Engaging with many different stakeholders

When addressing a health issue, why do we need to engage with communities, local authorities, policymakers, and international organisations? The first answer to this question is that only in this way we get all the information needed. Depending on whom you ask, you will get overlapping descriptions of the problem you want to solve. This makes an iterative process of identification of academic and non-academic stakeholders rather than a sequential approach rational. Whom to invite at the very beginning is a critical step. This is not carved in stone, since in the iterative, corkscrew-like process one can invite new stakeholders. In the life cycle of a project, however, one cannot always involve all stakeholders.

At some stages, very disciplinary information is needed, for example, the genetic characterisation of a pathogen or the recording of illness representations in the communities. This can spearhead your research and capture a tangible objective. Colleagues at the Geography Institute in Bern have depicted this as a fluctuating curve according to more or less involvement of disciplines and stakeholders. After an initial broad consultation, first results are fed back to all stakeholders. One then needs to be receptive and propose corrective actions or follow up unexpected and surprising results and outcomes. In the health of pastoralists programme in Chad, we went through nearly four of such five-years project cycles. Each cycle was composed of different funding.

The long duration, however, permitted us to validate results and to generate not only output but also outcomes that are applicable even outside Chad. Based on results, the stakeholders recommended in the first years to test joint services. In addition, they suggested that besides the disease situation, we should aim almost at a better understanding of the socio-cultural and political contexts. Our fourth large stakeholder workshop in 2005 initiated a process in which different ministries should project a national action plan to support nomadic communities in Chad. Participants were the concerned communities; their representatives and associations; authorities from the ministries; local authorities, including technicians and staff; NGOs working with pastoralists; international bi- and multilateral organisations, such as WHO and UNICEF; and donors.

Indeed, we only realised rather late that we had embarked in a transdiciplinary process. The consultative stakeholder seminars aimed at defining priorities of the populations and the authorities jointly, formulating health service priorities from a range of options and readjusting ongoing interventions, but also cross checking the relevance of activities. Pastoralists could express their concerns and needs directly to the authorities and also voice non-health-related demands, such as a new legislation on land use and education. Researchers can play the role as interlocutors between the communities and the authorities. In the widespread enthusiasm to improve the livelihoods of pastoralists, nine ministries stated their interest to be part of a more holistic national programme. However, the implementation was not feasible, a lesson learned.

In March 2016, there was the inauguration of a more operational new directorate for pastoralists at the ministry of health that should bring in different partners to offer not only health but also other basic social services to hard-to-reach communities of Chad. In the process, pastoralists’ communities started organising themselves to provide, for example, schooling for their children, and the government became active and created a new department for health. These dynamics were possible because pastoralists could voice their needs and priorities. Participants identified research and intervention objectives, and, as a consequence, trust and mutual respect have built gradually. From this experience, we may draw the following, more general conclusion.

Where communities interact with authorities in a participatory process in order to identify acceptable institutional and legal frameworks, arrangements for social service development in a given context can be achieved.