m a t ion wi th th em ; a tten d th eir m eetin gs a n d in vite th em to you r s;
a n d offer to ser ve a s a tech n ica l resou rce for th eir m eeti n gs a n d sem i n a r s. Th e str a t egies you
lea r n fr om you r own n etwor kin g exper ien ce ca n be a pplied to fosteri n g r ela t ion sh ips a n d tr u st
with poten tia l a l lies a n d su ppor ter s a s you im plem en t you r a dvoca cy str a tegy.
Box 3.11. The benefits of networks
Networks keep you up to date on what is happening in
health reform.
Networks provide a ready audience for your ideas and
policy analysis.
Networks generate support for your actions.
Networks provide access to resources and skills.
Networks pool limited resources for the common goal.
Networks provide safety and power in numbers.
Networks expand your base of support.
(adapted from Boyd et al. 1999)
Figure 3.3. Example of a Personal Network
Ministry of
FinanceChief
Economist
Executive
Commission on
Health Reform
Director
Health Policy
Think Tank
Director
MOHDirector
of Board of
Control
MOH-District
Level Directors
Social
SecurityChief
Financial
Officer
World Bank
Country Rep.
State University
Dir. Econ. Dept.
For ge alliances thr ough coalitions.
Coa liti on s a r e m or e form a l th a n n etworks, th er eby r equ ir in g grea t er com m itm en t a n d
r esou r ces. However, you r coa lition pa r tn er s a l so m a ke a gr ea ter com m it m en t to you a n d you r
objecti ves, so you ca n expect m or e fr om th em in r etu r n .
Th er e a r e differ en t types of coa lition s, a n d th e ca t egor ies a r e n ot m u tu a ll y excl u sive ( see Box
3.12) . Coa l ition s ca n be ver y flu id or h igh ly st ru ctu red, a n d differ en t types a tt ra ct di ffer en t a u di-
en ces.
To h elp en su r e th a t you r coa l ition fu n ction s sm ooth ly a n d you r effort s a t coa li tion - bu i ldin g
a re wor th wh ile, a gr ee on objectives befor eh a n d. Wor k with you r coa li tion pa r tn er s to defin e
sh or t- a n d lon g- term goa ls. Sel ect i ssu es a n d a cti vities th a t br in g th e coa lition togeth er. Fin a lly,
com m u n ica t e wit h you r pa r tn ers a bou t r oles, pr ogress, a n d di fficu lt
issu es. Coa liti on s r equ i re m ore wor k th a n n etwor ks, bu t th e ben efit s
ca n be gr ea ter. Before join in g or sta rt in g a coa liti on , ca r efu lly con -
sider th e a dva n ta ges a n d disa dva n ta ges, a s ou tl in ed in Ta bl e 3.3.
Allies, n etwor ks, a n d coa liti on s a r e va lu a ble wh en th ey dem on -
str a t e t h eir su ppor t. As dem on str a ted by t h e exa m pl e fr om th e
Dom in ica n Repu bl ic ( Box 3.13) , a l lies ca n su ppor t you r effor ts in
m a n y wa ys. Th e Mu n icipa l Hea lth Dir ect or a te of Sa n to Dom in go
Cen tr o fou n d pa r tn ers th a t cou l d deliver h ea lth ser vices a n d bu ild
com m u n ity su ppor t. Su pport ive in dividu a ls a n d or ga n iza ti on s a r e
on e of you r m ost i m por ta n t r esou r ces; cu l tiva te a n d u se th em . Th in k
a bou t h ow th ey ca n h el p you a n d t h en speci fica lly r equ est th eir
a ssista n ce.
A coalition is a group of
several like-minded
organizations working
together to achieve a
common goal.
Box 3.12. Types of coaIitions
Permanent: These are incorporated organizations with a
staff and board of directors, such as associations, trade
unions, or federations.
Temporary: Organizations may come together for a specific
goal. Once the goal is achieved, these types of coalitions
typically disband.
FormaI:Members formally join the coalition, pay dues, and
are identified as coalition members.
InformaI: There is no official membership, and members may
often change, as may issues and tactics.
MuIti-issue: Coalitions that work on a number of issues or
objectives, although they may address only one issue at a
time.
SingIe-issue: Coalitions are formed around a single issue or
objective, which sometimes leads to strange alliances
between organizations that oppose each other on other
issues.
(adapted from Sharma n.d.)
Table 3.3. Advantages and Disadvantages of Coalitions
Advantages Disadvantages
Enlarges your base of support Distracts from your other work
Provides safety for advocacy efforts and
protection for members
May require that you compromise your position
on issues or tactics
lncreases financial and programmatic
resources
May require that you give in to more powerful
coalition partners
Enhances credibility and influence of
advocacy campaign and individual coalition
members
You may not receive credit for your work if
recognition goes to the coalition as a whole
Helps develop new leadership All members' credibility may be damaged if the
coalition breaks down
Assists in individual and organizational
networking
Broadens your scope of work
Adapted from Sharma n.d.
Advocacy Activity 2: Policy Communication
Use data as a r esour ce for communicating with
stakeholder s.
A secon d sign i fica n t r esou r ce for you r a dvoca cy str a tegy a n d
a ctivities is in for m a ti on . As th e sa yin g goes in form a tion is
power,a n d, a s a m em ber of a h ea lth r efor m tech n i ca l t ea m , you
h a ve a ccess to i m por ta n t a n a lyses, da ta , a n d ot h er t ypes of in for -
m a t ion on h ea lth r efor m ( see Ta ble 3.4) . Th is in for m a tion ca n
be u sed effectively in a dvoca cy ca m pa ign s to su ppor t r efor m in iti-
a tives. Policy a n a lyses ca n h elp sh a pe th e deba te on h ea lth
r efor m , crea te a m or e posi tive im a ge for you r r eform effor ts, a n d
foster a n a ccu r a te di scu ssion a m on g key st a keh older s on h ea l th
r efor m issu es. Fa cts a n d figu res m a ke per su a sive a r gu m en t s for
r efor m polici es. Fin a lly, in for m a tion better pr epa res you r a u di-
en ce for both th e posi tive a n d n ega tive con sequ en ces of h ea lth
r efor m policies. For exa m ple, in Ecu a dor, focu sed r esea r ch a n d th e ta r geted pr esen t a t ion of th e
r esu lts h el ped to bu ild con sen su s for m a kin g equ ity a n im por ta n t objective of th e cou n tr ys
h ea l th sector r efor m ( see Box 3.14) .
Develop your message.
Sh a r in g da ta with you r sta keh olders is on ly h a lf th e ta sk; to be a n effective a dvoca te, you n eed to
com m u n ica t e t h is i n for m a ti on i n a wa y t h a t h elps you r ta r get a u dien ces listen , u n der sta n d,
a n d a ct. To com m u n ica te effectivel y, you n eed a clea r a n d con sisten t m essa ge th a t is ta ilor ed to
you r ta r get a u dien ces in ter ests. Au dien ce r esea r ch pl a ys a n im por ta n t r ole in iden tifyin g a ppr o-
pri a te m essa ges ta r geted to va r iou s policy a u dien ces. ( See Sh a r m a n .d., a n d Mu rph y 1994, for
m or e deta iled descr ipti on s of pol icy com m u n ica t ion ) .
Th e pr ocess of developin g a n d deli ver in g policy m essa ges en ta ils sever a l el em en ts
( see Box 3.15) :
Messa ge con ten t a n d la n gu a ge
Sou r ce/ m essen ger
Form a t
Tim e a n d pla ce
Messagecontent and language. A m essa ge is a con cise a n d
per su a sive sta tem en t a bou t you r pol icy th a t ca ptu r es wh a t you
wa n t to a ch ieve, wh y you wa n t to a ch ieve it , a n d h ow you pla n t o
a ch i eve it. Th e u n derlyin g pu r pose of a m essa ge is to cr ea te
a ction , a n d so you r m essa ge sh ou l d in clu de th e speci fic a ction s
you wou l d l ike th e a u dien ce to ta ke. Messa ges u su a ll y in clu de th e
followin g el em en ts:
Box 3.13. CoIIaboration to strengthen community
support and provide heaIth services in the
Dominican RepubIic
The Municipal Health Directorate of Santo Domingo Centro
(SDC) is tasked with providing health services to the more
than 1.3 million Dominicans living in its jurisdiction. The SDC's
ability to provide health services is constrained by scarce
resources and the complex, urban environment in which it
operates.
Given these constraints, SDC concluded that, alone, it cannot
successfully meet community health needs, and it has
developed links with other service providers and health sector
actors in its jurisdiction. ln 1999, SDC began identifying key
audiences that could help encourage community
participation, develop favorable public opinion, mobilize
financial resources, expand coverage, and enhance quality of
specific programs (such as tuberculosis control). To date,
SDC has developed a list of approximately 40 organizations,
with areas for potential collaboration and expected results for
each. SDC hopes to develop targeted partnerships with these
organizations to support implementation of its work plan.
Box 3.14. Equity as a heaIth sector objective in
Ecuador
Remedying inequities in health provision and services is an
objective common to many health sector reform agendas. Yet
it can be difficult to promote the importance of equity solely by
appealing to people's morality and emotions, especially when
equity objectives compete for financially scarce resources. ln
Ecuador, the Ministry of Health incorporated equity into its
health sector reform agenda and tasked the Centro de
Estudios de Poblacin y Promocin para el Dessarrollo Social
(CEPAR), a nonprofit research institution, with identifying and
documenting the current state of health inequities. CEPAR
documented the principle health problems of the population
and mapped them spatially to show how they were
geographically concentrated in poor, indigenous, rural, and/or
suburban areas. This information was used to create targeted
materials, which helped build widespread consensus on the
need for reform among a variety of audiences.
A message is a concise
and persuasive
statement about your
policy that captures
what you want to
achieve, why you want
to achieve it, and how
you plan to achieve it.
Table 3.4. Data Sources for Health Sector Reform
Type of data Routine information Surveys Studies
Demographic
information and heaIth
status
Health information system Census Burden of disease
Annual reports of ministry of health Demographic Health Survey Maternal and infant mortality
Web sites of World Health
Organization, World Bank, and
other international organizations
Living Standard
Measurement Survey
Other specific research and
analysis
Consumption surveys
Surveillance Nutrition surveys
Vital registration
HeaIth care financing Government budget Household surveys National health accounts
Expenditures of public financing
agencies (MOH, social insurance
schemes, etc.)
Provider surveys Public expenditure reviews
Labor force participation
Pharmaceutical procurement
reports
Macroeconomic data on prices
Resource aIIocation Budgets and expenditures of
public financing agents
National health accounts
Facility-level costing
budget tracking systems (where
available)
Equity analysis
Cost-effectiveness analysis
Public expenditure reviews
Consumer demand Health information system Household surveys Special studies and analyses
(e.g., rapid assessment)
Focus groups
SuppIy of heaIth care
services
Health information system Provider surveys Health manpower
Routine annual reports of MOH
and other public entities
Facility-level costing studies
Service delivery statistics
InstitutionaI and system
performance
Laws and regulations governing
health sector
Analysis of organizational
structure
Licensing and accreditation
procedures
lnstitutional analysis
PoIiticaI framework and
environment
Observation Focus groups Political mapping
Public statements, position papers Polls/public opinion surveys Stakeholder analysis
Media scans Baseline surveys Key informant interviews
Ministry reports, five-year plans,
annual workplans
Wh a t you wa n t to a ch ieve: Depen din g on you r a u dien ce a n d h ow dir ect ly th e poli cy con cer n s
th em , th is m a y be ph r a sed a s you r goa l, you r obj ecti ve, or a pa r t of you r goa l or objective.
Wh y you wa n t to a ch ieve i t: Sh ow th e ben efits of a ction ver su s th e n ega t ive r esu lts of in a c-
tion . Ta ilor th e m essa ge to you r a u dien ces by focu sin g on th eir in ter ests a n d fr a m i n g th e
ben efits a n d costs i n t er m s of th ose in ter ests.
How you pr opose to a ch ieve i t: Descr ibe you r poli cy st ra tegy. Th e ch a r a cteri st ics of you r ta r -
get a u dien ce m a y dicta t e h ow deta il ed a n d com pr eh en si ve you r descri pt ion sh ou ld be.
Wh a t a ction you wa n t th e a u di en ce to ta ke: Be specific a bou t wh a t you wa n t th e ta r get a u di-
en ce to do. Pr ovi di n g deta ils in cr ea ses th e l ikelih ood th a t you r a u dien ce will ta ke th e desir ed
a ction .
Th e Messa ge Con t en t Wor ksh eet ( An n ex 3- D) ca n h elp you cr a ft you r pol icy m essa ge. Fir st,
iden tify you r ta rget a u di en ce a n d th e a ct ion you wa n t th em to ta ke. Th en , fil l in t h e ba sic com -
pon en ts of you r m essa ge wh a t , wh y, a n d h ow. After you h a ve wr itten th e com pon en t pieces of
you r m essa ge on t h e wor ksh eet, u se a cl ea n sh eet of pa per to r ewor d you r m essa ge so th a t it is
m or e effective. Th er e a r e five ch a r a cter istics of a n effect ive m essa ge ( see Mu r ph y 1994) :
Th e m essa ge i s sim ple.
Th e m essa ge i s con cise.
Th e m essa ge u ses n on tech n ica l la n gu a ge.
Th e ton e a n d la n gu a ge a r e con sisten t wi th th e m essa ge.
Pr a cti ce th is fir st cu t a t you r pol icy m essa ge with you r collea gu es on th e r efor m t ea m to see if
th ey u n der sta n d you r m essa ge. I f n ot, go ba ck to th e dr a wi n g boa r d u n til you su cceed.
An oth er a ppr oa ch t o develop you r poli cy m essa ge is th e SEEm eth od: Sta tem en t , Eviden ce
a n d Exa m ple ( see Figu r e 3.4) . Th e SEE a ppr oa ch is a ver y per su a sive com m u n ica tion m eth od
beca u se it pu ts a h u m a n fa ce on th e issu e by t ellin g a stor y a bou t a per son , fa m i ly, or gr ou ps
a ffected by th e pr oposed poli cy. Sta te you r m essa ge, pr ovide eviden ce to ba ck it u p, a n d con clu de
with a stor y or a n a logy. Th i s m eth od fr a m es th e r efor m policy in h u m a n term s t h a t t h e a u di-
en ce ca n r ela t e to. Box 3.16 in clu des a n exa m pl e of a policy m essa ge th a t u ses th e SEE m eth od.
Box 3.15. Discussion questions: DeveIoping and
deIivering poIicy messages
Message content and language: What ideas do you want
to convey? What arguments will you use to persuade
your audience? What words will you choose to get your
message across clearly? Are there words you should not
use?
Source/Messenger: Who will the audience respond to as
credible?
Format: How will you deliver your message for maximum
impact?
Time and Place: When is the best time to deliver the
message? ls there a place that will enhance its credibility
or give it more political impact?
adapted from Sharma n.d.
Figure 3.4. The SEE Method
Statement
Evidence
Example
Box 3.16. DecentraIizing heaIth services
PoIicy
Decentralization of health services: redistribution of power, responsibilities, and resources (human
and financial) to the local levels of government.
Promote participation by local population in health-related decisions.
Address problems and provide needed resources at the levels where the population is affected
(i.e., where the problems are occurring).
Ensure that health care providers and users are supported by an adequate national regulatory
system.
Advocacy objective
Create support and better understanding of the benefits of decentralization among ministry of health
leadership.
Target Audience
Minister of health, deputy minister of health, permanent secretary, and other high-level ministry
officials
Message
The decentralization of services is a proven mechanism for improving the health of families in our
country. Mayor Juan Perez from Santiago de Plano, a town in the rural areas, helped establish a clinic
in partnership with MSP. ln a very short time, Mayor Perez along with the clinic staff and the
municipal health advisory board succeeded in linking all services and institutions related to health
care provision. At this time, virtually everyone in the community enjoys basic health care coverage,
people are using the services appropriately, and there are visible and documented improvements in
the overall health status of the town. We should be helping mayors from all towns improve their health
care services. We need your support and leadership to facilitate decentralization in all regions.
Th er e a r e th r ee poin t s to keep in m in d wh il e developin g you r m essa ge:
Lim it t h e n u m ber of poin t s. Th er e sh ou ld idea lly be on e poi n t a n d, a t m ost , t h r ee poin ts in
you r m essa ge. Too m a n y poin ts wi ll con fu se a n d possibly over wh elm you r ta r get a u dien ce.
Pr etest t h e m essa ges. Pretest m essa ges with r epr esen ta tives of you r ta r get a u dien ce to en su r e
th ey u n dersta n d t h e m essa ge. To t h e ext en t possible, m essa ges sh ou ld be tested in th ei r fi n a l
for m a t. Sch edu le su fficien t tim e to r espon d to t h e feedba ck you receive a n d to a da pt t h e m a -
ter ia ls a s n ecessa r y.
Focu s th e m essa ge on a ction . Use da ta ca refu lly a n d on ly to su pport th e m essa ge, n ot repla ce it.
Source/Messenger. You r m essen ger m a y be a s im por ta n t, or m or e im por ta n t, th a n t h e m es-
sa ge. He or sh e m u st h a ve a ccess to th e ta r get a u di en ce, be per ceived a s cr edible, a n d be som e-
on e to wh om th e a u dien ce r espon ds. Th e m essen ger sh ou ld be a r ticu la te, kn ow th e issu e th or -
ou gh l y, a n d be a ble to presen t th e m essa ge clea rl y. Th er e a r e ba sica ll y two types of m essen gers
( Mu rph y 1994) :
Ch a n ge a gen ts: people wh o a r e h igh l y r espected by th e a u dien ce bu t, in gen era l, a r e n ot
m em bers of th e t a rget a u dien ce, su ch a s in t er n a tion a l exper ts in h ea lt h r eform or pol itica l
lea der s
Opin ion lea ders: pr om in en t, tr u sted m em ber s of th e ta r get a u dien ce, u su a lly livi n g a n d
worki n g a m on g t h em .
Use th e Selecti n g a Messen ger Wor ksh eet ( An n ex 3- E) t o li st a ll possible m essen gers for a ta r -
get a u dien ce a n d a ssess wh et h er t h ey m eet cer ta in crit er ia th a t wil l m a ke t h em effect ive: a ccess
to t a r get a u dien ce, credibility, kn owledge, a n d spea kin g ski lls. Ra n k ea ch poten ti a l m essen ger
by t h ese cr iteri a , a n d deter m in e wh o fu l fills th e m ost. Assess wh i ch cr iter ia a re m ore im por ta n t
a n d sel ect you r m essen ger a ccordin gly. For exa m ple, exper ien ce h a s dem on str a ted t h a t th er e
a re few cr edi bl e a n d kn owledgea ble spokesper son s wh o a re a lso good spea ker s.
Format. Th e for m a t is th e m edi u m th rou gh wh ich you deli ver you r m essa ge for m a xim u m
im pa ct. Possible m essa ge form a ts i n clu de t h e followin g ( a da pted fr om Sh a rm a n .d.) :
Form a l or in for m a l m eetin gs
I n for m a l con ver sa tion s a t socia l, r eligi ou s, bu si n ess, or politica l ga th er in gs
Policy foru m s
Pu bl ic ra ll ies
Execu tive br iefin g pa ckets
Pa m ph let s, br och u r es, or fa ct sh eet s
Poster s a n d/ or flyer s i n pu blic pla ces
Com pu ter a n d slide pr esen t a tion s
Newspa per a r ticl es or a dver ti sem en ts
Br oa dca st com m en t a r y or cover a ge
Pu bl ic deba t e.
Th e for m a t m u st be a ppr opri a t e t o you r ta r get a u di en ce, m essa ge, a n d m essen ger. As i llu s-
tr a ted by th e exa m ple in Box 3.17, differ en t a u dien ces ca n be ta rgeted u sin g differ en t for m a ts.
For exa m ple, h igh - level a u dien ces do n ot h a ve m u ch ti m e, so th e m essa ge for m a ts a ppr opr ia te
for th em a r e br ief, to-t h e- poin t , ea sy-t o-r ea d, a n d fr ee of tech n ica l ja rgon . Th e for m a t sh ou l d
dem on str a te t h e followin g ch a r a ct er istics ( Mu r ph y 1994) :
Cla r ity: Th e m essa ge, in cl u din g gr a ph i cs, sh ou ld n ot be too tech -
n ica l or com plex.
Br evity: Keep it sh or t, with a n execu tive su m m a r y, h igh ligh ted
qu otes, text boxes, or ta bles, a s a ppr opr ia te.
Attr a ctiven ess: Good design m a kes pu blica tion s a n d visu a l a ids
ea sier t o r ea d a n d u n der st a n d.
Accu ra cy: Da ta m u st be cor r ect , a n d cl a i m s of ben efits or costs
sh ou ld be r ea li st ic a n d defen sible, beca u se cr edibilit y i s pa ra m ou n t .
Ti m in g: In for m a ti on sh ou ld be com m u n ica t ed wh en it is n ew or m ost r eleva n t.
Timeand Place. Th e fin a l elem en t i n t h e process of developin g a n d deliveri n g you r m essa ge
is th e t im e a n d pla ce.
Ti m in g is im por ta n t . In m a n y cou n tr ies br ea kfa st m eetin gs or ea r ly m or n i n g sem in a r s a r e
com m on pr a ctice a n d r epr esen t a ccepta bl e t im es to deliver m essa ges. You m a y li n k th e de-
liver y of you r m essa ge to oth er politi ca l even ts to dr a w m or e a t ten t ion to you r issu e. For ex-
a m ple, is th er e a n elector a l ca m pa ign u n der wa y th a t m igh t m a ke policym a ker s m or e recep-
tive to you r m essa ge?
Th e pla ce wh er e you deliver you r m essa ge is a lso a s im por ta n t a s tim in g a n d sh ou ld be a p-
pr opr ia te for you r ta r get a u dien ce. I s th er e a pla ce to del iver th e m essa ge th a t en h a n ces it s
cr edibili ty or gi ves it m ore politica l im pa ct? For exa m ple, a pr ess r el ea se on equ it a bl e a ccess
to h ea lth ca r e presen ted a t a h ea l th post in a poor n eigh bor h ood m a y h a ve m or e im pa ct
th a n a sim ila r m essa ge delivered fr om a podiu m in a down town h otel.
MessageDevelopment. On ce you h a ve det er m in ed th e deta ils of you r m essa ge, t h e Com m u n i-
ca tion s Pla n Wor ksh eet ( An n ex 3-F) h elps you br in g togeth er a ll th e com pon en ts of you r com -
m u n ica tion pla n , a ssessin g a n d a dj u stin g th e pla n a s n eeded. Fir st , l ist you r ta r get a u dien ce,
followed by th e a ction you wa n t th e a u dien ce to ta ke. Secon d, in clu de you r con cise poli cy m es-
sa ge ta rgeted for th is specific a u dien ce a l on g with th e list of possible m essen ger s, ti m e a n d pl a ce
for deli ver y, a n d th e form a ts you pla n to u se.
Advocacy Activity 3: Conflict resolution and negotiation
Con flict r esolu ti on a n d n egoti a tion a re skills th a t a r e u sed in every a spect of t h e h ea lt h r eform
pr ocess. Negot ia tion h el ps you br oker expecta ti on s wh i le tr yin g to bu ild con sen su s for you r pr i -
ori ty h ea lth r efor m policy. Negotia tion skills a r e cr u ci a l for di rectly a ddressin g con flict or cra ft -
in g a gr eem en ts th a t redu ce or n eu tr a lize you r opposi tion . Fin a l ly, you n eed to n egotia te a n d
Box 3.17. Different formats for nationaI heaIth
accounts advocacy in Ecuador
ln Ecuador, the Ministry of Health advocated National Health
Accounts by 1) holding seminars, 2) developing policy-
relevant materials (directly relating NHA to audience's
interests), 3) disseminating news bulletins communicating
progress, and 4) holding individual meetings. As a result of
these activities, all of the sectors are providing information
and support for NHA.
ba rga in politi ca l r esou r ces in exch a n ge for r esou r ces n ecessa r y to i m plem en t h ea lth r efor m
policies. Th e con flict n egotia ti on gu idelin es ( Secti on 4 of th i s toolkit) pr ovide m or e su bst a n tia l
dir ecti on a n d deta il on h ow a n d wh en t o u n der ta ke n egotia tion .
Step 6: I mplement Advocacy Activities
Now it is ti m e to pu ll togeth er a ll th e pr odu cts fr om Steps 15 a n d to iden tify differen t a ct ivit ies
th a t ca n h elp you a ch ieve you r a dvoca cy object ives. Be cr ea t ive. Th er e is a wi de r a n ge of a dvo-
ca cy a ct iviti es fr om wh ich t o ch oose, in cl u din g town - h a ll m eetin gs, on e- on - on e m eetin gs, ca u -
cu ses, lobbyin g, poli cy sem i n a r s, wor ksh ops, con fer en ces, a n d devel opin g m a ter ia ls su ch a s
execu tive br iefin g pa ckets, positi on s sta tem en ts, a n d pr ess r elea ses. Press con fer en ces, pu blic
a wa ren ess ca m pa ign s, pu blic r a llies, n et wor kin g, bu ildin g a l lia n ces, a n d pa r ti cipa tin g i n coa li-
tion s a re a ll a dvoca cy a ctivities. Th er e is n o r igh tor wr on g a dvoca cy a ctivity. Th e key to
su ccessfu l a dvoca cy is to be per sisten t, to u se m u lt iple a ctivi ties with a con si st en t m essa ge, a n d
to be in n ova tive a n d cr ea tive in select in g a ctivit ies t o r ea ch you r ta r get a u di en ces. Boxes 3.18
a n d 3.19 h igh ligh t two of th e m ost com m on a dvoca cy a ctivi ties for effectively com m u n ica t in g
with differen t ta r get a u dien ces, m a ss m edia a n d lobbyin g.
Box 3.18. Using mass media
Print (newspapers and magazines) and broadcast (television
and radio) media are key channels of communication. The
media enable you to influence the greatest number of people
in the shortest time. Use mass media when your target
audience is the public. The media are useful for educating
people about proposed reforms, changing attitudes toward
reforms, recruiting supporters, and raising money. Media also
can be helpful when you want your secondary audience, the
public, to influence decision-makers.
To effectively use the media, you must understand the
different ways media sources and specific reporters and
journalists cover health sector and health policy issues. What
are the patterns of media coverage? Who is interested in
health-related stories? What appear to be their particular
biases or preferences? You can discover this information by
monitoring and tracking the media's coverage of health
issues. Understanding the media's interest in health will help
you improve the timing of your communications efforts and
present your message in a way the media consider
newsworthy.
Use these and other media tools encourage or facilitate
the media's coverage of your issues:
Press releases
Press conferences
Letters to the editor
Editorials
Newspaper and magazine articles
Television and radio appearances
Televised or printed interviews
For more detailed advice on preparing specific
communications pieces, see lPPF 1995 and Center for
Development and Population Activities 1995.
Box 3.19. Lobbying
Lobbying is a special type of communication involving
policymakers. You approach policymakers through
interpersonal channels. Possible formats include formal or
informal meetings, briefings, letters, or phone calls. Because
of the intimate nature of the communication, audience
research is especially important. You will need to understand
your policymakers' positions, interests, and issues in order to
appropriately target your messages. Selecting credible
messengers is also critically important. Here are some
additional tips for effective lobbying:
Understand the decision-making process. This will help
you target the right decision-maker and time your lobbying
efforts for maximum effect.
Help educate your audience about your policy. Become an
information resource and be willing to help out.
Develop a relationship with your audience. lnform
policymakers about your progress and efforts, and include
them in activities where appropriate.
Endeavor to keep your issue on policymakers' agenda.
Communicate with them frequently and provide them with
helpful information.
Engage and be willing to assist the policymaker's staff.
Staff members are influential, and you should consider
them a key secondary audience.
For more detailed advice on lobbying, refer to lPPF 1995 and
Center for Development and Population Activities 1995.
Developing an Advocacy Strategy: Component I I I
Looking Ahead
Avoid gettin g ca u gh t u p in th e deta ils of design i n g a n d im plem en t in g you r a dvoca cy str a tegi es
a n d losin g si gh t of you r lon g- ter m goa l: su sta in in g su ppor t to im plem en t you r r efor m policy. To
keep focu sed on you r u ltim a te goa l, you n eed to look beyon d you r a dvoca cy str a tegies a n d keep
you r r efor m policy in si gh t. To su cceed, you will n eed to con sta n tly a ssess a n d a dju st you r a dvo-
ca cy str a tegy. Mon itor in g a n d eva lu a t ion a r e a lso essen tia l for well- ta r geted a n d focu sed
a dvoca cy.
Th is com pon en t defin es th e differ en ce bet ween m on itor in g a n d eva lu a ti on , h el ps you
develop a m on it or in g a n d eva lu a tion fr a m ewor k, a n d pr ovides som e qu esti on s to h el p you
a ssess th e pr ogr ess a n d im pa ct of you r a dvoca cy a ctivities.
The need for advocacy
never ends. When one
objective has been
achieved, there is always
another to tackle.
Step 7: Evaluate and Adjust Strategy
A sou n d m on itor in g a n d eva lu a ti on com pon en t h elps you tra ck th e su ccess of you r a dvoca cy
str a t egy, bu ild cr edibilit y, a n d m ot iva te you r tea m m em ber s to su st a i n t h e m om en tu m . If you
a ch i eve you r a dvoca cy obj ecti ve a n d/ or su cceed in br in gi n g a bou t th e ch a n ges im pli ed in you r
r efor m policy, m on itor in g a n d eva lu a ti on wi ll h elp you dem on st ra te a clea r con n ection
between you r a ct iviti es a n d objecti ves a n d th e policy ou tcom e.
Monitoring Your Progress
Mon itor in g is th e pr ocess of r ou t in el y ga th eri n g in for m a tion on a ll a spects of a n a dvoca cy ca m -
pa ign a n d u sin g th e i n for m a t ion t o m a n a ge decision - m a ki n g r ega r din g you r st ra tegy ( a da pted
fr om Boyd et a l . 1999) . I t h elps you i den ti fy a r ea s for im provem en t, m a ke m id- cou r se cor rec-
tion s, a n d r evise you r objective or str a tegy a s n eeded. You m u st be cr ea t ive a n d per sisten t: if on e
a ctivity does n ot wor k, tr y a n oth er. I f you decide to m a ke a dju stm en ts, be su r e th a t a ll th e ele-
m en ts of you r str a t egy rem a in coh esive, wi th rea listic tim efr a m es a n d a ppr opr ia te people
a ssign ed r espon sibiliti es. To effectively m on it or you r pr ogr ess, bu ild in to you r a dvoca cy st ra t egy
system s for col lect in g da ta a n d i n for m a t ion on key a cti vities a s wel l a s system s for su m m a r iz-
in g, a n a lyzin g, a n d u sin g th a t in form a tion to m a ke decision s a n d t a ke cor r ect ive a ction if n ec-
essa ry.
Ga th er you r collea gu es togeth er a ga in to develop a m on itor in g a n d eva lu a ti on fra m ewor k.
To develop you r m on itor in g pla n for you r a dvoca cy stra t egy, a n swer th e fol lowin g qu estion s:
Wh a t sh ou ld we m on i tor? ( Box 3.20 su ggests qu estion s to gu i de you r a n a lysi s.)
Wh o will be r espon sible for col lect in g a n d a n a lyzin g th e in for m a tion ?
Wh en wil l t h e m on itor in g t a ke pla ce?
Wh a t a re th e m ea su r a ble in di ca tor s a n d t h eir sou rces of in for m a tion ?
How will we ga th er th e n ecessa ry in for m a tion ?
How will we presen t th e in for m a tion ?
Ba sed on th e i n for m a t ion , wh a t decision s or a cti on s n eed to be t a ken t o im pr ove t h e per for -
m a n ce of ou r a dvoca cy str a t egy?
Evaluating Your Results
Eva l u a tion h elps you a ssess th e im pa ct a n d resu lts of you r a dvoca cy str a tegy. I t is n ot en ou gh to
kn ow i f you r a dvoca cy str a tegy h a s been well- pla n n ed, well- tim ed, a n d well- im plem en ted. I t is
a lso im port a n t t o kn ow wh eth er you r a cti vities h a ve been effective, t h a t is, i f th ey h a ve br ou gh t
a bou t t h e desir ed policy ch a n ge. Eva lu a t ion i n volves a syst em a t ic, object ive a n a lysis of you r
a dvoca cy str a tegys per for m a n ce ( a da pted from Boyd et a l. 1999) . Eva lu a te you r str a tegy to:
Determ in e if you h a ve su ccessfu lly a ch ieved you r policy goa l a n d a dvoca cy objectives
Dr a w lesson s l ea r n ed fr om you r exper i en ce t o im pr ove th e ef-
fectiven ess of you r cu r r en t a n d fu tu r e a dvoca cy str a tegi es
Dem on str a te su ccess t o you r tea m m em bers or ot h er s in volved
in you r a dvoca cy str a tegy to m a i n ta in th eir m oti va tion to con -
tin u e a dvoca tin g for h ea lth r efor m .
To develop a n eva l u a tion fr a m ework, ga th er you r collea gu es to
a n swer t h e followin g qu esti on s:
Wh a t sh ou ld we eva lu a t e? ( See Box 3.21)
Wh o will be r espon sible for col lecti n g a n d a n a l yzin g th e in for -
m a tion ?
Wh a t will be t h e m ea su r a ble in dica tor s a n d th eir sou r ces of
in for m a tion ?
Wh en wi ll t h e eva lu a tion ta ke pla ce?
How will we ga th er th e n ecessa ry in for m a ti on ?
How will we pr esen t th e in for m a ti on ?
Ba sed on th e in for m a t ion , wh a t decision s or a cti on s n eed t o
be t a ken to im pr ove t h e r esu lts of ou r a dvoca cy stra t egy?
Conclusion
Hea lth sector r efor m i s typica lly com plex a n d i s often con str a in ed
by poli tica l in t er ests, l im ited resou rces, a n d r igid or ga n i za tion s.
Advoca cy h elps you r espon d to th ese ch a llen ges by sh a pin g th e
policy deba te, bu ildin g su ppor t for r efor m s, a n d m otiva tin g
a ction . You r a dvoca cy str a tegy ca n bu il d a con stitu en cy for
h ea l th refor m s a n d m obi lize deci si on - m a ker s a n d oth er sta ke-
h older s t o a ct on beh a lf of you r h ea lth sector objectives.
You r a dvoca cy effor ts t o pr om ote a n d su st a in h ea lth sector
r efor m s will ben efit from th e str a tegic a ppr oa ch ou tl in ed in th ese
gu idel in es:
Looki n g ou t forces you to r ecogn ize you r en vir on m en t a n d th e oppor tu n iti es a n d con st ra in ts
you fa ce. You a r e pu sh ed t o a r ticu la te speci fic a dvoca cy objectives th a t will i n spir e a n d gu ide
you r a dvoca cy a cti vities. You wi ll u n der sta n d th e pr ocess by wh i ch poli cies a r e m a de a n d im -
plem en t ed a n d iden tify t h e best pla ces to in terven e to in fl u en ce h ea lth r efor m ou tcom es. You
will iden tify th e key pla yer s a n d th eir in ter ests, in or der to develop m ore t a r get ed a n d per su a -
sive a dvoca cy m essa ges a n d a ct iviti es. By lookin g ou t, you will better u n dersta n d you r policy
en vir on m en t a n d be a ble to deter m i n e wh a t is fea sible wit h in th a t con text.
Box 3.20. Discussion questions: Monitoring your
progress
Objective:
What progress did you make toward achieving your
objective?
ls your objective still achievable?
Why does it make sense to continue to focus your
advocacy efforts on that objective, or why might you select
another?
Audience:
Did you reach your target audience?
Were you able to influence their actions?
Do they have the influence you anticipated?
Was your information on target audiences accurate?
Was the information sufficient?
Advocacy Activity 1: AIIies, networks, and coaIitions
Are your existing allies, networks, and coalitions
sufficient?
How have your alliances helped you expand your base of
support?
Have you been able to build your network and/or
coalitions?
Have coalitions focused on your most important issues?
Has the benefit of building your constituency been worth
the effort?
Advocacy Activity 2: PoIicy Communications
Messages Were the messages appropriate for the
different audiences as indicated by audience research?
Were the messages concise, easy to understand, and
action oriented?
Messenger: Did you select good messengers? Did your
target audience consider them credible? Did the
messengers succeed in delivering the message? Were
they able to influence the target audience?
Channel Did you use the best channels available to reach
your audience? Did you use different channels for
different audiences and messages?
Format Was the format appropriate for the audience?
Were the products attractive and easy to understand? Did
you pretest the messages and formats with members of
the target audiences?
Timing: Was the timing right? Were messages delivered
when the target audience had time and opportunity to act?
Did the timing enable messages to link into other related
activities? Was the message repeated often enough to
have lasting impact?
Lookin g in en a bles you t o a ssess wh er e you a re. You ca n ga u ge
wh a t r esou r ces a r e a va il a bl e to you wh a t a llies h a ve in flu en ce,
wh a t in for m a tion you con tr ol, wh a t fin a n cin g or tech n ica l ex-
per tise you com m a n d. Wh en you fu lly u n der sta n d you r a dvoca cy
objecti ves a n d a ccu r a tely ga u ge you r a va ila ble resou rces, you
ca n select th e m ost a ppr opr i a te a dvoca cy a ctivi ties. Th ese m a y
in clu de developi n g a ll ia n ces, n etwor ks, a n d coa liti on s; com m u -
n ica tin g with policym a kers a n d oth er sta keh ol ders; a n d n egotia t-
in g con fli cts. By looki n g in , you select a dvoca cy a ctivities th a t a r e
fea sible a n d t h er efor e ca n r ea listica lly m ove you t owa r d you r a d-
voca cy objectives.
Lookin g a h ea d h el ps you t ra in you r sigh ts on you r u ltim a te goa l
a n d h elps you see t h e r oa d th a t lea ds th er e. Th is is th e oppor tu n i-
ty to a pply you r resou rces, im pl em en t you r a dvoca cy a ctivities,
a n d crea te desi red ch a n ges i n beh a vior s a n d opin ion s. Mon itor -
in g you r pr ogr ess h elps you determ in e wh eth er you a r e h ea din g in th e r igh t dir ect ion . Eva l -
u a tin g th e r esu lts h elps you r ecogn ize wh en you h a ve a rr ived. Usi n g th e in for m a tion
ga th er ed du r in g you r m on i tori n g a n d eva l u a tion h elps you a da pt you r str a t egy a n d/ or ob-
jectives a n d be a s effecti ve a s possible in a ch ievi n g you r h ea lth sector r eform s.
Box 3.21. Discussion questions: EvaIuating your
resuIts
To determine what your team should evaluate, refer to your:
reform policy
advocacy objectives
target audiences
advocacy strategies
alliances, networks, coalitions
policy communication
conflict resolution and negotiation
advocacy activities.
Then develop questions for each step of the process to
develop an advocacy strategy. For example, the evaluation
questions for your advocacy objective could be:
Did you achieve your advocacy objective?
lf you achieved all or part of your objective, how did it
contribute toward your policy and goal?
Your own assessment may not be completely objective.
You should consult with your allies and colleagues to
obtain their feedback as well.
Bibliography
Boyd, Su sa n et a l . 1999. Networ kin g for Policy Ch a n ge: An Advoca cy Tr a i n in g Ma n u a l .
Wa sh in gton , DC: USAID Agen cy for I n ter n a ti on a l Developm en t . Th e POLI CY Pr oj ect.
Br in kerh off, Der ick W. 1994. Lookin g Ou t , Lookin g in , Looki n g Ah ea d. PATimes. Vol. 17, No.
12, p. 11.
Cen ter for Developm en t a n d Popu l a tion Activi ties. 1995. Cairo, Beijing, and Beyond: A
Handbook on Advocacy for Women Leaders. Wa sh in gton , DC.
I n ter n a t ion a l Pla n n ed Pa ren th ood Fou n da tion . Ja n u a r y 1995. Advocacy Guide.
Mu r ph y, Ela in e M. Ma y 1994. Com m u n ica ti n g Popu la ti on a n d Fa m ily Pla n n in g I n for m a t ion
to Policym a ker s. Wa sh in gton , DC: U.S. Agen cy for I n t er n a tion a l Developm en t.
OPTIONS II Pr oject . Policy Pa per Seri es No. 4.
Sh a r m a , Ritu R. n .d. An Introduction to Advocacy: TrainingGuide.Wa sh in gton , DC: U.S.
Agen cy for I n ter n a tion a l Developm en t . Su ppor t for An a lysis a n d Resea r ch in Afr ica
Pr oject a n d Hea lth a n d Hu m a n Resou rces An a lysi s for Afr ica Pr oject .
3-33
Annex 3-A
Audience I dentification Worksheet
Th is wor ksh eet ca n h el p you list a n d or ga n ize you r ta r get a u dien ces. For ea ch objective, list
everyon e with a key r ole in m a kin g deci si on s or im plem en tin g ch a n ge u n der "pri m a r y a u di-
en ce." For ea ch pr im a r y a u di en ce, list ever yon e wh o m igh t in flu en ce th e pr im a r y a u dien ce' s
decision s.
Advocacy Objective:
Primary Audience
"Key actors"
Secondary Audiences
"Influentials"
(including opposition)
1. 1.
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3.
4.
2. 1.
2.
3.
4.
3. 1.
2.
3.
4.
4. 1.
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4.
3-35
Annex 3-B
Audience Knowledge, Position, and I nterests Worksheet
Th is wor ksh eet ca n h el p you or ga n ize in form a tion a bou t you r a u dien ces. For ea ch ta r get a u di-
en ce l isted i n t h e left -h a n d col u m n , descr ibe wh a t you kn ow a bou t th eir kn owledge, posit ion ,
a n d i n ter ests in th e a ppropr ia te cells. ( See rever se si de.)
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3-37
Annex 3-C
Allies and Opposition Matrix
Th is m a tr ix ca n h elp you visu a li ze you r su pport er s a n d opposit ion . Wh en you develop a str a tegy
to in cr ea se su ppor t, you wil l wa n t to con sider th e object ive, ta r get a u dien ce, oth er su ppor ter s,
a n d opposition in deci di n g wh er e to focu s you r effor ts.
Core Supporters Potential Allies Opposition
3-39
Annex 3-D
Message Content Worksheet
Wh en com m u n ica tin g wit h you r ta r get a u dien ce, you m u st be clea r a bou t wh a t you a r e a ski n g
of th em a n d wh y. I n com pletin g th i s worksh eet, be su r e t h a t you pr esen t wh a t you wa n t to
a ch i eve a n d wh y a s releva n t t o you r a u dien ce' s posit ion s a n d in t er ests. How you propose to
a ch i eve you r goa l sh ou ld expla in h ow th e a u dien ce' s r ole con tr ibu t es to wh a t you wa n t t o
a ch i eve.
Audience:
Action you want the
audience to take
What you want to achieve
Why you want to achieve
it
How you propose to
achieve it
3-41
Annex 3-E
Selecting a Messenger Worksheet
Use th is wor ksh eet to a ssess a possible m essen ger a ga in st cer ta in cr iter ia . For exa m ple, list a ll
th e m ea n s th e m essen ger h a s to a ccess you r a u dien ce. For t h e m essen ger ' s cr edi bi lity, kn owl-
edge, a n d pr esen ta tion a bilit y, n ote wh eth er it is h igh , m ediu m , or low. Th e m ore in for m a ti on
you in clu de, th e ea si er it wi ll be to select a m on g th e ca n dida tes. ( See r ever se side.)
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3-43
Annex 3-F
Communications Plan Worksheet
Th is wor ksh eet br in gs toget h er a l l th e com pon en ts of you r com m u n ica t ion s pla n for ea ch
objecti ve you h a ve esta blish ed. Ha vin g it a ll on on e pa ge ca n h elp you a ssess im port a n t fa ctor s
su ch a s wh eth er va r iou s a ctivi ties com plem en t or com pete with on e a n oth er, wh eth er you h a ve
a dequ a te fin a n cia l a n d person n el r esou r ces, wh et h er a l l you r r esou r ces a re bei n g effect ivel y
u sed, a n d wh a t wou ld be a r ea listi c t im efr a m e for ea ch a ctivit y. ( See rever se si de.)
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Section 4
Conflict Negotiation
Guidelines
Kathleen Novak
Chr istianne Hall
Section 4
Guidelines
Table of Contents
I n tr odu ct ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 1
Un der sta n din g Con flict . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 5
Developin g Effective I n terperson a l Com m u n ica tion Ski lls
a n d Bu ildi n g Wor kin g Rela tion sh ips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 11
Ma n a gin g th e Negotia ti on Process: An I n ter est -Ba sed Approa ch . . . . . . . . . . . . . . . . . . . . . . 4- 17
Resu lt s of Effective Con flict Negotia ti on . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 26
Bibli ogr a ph y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 27
An n ex 4- A: Negoti a tion St yle Assessm en t a n d Scor i n g Sh eet . . . . . . . . . . . . . . . . . . . . . . . . . 4- 29
An n ex 4- B: Self- I n ven tor y Wor ksh eet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 39
An n ex 4- C: Negotia tion Pr epa r a tion Wor ksh eet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 41
Box 4.1. Str a tegic qu estion s to a sk wh en you a r e defin in g
th e issu e a n d decidin g to n egotia te . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 18
Box 4.2. Br a in stor m in g tech n iqu es . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 23
Box 4.3. Som e object ive cr iter ia for h ea l th sector r efor m issu es . . . . . . . . . . . . . . . . . . . 4- 23
Figu r e 4.3. Th e Pol icy Pr ocess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 4
Figu r e 4.4. Con flict Negotia ti on Styles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 7
Figu r e 4.5. Con flict Sca le . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4- 10
Ta ble 4.1. Assessin g th e Rel a t ive Power of Negotia ti n g Tea m s . . . . . . . . . . . . . . . . . . . . . . . . 19
Conflict Negotiation at a
Glance
What is conflict negotiation?
Con flict n egot ia tion is a ba ck- a n d- for th com m u n ica tion pr ocess design ed to a n ticipa te, con -
ta in , a n d r esolve dispu tes so th a t pa rt ies wit h som e sh a red a n d som e opposin g in t er ests ca n
r ea ch m u tu a l ly a ccepta ble solu ti on s. Con fli ct n egotia ti on r efer s to a volu n ta r y, t wo- wa y com -
m u n ica tion in wh ich pa r ties in vol ved con tr ol bot h t h e process a n d t h e ou tcom e.
Con flict n egot ia tion in vol ves five key com pon en ts:
th e pa r ties in volved
th e in ter ests i n volved
th e r ela ti on sh ip between pa r ties
th eir in ter a ction s th r ou gh ou t th e n egot ia tion process
th e r esu lt s a ch i eved.
Components of Conflict Negotiation
YOU
Self Management
Skills
Interpersonal
Communication
Skills
Negotiation Skills
COUNTERPART(S)
NEGOTIATION
PROCESS
MUTUALLY
ACCEPTABLE
SOLUTION
I
N
T
E
R
A
C
T
I
O
N
What is involved in conflict negotiation?
To effecti vely n egotia te con fl ict a n d r ea ch m u t u a lly a ccepta ble a gr eem en ts you n eed to:
Pr epa r e in a dva n ce.
Ma n a ge you r self ( you r em otion s a n d beh a vior ) du r in g con fli ct.
I n ter a ct with you r cou n ter pa r t( s) in a pr odu cti ve wa y, u sin g effect ive in t er per son a l com m u -
n ica tion skil ls a n d bu ildin g a good wor kin g r ela tion sh ip.
Use t h e in terest-ba sed a ppr oa ch a s ou t lin ed in th ese gu idelin es.
What is gained through conflict negotiation?
Con flicts a n d disa gr eem en ts a r e a n a tu r a l a n d in evita ble pa r t of you r wor k a s a ch a n ge a gen t in
th e h ea lth sector. With ca r efu l, th ou gh tfu l self-pr epa r a tion , a n d by fol lowin g th e n egoti a tion
process ou tl in ed in th ese gu i delin es, you a r e m or e likel y t o r esolve con flict a n d a ch ieve t h e fol-
lowin g con str u ctive ou t com es:
Br in g to t h e su r fa ce a n d cla ri fy im por ta n t issu es.
Gen er a t e i m pr oved, m or e cr ea ti ve sol u tion s.
Rea ch m u tu a lly a ccepta ble a gr eem en ts th a t m eet you r key in ter ests a n d th ose of you r cou n -
ter pa r t( s) .
Str en gth en you r workin g r ela ti on sh ip with you r cou n t er pa r t( s) a s you h on estly a n d r espect-
fu l ly n egotia te you r differen ces.
Wh en disa gr eem en ts a r e den ied, a voided, or com pr om i sed a wa y, th ey ca n :
Divert en er gy from im por ta n t a ctivities a n d issu es.
Destr oy m or a le.
Pola r ize gr ou ps a n d in dividu a ls a n d, u ltim a tel y, m a ke fu tu re cooper a tion or col la bor a tion
im possible.
Pr odu ce ir r espon sible a n d r egr et ta ble beh a vior.
Da m a ge or destr oy wor kin g r ela tion sh ips.
With negotiation
Without negotiation
Section 4
Guidelines
I ntroduction
Wh en wor kin g on h ea lth sector r efor m , a n in h er en tly politica l pr ocess, it i s n ot u n com m on to
en cou n t er disa greem en t s a m on g key sta keh older s on pr ior ities, a ct ion s to be t a ken , or desir ed
r esu lts. Th ese di ffer en ces con cern ver y r ea l issu es th a t h a ve a dir ect a n d im m edia te im pa ct on
peoples lives a n d l iveli h oods. Con fli cts em er ge, ten sion s ri se, em oti on s fl a r e, a n d a greem en t s
m u st be n egotia ted. Th e followin g a r e exa m ples of h ea lth r efor m in it ia tives t h a t h a ve gen er a t ed
su ch con flict s:
Rea lloca t in g r esou rces fr om cen tr a l level m in i st ri es to decen tr a lized u n its
Sh ift in g from h istor ica l to per for m a n ce- ba sed bu dgetin g for pu bli c h ospit a ls a n d clin ics
I n cr ea sin g th e a u t h or ity of pu bl ic h ospi ta l dir ector s to h ir e a n d fir e per son n el
Ch a n ges in th e con dition s, sa la r ies, a n d eva lu a t ion st a n da rds for h ea lt h ca re wor ker s.
Wh en we seek to im plem en t h ea lth sector r efor m s, th e fin a n cia l, h u m a n , a n d tech n i ca l
r esou r ces n eeded a r e l ost to com pet in g u ses a n d u ser s. I t is r ea son a ble, t h er efor e, t o a n ti cipa te
som e con flicts between h ea l th r efor m tea m s a n d t h ose h ea l th sect or officia ls, m a n a ger s, pr ovid-
er s, a n d oth er s wh o believe t h a t sh iftin g r esou r ces a n d oth er or ga n iza t ion a l ch a n ges r equ ir ed
by r eform wi ll t h r ea ten th eir power, posit ion , a n d secu r ity.
What is conflict negotiation?
Con flict n egot ia tion is a ba ck- a n d- for th com m u n ica tion pr ocess design ed to a n ticipa te, con -
ta in , a n d r esolve dispu tes so th a t pa rt ies wit h som e sh a red a n d som e opposin g in t er ests ca n
r ea ch m u tu a l ly a ccepta ble solu ti on s. Con fli ct n egotia ti on r efer s to a volu n ta r y, t wo- wa y com -
m u n ica tion wh ere th e pa r ties in volved con tr ol both th e pr ocess a n d th e ou tcom e. Con flict n ego-
tia tion in volves five key com pon en ts ( Fi gu r e 4.1) :
th e pa r ties in volved
th e in ter ests i n volved
th e r ela ti on sh ip between pa r ties
th eir in ter a ction s th rou gh ou t th e n egot ia tion process
th e r esu l ts a ch ieved.
I f th e n egotia ti on is n ot su ccessfu l, a n eu tr a l th ir d pa r ty or m edia tor m a y be br ou gh t in to
a ssist th e in ter ested pa rt ies i n vol u n t a ril y r ea ch in g th eir own settl em en t or a greem en t . Wh en
m edia tion pr oves u n su ccessfu l , especia ll y in situ a ti on s th a t h a ve lega l im plica t ion s or con sider -
a ble soci eta l im pa ct, exter n a l, bin din g, n on volu n ta ry a r bitr a tion m a y be in t rodu ced by a ppro-
pri a te gover n m en ta l a u th ori ties. Su ch bin din g a r bitr a ti on m igh t be in dica t ed, for exa m pl e, in
th e ca se of a th r ea ten ed sh u tdown of pu blic h ospita ls th a t wou ld pu t pa tien ts welfa r e a t r isk.
Figu r e 4.2 ou tlin es th e va r iou s m ech a n ism s for con flict / dispu t e r esolu tion , wh i ch r a n ge a l on g
a con tin u u m fr om a volu n ta r y, pa r ticipa n t-dr iven pr ocess to a n on volu n ta r y process con tr olled
by exter n a l a rbit ra t or s.
Th ese gu idelin es focu s on th e volu n ta ry n egotia tion of con fli ct. Th ey ca n h elp h ea lth r efor m
tea m s t h in k a n d a ct str a tegica l ly in or der t o a n t icipa te poten tia l con flict s a n d ta ke a dva n ta ge of
win dows of oppor tu n ity to in it ia te th e n egot ia tion process befor e th e situ a t ion deter ior a tes a n d
exter n a l , bi n din g a rbit ra t ion becom es n ecessa ry. Th is in for m a ti on i s a lso u sefu l to th ir d-pa r ty
m edia tor s, bu t it will n ot n ecessa r il y a pply to sit u a tion s wh er e n on volu n ta r y, bin din g a r bitr a -
tion h a s been in it ia ted.
Figure 4.1 . Components of Conflict Negotiation
YOU
Self Management
Skills
Interpersonal
Communication
Skills
Negotiation Skills
COUNTERPART(S)
NEGOTIATION
PROCESS
MUTUALLY
ACCEPTABLE
SOLUTION
I
N
T
E
R
A
C
T
I
O
N
Con flic t Negotia tion Guideline s 4-3
Where does conflict negotiation fit into the policy process?
As ou tl in ed in Secti on 1, th is toolkit is ba sed on a con cept u a l fra m ewor k of th e policy pr ocess
th a t in clu des si x sta ges. In br ief, t h e m odel sta tes th a t refor m s a r e la u n ch ed wh en i ssu es a n d
a gen da s com e t ogeth er a n d policym a ker s decide on th e gen era l direction of th e h ea lth r efor m s.
Th e su bsequ en t five sta ges in th e policy pr ocess, a s iden t ified in Figu r e 4.3, a re cyclica l , wi th
m a n y cross l in ka ges. Th ese sta ges a r e:
Policy for m u l a t ion a n d legi tim iza tion
Con sti tu en cy- bu i ldin g
Resou r ce m obil iza tion
I m plem en ta tion design a n d or ga n iza tion a l str u ctu r in g
Pr ogress/ im pa ct a n d m on it or in g.
Th is fi ve- sta ge cycle is tech n ica l ly led beca u se t ech n ica l in pu t is requ ir ed a n d th e pr ocess is gen -
er a lly led by tech n ica l sta ff. Over a ll, h owever, th is rem a in s a n in h er en t ly poli tica l process. Th e
a bility to n egotia te con fl ict is u sefu l a t a ll st a ges, bu t it is m ost cr iti ca l du r in g t h e foll owi n g two
sta ges:
Resou r ce m obil iza tion : Im plem en tin g h ea lt h sector r efor m r equ ires su bsta n ti a l fi n a n ci a l,
h u m a n , a n d tech n ica l r esou r ces. Resou r ces a lloca ted to h ea lt h sector r efor m a r e lost to com -
Figure 4.2. Continuum of Conflict/Dispute Resolution Mechanisms
Negotiation:
Voluntary,
Participants control
the process &
outcome
Mediation:
Neutral third party helps
participants reach
voluntary agreement
Arbitration:
Non-voluntary,
Interested parties
have the least control
petin g u ses a n d u ser s. Advoca tes for r efor m wi ll n eed to a n t icipa te, r ecogn ize, a n d n egot ia te
th e con flicts th a t su ch r esou r ce r ea ll oca tion ca n cr ea te.
I m plem en ta tion design a n d or ga n i za tion a l str u ctu r in g: Hea lth sector r efor m s a ssign n ew
object ives a n d ta sks to in di vidu a ls a n d or ga n iza tion s. Frequ en tly, n o r ea dily a va i la ble, cou n -
tr y- specifi c m odels a r e a va ila ble to pr ovi de gu i da n ce a n d h elp m a n a ge th e tr a n sit ion . Re-
for m effor ts a l so ca n lea d t o n ew pa r tn er sh i ps a s n on gover n m en ta l or ga n iza tion s ( NGOs) ,
pri va te- sect or ph ysicia n s, profession a l a ssocia tion s, a n d com m u n ity gr ou ps becom e m or e
a ctive i n t h e refor m process. For th ese grou ps, a s wel l a s for pu blic- sector a ctor s, a doptin g
n ew wa ys of doin g bu si n ess m a y be per ceived a s a loss or a th rea t, r a th er th a n a s a n excit in g
oppor tu n ity or ch a llen ge. Du r in g th i s tr a n sition a l ph a se, h ea lth r efor m tea m s m a y fin d
th em sel ves i n con fli ct wi th th ose h ea lt h pr ofession a ls wh o r esist ch a n ge a n d a r e r el u ct a n t t o
give u p fa m i lia r pr ocedu r es, r ou ti n es, r esou r ces, a n d r ela tion sh i ps.
How can conflict negotiation help you?
Con flict is n ot u n com m on du r in g r efor m effor ts, a n d developin g skil ls to n egotia te sou n d
a greem en ts, even in th e pr esen ce of h ea ted em oti on , will be va l u a ble in h el pi n g you fu r th er
r efor m . As a tech n ica l per son i n volved in th e h ea lth sect or, you m a y feel som ewh a t u n pr epa r ed,
or ill a t ea se, wh en you r r efor m a gen da i s gr eeted with str on g r esista n ce or over t oppositi on .
Un der sta n da bly, you m a y wish to a void su ch situ a tion s a l togeth er a n d con sider t h a t dea lin g
with th ese con flicts is n ot you r r espon sibil ity. However, wi th th e h elp of th ese gu i delin es on con -
flict n egotia tion cou pled with you r own ca refu l, th ou gh t fu l self- pr epa ra t ion , per sever a n ce,
Figure 4.3. The Policy Process
a n d discipli n e you ca n a n d wi ll ga in com peten ce a n d exper tise i n th is a rea . Th e r ewa r ds wil l
be t h e followin g:
I m por ta n t issu es wi ll be br ou gh t to t h e su r fa ce a n d cla r ified.
New i n for m a t ion a n d option s will be gen er a ted.
Cr ea tive, im proved solu t ion s wil l be fou n d.
Wor kin g r ela tion sh i ps will be str en gth en ed a s bot h pa r ties h on estly a n d r espectfu ll y n egoti-
a te th ei r differen ces.
How does conflict negotiation relate to the other guidelines?
Th e Sta keh older An a l ysis Gu i delin es ( Section 2) , th e fi rst tool i n t h is col lect ion , ou tl in es a sys-
tem a tic pr ocess for i den tifyin g in t er ested sta keh older s a n d a ssessin g th eir power, i n terest s, a n d
posi tion s on speci fic issu es a n d policies. Th is clea r u n der sta n din g of th e in ter ests a t sta ke a n d
th e position s of key sta keh ol der s is cr it ica l to su ccessfu l con flict n egot ia tion .
Th e Advoca cy Gu idelin es ( Section 3) offer h ea lth sector r efor m tea m s a m eth odology a n d
th e n ecessa r y tools for fa cil ita tin g som e of th e beh a viora l a n d or ga n i za tion a l ch a n ges n ecessi-
ta ted by h ea lth sect or refor m s. Advoca cy ca n h elp m obilize con st itu en ci es, bu ild su ppor t for
r equ ir ed ch a n ges, a n d r edu ce i n ter n a l a n d/ or exter n a l opposition . Advoca cy str a tegi es a r e a l so
u sefu l for pu bl icizin g a n d com m u n ica ti n g th e r esu l ts of su ccessfu l n egotia tion s to a ll in t er ested
pa rt ies.
Understanding Conflict
Con flict a lwa ys t a kes pla ce in th e con text of in ter per son a l r ela tion sh i ps: with in dividu a ls,
with in fa m il ies, in th e wor kpl a ce, with in com m u n ities, a n d between a n d a m on g opposin g pro-
fession a l gr ou ps or politica l fa ction s. Th ese gu idelin es specifica lly a ddr ess con flicts th a t a ri se a s
a r esu l t of h ea lt h r efor m effor ts, su ch a s r esou r ce r ea lloca ti on t o decen tr a lized distr ict - l evel
fa cil ities, th e r esh u ffli n g of r oles a n d r espon sibiliti es with in a u n it of t h e m in istr y of h ea lth , or
su bsta n tive r estr u ctu r in g of h ea lt h sector or ga n iza ti on s a n d deliver y system s, etc..
Su ccessfu l con fl ict n egotia t ion does n ot ju st h a ppen . People a r e n ot born good n egotia tor s.
Self- a wa r en ess, specifi c com m u n ica tion skills, kn owledge of th e t ech n ica l con ten t of th e i ssu es
u n der discu ssion , a n d com m a n d of t h e n egoti a t ion pr ocess a re a ll essen t ia l. Wh a tever kin d of
n egoti a t ion you fa ce, sou n d a n d t h or ou gh pr epa r a tion is t h e cr itica l el em en t for su ccess.
You m a y a ssocia te th e word con fl ict with n ega ti ve exper ien ces a n d ou tcom es. To be a su c-
cessfu l n egot ia tor, h owever, you m u st set a si de th ese n ega tive pr econ ception s a n d objectively t ry
to a ssess th e fol lowin g:
You r own beli efs, a ttitu des, a n d r espon ses t o con flict
Th e n a tu r e of th e con fli ct a t h a n d
You r person a l in vestm en t in th e ou tcom e of th e n egotia tion pr ocess.
You m a y be ca lled u pon to n egotia te con flicts rega r din g issu es th a t deeply con cer n you a n d
in volve you r per son a l in ter ests. Th is ca n m a ke th e l in e between m a n a gin g you r own feel in gs
a n d r ea ction s a n d m a n a gin g t h e n egotia ti on pr ocess i tself di fficu lt to distin gu ish . You r u lti m a te
su ccess a s a n egotia tor, h owever, will depen d on you r a bility to tr a ck a n d m a n a ge you r feeli n gs,
r ea ction s, a n d beh a vior in a disci pl in ed m a n n er wh ile you sim u lt a n eou sly in ter a ct a n d n egoti-
a te with you r oppon en ts. Th e r em a in der of th is section h elps you pr epa re for t h is com plex a n d
ch a l len gin g effort .
Understanding Your Beliefs, Attitudes, and Responses to Conflict
Th e a tt itu des a n d bel iefs th a t sh a pe you r r espon se to con flict a r e h igh l y in dividu a lized a n d a r e
in flu en ced by m a n y fa ct or s, in clu din g you r cu l tu r e, fa m ily ba ckgr ou n d a n d beh a vior, a n d per -
son a l experi en ces ( eith er positive or n ega tive) i n dea l in g wi th con fl ict, to n a m e a few. I n a ddi-
tion t o a t titu des a n d beliefs, you r beh a vior in a n y con fli ct n egotia tion a lso is in flu en ced by you r
va lu es a n d a ssu m ption s r ega r din g: 1) th e n a tu r e a n d im porta n ce of r ela tion sh ips; 2) h ow oth er
people fu n ction ; 3) h ow you sh ou ld go a bou t gettin g wh a t you wa n t; 4) you r kn owledge of th e
specifi c sit u a tion ; a n d 5) you r u n der sta n din g of you r oppon en ts. Fin a lly, you r a ppr oa ch to con -
flict n egotia tion is a ffect ed by th e exten t t o wh ich you ba la n ce in ter est- dr iven con cer n s ( goa l
a tta in m en t) , a n d r ela tion sh ip- dr iven con cer n s ( devel opin g a n d m a i n ta in in g positive, wor kin g
r ela tion sh ips) .
To be a n effective con flict n egot ia tor, you m u st fir st u n der sta n d you r per son a l st yle or
a ppr oa ch t o con fli ct n egoti a t ion a n d th en a da pt a n d a dju st th a t styl e in r espon se to th e cir cu m -
sta n ces u n der wh i ch you m u st n egotia te.
1. Identify your conflict negotiation style.
Alth ou gh t er m in ology m a y va ry, m ost a u th ori ties on con flict a gr ee t h a t i n divi du a l styles of con -
flict m a n a gem en t ca n gen er a lly be descri bed a s fa l lin g in to on e of th e followin g five pa ttern s
( Figu r e 4.4) : 1) colla bor a tive, 2) com petit ive, 3) com prom isin g, 4) a ccom m oda tin g, a n d 5)
a voidin g. Th er e is n o on e r igh t st yle for m a n a gin g con fl icts; ea ch styl e is h el pfu l in cer ta in
situ a ti on s a n d ca n h a ve n ega t ive con sequ en ces wh en over u sed, or wh en u sed i n a ppropr ia tel y.
Collaborative. Colla bor a t ion is both in ter est- a n d rela tion sh i p-dr iven , a s sh own in Figu r e 4.4.
Tru e colla bor a t ive a greem en ts a re r ea ch ed by diggin g deep i n to a n issu e to iden t ify th e u n der ly-
in g con cer n s a n d in t er ests of th e pa rt ies a n d fin din g solu tion s th a t tr u ly sa tisfy th ese con cer n s.
Su ch a gr eem en ts r equ i re in vestm en ts of t im e a n d en er gy a n d both a r e va lu a bl e a n d lim ited
r esou r ces.
I n th e a r en a of h ea lth sector r efor m , th e sta kes ca n be h igh : differ in g objectives a n d m eth ods
cla sh fr equ en tly, th e resu ltin g con flict s a r e su bsta n tive, a n d th er e is a ver y r ea l n eed to m a in ta in
sa t isfa ctor y wor kin g r ela ti on sh ips wit h cou n t er pa r ts. Given th e h igh sta kes, in vestin g th e extr a
r esou r ces n eeded to r ea ch colla bora t ive a greem en ts th a t a ch ieve you r in terest -dr iven a gen da
wh il e pr eser vin g sou n d wor kin g r ela tion sh ips with you r oppon en ts wil l gen er a lly be m or e th a n
wort h wh i le i n th e lon g ter m .
Colla bor a tion is a ppr opr ia te wh en th e con cer n s of both sides a r e too im port a n t t o be com -
prom ised, bu t n ot a ll pr oblem s a n d con flicts requ ir e su ch optim a l solu tion s. Be ca r efu l n ot to
over u se colla bor a tion on less su bsta n t ive m a tt er s, pa r ticu la r ly ju st to m in i m ize r isk or a void
r espon sibility. I n a ddi tion , you r colla bor a tive effort s sh ou ld elicit sim il a r, colla bor a t ive
r espon ses fr om you r opposit ion ; if th ey don t, th i s m a y be a sign a l th a t you n eed to reth in k th e
r ela tion sh ip issu es a n d develop a n oth er n egoti a tion a ppr oa ch a n d str a tegy.
Competitive. A com petiti ve n egotia ti on style i s pr im a r ily in ter est- dr iven , with th e goa l of h a v-
in g you r side win a n d th e oth er side l ose. Mu ch less, if a n y, em ph a sis is pla ced on r ela ti on sh ip
issu es. Th is is a power-or ien ted n egoti a tion style in wh ich you u se wh a tever power a n d in flu en ce
is a va il a bl e to prot ect a n d pr om ot e you r in ter ests.
A com petit ive style of n egotia ti on i s a ppr opr ia te wh en : 1) qu i ck, decisive a ct ion is vit a l , e.g.,
em er gen cies; 2) u n popu la r cou r ses of a ction a re n eeded, e.g., cost- cu t tin g, en for cin g str in gen t
r egu la ti on s; a n d 3) in i tia l, m or e colla bor a tive a ppr oa ch es h a ve sh own th a t you r oppon en ts a r e
likel y to ta ke a dva n ta ge of n on com petitive beh a vior.
An over u se of th e com pet itive a ppr oa ch , h owever, m a y r esu lt in lost a llia n ces a n d pa r tn er-
sh ips, relu cta n ce on th e pa r t of you r su bor din a tes to provide n eeded in for m a tion or da ta ( i.e.,
beca u se it ch a l len ges you r posit ion ) , a n d a com petit ive clim a te wh ere m or e tim e m a y be spen t
on figh tin g for in flu en ce a n d power t h a n on pr odu ct ive problem - solvin g.
Compromising. Com pr om ise i s both in terest- a n d rela tion sh i p-dr iven , a lth ou gh a s sh own in
Figu r e 4.4, less so th a n colla bora t ion . Com prom ise is th e a tt em pt to fin d m u tu a ll y a ccepta ble
sol u tion s th a t pa rt ia lly sa t isfy you r i n ter ests a n d th ose of you r oppon en ts wi th ou t u n du ly str a in -
in g you r wor kin g r ela tion sh ip. Th i s a pproa ch r equ ires th a t you dea l dir ectl y wit h t h e con flict
Figure 4.4. Conflict Negotiation Styles
I
s
s
u
e
-
d
r
i
v
e
n
Relationship-driven
Collaborative Competitive
Avoidance Accommodating
Compromising
Source: Kilma and Momar 1974.
a n d u n der lyin g in terests a t h a n d, bu t doesn t r equ ir e th a t you explor e th ese in ter ests in a s m u ch
depth a s th e col la bor a ti ve a ppr oa ch .
Com prom ise is a ppropr ia te wh en you a n d you r oppon en ts h a ve equ a l power a n d a re str on gly
com m it ted to m u t u a lly exclu si ve objectives. Tem por a r y set tlem en ts to com pl ex issu es a lso m a y
in volve com pr om ise, pa rt icu l a rl y wh en th ere is sign ifica n t t im e pr essu r e. For exa m ple, a s a
h ospita l dir ector i n volved in n egotia tion s wit h h ea l th pr ovider u n ion s, you m a y com pr om ise on
th e n u m ber of positi on s to be el im in a ted in you r h ospi ta l i n exch a n ge for t h e u n i on s pr om ise
to defer sa la r y n egotia tion s for a n a ddit ion a l 6 m on th s. Th i s solu tion i s n ot com pletel y sa tisfa c-
tor y t o eit h er side. Th e com prom ise st ru ck, h owever, a voids th e poten t ia l disr u pti on of a str ike,
a ch i eves a t em por a r y settlem en t, a n d lea ves t h e wa y open for m or e colla bora t ive n egot ia tion s in
th e fu tu r e.
Accommodating. Accom m oda tin g is r el a t ion sh ip- dr iven a n d pla ces em ph a sis on th e con -
cer n s a n d in ter ests of th e opposit ion r a th er th a n you r own . Alth ou gh i t wil l n ot m ove you r tech -
n ica l a gen da for wa r d, a ccom m oda tion ca n be a u sefu l str a tegy, especi a l ly if th e issu e a t h a n d is
ver y im por ta n t to you r oppon en ts a n d t h e ou tcom e h a s n o pa rt icu l a r n ega ti ve con sequ en ces for
you or you r in ter ests. Un der su ch cir cu m sta n ces, a ccom m oda tion ca n be u sed a s a goodwil l
gestu r e to h elp m a in ta in a cooper a tive r el a t ion sh ip with th e opposition a n d bu ild u p socia l
cr edits for fu tu r e issu es th a t m a y be m or e i m por ta n t to you .
Over u se of a ccom m oda tion , i.e., con ti n u a l deferen ce to th e con cer n s of you r oppon en ts, m a y
depr ive you of t h e recogn it ion a n d r espect you n eed to in fl u en ce fu tu r e n egotia tion s a n d ou t-
com es wit h you r oppon en ts. Pr eser vin g h a r m on y a n d a voidi n g disr u pti on th r ou gh a ccom m o-
da tion m u st be ba la n ced a ga i n st m a in ta in in g you r lea der sh i p a n d cr edibilit y a n d a ch i evin g
you r r efor m obj ecti ves.
Avoidance. By a voidi n g con flict a lt ogeth er, you a ddr ess n eith er you r in ter ests n or th e com pet-
in g in terest s of th e opposi tion . Alth ou gh n ot gen er a l ly viewed a s a u sefu l str a tegy or a lon g- ter m
sol u tion , a voida n ce is a ppr opria t e u n der t h e followin g cir cu m st a n ces:
An issu e i s tr ivia l a n d doesn t m er it you r ti m e
Th e poten tia l da m a ge of con fr on tin g th e con fli ct fa r ou twei gh s a n y possi ble ben efi ts
You h a ve lit tle or n o power a n d per ceive n o ch a n ce of sa tisfyin g you r in ter ests.
Postpon em en t, a va r ia ti on of a voida n ce, is a u sefu l str a tegy wh en you n eed t im e to r egrou p
a n d a ssess a sit u a tion , ga th er m or e in for m a ti on or r esou rces, or recr u it a llies wh o h a ve th e
power a n d in fl u en ce requ ir ed to a ddr ess a n d n egotia te th e con flict m or e effectively.
2. Adopt a negotiation style that is appr opr iate to the cur r ent situation and
your goals.
On e key to su ccessfu l con flict n egotia tion is th e a bility to r ea lize wh en you r own n a t u r a l n egoti-
a tion style is, a n d i s n ot, a ppr opr ia te. Review th e styl es descr ibed a bove, a n d i den ti fy th e style
th a t m ost closely descr ibes you r a ppr oa ch to con fli ct. I f you kn ow th a t you ten d to com pete for
spa ce a n d dom in a t e con versa ti on s, especia ll y wh en you a re tr yin g to wi n a poin t, pa y pa rt icu l a r
a tten tion to th e su ggestion s i n t h e followin g sect ion for devel opi n g con str u cti ve com m u n ica -
tion a n d a ctive listen in g skills. I f, on th e ot h er h a n d, you fin d it difficu lt to sta t e you r poin t
clea r ly a n d wit h su fficien t con viction , or you t en d to a void con flict a t a n y cost, wor k on i m pr ov-
in g you r a bil ity to cl ea r ly st a t e you r in ter ests a n d com m u n ica te you r n eeds t o th e opposition .
No sin gl e a ppr oa ch or st yle for con flict n egotia tion will pr ove su ccessfu l u n der a l l ci rcu m -
sta n ces. Th r ou gh ca r efu l a ssessm en t a n d pr epa ra t ion , h owever, you wil l be a ble t o a dju st you r
a ppr oa ch a n d a void th e n ega tive em oti on a l r ea ction s t h a t often der a il com m u n ica ti on a n d
a lm ost a lwa ys esca l a te t h e level of con flict . Pr epa ra ti on th i n kin g th r ou gh in a dva n ce wh a t
you a r e tr yi n g t o a ccom plish a n d h ow you will pr oceed wil l h elp you a cqu ir e a n d m a in ta in
th e self-con tr ol you n eed du r in g di fficu lt n egotia t ion pr ocesses. To lea rn m or e a bou t you r in di-
vidu a l str en gth s a n d wea kn esses a s a n egotia tor, com plet e t h e qu estion n a ir e ( wh ich ca n be self-
a dm in ister ed) a n d scor in g sh eet a n d r ea d th e a ccom pa n yin g list of su ggested i m pr ovem en ts i n
An n ex 4- A.
Assessing the Nature of the Conflict I nvolved
Con flict h a s a su bsta n tive com pon en t ( th e issu es a bou t wh ich you disa gr ee) a s well a s a n em o-
tion a l com pon en t. In th e r ea l wor ld, th e two com pon en ts t en d to be in extr ica bly in tert win ed.
You will n ot be im m u n e to t h e em otion a l ten si on th a t con flict n egoti a t ion ca n en ta il . Wh en
con fron tin g st ron g opposit ion , you a r e li kely to experi en ce n ega tive feelin gs su ch a s a n im osity,
a n ger, distr u st, fru str a t ion , a n d a n xiety. Better pr epa r a tion a n d a n a lysis, on both si des, ca n h elp
con t a i n th e em otion a l ten sion s a n d en cou r a ge th e cr ea ti ve pr obl em -solvin g th a t lea ds t o m u tu -
a lly a ccept a bl e solu t ion s.
On e im por ta n t step in you r prepa r a tion is to a n a lyze th e n a t u r e of th e issu e a t h a n d a n d it s
per son a l im por ta n ce or sign ifica n ce for you : Is th is a n issu e t h a t con fr on ts you r ba sic va l u e sys-
tem ? I s it a bou t th e pr iori ty you pl a ce on you r im m edia te obj ecti ves? Do t h e pa rt ies in volved
h a ve sim ila r objectives bu t ch oose differ en t m et h ods to rea ch th e sa m e en d? Are th e pa r ties
r ea lly disa gr eein g a bou t fa cts a n d figu r es?
You r ca pa city to n egotia te m u tu a l ly a ccepta ble solu ti on s will u su a l ly decr ea se a s you pro-
ceed fr om disa greem en ts a bou t in for m a ti on a n d m eth ods t o disa greem en ts th a t in volve you r
objecti ves a n d cor e va lu es. For tu n a tely, in th e a r en a of h ea lt h r eform , r espect for h u m a n li fe,
sol ida ri ty, a n d oth er cor e va lu es a r e gen er a lly sh a r ed a m on g key sta keh older s. Di ffer en ces a r e
m or e likel y to occu r a t t h e level of object ives, m eth ods, a n d i n for m a t ion . Figu r e 4.5 i llu str a tes
th e r ela ti on sh ip between th e level of con fl ict a n d t h e a bi lity to n egotia te.
Con flict va r ies in in ten sity fr om m ildly a dver sa r ia l to bi tter. On e in dica t or of th e i n ten sity of
th e con flict is th e level of em otion a l en er gy th a t a ccom pa n ies you r i n ter a cti on s a n d a ttem pts t o
n egoti a t e. Th e em otion a l in ten si ty, h owever, does n ot a lwa ys i n dica te th e t ru e substantive
weigh t of th e issu e. Som e i n dividu a ls br in g th e sa m e h ea t a n d in ten sity to a l l discu ssi on s,
wh et h er th ey a r e a bou t th e va lidi ty of da ta set s or t h e i n clu sion of cer ta in life- sa vin g tech n iqu es
in a socia l in su ra n ce pa cka ge.
Avoid u n n ecessa r y ten sion a n d esca la tion by iden t ifyin g th e l evel a n d sign ifi ca n ce of th e
con flict a t h a n d. Spen d t h e tim e a n d effort r equ i red to i den ti fy com m on va lu es a n d obj ectives
beforediscu ssin g t h e a r ea s of differ en ce a n d con flict. Th is h elps you diffu se ten sion , focu s you r
n egoti a t ion a t th e a ppr opri a t e l evel , a n d in cr ea se you r likelih ood of fin din g m u tu a lly a ccept-
a ble solu tion s.
Assessing Your I nvestment in the Negotiation
Before you com m it t o pa rt icipa te in a n y su bsta n ti ve n egotia t ion , ta ke t h e tim e to com plete th e
per son a l in ven tor y i n An n ex 4- B. Th is tool h elps you a ssess you r per son a l in vestm en t i n th e ou t-
com e of th e n egoti a t ion a n d iden ti fy a n y per son a l ri sk fa ctor s th a t a r e r eleva n t. After a n swer in g
th e qu est ion s, st op a n d a ssess you r a n swer s. Wh a t specifica lly con cer n s you a bou t th i s issu e?
Wh a t is a t sta ke for t h e r efor m s you a r e t ryin g to im pl em en t? Wh a t person a l or professi on a l ri sks
a re in volved if you a re n ot su ccessfu l? Wh a t wou ld be th e best m u tu a l ly a ccepta ble ou tcom e you
ca n im a gi n e? Wh a t wou ld be a n ou tcom e you cou ld a ccept? Wh a t is th e best ou tcom e you ca n
expect if you don t n egot ia te?
An swer in g th e qu est ion s in t h is per son a l in ven t or y h elps you pu t th e n egot ia tion pr ocess in
per spective a s it r el a t es to you , you r in t er ests, a n d you r effor ts to im plem en t ch a n ge. Ba sed on
th i s in for m a tion , you ca n a ssess wh eth er it is in you r best in ter est t o en t er in to n egot ia tion s a n d
th e pot en t ia l con sequ en ces of a decision eith er wa y. Ha vin g a rea listic i dea of th e st a kes in volved
en a bles you to be fir m , yet flexi ble, du r in g th e a ctu a l n egotia tion pr ocess, with ou t feelin g in se-
cu r e or vu ln era ble.
Summary
Effecti ve con fli ct n egotia ti on r equ ir es th a t you expr ess you r in ter ests a n d n eeds cl ea r ly, u n der -
sta n d t h e in ter ests a n d n eeds of th e opposition , a n d u se you r join t pr obl em -solvi n g skill s to
r ea ch a n a ccepta ble solu ti on . Th e n ext section in t rodu ces com m u n ica tion a n d in terperson a l
ski lls th a t ca n i n cr ea se you r n egotia ti n g a bili ty a n d gr ea tly im pr ove you r ch a n ces of su ccess.
Figure 4.5. Conflict Scale
Information Methods Objectives Values
DECREASING Ability to Negotiate
INCREASING Intensity of Conflict
Con flic t Negotia tion Guideline s 4 -1 1
Developing Effective I nterpersonal Communication Skills
and Building Working Relationships
Effective com m u n ica tion a n d in terperson a l skills a r e essen ti a l to su ccessfu l con flict n egotia tion
beca u se:
Dem on str a tin g respect for th e oth er pa r ty is a cri tica l fa ctor in con str u ct ive con flict r esolu -
tion .
Th e m or e i n for m a ti on ea ch si des h a s a bou t th e i n terest s a n d n eeds of th e oth er, th e m or e
likel y both sides a r e to r ea ch a m u tu a ll y a ccepta ble sol u tion .
A pr oblem - solvin g a ppr oa ch th a t em ph a sizes colla bor a tion r a th er th a n com petiti on is m or e
likel y to r esu lt in a positive ou tcom e.
Wh en n egotia tin g con flict , it i s essen ti a l th a t you expr ess you r in ter ests a n d n eeds cl ea r ly,
u n dersta n d th e i n ter ests a n d n eeds of th e opposi tion , a n d u se you r j oi n t problem - solvin g skills
to rea ch a n a ccepta ble solu t ion . Th ese a ssu m ption s set th e st a ge, bu t th e com m u n ica tion skills
descr ibed below a r e essen tia l. Alt h ou gh th ey do n ot n ecessa r ily com e n a tu ra ll y, t h ey ca n be
lea r n ed a n d m u st be pr a ct iced, a n d th is section h elps you do both .
Developing Effective I nterpersonal Communication Skills
1. Be an active listener.
Listen i n g i s la bor- in t en sive. Active li st en in g r equ i res a clea r focu s on u n dersta n din g t h e
spea ker s m essa ge. I n con fli ct si tu a tion s, people a ll too fr equ en t ly begin to fr a m e t h eir respon ses
befor e t h e ot h er pa r ty h a s fin ish ed spea kin g, im pedin g th eir a bilit y to fu lly com preh en d wh a t is
bein g sa i d a n d in vi tin g m i scom m u n ica tion ba sed on in com plete m essa ges. Developin g you r
listen in g ski lls ca n h elp you :
Pr even t m i su n der sta n din gs a n d cla r ify, pa ra ph r a se, a n d su m m a r ize wh a t you th i n k you
h ea r d. Th is in cr ea ses you r u n der st a n din g wh ile lettin g you r opposition kn ow you a re r ea lly
listen in g.
Dem on str a te respect by listen in g a tten tively with ou t givin g grou n d on th e issu e.
Receive a ccu ra te a n d specifi c i n for m a ti on a n d explor e for m or e deta il s. Th is h elps you for -
m u la te a m ore pr eci se defin iti on of th e pr oblem a n d m or e precise option s for sol u tion s.
Un der sta n d you r oppon en ts wh ile a llowin g th em to expr ess t h ou gh ts in th eir own wa y.
Th e h u m a n br a in pr ocesses in for m a ti on fou r to t en tim es fa ster th a n th e speed of speech .
Th is m ea n s th a t you r m in d h a s tim e t o wa n der wh en you a r e l isten in g. I t ta kes focu sed con cen -
tr a tion to sta y with th e spea ker a n d h i s or h er m essa ge a n d a void j u m pin g a h ea d to th in k a bou t
proposed solu tion s, object ion s, or a ddition a l topics. You m u st overcom e both in t er n a l a n d
exter n a l distr a ction s a n d focu s you r en er gy a n d a tten ti on on fu l ly u n dersta n di n g t h e m ea n in g
of wh a t is bein g sa i d to you , n ot on wh a t you wa n t to sa y n ext.
2. Use questions.
Qu esti on s a r e in terven ti on s. Th ey r equ ir e t h e per son a n swer in g to or ga n i ze h is or h er t h ou gh t s
on th e su bject a n d th en fr a m e a r espon se. Askin g a ppr opri a t e qu estion s ca n h elp you :
Ga in m or e in for m a tion : Wh a t led you to t h a t con clu sion ?Wh a t is you r opin ion on th a t
situ a ti on ?
Refocu s a discu ssi on : Wh a t is th e pr oblem we a r e t ryin g to solve h ere?
Reor ien t a pot en ti a l a tta ck or esca la ti on of con flict: I s th er e a n oth er, m or e posi tive wa y we
ca n fr a m e th is issu e?"
Sh ow r espect for a n d in ter est in you r opposition s view: I s th er e a n yth in g else you t h in k I
sh ou ld kn ow t h a t wou ld h elp m e u n dersta n d you r posi tion on t h is?
I n tr odu ce in for m a tion a s well a s option s for solu tion s: Wh a t wou l d you th in k i f we i n volved
th e ph ysi cia n s in th is deliber a tion ?
Be ca r efu l, h owever, n ot to a sk l ea din g qu estion s th a t con t a in a n im plied a n swer, for exa m -
ple: Don t you th in k it wou ld be a good idea to in volve th e ph ysici a n s? Th i s is n ot a qu estion
bu t a n i m pli ed sta tem en t; you r oppon en t will n ot be fooled, a n d you m a y bu ild r esen tm en t by
su ch a ttem pts to overr ide h i s or h er th i n kin g.
3. State your inter ests, needs, goals.
A cl ea r, specific st a t em en t of you r in ter ests, n eeds, a n d goa ls a llows you r opposi tion to be clea r
a bou t wh a t you expect fr om th e n egoti a tion process a s well a s wh a t n eeds or in ter ests m u st be
sa t isfied for a solu tion to be a ccept a ble. Th e m or e com plet ely you a n a lyze t h e si tu a tion a n d
iden tify you r u n derl yin g in ter ests a n d logic, th e m ore clea r ly you ca n st a t e you r ca se.
4. Set a constr uctive tone.
Em ph a size positive in ten tion s wh en ever possible, for exa m ple, I a m con fiden t th a t we ca n
r ea ch a n a ccepta ble solu ti on t o th i s dispu te.Th e u se of th e wor d we a lso con veys a n i m por -
ta n t m essa ge by con veyin g th a t th e n egotia ti on is a join t pr ocess, n ot som eth i n g t h a t on e of you
will im pose on th e oth er.
5. Acknowledge and validate the other per sons per ceptions.
For exa m pl e, Th i s n ew in for m a tion h elps m e u n der sta n d you r con cer n s a bou t t h is ch a n ge in
sta ffin g, h owever, Va l ida tin g you r oppon en ts per ception s does n ot im ply th a t you a gree
with or a ccept t h em . I t does, h owever, let th em kn ow th a t you h a ve h ea rd a n d r espect th eir per -
spective. I t a lso r elieves th em of t h e n eed to m a ke th e sa m e poin t over a n d over, beca u se th ey
kn ow you h a ve h ea r d a n d u n der st ood th em .
6. Impr ove your under standing of the opposition.
Som e of t h e m ost su ccessfu l n egotia tor s a r e th ose wh o ca n for m a rela tion sh ip with th eir oppo-
n en ts for th e specifi c pu rpose of joi n t pr oblem - solvin g a n d rea ch in g m u tu a lly a ccepta ble solu -
tion s. Th is r equ ir es th e a bil ity to im a gin e on eself i n th e oth er per son s posit ion , with h i s or h er
in t er ests, n eeds, a n d, per h a ps, con st itu en ci es. How wou ld you be th in kin g, pla n n i n g, r ea cti n g if
you wer e on th e ot h er side of th e ta ble? Devel opi n g th is deeper u n der sta n din g of t h e opposition
im proves you r a bility to gen er a te m u tu a l ly a ccepta ble option s a n d solu t ion s on es th a t you
wou ld a ccept if you wer e i n you r oppon en ts sh oes.
7. Pr ovide constr uctive feedback.
As you a ct ivel y l isten , explore, a n d a ssess wh a t you h ea r fr om th e opposition , you m u st a lso pr o-
vide feedba ck. Th is m a y con cer n t h e oppositi on s sta ted i n ter est s a n d dem a n ds ( con t en t) , or its
beh a vi or a n d r espon ses ( pr ocess) du ri n g th e a ctu a l n egoti a tion . Feedba ck is m ost u sefu l wh en
it is:
Specifi c r a th er th a n gen er a l: Specific st a t em en ts set t h e st a ge for pr oblem - sol vin g in t er a c-
tion wh il e gen er a liti es ca n lea d to con fu sion . Spea k in clea r, pr ecise la n gu a ge.
Gen era l : You wer en t h elpfu l du r in g th e m eeti n g.
Specifi c: You wa i ted u n ti l th e en d of th e m eetin g to tell u s you th ou gh t we h a d been on
th e wr on g t ra ck th e wh ol e t im e.
Focu sed on a cti on s, n ot a tt itu des: Be specific, a n d focu s on obser va ble beh a viors, n ot feelin gs
a n d a tt itu des.
Attitu de: You don t ca r e a bou t th is in itia tive.
Action s: You h a ven t a tten ded th e la st t wo m eeti n gs a n d di dn t r etu rn m y ph on e ca ll
a bou t t h e dra ft wor k pla n .
Wel l-t im ed a n d focu sed on th e issu e u n der discu ssion : Pr ovide feedba ck, wh eth er on con ten t
or process, a s soon a s fea sible with i n th e n egotia tion pr ocess. Avoid th e tem pta tion to in clu de
oth er sa l ien t issu es, a n d focu s you r sta t em en ts on th e specific issu e a t h a n d.
Ch ecked for cla r ity a n d u n dersta n din g: You r feedba ck m a y be specific, descri pt ive, a n d well-
tim ed, bu t if it i s n ot clea r ly u n der stood by t h e oppositi on you wil l n ot a ch ieve you r objec-
tives. Ch eck th a t you r feedba ck wa s h ea rd andu n der stood.
8. De-escalate tension and conflict.
No m a tter h ow wel l pr epa r ed you a r e, th er e m a y be t im es du r in g a con flict n egotia tion wh en
ten si on s begin to esca la te. On ce a n ger i s expr essed, i t ten ds to bu ild u n l ess on e or both pa rt ies
a ctively a t tem pt to di ffu se or de-esca la te t h e em ot ion a l t en sion . I n or der t o de- esca la te con fl ict,
tr y t o:
Spea k slower a n d, i f th e t on e a n d vol u m e of th e oppon en t a r e r isin g, spea k softer.
Rem in d you r self: We ca n fin d a solu tion th a t we bot h a gr ee on .
Ask for a br ea k to coll ect you r th ou gh ts. Th is is n ot a sign of wea kn ess a n d will a llow you t o
r efocu s, a n a l yze wh a t is occu r r in g, a n d pr epa r e a su bsta n ti ve, effecti ve r espon se.
Br ea th e.
Wa tch you r l a n gu a ge. Don t u se wor ds th a t ca n esca la te a con flict su ch a s: n ever / a lwa ys; n o/
won t ; sh ou ld/ sh ou ldn t; you m u st/ you m u st n ot.
Ackn owledge a n d va lida te th e opposi tion s position ( see a bove) .
Listen to you r voi ce. I s it h igh - pi tch ed? Ten se?
Ch eck t h a t you a r e still listen in g to t h e oth er pa r ty. Ha ve you sta r ted fra m in g a n swer s or r e-
spon ses pr em a tu r ely?
I f th e tech n iqu es a bove do n ot wor k or do n ot feel n a tu r a l for you , exper im en t a n d fin d th ose
m eth ods th a t h el p you t o sta y ca lm in th e m idst of i n ten se em ot ion . Th e a bility to m a i n ta in ( or
a t l ea st r ega in ) com posu r e is cr iti ca l t o you r su ccess a s a n egotia tor. I t is especia lly im por ta n t
wh en th e opposition is tu r n i n g u p th e h ea t a n d dir ect in g a n ger towa r d you . If you a llow you r
oppon en t to yell or beh a ve i n ot h er i n a ppropr ia te wa ys, you will be u n com for ta ble or even
a n gr y, a n d it will be extr em ely difficu lt, if n ot im possible, to con tin u e wi th th e n egot ia tion . I t
m a y u l tim a tely lea d to you r oppon en ts em ba r r a ssm en t, wh ich wi ll m a ke it m or e difficu lt to
n egoti a t e i n t h e fu tu r e.
Pr ovide you r oppon en t con str u ctive, specific feedba ck r ega r din g h is/ h er beh a vi or a n d it s
observa bl e effects on th e n egotia ti on process. If t h is does n ot im prove th e situ a tion , it is better to
su ggest a brea k u n til you ca n a ll cool down a n d ga th er you r th ou gh ts t h a n to r isk h a vin g th e
n egoti a t ion qu ickly deter iora te.
9. Avoid judging, cr iticizing, and/ or blaming other s.
Wh il e i t seem s obvi ou s th a t th ese beh a vi or s sh ou ld n ot be u sed in con fl ict n egoti a t ion , th ese
r oa dblocks to com m u n ica tion occu r fr equ en tly du r in g h ea ted n egotia tion s. Wh en you feel a n x-
iou s or vu ln er a bl e, you a r e m or e likely to look for a n expla n a t ion ba sed on th e sh or tcom in gs of
th e opposi tion : if th ey were m ore r ea son a ble,if th ey h a dn t spoken to th e pr ess i n t h e fir st
pla ce,if th ey h a d been bet ter pr epa r ed for th e u n ion n egotia t ion s,etc. Th ese a r e u n der -
sta n da ble a n d a ccepta ble feel in gs; h owever, wh en you a ct on su ch feelin gs a n d becom e ju dg-
m en ta l, crit ica l, a n d bla m in g, you redu ce you r effectiven ess a s a n egot ia tor. I r on ica ll y, th ese
ver y r espon ses to feel in gs of vu ln er a bilit y ser ve to m a ke you tr u ly vu ln er a ble.
Wh en em otion s cl ou d you r th in kin g, you a r e l ess a ble to r epresen t t h e in ter ests a n d n eeds of
th ose you seek t o su ppor t. It is u su a lly a sign a l th a t you a r e losi n g gr ou n d in a n egotia tion if
you stop a tta ckin g t h e issu es a n d sta r t a tta ckin g th e per son . I f you h ea r you r self doin g th is, ta ke
a brea k or u se on e of th e m et h ods listed a bove t o diffu se th e sit u a tion . Th e situ a tion is n ot likel y
to i m pr ove by i tself; you n eed to a ctively ch a n ge t h e cou r se of you r beh a vior.
10. Over come past negative histor y with the opposition.
Em ph a sizin g you r posit ive in ten ti on s a n d expecta tion s is especia lly im por ta n t wh en you r pr ior
in t er a ction s, h istor y, a n d/ or n egotia tion s wi th th e oppositi on h a ve been n ega tive, pa rt icu l a rly if
you h a ve m a de n u m er ou s u n su ccessfu l a ttem pts to r esolve con fl icts a n d th ey wer e la den with
in t en se em otion a n d/ or resu lted in n ega t ive ou tcom es. Th er e is n o m ir a cl e cu r e for th i s situ a -
tion , bu t on e th in g is fa ir ly cer ta i n : if you don t m a ke som e a dju stm en ts to th e wa y you in ter a ct
with th e opposition , you wil l li kely con ti n u e to h a ve n ega ti ve resu lts.
On e h elpfu l tech n iqu e is to a ckn owledge, u p fr on t, you r di fficu lt h i st or y t ogeth er a n d be spe-
cifi c a bou t you r goa l s a n d expecta tion s for th is pa r ticu la r in ter a cti on . For exa m ple, I kn ow we
h a ve h a d sever a l u n su ccessfu l a ttem pts to r esolve th is qu est ion r ega r di n g a u th ori ty over per son -
n el decision s i n th e h ospita l . I a m con fiden t t h a t if we focu s ou r discu ssion t oda y on ou r m u tu a l
con cer n for equ i ty a m on g h ea lt h ca r e pr ovider s, we wil l m a ke som e pr ogr ess.Th is sta t em en t
n ei th er ign or es th e pa st , n or focu ses on i t. I n stea d, i t sets posit ive expecta tion s for th e pr esen t. By
specifi ca lly settin g th e bou n da r ies a n d a con fiden t expecta tion of su ccess, you con vey th a t you
a re r ea dy to do bu sin ess i n a con str u ctive m a n n er.
Th e r ea l ch a llen ge is to sta y positi ve a n d focu sed on th e specifi cs of th e discu ssion , a n d n ot to
give in to t h e ver y h u m a n ten den cy t o br in g u p pa st in su lts, gr ieva n ces, a n d u n r esolved issu es.
Rea ch in g a gr eem en t on on e, specific issu e ca n h el p pa ve t h e wa y for a n im pr oved wor kin g r ela -
tion sh ip a n d im pr oved n egot ia tion s on m or e su bsta n tive issu es in th e fu tu r e. I t i s a lwa ys h elp-
fu l to esta blish a n d em ph a size com m on gr ou n d wh en ever possi ble.
In situ a tion s wh ere a rea l n ega tive h istory preven ts con stru ctive n egotia tion , con sider brin gin g
in a n eu tra l th ird pa rty th a t is a ccepta ble to you a n d th e opposition . Th is n eu tra l pa rty ca n m ore
effectively fa cilita te th e n egotia tion process a n d in crea se th e proba bility of a positive ou tcom e.
Building Working Relationships
1
Negotia tion r equ ir es th a t th e pa r ti es in volved a ddr ess su bsta n tive differ en ces in a n open , fr a n k,
a n d n on - com ba t ive m a n n er. I n or der to in t er a ct wi th ea ch oth er in a con str u cti ve wa y, th e pa r -
tici pa n ts m u st bu ild m u tu a l tr u st a n d develop a wor kin g r ela ti on sh ip. Som e wor kin g r el a tion -
sh ips wil l be closer, m or e resi lien t, a n d m or e pr odu ct ive th a n oth er s, depen din g on t h e n a tu re
a n d i n ten sity of th e bon d between th e in di vidu a ls in vol ved. All good wor kin g r ela tion sh ips,
h owever, per son a l or profession a l, lifelon g or br ief, requ ir e th e followin g:
focu sed a tten tion a n d effor t
tr u st
a ccou n ta bilit y
r ecipr ocit y
a n a bsen ce of th r ea t or fea r
effective com m u n ica tion
som e degr ee of toler a n ce for ea ch oth er s per spect ive.
Th e fir st step in bu ildin g a good wor kin g r el a t ion sh ip i s to be con sciou s of you r beh a vior a n d
its poten tia l effect on ot h er s. Below a r e som e specific tech n iqu es to h elp you develop a n effective
workin g r ela t ion sh ip with you r collea gu es, wh eth er th ey su pport or oppose you r ch a n ge effor ts.
1. Au sefu l r esou r ce on t h is su bj ect is Fish er a n d Br own 1989.
1. Build tr ust and accountability.
Tru st is bu ilt in m ea su r es; it requ ir es fu lfil lin g you r com m itm en ts a n d keepin g you r a gree-
m en ts over ti m e. Bein g pu n ctu a l a t n egotia t ion m eetin gs, r especti n g t h e grou n d r u les for th e
process ( i.e., discu ssi on t im e, cou r tesy r u les, et c.) , a n d r especti n g a n y pr om ises of con fiden -
tia lit y r ega r din g th e pr oceedi n gs a r e a ll im por ta n t for bu il di n g t ru st . Th e r ea l test of you r
tr u stwor th i n ess, h owever, will be th e exten t t o wh i ch you keep t h e prom ises a n d com m it-
m en ts m a de du r in g th e n egot ia tion process. Be ca refu l to m a ke on ly th ose prom ises a n d
com m i tm en ts t h a t you ca n keep. En su ri n g you beh a ve in a tr u stwor th y m a n n er a n d a r e
per cei ved a s su ch is especia lly cr iti ca l wh en you don t h a ve a n existi n g r el a t ion sh ip with you r
cou n ter pa r ts.
Dem on str a te you r will in gn ess t o in vest th e t im e, r esou r ces, a n d effor t r equ ir ed for a m u tu a l-
ly a ccept a ble r esolu tion of th e con fli ct.
Rein force you r i n terdepen den ce by solicitin g you r cou n ter pa r ts i n pu t a n d feedba ck, wh er ev-
er possible, th rou gh ou t th e n egotia tion pr ocess.
2. Establish a non-thr eatening envir onment.
I t is im por ta n t th a t you esta bli sh a positi ve, con st ru ctive, a n d con gen ia l en vir on m en t du ri n g
th e n egoti a tion s. If you r cou n terpa r ts feel i n su lted or th r ea ten ed, th ey a r e m or e a pt t o with h old
in for m a tion , a ct defen sively, a n d even ter m in a te th e n egotia tion s.
Atta ck th e issu es, n ot th e people wh o su ppor t th em .
I f per son a lly a tta cked, redi rect th e focu s ba ck to th e su bsta n t ive differen ces a n d a wa y fr om
per son a lities. Rem em ber th a t every for m of com m u n ica ti on , n o m a tter h ow u n plea sa n t,
provides you wit h va lu a ble in for m a tion a bou t you r oppon en ts i n terest s a n d con cer n s. I t is
im por ta n t to a ckn owledge ( by pa r a ph ra sin g) a n d cla r ify ( by qu est ion in g) th e su bsta n tive
issu es. By r efu sin g to cou n t er a tta ck, you will a void h ea d-t o- h ea d con fr on ta tion a n d de-l egit-
im ize you r oppon en ts t h r ea ten in g beh a vior.
Dem on str a te th e sa m e beh a vi or s you expect fr om th e opposit ion . Avoid dir ect or i n dir ect m a -
n ipu la tive ta ct ics.
3. Communicate effectively.
Effecti ve com m u n ica tion en cou r a ges a n open , h on est, a n d con st ru ctive dia logu e. I t is essen ti a l
for r ea ch in g m u tu a lly a ccepta ble a gr eem en ts a n d bu i ldin g a n d/ or su sta in in g a good r el a tion -
sh ip wi th th e opposit ion .
Use la n gu a ge th a t cr ea tes a n d su sta in s a t ea m m en ta lity by em ph a sizin g sh a r ed goa ls, i n ter -
ests, a n d expected ben efits.
Be ca n di d in com m u n ica t in g you r i n ter ests, con cer n s, a n d em ot ion s. Th i s is pa r ticu la r ly
h el pfu l wh en you sen se th a t you r cou n ter pa r ts m igh t be h esit a n t t o sh a r e in for m a tion
open ly; you ca n en cou r a ge you r cou n ter pa r ts to be m or e for th com in g by you r exa m pl e.
4. Demonstr ate your under standing and r espect for the other side.
Feeli n g r espected i s a fu n da m en ta l h u m a n n eed. Th e m or e you expli citl y dem on str a te you r
u n dersta n din g a n d r espect for you r cou n ter pa r ts a n d th eir u n der lyin g n eeds a n d in t er ests, th e
m or e likel y th ey a r e to feel com for ta ble a n d i n vested in th e n egotia tion pr ocess.
Be exh a u st ive in explor in g th e oth er sides in ter ests a n d n eeds. Assu m e you do n ot kn ow
en ou gh : a sk a s m a n y per tin en t qu estion s a s possible.
Get to kn ow you r cou n t er pa r ts. Sch edu le a n in for m a l m eetin g, or a r r ive ea r ly a n d/ or sta y
la te du r in g n egoti a t ion s to a llow for som e less- st ru ctu red con ver sa t ion s.
Be r ecept ive to you r cou n ter pa r ts gr ieva n ces a n d cr itici sm s. Not on l y l isten to a n d va lida te
th eir con cer n s, bu t a ddr ess th em su bst a n tively.
Sh ow t h a t you a ppr eci a t e t h e oth er si des con cer n s by tr ea tin g ea ch wi th th e weigh t it
deser ves.
Be open to r evisin g you r views.
Summary
Up to th is poi n t, th ese gu idelin es h a ve focu sed on t h e im por ta n t pr ocess of prepa r in g you rself
for con flict n egotia tion , u n der sta n din g va r iou s a spects of con fl ict befor e you en ter a n egotia -
tion , a n d th e i n ter per son a l com m u n ica t ion skil ls a n d rela tion sh ip bu i ldin g you n eed to su ppor t
you r n egotia ti on effor ts. Th e n ext sect ion will ta ke you step by step th rou gh t h e a ctu a l n egoti a -
tion pr ocess.
Managing the Negotiation Process: An I nterest-Based
Approach
2
I n a lm ost ever y con flict situ a ti on , th ere exists th e possibi lity of n egotia tin g a m u tu a lly a ccept-
a ble ou tcom e. Ma n y n egot ia tion s fa il, h owever, beca u se th ey a r e n ot pr oper ly focu sed a n d
opposin g pa r ties ca n n ot dea l with th eir differ en ces in a r a tion a l, effective m a n n er. Su ccessfu l
con flict n egoti a t ion is in ter est- ba sed, n ot position -ba sed. Un dersta n di n g t h e dist in ction
between positi on s a n d in ter ests is cr itica l:
A position tells ot h er s what you wa n t. You r posi tion r eflects you r pr edet er m i n ed poi n t of view
or a ttit u de on a cer ta in issu e.
You r i n ter est s tell oth er s why you wa n t som eth in g. You r in ter ests r eflect you r u n der lyin g
con cer n s for you r own ben efit or a dva n ta ge ( you r n eeds, desi res, a n d con cer n s) .
2. Th e in t er est- ba sed a ppr oa ch ou tl in ed in t h is gu idelin e i s si m i la r t o t h e m eth odol ogies u sed in pr ecedi n g
wor ks wr i tt en on con fli ct n egoti a t ion . Plea se r efer t o t h e bibli ogr a ph y for ci ta ti on s of t h e text s t h a t wer e u sed
by th e a u th or s in developin g th ese gu idelin es.
You a rr ive a t you r posit ion s th r ou gh a com plex decision - m a kin g pr ocess th a t ta kes you r
in t er ests in to a ccou n t. I n posi tion - ba sed n egotia tion , t h ese u n derl yin g in t er ests m a y n ever be
explicitly m en ti on ed. I n i n ter est- ba sed n egotia tion , h owever, th e in ter ests from both sides a re
iden tified a n d explored. Focu sin g th e n egoti a t ion s on th e i n ter ests a t sta ke h el ps ea ch side
u n der sta n d th e ot h er s per spect ives, n ot ju st it s im m edia te rea ction s or position s. Th is a ppr oa ch
en cou r a ges n egotia tor s to seek com m on a r ea s of con cer n a n d fa cilita tes a n egotia ted a gr ee-
m en t th a t r espon ds to t h ei r key con cer n s. Exper ien ce a lso sh ows th a t discu ssin g in ter ests i s less
in cen dia r y beca u se th ey a r e ta n gible, m or e u n der sta n da ble, a n d m or e l ikely t o i n voke em pa th y
fr om oth ers.
Th e process ou tlin ed in th is section follows a n in terest-ba sed a pproa ch to h elp you pla n , stru c-
tu r e, a n d im plem en t a n effective con flict n egotia tion th a t yields m u tu a lly a ccepted solu tion s.
Steps To Take Before the Negotiations Begin
Step 1. Identify the issue to be negotiated.
Con flict n egot ia tion is a t im e- a n d resou r ce- in t en sive pr ocess t h a t i s best u tili zed wh en :
Con flict r esolu ti on i s cen tr a l to m ovin g t h e h ea lt h r eform a gen da for wa r d.
Oth er, less r esou r ce- in ten se, m eth ods h a ve n ot su cceeded.
Th e pr oblem or i ssu e a t h a n d len ds itself to n egotia ti on .
Before you begin to n egotia t e, ca r efu l ly defin e th e issu e a n d
a r ticu la te it clea r ly. I den ti fy wh a t you h ope to a ch ieve a s a r esu lt
of t h e n egotia t ion a n d h ow th is con tr ibu tes t o you r refor m
a gen da . Be su r e you r expecta tion s a re well gr ou n ded in th e r ea l-
ity of you r experi en ce a n d a re n ot overl y a m bitiou s or u n rea lis-
tic.
Som e issu es do n ot len d th em selves to n egot ia tion . Con flicts
ba sed on differi n g va lu es m a y be extr em el y difficu lt to n egotia te
to a m u tu a ll y a ccepta ble sol u tion . As n oted, h owever, i n t h e
a ren a of h ea lth r efor m , key sta keh ol ders gen era ll y sh a r e sim ila r cor e va lu es. Con fli ct t h er efor e
is m or e likely to su r fa ce in defin i n g th e objectives of r efor m a n d deter m in in g th e m eth ods to be
em ployed for im plem en t in g r efor m .
For th e pu r poses of n egoti a t ion , it is h elpfu l to di ssect com plex con flict situ a t ion s a n d r ede-
fin e th e issu e in ter m s of in dividu a l com pon en t s. Negoti a t in g t h e over a ll pr oblem issu e by issu e
m a y fa cilit a t e som e m ea su r e of a greem en t wi th th e opposition even if n ot a ll a spects of th e con -
flict a r e resol ved. Th is str a tegy ca n im prove th e im m edia te ou t com e a s well a s th e pr ospects for
fu t u r e n egotia ti on .
Step 2. Secur e the par ticipation of the r ight people ( and r esour ces) on your
side.
For a su ccessfu l n egotia t ion , you n eed th e r igh t people a t th e ta ble. You r idea l n egoti a tin g tea m
will va r y i n n u m ber a n d m a keu p depen din g on th e situ a ti on , bu t in gen er a l you n eed a t ea m
Box 4.1. Strategic questions to ask when you are
defining the issue and deciding to negotiate
Does this conflict merit the time and resources required to
reach a mutually acceptable resolution?
ls resolution of this conflict critical to moving our health
reform agenda forward?
Does the problem/issue lend itself to negotiation?
ls it realistic to expect that the negotiations will have some
positive results?
lf not, is there a way to reframe the problem/issue to make it
more manageable?
th a t h a s t h e power a n d a u th or ity to n egotia te effect ivel y, m a ke decision s on beh a lf of you r
grou p/ or ga n iza tion , a n d im pl em en t th e n egot ia ted a gr eem en t.
Th e pr ocess a n d r esu lt s of t h e n egotia t ion wi ll l ikely be h a m pered if th ere is a su bsta n ti a l
power differ en ti a l between th e opposi n g sides. I f you r a ssessm en t in dica t es th a t you r own n ego-
tia tin g tea m is n ot of opti m u m stren gth in term s of power, a u th ori ty, tech n ica l kn owledge,
n egoti a t in g skill s, et c., it is im por ta n t to seek th e pa r ticipa ti on of ot h er i n dividu a ls wh o ca n ba l-
a n ce you r a rea s of wea kn ess. An oth er stra t egy i s to a li gn wi th ot h er gr ou ps or orga n i za tion s to
in crea se you r collective n egotia tin g power.
Ta bl e 4.1 ou tl in es th e ca tegor ies to con sider wh en a n a lyzin g th e r especti ve power of th e two
sides:
Step 3. Identify your counter par t( s) for the negotiations, and make meeting
ar r angements.
To iden tify th e m ost a ppr opr ia t e cou n terpa r ts, con sider th e followin g cr it er ia in you r selection :
Willi n gn ess to n egot ia te: At a m in im u m , you r cou n ter pa rt s n eed to be wil lin g to n egotia te.
I dea lly, th ey a lso sh ou ld be m otiva ted a n d com m it ted t o seekin g a m u tu a l ly a ccepta ble solu -
tion .
Power a n d a u th or ity t o n egot ia te: Ea ch n egoti a t or m u st h a ve su fficien t power a n d a u t h or ity
to ca r r y ou t th e a gr eem en t s r ea ch ed th rou gh n egotia tion .
Legitim a te spokesperson / r epr esen ta tive for t h eir grou p or or ga n iza ti on : It is cr itica l th a t
ea ch in di vidu a l in th e n egotia tion is a ccepted a n d t ru sted a s a legit im a te r epr esen ta tive of
h is or h er gr ou p or or ga n iza tion .
I n flu en ce on oth er pa r ties poten tia lly a ffected by th e n egotia tion s: Oth er people, gr ou ps, a n d
orga n iza tion s a re likely to be a ffected by th e ou tcom e of th e n egotia tion s. If th e issu e to be n e-
gotia ted is ver y con tr over sia l, select th ose in dividu a ls with th e gr ea test in flu en ce on th ese oth -
er pa rties from th e list of poten tia l cou n terpa rts. Th e gr ea ter you r cou n terpa rts in flu en ce, th e
grea ter th e likelih ood th a t th ey will su ccessfu lly im plem en t th e n egotia ted solu tion .
Th e com plexi ty of th e issu e: Th is m a y in flu en ce th e n u m ber of pa r ti es in volved in th e n ego-
tia tion . In selectin g th e a ppr opria t e in dividu a ls, t ry to st ri ke a ba la n ce between foster in g a
cr ea tive en viron m en t a n d in cl u din g too m a n y dispa r a te in t er ests a n d/ or person a l ities. Lim it
th e n u m ber of n egotia tor s to th ose in dividu a ls wh ose pa r ticipa ti on i s a bsolu tely n ecessa r y.
Table 4.1 . Assessing the Relative Power of Negotiating Teams
Authority Elected officials, power accorded by policies or law, and authority
related to job title/position within the organization
Resources Financial, capital, technical, and human resources
Personal Leadership, charisma, and the ability to mobilize resources.i.e.,
organize strikes and protests, generate active support, etc.
Social Affiliation or influence with community groups, professional
associations, labor unions
Knowledge Technical or professional expertise
I n m a n y ci rcu m sta n ces, a n or ga n iza ti on wil l n om in a te on e or m or e in di vidu a ls to n egotia te
on its beh a lf. I n t h ese ca ses, si n ce you will n ot be sel ecti n gyou r cou n ter pa r ts, u se t h e cr i-
ter ia a bove to ju dge wh et h er to a gr ee to th e pr oposed in dividu a l or su ggest a n a l ter n a tive.
On ce you h a ve i den ti fied th e m ost a ppr opr ia te n egoti a t ors, con fir m th eir pa r ticipa ti on a n d
a va ila bili ty. Ar r a n ge to m eet a t a m u tu a lly sa tisfa ct ory tim e, wh en a ll pa r ti es a r e fr ee fr om oth er
distr a ction s. Th e ph ysica l setti n g of th e m eeti n g i n flu en ces th e n egotia tin g en vir on m en t, so
r eser ve th e ven u e well in a dva n ce. Be su r e it h a s a m pl e spa ce a n d ligh t a n d th a t it is per ceived to
be n eu t ra l ter r itor y.
Step 4. Pr epar e for negotiation.
Th or ou gh , a dva n ce pr epa ra ti on is cr itica l for su ccessfu l n egotia tion . I t en su r es th a t you r expec-
ta tion s a r e rea listic, t h a t you ca n a n t icipa te wh a t m igh t h a ppen du r in g th e n egotia tion pr ocess,
a n d, a s a con sequ en ce, th a t you a r e better equ ipped to r espon d in a th ou gh tfu l, effective m a n -
n er. Th e pr evi ou s sect ion of th ese gu i delin es ou t lin ed h ow t o a ssess you r person a l in vestm en t in
th e n egotia tion s ( see th e Person a l I n ven tor y Wor ksh eet in An n ex 4- B) a n d h ow to psych ologi-
ca lly pr epa r e you r self for th e n egotia tion pr ocess. Th e a ddition a l in form a tion in th is sect ion
will h elp you pr epa r e, orga n ize, a n d pr esen t th e i n for m a t ion you n eed to su ccessfu lly n egotia te
with you r oppositi on a n d r ea ch m u tu a l ly a ccepta ble a gr eem en ts.
Reviewthestepsinvolved in thenegotiation process. Th or ou gh ly fa m il ia r i ze you r self with
th e str u ctu r e of th e n egotia tion pr ocess by r eviewin g th e n egot ia tion gu idel in es u n t il you feel
com fort a bl e t h a t you u n der sta n d a n d h a ve m a ster ed th e steps.
CompletetheNegotiation Preparation Worksheet. To be well prepa red, you m u st n ot on ly
u n der sta n d th e steps in vol ved bu t a l so begin to a n t icipa te h ow th e a ctu a l n egotia tion will pla y
ou t. Com plet e th e Negotia tion Pr epa r a tion Wor ksh eet in An n ex 4- C to better a ssess poten tia l
oppor tu n iti es a n d problem s, focu s on th e su bsta n ti ve issu es th a t m ost con cer n you , a n d gen er -
a te va lu a ble in form a tion you ca n u se in th e n egoti a tion s. A sa m ple com pl eted wor ksh eet i s a lso
in clu ded in An n ex 4- C a s a r efer en ce.
Collect additional information about theissueand/or your counterpart(s). Ta ke a
m om en t t o r eflect on you r pr epa ra t ion a n d a sk you rsel f som e cri tica l qu estion s. Do you kn ow
en ou gh a bou t th e i ssu e? Ar e you clea r a bou t you r in t er ests a n d wh a t is a t sta ke? Do you kn ow
en ou gh a bou t you r cou n ter pa r ts in ter ests? I f you r a n swer is n oto a n y of t h ese qu estion s, you
n eed m or e i n for m a t ion a n d a r e n ot a dequ a tely pr epa red for th e n egotia tion pr ocess. To r em edy
th i s, con su lt exper ts or t h ir d pa r ties, a n d review wr itten docu m en ts, m edia sou r ces, a n d liter a -
tu r e to get m or e in for m a ti on .
Prepareto communicateeffectively. Befor e en ter in g th e n egot ia tin g r oom , r eview th e pr evi-
ou s section on effective in ter per son a l com m u n ica tion skills. Ma ster in g th ese skills will a llow
you to con cen tr a te on th e la rger, su bsta n tive issu es u n der n egotia tion , a s com m u n ica ti n g
clea r ly, dir ectly, a n d a ppr opr ia tely with th e opposi tion becom es m or e effor tless. You m a y a lso
wa n t to develop a m en ta l list of n eu tr a l ter m s a n d ph ra ses t h a t serve a s a l ter n a ti ves t o a n y
in fla m m a tor y l a n gu a ge th a t m a y be in you r cu r r en t n egot ia tin g reper toir e.
Useall theinformation fromthePreparation Worksheet (Annex 4-C) duringyour
negotiation. Com pleti n g th e pr epa r a tion wor ksh eet will give you a clea r u n der sta n din g of
you r key i n ter est s, a better idea of you r cou n t er pa r ts in t er ests, a n d som e pr eli m in a ry idea s
a bou t t h e possible con ten t of a n egot ia ted ou tcom e. Th is cr iti ca l i n for m a t ion sh ou ld be u sed
du r in g th e a ctu a l n egotia tion pr ocess.
Du r in g th e n egotia tion pr ocess, you a r e likel y to fa ce a cou ple of u n expect ed cu r ves. Ma in -
ta in you r focu s on t h e su bsta n ti ve issu es a n d th e desir ed r esu lt s of th e n egotia tion . Th is wil l h elp
you a dju st you r str a tegy a s n eeded wh ile keepi n g you r em otion s a n d sh or t- term fru str a tion s
fr om in ter fer in g with you r su ccess. Ca r efu l self- m a n a gem en t is crit ica l to you r su ccess ( a s
descr ibed i n t h e previou s section ) . You r beh a vior wi ll gr ea t ly a ffect you r resu lts by in flu en ci n g
you r cou n t er pa r ts beh a vi or, by color in g h ow oth er pa r tici pa n ts exper ien ce th e n egot ia tion pr o-
cess, by sh a pin g th e pr ocess/ ou tcom e of t h e n egoti a t ion s, a n d by determ in in g t h e poten t ia l for
n egoti a t ion a n d coll a bor a tion in th e fu tu re.
Steps to Take During the Negotiation Process
Step 1. Clar ify expectations and establish gr ound r ules.
Rea ch a pr eli m i n a r y con sen su s a bou t wh a t you a n d you r cou n ter pa rts collectively h ope to
a ch i eve a n d t h e process you will follow to get th er e beforeyou la u n ch a n y su bsta n tive discu s-
sion of th e issu es. Th is con sen su s h elps you develop clea r l y sta ted, r ea l ist ic expecta ti on s for t h e
n egoti a t ion s. Begin th e pr ocess by sh a r in g wh a t you wou ld like to see a s a n ou tcom e of t h e
m eetin g a n d in vitin g you r cou n t er pa rts to do t h e sa m e.
To develop fea sibl e solu t ion s, you m u st con sider a ll th e possi bilities a s wel l a s th e exter n a li -
ties th a t defin e wh a t ea ch pa r ty ca n a n d ca n n ot do. Th ese m a y i n cl u de con tr a ctu a l r equ ir e-
m en ts, a va ila ble r esou r ces, politi ca l a ccou n ta bi lity, la ws, pol icies, a n d orga n iza tion a l r egu l a -
tion s. Fr a m in g you r n egot ia tion s wi th in a rea l istic con t ext h elps en su r e th a t ea ch pa r ty wi ll
h a ve th e com m itm en t a n d r esou r ces n eeded to i m plem en t n egotia ted solu t ion s.
Cla r ify th e pr ocess you will follow to get to a n egotia ted a greem en t . Th e pr ocess m u st be
tr a n spa ren t, be m u tu a ll y a ccepta ble, a n d u til ize a n in terest -ba sed a ppr oa ch . Th ese gu idel in es
provide a sim ple, sou n d n egotia tion pr ocess wh ich you ca n pr opose to you r cou n ter pa r ts. You
ca n discu ss th is a ppr oa ch with th em a n d m odify it sl igh tly a s n eeded ba sed on th ei r feedba ck.
Th is in i tia l dia logu e wil l set th e sta ge for th e r em a in der of th e n egotia tion s, a n d so it is pa r ticu -
la r ly im porta n t to com m u n ica te clea r ly, li sten a tten tively, a n d dem on str a te r espect for th e oppo-
sition ( a s descr ibed in th e section on Developi n g Effective I n terper son a l Com m u n ica t ion Skil ls
a n d Bu ildi n g Wor kin g Rela ti on sh ips) .
Esta blish som e ba si c gr ou n d r u les to gu ide th e n egoti a t ion pr ocess a n d h elp a l l pa r ties feel
secu re a lon g th e wa y. Th ese r u les will depen d on th e issu e, cir cu m sta n ces, a n d per son a l pr efer -
en ces of pa r ti cipa n ts th ey ca n be few or m a n y a n d ca n be r ela ted t o pr ocess, beh a vior, or com -
m u n ica tion s. I f th e issu e is pol itica ll y sen sitive, cla r ify wh eth er th e n egotia t ion proceedin gs will
be con fiden tia l, a n on ym ou s, or pu blic. I n a n y even t, a ll pa rt ies sh ou ld kn ow wh o wi ll h a ve
a ccess to th e proceedin gs a n d wh en th is in for m a tion will be sh a red. Esta blish i n g tim e lim its for
m eetin gs a n d ru les of com m on cou rt esy ( n o i n ter r u pti n g a n d equ a l discu ssion tim e for a ll
sides) a l so cr ea tes a n a tm osph er e of m u t u a l r espect.
Step 2. Define and explor e the issue.
Th e issu e is th e essen t ia l poin t of discu ssion or deba te du r in g th e n egot ia tion s a n d m u st be
clea r ly defin ed a t th e sta r t of th e pr ocess to en su r e th a t a ll pa r ticipa n ts a r e workin g towa r d th e
sa m e en d. You a n d you r cou n t er pa r ts n eed to sh a re you r u n der sta n din gs of th e issu e a n d a s
m a n y of th e u n der lyi n g ca u ses a n d sym pt om s a s possible. Com pa r e, con t ra st, a n d di scu ss you r
va r iou s perspectives in order to develop a n d a r ticu la te you r sh a red u n der sta n din g of th e issu e.
Recor d th e r esu lt in g sta tem en t of th e issu e on a fli p ch a r t a n d h a n g it wi th in clea r view to ser ve
a s a visu a l r efer en ce a n d r em in der th r ou gh ou t t h e n egoti a t ion pr ocess.
Step 3: Explor e inter ests.
Open l y explor e a n d di scu ss th e in ter ests a t sta ke for a ll si des beca u se th ese in terest s ser ve a s th e
bu ildi n g blocks for developin g possible sol u tion s. Th er efor e, you m u st n ot on ly clea rl y a r ticu -
la te you r own in ter ests bu t m u st a lso en cou r a ge you r cou n t er pa r ts to do th e sa m e.
Th rou gh ou t th i s sta ge, a sk ea ch oth er explor a tory a n d cla r ifyin g qu estion s. I f som eon e is
h a vi n g tr ou bl e expr essin g h is or h er in ter ests, r efra m e qu estion s to h elp st im u la te th e pr ocess.
For exa m pl e, "Wh a t specific con cern s do you h a ve a bou t th is issu e?" "Wh a t bu si n ess- rela ted
in t er ests con cer n you ?"Wh a t i s a t sta ke for th e pr ogr a m s, pr oject s, or refor m s you a re tr yin g to
im plem en t ?
I t is h el pfu l to tr a ck ea ch pa rt ys in t er ests by r ecor din g th em on a flip ch a r t i n sepa r a te col-
u m n s. ( Use a for m a t sim ila r to t h e Negotia ti on Pr epa r a t ion Wor ksh eet in An n ex 4- C) . Wh en t h e
lists a r e com plete, h igh ligh t sh a r ed or com m on in ter ests. I t is im por ta n t to r ecogn ize t h e legiti -
m a cy of th e fu ll ra n ge of in t er ests iden tifi ed, bu t a t ten t ion sh ou ld be focu sed on th e m u tu a l
in t er ests for t h e r em a i n der of th e n egotia tion session .
Step 4: Invent options for mutual gain.
Th e pu r pose of th is step is to devel op a s m a n y opt ion s or solu tion s to th e pr oblem a s possible. All
pa rt ies m u st wor k togeth er so th a t a n y solu ti on a dopted is th e r esu l t of a tr u ly pa r tici pa t or y pr o-
cess du r in g wh i ch ever yon es voice wa s h ea r d. Th i s is a th r ee-step pr ocess: in ven tin g option s for
m u tu a l ga in ( Step 4) , devel opi n g objective cr it er ia to eva lu a te th e option s ( Step 5) , a n d a gr ee-
in g on t h e best possible solu tion ( Step 6) . Cla r ify th a t, du r in g Step 4, pa r ticipa n ts sh ou l d focu s
sol ely on gen er a tin g idea s, n ot on ju dgin g th em or selectin g a m on g th em . Th ese la tter ta sks
will occu r in th e n ext t wo steps.
Th e m or e crea tive, expa n sive, a n d colla bor a tive you a r e i n i n ven tin g option s, th e m or e i dea s
you gen era te. Box 4.2 su m m a r izes som e br a in stor m in g t ech n iqu es. You m a y a l so con sider h a v-
in g a fa ci lita tor on h a n d to m a n a ge th e br a in stor m in g sessi on so t h a t you ca n focu s you r a tten -
tion on gen er a tin g idea s a lon g wit h you r col lea gu es.
Recor d ea ch idea th e gr ou p gen era t es on a fli p ch a rt. On ce you
h a ve exh a u sted you r cr ea t ive ju i ces, qu ickl y r eview th e list of
option s. Cla r ify va gu e idea s, expa n d on i n com plete option s, el im i-
n a te du plica tion s, a n d clu ster sim i la r idea s a s n eeded.
Step 5: Use objective cr iter ia to evaluate options.
Eva l u a tin g pr oposed opt ion s is a pa rt icu la rl y sen sitive bu t cr iti ca l
sta ge in th e n egotia ti on pr ocess. You m a y be in cl in ed to sta r t by
cla ssifyi n g th e opt ion s a s a ccepta ble or u n a ccepta ble,or sta te
wh a t you a re willi n ga n d n ot willin g to do. Alth ou gh th is is
tem ptin g beca u se of its sim plici ty, th is is n ot th e m ost pr odu cti ve
a ppr oa ch beca u se it bypa sses a n y expla n a t ion of th e u n der lyin g
a ssu m pti on s, i n ter ests, a n d logic u sed t o a r ri ve a t su ch con clu -
sion s. Th i s type of dia l ogu e ca n dera il in ter est- ba sed com m u n i ca -
tion , lea d to positi on - ba sed ba rga in in g, a n d ca u se a l l pa r ties to
becom e m or e defen si ve a n d en tr en ch ed in th eir r espect ive posi-
tion s.
Th e ta sk a t th is sta ge i s to j oi n tly a gr ee to eva lu a te th e differ en t
option s ba sed on som e objective cri ter ia , ra t h er t h a n on person a l
prefer en ces or pr essu r e. An objective cr iter ion i s a pr in cipled rea -
son , or in depen den t sta n da r d of fa ir n ess, a ga in st wh ich th e di ffer -
en t option s ca n be m ea su r ed. Nu m er ou s obj ecti ve cr iter ia ca n be
u sed for eva lu a tin g possible option s in a n y n egoti a t ion ( see Box
4.3) . Th e pa r ties m u st deter m in e wh ich sta n da r ds a r e m ost a ppr o-
pri a te for t h eir n egotia ti on a n d h ow th ey will a pply th ese sta n da r ds
to eva lu a te th e opti on s.
Fra m e th is ta sk a s follows: Togeth er weve developed sever a l
possible wa ys of a ddr essi n g th e issu e. Lets focu s n ow on figu r in g ou t wh i ch opti on is th e fa ir est.
Wh a t sta n da r ds wou ld you su ggest we u se to eva lu a te th ese option s? You m a y su ggest on e or
m or e cr iteri a a n d t h en in vite you r cou n ter pa r t( s) to sh a r e h is or h er i dea s.
Step 6. Agr ee on the best possible solution.
I n som e ca ses, on e solu ti on sta n ds ou t a s clea r ly su per ior. Wh en th is h a ppen s, you ca n su m m a -
r ize you r u n dersta n di n g of th e em er gin g decision a n d test wh eth er th er e is con sen su s with i n th e
grou p. Rem em ber th a t silen ce does n ot m ea n a gr eem en t; en su r e th a t you h ea r fr om ea ch pa r ty
befor e you a ssu m e a n yon es con sen t.
I n oth er ca ses, r ea ch in g con sen su s on th e best sol u tion r equ i res a ddi tion a l effor t. Her e a r e
sever a l tech n iqu es for r ea ch in g con sen su s wh en th e in itia l eva lu a tion of option s ( Step 5) does
n ot iden t ify a con clu sive r esu lt:
Re- eva lu a te th e iden tified option s u sin g a ddi tion a l cr iter ia th a t wer e n ot u sed pr eviou sly.
I den tify a r ea s wh er e th er e is som e pr el im i n a r y a gr eem en t.
Box 4.2. Brainstorming techniques
Make the brainstorming session distinctively different from
the rest of the negotiation process by moving to an informal
environment.
Seat participants side by side. Hang flip charts listing the
problem and the interests of parties involved directly across
from the participants.
Aim for quantity, that is, produce as many ideas as possible.
Ask thought-provoking questions to stimulate creativity:
What solutions (if any) have we/others proposed to deal with
this problem? What are some theoretical cures? What has
been tried in the past to deal with similar problems? ln other
organizations? ln other countries? Encourage participants
to build on each other's ideas.
Use role reversal to make people break from everyday
thoughts and solutions.
lnvite third-party experts (from different professions or
disciplines) to participate in the session.
Be careful to record what each person says. There should
be no editing at this point in the process.
Refrain from attributing ideas to particular individuals.
Establish a rule that no ideas should be judged or criticized
during the brainstorming session.
Box 4.3. Some objective criteria for heaIth sector
reform issues
Equity
Efficiency
Benefits/health effects
Opportunity cost (especially where faced with strict
budgetary constraints)
Market value
Precedent
Professional standards
Explor e th e a r ea s of disa gr eem en t t h r ou gh open di a logu e.
Solicit idea s fr om th e grou p on h ow t o join tly a ddr ess a n d r esolve th e a r ea s of disa gr eem en t.
Solicit idea s fr om th e grou p a bou t m odifyin g th e pr oposed sol u tion s. For exa m ple, Wh a t
wou ld it t a ke for t h is solu tion to be fa ir a n d/ or a ccepta ble to you ?
Con sen su s m ea n s th a t everyon e a ccept s th e decisi on , is wil lin g to su ppor t i ts im plem en ta -
tion , a n d ca n live wit h t h e con sequ en ces. Gr ou p con sen su s is bu ilt th r ou gh open dia logu e a n d
r equ ir es tim e, pa tien ce, a n d a willi n gn ess to seek com m on gr ou n d a n d wor k th r ou gh di ffer -
en ces. Al th ou gh con sen su s ca n n ot a lwa ys be fou n d, it ca n be developed m or e often th a n
m i gh t be expected.
3

Bu ildin g con sen su s is clea r ly pr efer a ble to m a kin g gr ou p deci sion s by votin g or by m a jor ity
r u le, wh ich ca n be ri sky wh en n egotia tin g con flict. You n ever kn ow wh eth er th e m in ori ty
th ose wh o opposed th e decision bu t wer e overr u led will a ccept th e gr ou ps decision or a tt em pt
to block its im plem en ta tion .
I n som e ca ses, i t m a y be im possibl e to r ea ch a m u tu a lly a ccept a bl e solu t ion . Wh en th er e is
on ly a pa r tia l con sen su s or n o a gr eem en t , t h e grou p sh ou l d join tly decide to su spen d th e n ego-
tia tion s. Su spen din g n egotia t ion s a t th i s poin t ca n : 1) a llow pa r tici pa n ts th e oppor tu n ity a n d
tim e to reflect, 2) dim in ish feeli n gs of fr u str a tion , a n d 3) en cou r a ge t h e gen er a tion of n ew idea s
( vi a in form a tion -ga th er in g or con su l ta tion with oth ers) . Befor e con cl u din g th e n egot ia tion s,
h owever, you m u st pr epa r e a su m m a r y of th e discu ssi on , li st ba r r ier s to a gr eem en t, a n d i den tify
th e con dition s to be sa t isfied befor e fu tu r e n egot ia tion s ca n t a ke pla ce. If you a r e com m itted to
r ea ch i n g a n a gr eem en t , you m u st a lso iden tify foll ow- u p steps a n d develop a t im elin e th a t wil l
en a ble th e n egotia ti on s to resu m e in th e n ea r fu tu r e.
Step 7: Develop an implementation plan.
Ach i evin g con sen su s on th e best solu ti on a ssu m es t h a t a ll pa r ties sh a re a m u t u a l com m itm en t
in pr in ciple, bu t it does n ot deta i l h ow th a t com m itm en t wi ll be tr a n sla ted in to a ction . On ce you
h a ve a gr eed on a gen er a l a ppr oa ch or solu t ion , you m u st develop a specifi c str a tegy for im ple-
m en ti n g th a t solu tion .
Before developin g th e im plem en t a tion st ra tegy, br iefly deta il th e r esou r ces you a n d you r
cou n ter pa r ts a r e wi llin g to com m it to th e en dea vor ( fin a n cia l, m a ter ia l, a n d h u m a n ) a n d th e
specifi c skill s or exper tise you a n d you r or ga n iza t ion s ca n con tr ibu te. Th i s will be t h e ba sis of
th e im plem en t a t ion str a tegy, wh ich will deta il th e speci fic a ction s to be ta ken a n d th e roles a n d
r espon sibiliti es of ea ch pa rt icipa n t .
Fin a ll y, you n eed to iden tify th e m et h odology a n d tim in g for m on itor in g a n d eva lu a t in g
progr ess. After r ea ch in g fu ll a gr eem en t, you a n d you r cou n terpa r ts m u st r ecor d th e t er m s of
a greem en t, r eview, sign , a n d da te th em .
3. Con fli ct Resea r ch Con sor ti u m , Un i ver sit y of Color a do. Con sen su s Ru l e Pr ocess, fr om t h e I n ter n a ti on a l
On l in e Tr a i n in g Pr ogr a m on I n tr a ct a ble Con fli ct.
Step 8. Take extr a steps to suppor t your agr eement.
An a stu te n egotia tor h a s m ore th a n j u st t h e kn ow- h ow a n d skill to m a n a ge th e n egoti a t ion pr o-
cess; h e or sh e a lso is a ble to su ppor t th e im plem en ta tion of t h e a gr eem en t a fter th e for m a l
n egoti a t ion s h a ve con cl u ded.
Negotia tion u su a lly occu r s a m on g a sm a l l gr ou p of people, a n d beh in d cl osed door s.
However, on ce th e pa r tici pa n ts step ou tside, th ey m u st com m u n ica te th e r esu l ts of t h e n egoti a -
tion to t h e la r ger con sti tu en cy th ey r epr esen t. Negotia tor s m u st be a ble to expla in th e r a tion a le
beh i n d th eir decision s a n d h ow th ey a ddr essed t h e key in terest s of t h eir con stit u en cies.
I m plem en ta tion of you r a gr eem en t is m or e likel y to su cceed if you th in k th r ou gh in a dva n ce
wh a t gr ou ps m a y be a ffect ed by t h e a gr eem en t a n d h ow. Wh a t ext er n a l opposit ion m i gh t h a ve a
n ega ti ve im pa ct on you r cou n ter pa rt s willi n gn ess a n d a bili ty t o im plem en t th e solu tion a fter
th ey l ea ve th e n egot ia tion s? How ca n you cr a ft a m essa ge to com m u n ica te th e r esu l ts of t h e
n egoti a t ion s t o im por ta n t con stitu en cies to en l ist th eir su ppor t a n d diffu se a n y existin g or
a n ticipa ted opposition ?
Final considerations on the negotiation process.
For pu r poses of sim pl icit y a n d cla ri ty, th ese gu i delin es ou tlin e a stepby- step n egotia ti on pr ocess
th a t sta rt s a t t h e begin n in g a n d fi n ish es a t t h e en d. I n pra ct ice, n egotia ted a greem en ts a re sel-
dom r ea ch ed in on e m eetin g. Mor e often , n egotia ti on s spa n a ser ies of m eetin gs. Th erefore, it is
cr itica l th a t th e n egotia tor s keep a r u n n i n g r ecord of th e a gr eem en ts r ea ch ed a n d esta bli sh a
m ech a n ism for com m u n ica tin g with ea ch oth er r egu l a rl y, even in th e a bsen ce of sch edu led
m eetin gs. I n or der for th e process t o be su ccessfu l, pa r ti es n eed to keep a wh ole r a n ge of issu es
a n d pr oblem s on th e t a ble a n d fin d wa ys of or ga n izin g th em so th a t su sta in ed dia l og a cr oss a
ser ies of m eetin gs will con t in u e t o be both positive a n d pr odu ctive.
4
Summary
Th ese gu idelin es ou t lin e steps you ca n ta ke to prepa r e you r sel f for con fli ct n egotia ti on , to
u n dersta n d th e n a tu r e of con flict, to develop effect ive in t er per son a l com m u n i ca tion skills a n d
bu ild good workin g r ela ti on sh ips, to pr epa r e for n egoti a t ion , a n d to su ccessfu ll y i m plem en t a
con flict n egoti a t ion . Th is in for m a tion is m ost h elpfu l wh en you ta ke th e tim e to fi ll ou t a n d
scor e th e qu estion n a ir e on you r str en gt h s a n d wea kn esses a s a n egotia tor ( An n ex 4- A) a n d r ea d
th e a ccom pa n yi n g l ist of su ggestion s. Th e t wo a ddition a l wor ksh eets, Person a l I n ven tor y
( An n ex 4- B) a n d Negotia tion Pr epa r a tion Wor ksh eet ( An n ex 4-C) , sh ou ld be com pleted for
ea ch n ew n egotia tion you con sider.
Th e issu es, pa r ties, r isks, ch a ll en ges, a n d con sequ en ces will va r y con sider a bly fr om situ a ti on
to situ a ti on , bu t th e disciplin ed pr epa r a tion en cou ra ged in th ese gu ideli n es will gr ea t ly im prove
you r pr oba bility of su ccess, even if you a re a sea son ed, exper ien ced n egotia tor.
4. Ch u fr in a n d Sa u n der s 1993.
Results of Effective Conflict Negotiation
Con flict a n d di ffer en ces occu r a s a n a tu r a l a n d in evita ble pa rt of you r wor k a s a ch a n ge a gen t
in th e h ea lth sector. Wh en th ese di ffer en ces a r e den i ed, a voided, or com prom ised a wa y r a th er
th a n dea lt with open ly a n d con st ru ctively, th e r esu l t ca n be:
En er gy is diver ted fr om im por ta n t a ctivit ies a n d issu es.
Mor a l e i s destr oyed.
Gr ou ps a n d in divi du a ls a r e pol a r ized t o th e exten t th a t fu t u r e cooper a t ion or colla bor a t ion
becom es i m possible.
People beh a ve ir respon si bl y a n d r egr etta bly, for exa m ple, by n a m e- ca lli n g a n d a ggr ession .
Wor kin g rela tion sh i ps a re destr oyed or da m a ged.
I f, on t h e oth er h a n d, you a pply ca refu l , t h ou gh t fu l self- pr epa r a t ion a n d u se th e pr ocesses
ou tli n ed in th ese gu idelin es, you wil l be m or e likel y t o exper ien ce th e foll owin g con str u ct ive
ou tcom es of effect ively m a n a ged a n d n egotia ted con fl icts:
I m por ta n t issu es a r e br ou gh t to th e su r fa ce a n d cla ri fied.
Cr ea ti ve, im pr oved solu t ion s a r e fou n d.
Wor kin g rela tion sh i ps a re str en gt h en ed a s both pa r ties h on est ly a n d r espect fu lly n egotia te
th eir differ en ces.
Negotia tion i s a process th a t ca n bu ild tr u st, cr ea te spa ce for open a n d pr odu ct ive dia log, a n d
give opposin g gr ou ps exper ien ce in join t pr oblem - sol vin g a n d colla bora ti on . Over t im e, su c-
cessfu l exper ien ces with con flict n egotia tion ca n pa ve th e wa y for a br oa der tr a n sfor m a t ion in
h ow con fli ct is expr essed. On a per son a l level , n egotia tion ca n in cr ea se a n in dividu a l s a wa r e-
n ess a n d com m itm en t to ch a n ge. On a system s level, n egotia t ion ca n ch a n n el th e expression of
con flict a wa y from com pet itive, a ggr essive, or violen t beh a vior a n d towa r d n on violen t a dvoca cy,
con cilia tion , a n d cooper a tion .
Without negiotiation.
With negiotiation.
Bibliography
Ch u fr in , Gen n a dy, a n d Ha r old Sa u n der s. Apr il 1993. A Pu blic Pea ce Process. Negotiation
Journal 9( 3) :155 177.
Feder a l Media ti on a n d Con cili a t ion Ser vi ce. 1999. Mediation & Conflict Resolution Training:
Participant Handbook. Wa sh in gton , DC: Feder a l Media tion a n d Con ci lia tion Ser vice.
Fish er, Roger, a n d Ert el, Da n n y. 1995. GettingReady to Negotiate: TheGettingto YESWork-
book. New Yor k: Pen gu in Books.
Fish er, Roger, a n d Scott Br own . 1989. GettingTogether: BuildingRelationshipsasWeNegoti-
ate. New Yor k: Pen gu i n Books.
Fish er, Roger, Willia m Ur y, a n d Br u ce Pa tton . 1983. Gettingto Yes: NegotiatingAgreement
Without GivingIn. New Yor k: Pen gu in Books.
Kil m a n , Ra lph , a n d Ken n eth Th om a s. 1974. Thomas-Kilmann Conflict ModeInstrument.
Tu xedo, NY: Xi com I n cor pora ted.
I n ter n a t ion a l On lin e Tr a in i n g Progr a m on In tr a cta ble Con flict. Con flict Resolu tion Con sor -
tiu m , Un i ver sity of Col or a do. h ttp:/ / www.col or a do.edu / con fl ict ( a ccessed Spr in g 2000) .
Additional Resources
Fisch er, Roger, Eliza beth Kopelm a n , a n d An dr ea Ku pfer Sch n eider. 1994. Beyond Machiavelli:
Toolsfor CopingwithConflict. Ca m br idge, MA: Ha r va r d Un iver sity Pr ess.
Folger, Joseph , a n d Ma rsh a ll Scot t Poole. 1984. WorkingThroughConflict: ACommunica-
tion Perspective. Glen vi ew, I L: Scott For esm a n .
Ur y, Wil lia m . 1991. GettingPast No: NegotiatingwithDifficult People. New Yor k: Ba n ta m
Books.
3-29
Annex 4-A
Negotiation Style Assessment and Scoring Sheet
( See r ever se side of th is sh eet.)
Conflict Resolution Questionnaire
How Do You Deal with Conflict?
Answer the questions below as a way of examining how you deal with conflict. The survey was
designed by members of Jock McClellan's 1993 class on Conflict Resolution. The questions are
based primarily on the methods recommended by Dudley Weeks in The Eight Essential Steps to
Conflict Resolution (Los Angeles: Jeremy Tarcher, 1992), as well as on principles in Roger Fisher's
and William Ury's Getting to Yes ( Penguin Books, 1991).

First, print the survey. Use the printout to rate each of the following statements from 1 - 5 using the
ratings below to indicate how often you do as the statement says. Please write your responses in the
LEFT column of dashes. Answer the questions to portray your most usual way of dealing with con-
flicts like those at home or at work. Do not take a long time on any question. Give your initial reac-
tion. The more honest your answers, the more useful the results will be. When you are through, go to
the pages with instructions for scoring and interpretation.
1. Almost never
2. Occasionally
3. Half the time
4. Usually
5. Almost always
1. ____ / ____ I feel that conflict is a negative experience.
2. ____ / ____ When I resolve a conflict, it improves my relationship.
3. ____ / ____ I am afraid to enter into confrontations.
4. ____ / ____ I feel that in conflicts someone will get hurt.
V ____
5. ____ / ____ When I prepare to meet to discuss a conflict, I try to arrange for a mutually
acceptable time and setting.
6. ____ / ____ I feel it is important where a conflict takes place.
7. ____ / ____ I try to make people feel comfortable when meeting with them about a con-
flict.
8. ____ / ____ When I start to discuss a conflict with the other party, I choose my opening
statement carefully to establish positive realistic expectations.
A ____
9. ____ / ____ I state my true feelings when dealing with conflict.
10. ____ / ____ During a conflict I ask questions to clarify a statement that I'm not sure of.
11. ____ / ____ I try to be aware of how my negative and positive self-perceptions influence
the way I deal with a conflict.
12. ____ / ____ In conflict my reactions are based on how I think the other party perceives
me.
C ____
13. ____ / ____ I feel that only my needs are important.
14. ____ / ____ I feel for a relationship to last, the needs of both parties must be considered.
15. ____ / ____ In a conflict I strive to distinguish between real needs and desires.
16. ____ / ____ In order not to harm the relationship, I may temporarily put aside some of my
own less important personal wants.
N ____
17. ____ / ____ I share my positive attitude, hoping they will do the same.
18. ____ / ____ I find it necessary to overpower others to get my own way.
19. ____ / ____ I am aware of the other person may need to feel in control of the conflict.
20. ____ / ____ In a conflict, I believe there should be no upper-hand.
P ____
21. ____ / ____ I find it easy to forgive.
22. ____ / ____ I bring up old issues from the past during a new conflict.
23. ____ / ____ When dealing with a conflict, I consider the future of the long-term relation-
ship.
24. ____ / ____ In conflict I try to dominate the other party.
F ____
25. ____ / ____ I listen with an open mind to alternative options.
26. ____ / ____ I feel there is just one way to solve a problem.
27. ____ / ____ When dealing with a conflict, I have preconceived notions about the other
party that I am unwilling to let go of.
28. ____ / ____ I can accept criticism from others.
O ____
29. ____ / ____ I feel that winning the war is more important than winning the battle.
30. ____ / ____ I strive for a complete and genuine resolution of a conflict rather than settling
for a temporary agreement.
31. ____ / ____ When dealing with a conflict I have a pre-determined solution to the outcome.
32. ____ / ____ I feel the need to control an argument.
D ____
33. ____ / ____ If I had my way, I win, you lose.
34. ____ / ____ When in a conflict with someone, I ask them to explain their position.
35. ____ / ____ I bargain to resolve conflict.
36. ____ / ____ At the end of a conflict, it matters to me that the other person's needs have
been met as well as my own.
M ____
37. ____ / ____ I express anger constructively.
38. ____ / ____ In difficult conflicts, I would consider requesting a third party facilitator.
39. ____ / ____ I overlook my partners anger in order to focus on the real issues to conflict.
40. ____ / ____ I feel that it is okay to agree to disagree on specific issues in a conflict.
X ____
Total ________
Using the same 1-5 scale above, how often do you feel you are effective at resolving conflicts in a
way that builds your long-term relationship with the other parties?
___ 1 Almost Never
___ 2 Occasionally
___ 3 Half The Time
___ 4 Usually
___ 5 Almost Always
Scoring the Conflict Resolution Questionnaire
1. Reverse the scores for the 12 questions that give high scores for unrecommended responses.
Dudley Weeks says some responses to conflict lead to resolutions which build a relationship, and some do
not. All 40 questions need to be on the same scale, giving a high number for desirable or effective
responses and a low score for ineffective ones. But 12 of the questions are worded so that ineffective
answers get a "5" instead of a "1".
For example, question #1 reads "I feel that conflict is a negative experience." Weeks would say that some-
one who answers "Almost always", a "5", will probably have difficulty approaching a conflict and that
this will reduce the person's effectiveness. Therefore that response deserves a low score, and the "5"
needs to be reversed to a "1". Doing this for the 12 questions will assure that all scores will be consistent,
with higher scores going to "better" responses.
Please reverse the scores for the following questions: 1, 3, 13, 18, 22, 24, 26, 27, 31, 32, 33, and 35.
Reverse those questions by looking at the response given in the left hand column and writing in a
reversed score in the right hand column as follows:
Answer: Score:
5 becomes 1
4 becomes 2
3 remains 3
2 becomes 4
1 becomes 5

2. For the questions that do not need to be reversed.
For the questions that do not need to be reversed, write the same number given in the left-hand answer
column in the right-hand score column.

3. Compute sub-totals and the total.
The 40 questions are in groups of 4, based on topics in Week's book. Add the scores for each group of 4
and put the result in the blank. (The letter is just an abbreviation for the topic of that group.)
Then add the sub-totals and enter the result in the "Total" blank.

4. Interpret the results, and learn from them.
The higher your scores, the more effective you are likely to be at finding resolutions that meet everyone's
real needs and that build your long-term relationship. Of the 10 sub-totals, which were the highest? These
are probably areas where you are effective. Which sub-totals were the lowest? These are probably areas
where you might try a different approach. Use the sheet "Learning from the Survey" to understand where
you might improve. Pick 2 or 3 of the questions with the lowest scores, and try out behaviors, which
might make you more effective at resolving conflicts productively.
Learning from the Survey
The higher your score on any question or section of the survey, the more likely you are to be effec-
tive at arriving at resolutions that meet both people's needs and that build the relationship. Low
scores may indicate areas where you could increase your effectiveness.
For each question on the survey, some advice is given below. The advice was compiled by the Con-
flict Resolution class and is based primarily on Dudley Weeks' The Eight Essential Steps to Conflict
Resolution, but also includes ideas from other sources, including Getting to Yes by Roger Fisher and
William Ury. The guidelines are given in groups of four, corresponding to the ten lettered groups in
the survey, which are in turn based on the topics or steps in Weeks.
For the questions or sections on which you got the lowest scores, read the guidelines and consider
tying them.
They may help you be more effective.
V.
VIEW CONFLICT AS NATURAL AND POSITIVE.
View conflict as a natural outgrowth of diversity among people, which can be addressed
in a win-win way that strengthens your relationships. Remember the value of building
your long-term relationship. View the resolution of the conflict and the building of the
relationship as inter-related parts. Prevention works best.
1. View conflicts as opportunities for growth - for you and the other person, and for your
relationship.
2. Handle the differences in a way that strengthens your relationship - together you will find
more satisfying resolutions for this and future conflicts.
3. Address differences directly, realizing you are more likely to meet both your concerns
and the other's if you discuss issues openly.
4. Separate the people from the problem, so you can protect the relationship while
addressing the problem.
A.
ATMOSPHERE.
Start by establishing an effective atmosphere that promotes partnership and problem-
solving.
5. Meet with the other at a mutually satisfactory time, when you both have plenty of time
and are free from distractions.
6. Meet in an equally acceptable place that is tranquil and gives you equal power.
7. Help the other feel comfortable and safe, affirming the importance of the relationship.
8. Start by saying you know the two of you can invent some solutions together that are
mutually acceptable.
C.
CLARIFY PERCEPTIONS.
Work with the other so both are very clear about what the conflict is really about.
Eliminate ghost issues that arise from misperceptions. Separate the people from the
problem. Acknowledge emotions as legitamate. Then face the problem together.
9. Be clear with yourself and with the other how you feel and how you perceive the
problem Use "I - Statements" to tell the other how you feel, rather than "You -
Statements" that blame. Assert your needs without attacking the other.
10. Ask questions to clarify your perception of the other's perceptions. Listen actively.
Acknowledge what the other says.
11. Look at yourself honestly, clarifying needs and misperceptions.
12. Clear up misperceptions and stereotypes. Avoid pushing "buttons."
N.
Note NEEDS, not wants.
Identify the needs that are essential to you, your partner, and your relationship.
13. Acknowledge the legitimate needs of the other, as well as those of your own. Recognize
that there are usually multiple imterests. Fractionate the problem.
14. Recognize that sustaining your relationship requires meeting needs of both.
15. Distinguish between real needs and secondary desires. Identify the other's core goals you
can support.
16. Postpone contentious demands that may damage the relationship until you and your
partner have worked on meeting needs of the relationship first.
P.
Produce Positive Partnership POWER.
Build "power with," shared power which enables lasting resolutions and relations.
17. Be positive; be clear about yourself and your values. Keep reaching for the other's
positive power and potential for constructive action. Recognize the power of
effectiveness that comes from having the skills to develop the relationship, understand
interests, invent options, and agree based on objective criteria.
18. Avoid negative "power over," which wastes energy in seesaw battle, and which may
backfire, not achieving your lasting goals. Treat others as you want to be treated.
19. Don't stereotype the other only by their negative power; keep options open for the other's
constructive power. Don't ask who is more powerful; be optimistic about outcomes.
20. Work as a team, realizing you need each other's positive power to act effectively. Be
unconditionally supportive of the relationship.
F.
Focus on the FUTURE first, then learn from the past.
21. Forgive (which does not mean you approve). Acknowledge all fall short. Move beyond
negative past; look to positive potential. Be hard on the problem and soft on the people.
22. Focus on the current issue. Don't pick old wounds. Learn from the past; recall good
resolutions.
23. Remember the importance of the long-term relationship. Create images of an improved
relationship resulting from effective resolution of the conflict.
24. Work as partners for mutually beneficial agreements which will nurture your relationship.
O.
Open up OPTIONS for Mutual Gain.
25. Listen with an open mind to alternative options. Ask for the other's options first; learn
from them.
26. Prepare for discussions by inventing several specific new options that meet shared needs.
Don't view these as final goals, but as starting points. Together, brainstorm new
possibilities. Separate inventing from deciding. Postpone critical discussion.
27. Beware preconceived answers. Look for common ground behind seeming oppositions.
Avoid stereotypes.
28. Listen actively and acknowledge what is being said (which does not mean agreeing with
it).
D.
Develop "DOABLES," Stepping-stones to Action.
29. Develop small steps that lead you closer to a mutually healthy decision on larger issues.
Chose ones that meet shared needs and that you have shared power to implement.
30. Do not rest with temporary fixes which are not sufficient to meet the long-term problem.
As the three little pigs learned, solid construction will last.
31. View this as a cooperative process whose best outcome cannot be foreseen alone at the
beginning.
32. You will have a more satisfactory outcome if all factions participate as equals. Understand
that the others have interests and needs too.
M.
Make MUTUAL-BENEFIT AGREEMENTS.
33. Avoid win-lose solutions, which damage the long-term relationship. Consider the needs of
your partner, you, and your relationship, and you both will win. Avoid a contest of wills.
Yield to reason, not pressure. Do not be a "door-mat."
34. Ask the other to clarify his/her interests; clarify your own.
35. Avoid barganing, posturing, demands, and threats, which kill cooperative problem-
solving. Acknowledge non-negotiable elements. Focus on interests, not positions, but do
build large agreements on small prior doables.
36. Be caretaker of the other's welfare as well as your own. Make agreements that meet
objective, reasonable standards of fairness. Make agreements that meet the needs of both,
and that build the relationship.
X.
EXTRA Considerations.
37. Express anger constructively. Emotions are legitimate and communicate. Channel anger's
energy. Focus on the angering behavior, not the person.
38. Define your best alternative to a negotiated agreement. Seek a third party facilitator when
you and the other lack needed skills or when there seem to be intractable differences.
39. Hear the other's anger non-defensively. Don't react to emotional outbursts. Look for what
is within it you can do something about it together.
40. Agree to disagree on specific value differences. Don't feel you have to agree on
everything.
Annex 4-B
Self-I nventory Worksheet
Before committing to any negotiation process, carefully answer the questions below.
Review your answers and use them to gain perspective on the conflict and proposed negotiation from your
personal and professional point of view.
What specifically concerns me about this conflict?
What are my interests and underlying needs contained in this issue? What is at stake for the
reforms I am trying to implement?
What personal risks are involved for me if I am not successful?
Leadership position? Professional standing? Self-esteem? Job security? Other?
(Be specific and thorough so you are clearly aware of your strengths and/or vulnerability)
a) Am I sufficiently informed of the interests and needs of the group I represent? Have I ade-
quately discussed any underlying assumptions with my colleagues/constituents?
b) Do I have sufficient power and authority (or does my negotiating team) to make and carry
out agreements?
If not, who else needs to be at the table? How can I get them there?
What assumptions am I making about the opposition? Are they based on knowledge of current
interests, past negative experiences; preconceived notions based on what I have heard?
(Be specific and clear with yourself on this issue.)

What would be the best possible solution both parties could agree on?
What would be a solution I could live with?
What is the best situation I can expect if I do not negotiate?
Annex 4-C
Negotiation Preparation Worksheet
1
INSTRUCTIONS: To complete the worksheet, follow the steps listed below in sequential order.
(1) Develop a concise working definition of the issue, as you see it.
(2) Identify your interests at stake in the issue
In order to be able to focus on those interests of most importance to you during the negotiations, you need to
first be clear about all of the interests you have at stake in the issue. Develop a complete and detailed list of
your interests in the problem. Each interest should reflect a specific underlying need, desire, or fear. Once
the list is complete, be sure to double check it and clarify any position or value statements.
(3) Rank your interests
Naturally, some interests will be more important to you than others. To ensure that you focus on your key
interests during the negotiation process rather than get caught up in secondary issues, it is critical that you
assess the relative importance of each interest beforehand. A simple method to use in ranking each interest in
terms of its relative importance is to assign each a weight of 0 to 100 percent, based on its overall importance.
Enter a rank next to each interest listed in left-hand column.
(4) Identify possible interests at stake for your counterpart(s)
Because negotiation is a process of collaboration and compromise, it is important to also make a best estimate
of the other parties interests in the problem. Accurate information about the other sides interests is often-
times difficult to obtain, but try to develop as accurate an estimate as possible of what is at stake for your
counterpart(s). Empathy is the most important resource you have for inferring what these interests might be.
Consider the situation from the other parties perspective; identify the issues they might be concerned about.
What personal interests might be at stake for them (e.g., their leadership position, professional standing, job
security, financial wellbeing)? What business-related interests might they be concerned about? What is at
stake for the programs, projects, or reforms they are trying to implement? What are the interests of other indi-
viduals and/or groups affected by the issue that you might take into account?
Depending on the quantity of information and other resources at your disposal, you can research any publi-
cized statements they have made on the issue as well as information about their organization and/or projects.
(If you have conducted a stakeholder analysis or developed an advocacy strategy for the policy beforehand,
you can obtain information about your counterparts interests by referring to the Stakeholder Analysis Table
and Tool 3: Audience Identification Worksheet, respectfully).
(5) Invent options for mutual gain
You can draw upon both your interests and those of the other side to brainstorm possible options for mutual
gain (i.e., those that incorporate one or more interests from each side).
1. Ada pted wit h per m ission fr om GettingReady toNegotiate, a Stepby StepGuidetoPreparingfor Any Negotiation.
Finally, you will want to test these options by reviewing each individually and questioning whether you
would find the option to be a tolerable and acceptable solution. If you cannot answer yes to any of these
options, it signals the need to recheck your initial assumptions. You might have overlooked a key interest or
inaccurately measured the relative importance of an interest(s).
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Ann ex 4-C 4-4 5
Section 5
Intr oduction to
Str ategic
Management
Susan Scr ibner
Section 5
Introduction to Strategic
Management
Table of Contents
Figu r e 5.1. Fa cets of Str a tegic Ma n a gem en t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5- 2
Bibli ogr a ph y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5- 5
An n ex 5- A. Str a tegic Pla n n in g a n d Str a tegi c Ma n a gem en t . . . . . . . . . . . . . . . . . . . . . . . . . . 5- 6
Section 5
I ntroduction to Strategic
Management
Hea lth policy r efor m s, even on es th a t h a ve been a ppr oved, decreed, or sign ed in to la w, wil l n ot
n ecessa r il y be im plem en t ed a s i n ten ded wit h ou t th e im petu s a n d gu ida n ce of policy ch a m pi-
on s. Th e policy pr ocess, a s expla in ed a n d dia gra m m ed in th e in tr odu ction to th is toolkit ( Sec-
tion 1, especia ll y Figu re 1.1) , i n clu des th e followin g st a ges: policy form u l a t ion a n d legitim a -
tion , con st itu en cy-bu ildin g, r esou r ce m obil iza tion , im plem en ta tion design a n d orga n iza tion a l
str u ctu r in g, a n d pr ogr ess a n d im pa ct m on itor in g. However, pr oposed r efor m s a re n ot likely to
progr ess th r ou gh th ese sta ges wit h ou t som eon e m a n a gin g or sh eph er din g th em .
For th ose wh o wa n t to pa r ticipa te in a n d fu r th er th e process of h ea lth sector r efor m , str a t egic
m a n a gem en t pr ovides a n effective a ppr oa ch . Str a tegic m a n a gem en t is a pr ocess for developin g
a n d en a cti n g pla n s to r ea ch a lon g- ter m goa l th a t ta kes in to a ccou n t in t er n a l va r ia bl es a n d
exter n a l fa ct ors. Str a tegic m a n a gem en t en com pa sses a n in t egr a ted, fu tu r e- ori en ted m a n a ge-
r ia l per spect ive th a t is
ou twa r dly focu sed
for wa r d- th in kin g
per for m a n ce- ba sed ( see Ki ggu n du 1996) .
Str a tegic m a n a ger s iden tify lon g- r a n ge ta rgets, sca n th eir opera ti n g en vir on m en ts, eva lu a t e
th eir or ga n iza ti on s str u ctu r es a n d resou r ces, m a tch th ese to t h e ch a l len ges th ey fa ce, iden tify
sta keh older s a n d bu il d a llia n ces, pr iori tize a n d pl a n a ction s, a n d m a ke a dju stm en ts to fu lfill
per for m a n ce objectives over tim e.
Br in kerh off ( 1991 a n d 1994) ch a r a cteri zes str a tegi c m a n a gem en t a s l ookin g ou t , l ookin g
in , a n d lookin g a h ea d. Lookin g ou t m ea n s explor in g beyon d th e bou n da ri es of you r or ga n i-
za tion to set fea si bl e objectives, i den ti fy key sta keh older s, a n d bu il d con st itu en cies for ch a n ge.
Lookin g in im plies cr itica l ly a ssessin g a n d str en gth en in g you r syst em s a n d str u ctu r es for
m a n a gi n g person n el, fin a n ces, a n d oth er essen t ia l r esou r ces. Fin a lly, looki n g a h ea den ta ils
m eldin g you r str a tegy wit h str u ctu r es a n d r esou r ces to r ea ch you r policy goa ls, wh il e m on it or-
in g you r pr ogr ess a n d a dj u stin g you r a ppr oa ch a s n eeded.
Ba la n cin g str a tegic m a n a gem en ts ou twa rd- , i n wa r d-, a n d forwa r d- lookin g fu n cti on s h elps
you develop a vision a n d a str a tegy for wh er e a n d h ow to m ove h ea l th sector r efor m for wa r d.
Ba la n cin g th ese differ en t per spectives is th e essen ce of m a n a gin g st ra tegica lly ( Br in ker h off
1991) .
Str a tegic m a n a gem en t com pr ises five key fa cets: goa l- sett in g, a n a lysis, str a tegy for m a ti on ,
str a t egy im plem en ta ti on , a n d str a tegy m on itor in g ( see Figu r e 5.1) . Th ese a r e th e in tegr a l ele-
m en ts th a t, wh en a pplied togeth er, di st in gu i sh str a t egic m a n a gem en t fr om l ess com pr eh en sive
a ppr oa ch es, su ch a s oper a tion a l m a n a gem en t or lon g- ter m pla n n in g. Str a tegi c m a n a gem en t
is a n itera ti ve, con tin u ou s pr ocess th a t i n volves im por ta n t in tera ction s a n d feedba ck a m on g th e
five key fa cets, wh ich a r e expla in ed in m or e deta il in Ta ble 5.1.
Figure 5.1 . Facets of Strategic Management
Goal-setting
Analysis
Strategy
Formation
Strategic
Management
Strategy
lmplementation
Strategy
Monitoring
Intr o duction to Str ategic Man agement 5-3
As m en ti on ed, you ca n u se str a t egic m a n a gem en t to h elp m ove h ea l th sector r efor m s
th r ou gh th e va r i ou s sta ges in th e pol icy pr ocess. Th e fr a m ewor k of th e policy sta ges ca n h el p
you deter m in e you r loca ti on in th e pol icy process a n d i den ti fy t a sks t o be don e. By a pplyin g a
str a t egic m a n a gem en t a ppr oa ch to ea ch su bsequ en t sta ge of th e policy process, you ca n fu r th er
im plem en ta t ion of h ea lth sector r eform s. Con sider ea ch sta ge of th e policy cycle fr om a str a te-
gic per spective, ba la n cin g th e lookin g-ou t, looki n g- in , a n d looki n g- a h ea d i ssu es. I n so doin g,
you ca n effectively in t egr a t e a st r a t egic m a n a gem en t a ppr oa ch in t o th e policy cycle. As a n
exa m pl e, Figu r e 5.2 il lu str a tes h ow you m igh t str a t egica ll y m a n a ge you r r eform s t h r ou gh th e
policy for m u la tion a n d legitim a tion sta ge.
Table 5.1 . Five Facets of Strategic Management
GoaI-Setting Goal-setting enables you to articulate your vision: identify what needs to be accomplished, define
short- and long-term objectives, and relate them to what your organization needs to do. A "mission
statement summarizes your purpose and goals in terms easily understood by both staff and external
stakeholders.
AnaIysis Analysis guides you to collect and consider information so that you fully understand your situation.
Assess external environments and internal situations to identify the strengths and weaknesses of your
organization and the opportunities and threats you face as you seek to reach your goals.
Strategy Formation To determine a strategy, you reflect, prioritize, develop options, and make decisions. Review the results
of the analyses, identify the issues that you and your implementing partners need to address, and
prioritize them in terms of their urgency and magnitude. Use these results to design alternative
strategies and plans that address the key strategic issues.
Strategy ImpIementation To implement your strategy, assemble the necessary resources and apply them. Put the chosen plans
into practice, marshal the resources and commitments necessary for moving ahead, tap existing
capacity and/or build new capacity, and seek to achieve results.
Strategy Monitoring Monitoring allows you to check your progress toward achieving your goals and assess whether any
changes in the environment necessitate alterations to your strategy. Modify plans and actions to adjust
to the impact of changes in the operating environment. Effective monitoring allows you to react and
anticipate. Monitoring also feeds back into analysis, strategy design, and implementation in the
immediate term and into goal-setting over the longer term.
Figure 5.2. Strategic Management of One Stage of the Policy Process
Constituency
Building
Constituency
Building
PoIicy
FormuIation and
Legitimation
PoIicy
FormuIation and
Legitimation
Resource
Mobilization
Resource
Mobilization
lmplementation
Design and
Organizational
Structuring
lmplementation
Design and
Organizational
Structuring
Progress/lmpact
Monitoring
Progress/lmpact
Monitoring
Goal-setting
Analysis
Strategy
Formation
Strategic
Management of
Policy Formulation
and Legitimization
Strategy
lmplementation
Strategy
Monitoring
= primary linkage
= secondary linkage
Strategic Management of Policy Formulation and Legitimation
Goal-Setting: Your goals might be to 1) have a community leader speak publicly on behalf of the
policy to create legitimacy, and 2) have someone from the health sector reform team list the
resources and actions that will be necessary to implement the policy.
Analysis: You might evaluate your stakeholders to see who is likely to favor the policy and, of
those supporters, who has the respect of the community.
Strategy Formation: You could identify 1) a supportive community leader and ask him or her to
speak for the policy and 2) additional information and resources needed to develop the policy
details.
Strategy Implementation: You could 1) arrange for a presentation or media interview with the
community leader and 2) attempt to collect information and other resources.
Strategy Monitoring: You should assess whether your efforts at legitimation and policy
definition were successful enough to allow you to focus most of your time and energy on
constituency-building tasks, or whether you need to continue with policy formulation and
legitimation.
Intr o duction to Str ategic Man agement 5-5
Bibliography
Br in kerh off, Derick W. 1994. Looki n g Ou t, Lookin g I n , Lookin g Ah ea d. PATimes. vol. 17, n o.
12, 11.
_ _ _ _ _ . October 1991. Lookin g Ou t, Looki n g I n , Lookin g Ah ea d: Gu idel in es for Ma n a gin g
Developm en t Pr ogr a m s. Wor kin g Pa per No. 1. Wa sh in gt on , DC: I m plem en tin g Poli cy
Ch a n ge Pr oj ect, for US Agen cy for I n t er n a tion a l Developm en t.
Kiggu n du , Moses N. 1996. I n tegr a tin g St ra tegic Ma n a gem en t Ta sks in to I m pl em en ti n g Agen -
cies: Fr om Fir efigh t in g to Pr even t ion . World Developmentvol. 24, n o. 9: 14171430.
Annex 5-A
Strategic Planning and Strategic
Management
By Ben ja m in L. Cr osby
1
Thefollowingisan excerpt fromCrosby, Benjamin L. 1991. Strategic Planningand Stra-
tegic Management: What AreThey and HowAreThey Different?Technical NoteNo. 1.
Published by theImplementingPolicy ChangeProject, Management SystemsInterna-
tional, Inc., for theUSAgency for International Development.
Why Strategic Management?
Str a tegic pla n n in g a n d m a n a gem en t a r e m or e th a n a set of m a n a ger ia l tools. Th ey con stitu te a
m i n d- set, a n a ppr oa ch t o lookin g a t th e ch a n ges in th e in t er n a l a n d extern a l en vir on m en t th a t
con fron t th e m a n a ger. Usi n g pla n n in g a n d m a n a gem en t tool s str a tegica ll y, t h en , i n volves
essen t ia lly a wa y of t h in ki n g, a m en t a l fr a m ewor k or a ppr oa ch , a s well a s a set of a n a l ytic tools.
For st ra tegic m a n a gem en t to be effectively u sed th e m a n a ger m u st devel op a stra t egic m en ta lity
or ou tl ook. Th e pr oblem for th e con su lta n t is h ow to h el p th e m a n a ger a cqu ir e th a t m en ta lit y.
The Strategic Approach
Th e str a tegic a ppr oa ch or m en ta lit y con sists of fou r m a in elem en ts:
Fir st , th e str a tegi c a ppr oa ch is or ien ted towa rd t h e fu tu r e. I t recogn izes th a t th e en vir on m en t
will ch a n ge. I t is a lon g ra n ge ori en ta ti on , on e t h a t tr ies to a n ticipa te even ts r a t h er th a n sim -
ply rea ct a s th ey occu r. Th e a ppr oa ch lea ds th e m a n a ger to a sk wh er e h is/ h er orga n iza tion
wa n ts to be a fter a cer ta in per iod, wh a t i t will n eed to get to wh er e it wa n ts, a n d h ow t o devel-
op str a tegies a n d t h e m ea n s to get t h er e, a n d fin a l ly, h ow to m a n a ge th ose str a tegies to
a ch i eve th e or ga n iza ti on s goa ls a n d objectives. It is r ecogn ized th a t th e fu tu re ca n n ot be
1. Ben ja m i n L. Cr osby i s a Di r ector of MSI ; h e h olds a Ph .D. fr om Wa sh i n gt on Un iver si ty i n St . Lou is, Missou r i,
a n d m a n a ges th e I m pl em en tin g Pol icy Ch a n ge pr oject.
Ann ex 5-A 5-7
con t roll ed, bu t th e a r gu m en t ca n be m a de th a t by a n tici pa t in g th e fu tu re, or ga n iza t ion s ca n
h el p to sh a pe a n d m odify th e im pa ct of en vir on m en ta l ch a n ge.
Secon d, th e str a tegi c a ppr oa ch h a s a n extern a l em ph a sis. I t t a kes in t o a ccou n t sever a l com -
pon en ts of th e exter n a l en vir on m en t, in clu din g tech n ology, politics, econ om ics a n d th e so-
cia l dim en sion . Str a tegic t h in ki n g recogn izes t h a t ea ch of t h ese ca n eith er con str a in or fa cil-
ita te a n or ga n i za tion a s it seeks to im plem en t pol icy. Polit ics wil l det er m in e th e policies th a t
a re to be im plem en ted, econ om i cs will deter m in e t h e orga n iza tion s level of resou r ces, a n d
socia l fa ctor s m igh t well deter m in e wh o th e or ga n iza ti on s ben eficia r ies will be. I n pa r ticu -
la r, str a tegic th in kin g r ecogn i zes a n d em ph a tica lly ta kes in to a ccou n t politi cs a n d th e exer -
cise of polit ica l a u th or ity. Ma n a gers a r e n ot fr ee to do a n yth in g th ey decide. Ma n a ger s m u st
be sen sitive to th e n eeds a n d respon d to dem a n ds of con stitu en ts over wh om th ey h a ve l ittle
or n o con tr ol. Am on g th ose con st itu en ts, politica l a ct or s a r e per h a ps th e m ost i m por ta n t.
Th ir d, th e st ra tegic a ppr oa ch con cen tr a tes on a ssu r in g a good fit bet ween th e en vir on m en t
a n d t h e orga n i za tion ( in clu di n g i ts m issi on a n d object ives, str a tegies, str u ctu r es, a n d r e-
sou r ces) a n d a tt em pt s to a n ticipa te wh a t will be r equ ir ed t o a ssu re con tin u ed fit. Un der con -
dition s of r a pid polit ica l, econ om i c a n d socia l ch a n ge, str a tegi es ca n qu i ckly becom e ou t-
m oded or n o lon ger serve u sefu l pu r poses; or th e r esou r ces tr a di tion a lly r equ ired by th e
orga n iza tion to pr odu ce i ts goods a n d ser vi ces m a y su dden l y becom e u n a va ila ble. Th e st ra -
tegic a pproa ch r ecogn izes th a t to m a in ta in a close fit with th e en vir on m en t, th e differ en t el-
em en t s of t h e orga n i za tion will n eed to be con tin u ou sly r e- a ssessed a n d m odified a s th e en -
vir on m en t evolves.
Fin a lly, th e str a tegic a ppr oa ch is a pr ocess. I t i s con t in u ou s a n d recogn izes th e n eed to be
open to ch a n gin g goa ls a n d a ctivi ties i n l igh t of sh i ftin g cir cu m sta n ces wi th in th e en vi ron -
m en t. It is a pr ocess th a t r equ ir es m on it orin g a n d r eview m ech a n ism s ca pa ble of feedin g in -
for m a ti on to m a n a ger s con t in u ou sl y. Str a tegi c m a n a gem en t or pl a n n in g a r e n ot on e- sh ot
a ppr oa ch es, th ey a r e on goin g.
Wh en a ll ta ken toget h er, t h ese a ttitu des a n d beh a vi ors a r e r ea lly a wa y of a ppr oa ch i n g or
th i n kin g a bou t h ow t o m a n a ge or h ow to im pl em en t poli cy ch a n ge. Str a tegic m a n a gem en t ( or
pla n n i n g) is n ot som eth in g th a t ca n be a ppli ed on ly on ce a n d t h en for got ten a bou t or ign ored.
I n t h a t sen se i t is m or e th a n a t ool ; i t is a m en ta l fr a m ework.
The Strategic Management Process
Wh a t does a str a tegi c m a n a gem en t pr ocess l ook like? Th e a pproa ch descr ibed below is su g-
gested a s a gu ide:
1. Agreem en t on a n d in itia ti on of th e str a tegic m a n a gem en t pr ocess.
2. I den tifica tion a n d cla r ifica tion of th e or ga n iza tion s m ission , object ives, a n d cu r r en t
str a t egies.
3. I den tifica tion of th e or ga n iza tion s in tern a l str en gth s a n d wea kn esses.
4. Assessm en t of th e th r ea t s a n d oppor tu n ities fr om th e extern a l en vi ron m en t.
5. I den ti fica tion of key con stitu en t s/ st a keh older s a n d th eir expecta tion s.
6. I den ti fica tion of th e key str a tegic issu es con fr on ti n g th e or ga n i za tion .
7. Design / a n a lysi s/ sel ection of str a tegy a ltern a tives a n d option s to m a n a ge i ssu es iden tified
in step 6.
8. I m plem en ta tion of st ra tegy.
9. Mon it or in g a n d review of t h e str a t egys per for m a n ce.
Th er e i s m u ch sim ila r ity in th e a pproa ch descri bed h er e a n d th a t of ot h er s ( see Appen di x
On e for a descr iption of th r ee) . I f on e wer e t o stop a fter Step n u m ber 7, th e pr ocess wou ld be
sim pl y a str a tegic pla n n in g exer cise. Fr equ en tl y, th is is exa ctly wh er e th e pr ocess does stop, espe-
cia ll y wh en m a n a gem en t a n d th e st ra tegic pl a n n in g fu n cti on s h a ve been delin ked. Th is
occu rs wh en th er e i s n o a ttem pt t o develop a str a tegi c m en ta lity a m on g lin e m a n a gem en t;
in stea d, th e or ga n iza tion a ttem pts to set u p a specia l depa r tm en t , di vision , or gu r u for str a te-
gic pl a n n i n g r a th er th a n in tegr a te th e fu n cti on s in to n or m a l l in e m a n a gem en t. Wi th ou t th e
expr essed lin ka ge it is often difficu lt for th e lin e m a n a ger to see th e va lu e of th e str a tegic pla n ,
a n d t h er e will th erefor e be less i n ter est a n d i n cen tive i n str a tegi ca lly m a n a gin g. I n con tr a st, if
th e str a tegic a pproa ch i s em ployed, or th e or ga n iza tion is im bu ed with a str a tegic m en ta lity,
th en str a tegi c pla n n in g will be don e a s pa r t of th e cou r se of n or m a l ( str a tegi c) m a n a gem en t
fu n ction s.
Step One: Agreement on the process.
Th e fi rst step i n t h e str a t egic m a n a gem en t process is to get a gr eem en t n ot on ly to ca r ry ou t
th e pr ocess bu t a lso t o get a gr eem en t on h ow a n d wh en a n d by wh om it will be ca r r ied ou t.
Sin ce th e st ra tegic m a n a gem en t pr ocess is n ot a on e- sh ot exercise, com m i tm en t to th e l on g-
h a u l is vita l; with ou t com m it m en t, th e exercise wi ll be ster ile a n d likel y r ega r ded a s a wa st e of
tim e.
Wh o sh ou ld be in clu ded in th e st ra tegic m a n a gem en t pr ocess? At lea st th r ee differ en t t ypes of
in dividu a ls sh ou ld be con si der ed for i n clu sion : th e or ga n iza t ion s top decision - m a kers a n d
th ose offici a l s wh o wil l h a ve dir ect r espon sibilit y in im plem en ta tion of policy; t h ose wh o h a ve a
m a j or st a ke in th e ou tcom e of th e policy, wh eth er fr om with in or ou tside th e or ga n iza t ion ,
wh et h er su ppor ti ve or oppositi on a l, clien ts or resou rce su ppl ier s; a n d th ose with speci a l ized
kn owledge th a t ca n a dd to t h e a n a lysis of t h e policy to be decided or im plem en ted. Alth ou gh r el-
a tively br oa d i n volvem en t in th e pr ocess sh ou ld be en cou r a ged, ca re m u st be ta ken t h a t su ch
grou ps n ot be expa n ded to th e poin t of i n ca pa cit y t o m a ke a gile deci si on s.
How sh ou ld th e pr ocess be in itia ted? Fir st , a gr eem en t t o ca r r y ou t a n d com m i tm en t to th e
process of str a tegi c m a n a gem en t m u st be obta in ed from on e or m or e of th e or ga n iza tion s key
decision m a ker s. On ce su ch a gr eem en t a n d com m itm en t is a ccom plish ed, th en deci si on s a bou t
wh a t sh ou ld be con sider ed a n d wh o sh ou ld be in volved ca n be a ddr essed. I f issu es a r e com plex
a n d t h er e is a n eed to i n volve a rela tively wide spectr u m of a ctor s a n d sta keh older s, t h en wor k-
Ann ex 5-A 5-9
sh ops m igh t be con sider ed. I f th e i ssu es a r e less com plex or fewer a ctor s n eed to be in volved,
th en di rect con su lt a t ion s or sm a ll grou p a r ra n gem en ts m igh t pr ove m or e efficien t.
Step Two: I dentification and clarification of the organizations
mission, objectives and current strategies.
On ce a n or ga n iza tion h a s a gr eed to en ga ge in a str a tegic pr ocess, t h e fir st ta sk i s to deter m i n e
wh a t a n d wh er e t h e orga n i za tion is. Wh a t a re th e n eeds t h a t th e or ga n iza tion a ttem pts to sa t-
isfy, wh ose n eeds a r e th ey, a n d wh a t i s th e va lu e of sa tisfyin g th ose n eeds? All t oo often or ga n iza -
tion s devel op a ser vice or a pr odu ct a n d th en fa il to per iodica lly exa m i n e wh et h er or n ot t h a t
produ ct a ctu a lly sa tisfies a dem a n d or wh et h er sa ti sfa ction of t h a t dem a n d a ctu a l ly m a tter s.
Wh o a r e th e people th a t com pose th e or ga n i za tion , wh a t a r e t h ei r va lu es, a n d wh a t n eeds does
th e or ga n iza ti on sa tisfy for t h em ? ( I n r esou r ce- poor en vir on m en ts, a gen cies th a t sa tisfy on ly
m a r gin a l or per iph er a l dem a n ds a r e vu l n er a ble to bu dget cu ts, a bol ish m en t, or a bsor pt ion by
oth er orga n iza tion s.) Wh a t a r e th e objectives of t h e orga n i za tion a n d h ow wel l do t h ey m esh
with th e n eeds a n d dem a n ds of clien ts, sta keh older s a n d con st itu en ts? Wh a t str a tegies does th e
orga n iza tion em ploy to a ch ieve th e objectives it h a s set for itself? Is th e or ga n iza tion bei n g
a sked to m a ke fu n da m en ta l ch a n ges in wh a t it does, or in th e ki n ds of clien ts i t ben efit s? If so,
wh a t a re th ose ch a n ges?
At th is poin t, Lou ise Wh it e, wh ose fr a m ewor k is in cor por a ted in t h e IPC [ Im plem en tin g Pol-
icy Ch a n ge] pr oject pa per, a r gu es t h a t th e policy in qu estion sh ou ld be exa m in ed wi th r espect to
its com pa tibi lity with t h e orga n iza tion s m ission , objectives a n d str a tegy. To a ccom plish th is i t i s
n ecessa r y to sta t e th e obj ectives of th e policy, th e n a tu r e of t h e ser vice or a ct ivity in ten ded, t h e
ben efits t o be pr odu ced a n d th e ben eficia ri es, a n d descr ibe th e com plexi ty of th e policy. ( Wh it e
1989)
Cla r ifi ca tion of t h e m ission , objectives, a n d str a tegies is fu n da m en ta l to i n iti a t ion of th e
str a t egic pr ocess. I t a m ou n ts t o a sta tem en t of wh er e th e or ga n iza tion i s, wh a t it does a n d h ow it
goes a bou t its bu si n ess. It sh ou l d a lso h elp cla r ify wh ich policies or dem a n ds ca n be fa cilita ted
by t h e orga n i za tion a n d wh ich wil l be im peded.
Step Three: I dentification of the organizations internal strengths
and weaknesses.
On e wa y t o exa m in e th ese i s to look a t th e or ga n iza tion s r esou r ce ba se ( skil l ba se, ca pita l or
fin a n cia l r esou r ces, et c.) Does t h e or ga n iza t ion h a ve th e wh erewith a l t o a ch ieve it s sta ted obj ec-
tives or to pu t i n to m otion it s str a t egies? Wh a t a r e th e levels of in ter n a l resou r ces possessed by
th e or ga n iza ti on ? How a va i la ble a r e th ey?
An a lysis of r esou r ces by itself i s n ot su fficien t, th e or ga n iza tion m u st a lso l ook a t it s t a sk per -
for m a n ce. Wh a t ta sks does it do wel l, wh ich does it n ot? Th is wil l give a better idea of h ow th e
orga n iza tion s r esou rces a r e or ga n i zed a n d h ow effectively th ose r esou r ces a r e pu t to u se. An
orga n iza tion m a y well h a ve excellen t r esea r ch skill s, bu t if its pri m a r y ta sks a re in ser vice del iv-
er y, th en su ch skil ls m a y be m or e a wea kn ess th a n a st ren gth . However, on e sh ou ld n ot a u to-
m a t ica lly m a ke th e a ssu m ption th a t sin ce idle ca pa city exists, it sh ou ld be dispen sed wi th . Su ch
ski lls m a y well be qu ite u sefu l if th e or ga n iza tion sh ou ld n eed to m a ke ch a n ges in or der to be
m or e com pa t ible with its en vi ron m en t.
I n a dditi on t o skills a n d r esou r ces, oth er elem en ts of th e in ter n a l or ga n iza ti on n eed to be
exa m in ed: wh a t is t h e n a tu r e of th e or ga n iza tion a l cl im a t e ( a r e th er e clea va ges, a r e t h ey con -
flictive?) , h ow a da pta ble a r e th e pa r tici pa n ts ( wou ld th ey r ea dily ta ke on n ew ta sks, h ow l on g
h a ve th ey been doin g th e sa m e th in g?) , wh a t is th e n a tu r e a n d flexibili ty of th e or ga n iza t ion a l
str u ctu r e ( is it r igid, h a ve sign ifica n t ch a n ges been m a de in th e pa st , a n d wh a t h a s been th e
r ea ction ?) , is th er e a n in for m a l st ru ctu re ( h ow does i t wor k a n d is it m ore cogen t th a n th e for -
m a l str u ct u r e?) , wh a t is th e n a tu r e of t h e in cen ti ve st r u ctu re ( i s it design ed to en cou r a ge in n o-
va tive beh a vior, ca n i t r ecru it a n d m a in ta in a su fficien tly h igh level of per son n el?) ? Wh ich ele-
m en ts fa cilit a te a n d wh i ch im pede perfor m a n ce of th e or ga n iza tion s ta sks a n d wh ich m igh t
fa cil ita te or im pede or ga n iza tion a l ch a n ge?
Step Four: Assessment of threats and opportunities in the external
environment.
Wh il e t h er e is fr equ en t ly a ten den cy on th e pa r t of m a n a ger s to focu s on th e i n ter n a l dim en -
sion s of th e or ga n iza ti on , pol icy ch a n ge a n d th e oft en vola tile n a t u r e of politi cs in cou n tr ies
u n der goin g m a jor policy ch a n ges r equ ir es con sciou s explor a t ion of th e en vir on m en t ou tside
th e or ga n iza ti on .
Polit ica l, econ om i c, socia l, a n d t ech n ologica l ch a n ges will in flu en ce th e dir ection a n d
sh a pe of a n orga n iza tion s poli cies a n d objectives. Wh a t a r e th e m a j or tr en ds t h a t ca n be
detected in ea ch of th ese a r ea s th a t will h a ve som e bea r in g on th e a ct iviti es of th e or ga n iza t ion ?
How m igh t m a cro- econ om i c m ea su r es bein g in sti tu ted a ffect t h e fin a n cia l resou r ces of th e
orga n iza tion ? Wh a t is th e n a tu r e of poli tica l su pport for th e poli cy u n der con sidera ti on ? How
politica l ly st a bl e is th e cu rr en t regi m e? I s policy lea dersh i p a bou t to ch a n ge? Will key officia ls
with in th e ca bin et be ch a n ged a n d wh a t will th a t m ea n to th e developm en t a n d im pl em en ta -
tion of th e pr oposed policy ch a n ge? To wh a t exten t h a ve th e govern m en ts pr im a r y pol itica l coa -
liti on s begu n t o ch a n ge? Does th is si gn ify im pen din g ch a n ges i n poli cy pr ior it ies? How effective
is th e poli tica l opposit ion ? Wh a t r ole do in ter n a tion a l for ces or a ctor s pla y in th e det er m i n a tion
of policy? To wh a t exten t h a s th e socia l com position of th e or ga n iza tion s pri m a r y clien tel e
grou p ch a n ged? Ha s it ou tgr own th e r esou r ces of th e or ga n iza tion ? Ha ve its n eeds ch a n ged over
th e yea rs?
An im port a n t fa ctor in t h e or ga n iza ti on s ext er n a l en vir on m en t i s i ts bu rea u cr a tic a n d i n sti-
tu t ion a l settin g. Is th e or ga n iza ti on a u ton om ou s? Or i s it lin ked t o a m in istr y, or m u st it coor di-
n a te its a ction s with oth er en t ities a n d wh a t is th e n a tu r e of th ose m ech a n ism s? Ar e oth er orga -
n iza tion s i n volved in th e sa m e a ctivi ty, wh a t a r e th eir r oles? Ar e th er e in cen tives for
cooper a tion ?
Ann ex 5-A 5 -1 1
Step Five: I dentification of key constituents and stakeholders,
their expectations and resources.
Th e expecta tion s a n d dem a n ds of con st itu en ts a r e key in gr edien ts for decision s a bou t wh a t a n
orga n iza tion will do a n d h ow i t goes a bou t ca r r yin g ou t its ta sks. Sta keh ol der s or con sti tu en ts
a re th ose wh o h a ve a dir ect i n terest in a n d a re ca pa ble of in flu en cin g i n som e m ea su re th e ou t-
com es or a cti on s of th e or ga n iza tion . Sta keh ol ders pr ovide th e pri m a r y ba se of pol itica l su ppor t
for th e or ga n iza t ion , a n d i n a si gn ifi ca n t wa y a r e its r a ison dtr e. A r a th er wide ra n ge of a ctor s
m i gh t be in clu ded: com pet itor s, ben eficia r ies, dir ector s, em pl oyees, politi ca l pa r ties, con su m -
er s, in ter n a ti on a l don or s, etc. Wh a t do t h ese pa r ticu la r grou ps wa n t fr om t h e or ga n iza t ion ? Ar e
th ey sa ti sfied with th e cu r r en t a r r a y of ser vices a n d level of per for m a n ce? Ar e th eir in t er ests sh ift-
in g? I n wh i ch dir ecti on ? An d if so, will th e or ga n iza t ion be a ble to r ea ct fa vor a bly?
I n exa m in in g th e in t er ests of st a keh older s, a ca u tion a r y n ote is in or der. Th er e ca n be a
tem pta tion to tr y t o con sider ever y a ct or wh o m igh t h a ve som e in ter est or in flu en ce in th e orga -
n iza tion . Th a t tem pta t ion ou gh t to be a voided a n d th e a n a l yst sh ou ld ta ke ca r e to a ssu r e th a t
on ly th ose th a t ca n h a ve a rea listic a n d r ea son a bly sign i fica n t im pa ct a r e con si dered in th e
sta keh older a n a lysis.
Step Six: I dentification of key strategic issues.
Th e in for m a ti on gen er a ted by th e pr ecedin g steps sh ou ld iden tify a set of fu n da m en ta l qu es-
tion s or key problem s r ega r din g th e fi t of th e or ga n iza ti on wit h i ts en vir on m en t. Th ese pr ob-
lem s m igh t con cer n th e or ga n iza tion s m ission , i ts pr odu cts or services, its clien ts, fin a n cin g
m ech a n ism s, m a n a gem en t, or r el a t ion sh ip to cer ta in sta keh older s. Str a tegic issu es a r e th e
pri n cipa l pr oblem s th a t m u st be dea lt with effecti vely or th e or ga n iza tion ca n expect u n desir -
a ble r esu lts. Th e effect ive tr ea tm en t of st r a tegic issu es ca n sign i fy fu n da m en ta l ch a n ge in h ow
th e or ga n iza ti on goes a bou t it s bu sin ess. Su ch issu es m a y gen er a te con flict with in th e or ga n i-
za tion sin ce th eir r esolu t ion will pr odu ce win n er s a n d loser s both in ter n a ll y a n d ext er n a lly. Th e
orga n iza tion m u st be pr epa r ed to dea l wi th th a t con fl ict.
I n iden t ifyin g str a tegic i ssu es or pr oblem s, ca r e m u st be ta ken in specifyin g exa ctly wh a t t h e
problem or issu e is, wh y it is a pr oblem for th e or ga n iza tion , a n d th e or ga n iza tion a l con se-
qu en ces of i n a ction . All too often in su fficien t a tt en ti on is given to pr oblem iden tifi ca tion r esu lt-
in g in m i sa ll oca ted r esou rces a n d lost oppor tu n i ties. I t i s a lso im port a n t t o determ in e wh eth er
or n ot th e or ga n iza ti on ca n do a n yth in g a bou t th e pr oblem if n ot, it is n ot a n issu e. Ma n a g-
er s m u st a lso r ecogn i ze th a t it wi ll be im possible t o ta ckle a l l issu es a t on ce; th erefor e, pr oblem s
sh ou ld be i den tified a ccor di n g t o sh or t- , m ediu m - or lon g- r u n im port a n ce a n d t h e u r gen cy of
a ction n eeded. Ma n a gers will fi n d t h a t en ergy expen ded in pr obl em a n d issu e iden tifi ca tion a n d
cla r ifica tion will h a ve pa yoffs in th e developm en t of str a tegies for th eir tr ea t m en t.
Step Seven: Design, analysis, and selection of strategy alternatives
and options to manage issues identified in Step 6.
On ce issu es a n d pr oblem s h a ve been iden tified, str a tegies to solve t h ose pr oblem s n eed t o be
iden tified. Gen er a l ly, m or e th a n on e option for dea lin g wi th th e pr oblem will be iden ti fied; th en
option s m u st be exa m in ed for th eir com pa ra ti ve via bilit y, fea sibility, a n d desir a bi lity. Ca n th e
str a t egy wor k fr om a pr a ctica l a s well a s th eor etica l st a n ce? I s th e orga n iza tion ca pa bl e of ca r r y-
in g ou t th e str a tegy? I s th e str a t egy a ccept a bl e to t h ose ca r ryin g it ou t a n d t o th ose t o wh om it is
dir ected? Does th e or ga n iza tion h a ve th e h u m a n a n d m a ter ia l resou rces, does it h a ve th e
kn ow- h ow n ecessa r y, a n d is th e a ppropr ia te or ga n iza tion a l str u ctu r e a va ila ble for im plem en t-
in g th e str a tegy? Will th e str a tegy a ccom plish wh a t t h e m a n a ger wa n ts a n d ben efit th ose
in t en ded? Ca n th e str a tegy be su sta in ed, a n d ca n i t a da pt t o th e pr ojected ch a n ges in th e en vi-
r on m en t? I s flexibili ty bu il t in to th e st ra t egy? Ca n th e n ecessa r y r esou r ce ba se be su sta in ed over
th e life of th e str a tegy?
Desir a bility h a s to do wit h t h e fit of or ga n iza t ion a l a n d en vir on m en ta l va lu es a n d objectives
with th e str a tegy. I s th e str a tegy com pa tible with th e i m plem en tin g in sti tu ti on s m i ssion or it s
fu n da m en ta l obj ecti ves, a n d/ or wit h th e m issi on a n d objectives of colla bor a tin g or ga n iza tion s?
I s th e str a tegy ta r geted to th e m ost a ppr opri a te ben eficia r ies? I s i t com pa tible with th e l ega l a n d
bu r ea u cra t ic settin g? How well will th e str a tegy a dju st to for eca st tr en ds in th e m ediu m a n d in
th e lon g ter m ? How wil l key sta keh ol der s be a ffected, h ow com pa tible is t h e st ra t egy wi th th ei r
va lu es a n d expecta t ion s?
Step Eight: I mplementation of the strategy.
I m plem en ta tion of a str a tegy is n ot a n a u tom a tic process; th er e a r e two m a jor pa r ts to th e pr o-
cess. Th e fi rst step i s th e developm en t of a n a cti on pla n , wh ich is a sta tem en t of wh a t, wh o,
wh en , a n d h ow th e a ct ion s n ecessa r y t o ca r r y ou t t h e st ra tegy wi ll be don e. Per for m a n ce goa ls
a n d obj ecti ves wi ll a lso be specified. Mu ch of t h e in for m a tion n eeded to devel op th e a ction pla n
will h a ve been gen er a ted in Step Seven .
Th e secon d pa rt of im plem en ta tion con sists of a ction s a im ed a t m a rsh a lin g a n d a pplyin g
r esou rces. I n th e con text of policy ch a n ge th ese a ction s m a y con sist of ( bu t a re n ot lim ited to) ,
ch a n ges in orga n iza tion a l stru ctu res, sh ifts a n d recla ssifica tion of person n el, th e esta blish m en t of
n ew rou tin es, ta sks, a n d procedu res; in sta lla tion of n ew in cen tive system s; retoolin g produ ction
for n ew pr odu cts or services; m a rketin g of n ew ser vices or crea tion of dem a n d a m on g n ew ben efi-
cia ries or con su m ers; developm en t of n ew fin a n cin g m ech a n ism s; orga n izin g coa lition s to m a in -
ta in politica l, bu dgeta ry, a n d ben eficia ry su pport; a n d developin g colla bora tive m ech a n ism s with
coopera tin g orga n iza tion s. It sh ou ld be n oted th a t th e m a n a ger s ta sk is m ore th a n ju st th e in ter-
n a l opera tion of h is orga n iza tion , th ey m u st a lso m a n a ge its fit with th e en viron m en t.
Step Nine: Monitoring and review of performance.
Str a tegic m a n a gem en t a ssu m es con t in u a l ch a n ge. Th er efor e m ech a n i sm s m u st be developed
for m on itor in g a n d a n a lyzin g t h e per for m a n ce of th e or ga n iza tion with r espect to a ch ievin g th e
Ann ex 5-A 5 -1 3
goa l s a n d objectives set in th e a ct ion pl a n . As th e en vir on m en t u n der goes ch a n ges, a s m in i st er s
ch a n ge, election s occu r, or bu dgets go u p or down , pr ior iti es will a lso ch a n ge. Resou rce fl ows
m a y be u n even . Al l of th ese el em en ts ca n a l ter perfor m a n ce, pr ior iti es, a n d th e desi ra bili ty of
cer ta in policies. I f th e or ga n iza tion wa n ts t o m a i n ta in a good fi twit h t h e en vir on m en t, it
m u st fi rst be a ble to tr a ck th ese ch a n ges in order to a dju st.
Th e m on it or in g pr ocess sh ou ld be con ti n u ou s, r egu la r, a n d ca pa ble of feedin g in to th e deci-
sion - m a kin g pr ocess. Th e m a n a ger sh ou ld develop con trol m ech a n ism s to ga u ge th e efficien cy
of r esou r ces u sed a n d i m pa ct m ech a n ism s to ga u ge th e effect iven ess of its a ct ion s. Fin a lly, it is
vita l th a t th e m on it orin g pr ocess be tim ely a n d u sa ble.
Appendix One: Different Approaches to Strategic Planning
and Management
Mu ch a tt en ti on i n t h e litera tu r e h a s been devot ed to st ra t egic m a n a gem en t a n d str a tegic pla n -
n in g bu t wi th m ost em ph a si s on th e pr iva te sector. Never th eless, in th e la st sever a l yea r s,
th ere h a s been a gr owin g in terest a n d litera tu r e ( eg., Rin g a n d Per r y, 1985, a n d Sa m u el Pa u l,
1983) on a ppl ica tion s in th e pu bli c sector. Th r ee recen t a ppr oa ch es a r e br iefly descr ibed in th is
a ppen dix.
Two recen t books on str a t egic pla n n in g a n d str a t egic pu bl ic m a n a gem en t illu stra t e th e over -
la p bet ween th e two con cepts. Ea ch develops a str a tegic pr ocess con sisti n g of sever a l steps.
Dr a wi n g on Nu t t a n d Ba ckoff ( 1987) , Bozem a n a n d St ra u ssm a n ( 1990) ou t lin e six steps for
pu tti n g str a tegic m a n a gem en t to work. Th ese st eps a m ou n t to a ba sic fr a m ewor k for str a tegic
m a n a gem en t:
1. Dea lin g with h istory: a n a n a l ysis of th e h istor y of t h e orga n i za tion , it s m ission a n d its
m a n da t e.
2. Stock Ta kin g: a n eva l u a tion of t h e orga n iza tion s cu r r en t in ter n a l fin a n cia l, or ga n iza -
tion a l, a n d h u m a n r esou r ces.
3. Eva l u a tin g I ssu es: i den ti fica ti on of th e sign ifica n t issu es th a t will a ffect th e perform a n ce
or ca pa city of th e or ga n iza ti on .
4. Developin g St r a tegies: devel opm en t of str a t egic a lter n a ti ves t o r espon d t o a n d m a n a ge
th e issu es iden t ified.
5. Assessin g Fea sibility: eva lu a ti on of th e ca pa city of th e orga n iza tion to ca r r y ou t th e str a te-
gic a l ter n a ti ve with in th e con text.
6. I m plem en ta tion : t h e a ctu a l ca r r yin g ou t of t h e st ra tegy sel ected.
I t is ea sy to r ecogn ize sever a l pa r a l lels between Bozem a n a n d Str a u ssm a n a n d th e eigh t- step
process for str a tegic pla n n in g la id ou t by Joh n Br yson ( 1988) :
1. I n iti a t in g a n d a gr eein g on a str a tegic pla n n in g process.
2. I den tifyin g or ga n iza tion a l m a n da tes.
3. Cla r ifyin g or ga n i za tion m ission a n d va lu es.
4. Assessin g th e ext er n a l en vir on m en t oppor tu n iti es a n d th r ea ts.
5. Assessin g th e i n ter n a l en vir on m en t: st ren gth s a n d wea kn esses.
6. I den ti fyin g th e str a tegic issu es fa cin g a n orga n iza tion .
7. Form u l a t in g st ra tegies to m a n a ge th e issu es.
8. Esta blish i n g a n effecti ve orga n iza tion a l vision for t h e fu t u r e.
Lou ise Wh ite ( 1989) esta blish es a sligh tly sh or ter bu t sim ila r str a tegic pr ocess:
Step 1. Agr ee on a pr ocess for developin g a n im plem en ta tion st ra tegy.
Step 2. Ma p or a ssess th e situ a tion ( th is in clu des a n a lysis of th e ext er n a l a n d in ter n a l en vi-
r on m en ts, th e con ten t of th e policy, a n d sta keh older expecta tion s a n d r esou r ces) .
Step 3. I den t ify th e str a tegic issu es.
Step 4. Design a n im pl em en ta ti on str a tegy.
Step 5. Design a pr ocess for m on i tor in g r esu lts a n d m a kin g on goin g a dju stm en t s.
Wh ere do th ese pr ocesses di ffer ? I s i t r ea ll y on ly a t th e en ds of ea ch pr ocess? Br yson con -
clu des with th e form u l a tion of str a tegies a n d t h e esta blish m en t of a n effective or ga n iza ti on a l
vision for th e fu tu re; Bozem a n a n d Str a u ssm a n con clu de t h e process with im plem en ta tion of
th e st ra tegies for m u la ted. Pla n n er s in Bryson s m odel, a r e n ot dir ectl y r espon sible for th e im ple-
m en ta ti on of wh a t th ey h a ve pl a n n ed, except in sofa r a s th ose sa m e per son s a lso will be ta sked
with im plem en ta tion ( n ot a ll or ga n i za tion s ca n rea di ly sepa r a te th e pla n n in g a n d m a n a ge-
m en t fu n ction s) . Bu t in a ll fa ir n ess, Br yson is a da m a n t i n i n sistin g th a t th e a lter n a tives devel-
oped to cope wi th st ra tegic issu es be both wor ka ble a n d a ccepta ble. Assu r in g th a t cou l d well be
con sider ed ta n t a m ou n t t o im plem en t a t ion .
Wh it e, on t h e oth er h a n d, goes fu r th er th a n ei th er of th e ot h er t wo. Wh er ea s Bozem a n a n d
Str a u ssm a n en d wit h im plem en t a tion s,Wh ite con cl u des h er m odel of str a t egic m a n a gem en t
with su ggestion s for th e developm en t of m ech a n i sm s for m on itor in g to feed th e on goi n g pr o-
cess of a dju st m en t a n d cor rection s. Th is la st st ep i s a vita l on e, a n d deser ves em ph a si s. Th e LDCs
u n der goin g a dju stm en t ten d t o be ch a r a cteri zed by en vir on m en ta l vola ti lity t o a ssu m e t h a t a
sin gle str a tegy is n ot su bject t o eit h er r evision or m odifica tion ( a n d often r a th er extr em e r evi-
sion or m odifi ca tion ) wou l d be sh ort [ - si gh ted] . Th er efor e, m ech a n ism s to m on itor th e or ga n i-
za tion s con tin u in g fit with th e en vir on m en t a s well a s pr ogr ess towa rd obj ecti ves a r e cr itica l.
An oth er differ en ce li es in ea ch s tr ea tm en t of th e extern a l en vir on m en t. Wh it e a n d Br yson
pu t con sider a ble specifi c em ph a sis on t h e en vir on m en t in th e steps th ey descr ibe a s pa r t of th e
str a t egic process. Bozem a n a n d Str a u ssm a n cert a in ly r ecogn i ze th e im port a n ce of t h e exter n a l
en vir on m en t a s ca n be seen in th e foll owi n g excer pts fr om th eir wor k:
On e pu r pose of st ra tegic m a n a gem en t is to m edia te between th e orga n iza tion a n d t h e
en vir on m en t .
Ann ex 5-A 5 -1 5
Pu bl ic m a n a gem en t n ecessa r ily r equ ir es a t ten tion to th e or ga n iza t ion s en vir on m en t
beca u se th e in flu en ce of exter n a l politica l a u t h or ity em a n a tes from th e en vi ron m en t
[ for th is r ea son , effecti ve pu blic m a n a gem en t requ ir es a tt en ti on t o str a t egy.
...a n exter n a l per spective em ph a sizin g n ot a da ptin g to t h e en vir on m en t] bu t a n ticipa t-
in g a n d sh a pin g of en vir on m en ta l ch a n ge. Str a tegi c pu bl ic m a n a gem en t a dds a n a ddi -
tion a l in gr edien t: str a tegic th in kin g m u st be cogn iza n t of th e exercise of politica l
a u th or it y.
However, u n like eith er Wh ite or Bryson , Bozem a n a n d Str a u ssm a n do n ot descr ibe a specifi c
step for a n a l ysis of th e exter n a l en vir on m en t with in th ei r r ecom m en ded fr a m ewor k. An a lysi s of
th e en vir on m en t is left a s a n im plicit ta sk. Th e da n ger of th is a ppr oa ch i s th a t su ch a n a l ysis
m i gh t sim ply be over looked a s bein g t oo h a r d to do or a s bei n g too ten u ou s t o a dd a n yth in g.
Given t h e im pa ct of th e en vir on m en t on pu blic or ga n iza ti on s, explicit a n d direct a n a lysis is
im per a t ive.
Not su r pr isin gly, th e fa ct th a t bot h a ppr oa ch es em ploy t h e ter m str a tegic gives th e two a
grea t dea l in com m on . St ra tegy, or t h e str a t egic ou tlook sign ifies a for wa r d lookin g m en ta lit y.
Str a tegy does n ot con cer n t h e pa st except for th e lesson s a n d in pu t t h a t ca n be extr a ct ed fr om
pa st exper ien ce. Str a tegy con cer n s th e fu tu r e, a n d to th e exten t th a t th e fu tu re is u n kn own , th e
grea ter it s u n cer ta in ty. Ta sks th a t con cer n th e ver y sh or t r u n a r e gen er a lly n ot gri st for t h e st ra -
tegic m ill. Th e fu r th er th e h ori zon of tim e in volved in th e ta sk, th e gr ea ter t h e level of u n cer -
ta in t y. I n a sm u ch a s str a tegy in volves th e fu tu r e, a n d pa rt icu l a r ly th e m id- t o lon g- r u n fu tu r e,
u n cer ta in ty t h en becom es a pa r t of th e str a tegic pr oblem . Th e str a t egy m ou n ts to a bet th a t th e
fu t u r e wi ll evolve in a pa r ticu la r wa y a n d t h a t th e m a n a ger s pa r ticu la r vision of th e fu tu re
im plied i n th e selection of a st ra tegy wil l be th e cor r ect on e.
References
Ba r r y Bozem a n a n d Jeffr ey D. Str a u ssm a n , Public Management Strategies: Guidelinesfor
Managerial Effectiveness. Oxfor d: Jossey- Ba ss Pu blish ers, 1990.
Joh n M. Br yson , Strategic Planningfor Public and Nonprofit Organizations. Oxfor d:
Jossey- Ba ss Pu blish er s, 1988.
Ha yes, Rober t H., Wh y Str a tegi c Pla n n i n g Goes Awr y., TheNewYork Times, Apri l 20, 1986.
Nu tt , P.C., a n d Ba ckoff, R.W. A Str a t egic Ma n a gem en t Pr ocess for Pu bl ic a n d Th ir d-Sector
Or ga n iza tion s. Journal of theAmerican PlanningAssociation, 1987, 53, pp.4457.
Pa u l , Sa m u el, Strategic Management of Development Programmes: Guidelinesfor Action.
Gen eva : In ter n a t ion a l La bor Office, Ma n a gem en t Developm en t Ser ies, No. 19, 1983.
Rin g, P.S., a n d Per r y, J.L., Str a tegic Ma n a gem en t in Pu blic a n d Pri va te Orga n iza tion s: I m pl i-
ca tion s of Disti n cti ve Con texts a n d Con str a in ts. Academy of Management Review,
1985, 10, pp.27686.
Lou ise G. Wh ite, ManagingPolicy Reformin theLDCs. Bou lder, Color a do: Lyn n e Rein n er
Pu bl ish er s, 1990.
_ _ _ _ _ _ _ _ , I m plem en t in g Policy Ch a n ges ( u n pu bl ish ed pa per a t ta ch ed to USAI D Proj ect
Pa per for Im plem en tin g Policy Ch a n ge Pr oject.) Septem ber, 1989.
Ann ex 5-A 5 -1 7
I PC Technical Notesisa publication of theU.S. Agency for International Development
(USAID) ImplementingPolicy ChangeProject (#936-5470, Contract #AEP-5470-I-00-
5034-00), whichismanaged by theAgencysGlobal Bureau, Center for Democracy and
Governance. TheCenter for Democracy and GovernanceisUSAIDsfocal point for democ-
racy and governanceprogramming. TheCentersroleisto provideUSAID and other devel-
opment practitionerswiththetechnical and intellectual expertiseneeded to support demo-
cratic development. It providesthisexpertisein thefollowingareas:
Ru le of La w
Election s a n d Politica l Pr ocesses
Civil Soci ety
Gover n a n ce
Th e Cen ter pu bli sh es a n u m ber of tech n i ca l docu m en ts design ed to in dica te best pr a cti ces, les-
son s l ea r n ed, a n d gu idelin es for pr a cti tion er con sider a tion . Th ey a r e a lso in ten ded t o stim u l a te
deba te a n d discu ssion . For fu r th er in form a tion r ega r din g t h ese Cen ter- specific pu bli ca tion s,
plea se con ta ct th e Cen t er s In for m a ti on Un it a t ( 202) 661- 5847.
Th e IPC pr oject s con t ra ct tea m con sists of Ma n a gem en t Syst em s I n t er n a tion a l ( pri m e con tr a c-
tor ) ; Abt Associa tes I n c.; a n d Developm en t Alter n a t ives. Th e I PC Pr oject Office i s loca t ed a t MSI ,
600 Wa ter Str eet, S.W., Wa sh in gton , D.C., 20024. Teleph on e: ( 202) 484- 7170; Fa x: ( 202)
488- 0754.

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