Summary of stakeholder engagements pre-COVID-19 (March 2018–January 2020) and during COVID-19 (April–May 2020)
| Phase* | Activity/Stakeholder | Bangladesh | Pakistan | Kenya | Nigeria | |||
| Phase I | Inception meetings (n=343 participants)† | |||||||
| Multistakeholder meetings | 1 (n=25) | 1 (n=45) | 1 (n=59)‡ | 5 (n=70) | ||||
| Specific stakeholder groups | – | – | 7 groups (n-59) | Individual discussions: n=85 | ||||
| Phase II | Micro-level engagement (n=320)§ | Bangladesh | Pakistan | Kenya 1 | Kenya 2 | Nigeria 1 | Nigeria 2 | Nigeria 3 |
| Community residents/stakeholder groups workshops and discussions¶ | Women (n=119) | 1 (n=15) | 1 (n=21) | 2 (n=20) | 2 (n=20) | 3 (n=18) | 2 (n=11) | 2 (n=14) |
| Men (n=101) | – | 1 (n=15: 6 Muslim, 9 Christian) | 2 (n=20) | 2 (n=20) | 3 (n=18) | 2 (n=14) | 2 (n=14) | |
| Youth groups (n=16) | – | – | 1 (n=8: 4 men, 4 women) | 1 (n=8: 3 men, 5 women) | – | – | – | |
| People identifying themselves as living with disabilities (n=16) | – | – | 1 (n=8: 4 men, 4 women) | 1 (n=8: 4 men, 4 women) | – | – | – | |
| Community leaders (n=19) | n=1 (man) | – | n=8 (3 men, 5 women) | n=6 (2 men, 4 women) | n=2 (men) | n=1 (man) | n=2 (men) | |
| Local healthcare workers workshops and discussions | Nurses/clinical officers/doctors (n=3) | – | – | – | – | n=1 nurse | n=1 nurse | n=1 nurse |
| Pharmacists/PMVs (n=8) | 1 (n=5) | – | – | – | n=1 PMV | n=1 PMV | n=1 PMV | |
| Community health workers (n=34) | – |
| – | – | – | – | – | |
| Traditional healers (n=3) | – | – | – | – | n=1 | n=1 | n=1 | |
| Phase III | Feedback meetings (n=111)** | Bangladesh | Pakistan | Kenya | Nigeria 1 and 2 | Nigeria 3 | ||
| Multistakeholder workshops (n=111) | Planned but interrupted by COVID-19 outbreak | 1 multistakeholder workshop:
| 1 multistakeholder workshop:
| Planned but interrupted by COVID-19 outbreak | ||||
| Phase IV | COVID-19 phone discussions (n=86)†† | Bangladesh | Pakistan | Kenya 1 | Kenya 2 | Nigeria 1 | Nigeria 2 | Nigeria 3 |
| Community residents/stakeholder groups discussions | Women (n=15) | n=2 | n=6 | – | – | n=2 | n=3, total 6 discussions | n=2, total 5 discussions |
| Men (n=16) | n=3 | n=10 | – | – | n=1 | n=1, total 4 discussions | n=1 | |
| Community leaders (n=14) | n=2 (men) | – | n=3 (men), total 9 discussions | n=4 (2 women, 2 men), total 12 discussions | n=2 (men), total 8 discussions | n=1 (man) | n=2 (men) total 5 discussions | |
| Local healthcare workers and managers discussions | Nurses/clinical officers/doctors (n=12) | n=3 | n=2 | n=1 | n=1 | n=2, total 5 discussions | n=2, total 5 discussions | n=1, total 4 discussions |
| Pharmacists/PMVs (n=8) | n=4 | – | – | – | n=2, total 5 discussions | n=1, total 4 discussions | n=1, total 4 discussions | |
| Community health workers/volunteers (n=8) | n=4 | n=2 | n=1 | n=1 | – | – | – | |
| Traditional healers and birth attendants (n=5) | n=2 | – | – | – | n=1 | n=2 | ||
| Subcounty health managers (n=8) | – | – | n=4 (1 man, 3 women) | n=4 (women) | – | – | – | |
*Pre-COVID-19, the three stakeholder engagement phases were designed to support and complement wider project activities. They ran sequentially in each site and were tied to the availability of data from these other activities. Thus, each site followed a slightly different timetable in the implementation of their stakeholder engagements. This enabled cross-site information-sharing and helped us to streamline our approach as a whole. The timing of other data activities, as well as COVID-19, delayed planned activities in phase II (Bangladesh) and phase III (Bangladesh and Pakistan), leading to the smaller sample sizes reflected here.
†Phase I: inception meetings with stakeholders at micro-level and meso-level of the health system to introduce the project, identify stakeholder concerns about access to healthcare in each site and identify additional stakeholders for engagement (n=343).
‡In this meeting, participants undertook a mock exercise in which each stakeholder group assumed the role of another group to identify ‘their’ challenges and issues (eg, healthcare workers took on the role of community members/service users, county teams became healthcare workers). This role-play encouraged participation and provided an opportunity for clarification and discussion of access issues from multiple perspectives.
§Phase II: micro-level community engagement to explore health beliefs, practices, challenges and solutions with residents, leaders and healthcare workers (n=320).
¶Depending on the flow and direction of the discussion, researchers asked ‘what if’ questions to ground the issues in the experience of participants, for example, “What would you do if your neighbour needs urgent medical attention?” ‘What would happen if a young child has diarrhoea’?
**Phase III: feedback meetings to explore the meaning of the study results with stakeholder groups at micro-level and meso-level (n=111). Immediately prior to the COVID-19 pandemic, multistakeholder dissemination meetings were held in Nigeria and Kenya, bringing together a range of stakeholders, including many from previous engagements, to share and discuss results from our broader study. Similar events were planned in Bangladesh and Pakistan. However, these plans were disrupted with the emergence of COVID-19.
††COVID-19 phase IV: telephonic engagement with stakeholders at micro-level to explore health needs and access to healthcare during the pandemic (n=86). Telephone calls were conducted over 4 weeks in April and early May 2020 with individuals drawn from different stakeholder categories. In Nigeria and Kenya, we held repeat conversations with some community residents/leaders and health providers (two to four calls per person). For all other stakeholders, we held once-off telephone discussions, in recognition of COVID-19 pressures on health workers and to bring in a breadth of perspectives in each stakeholder category.
NGO, non-governmental organisation; PMV, patent medicine vendor.