1. Stakeholder Analysis Jack Thompson, MSW Principal Lecturer Emeritus
University of Washington School of Public Health
The purpose of this presentation is to give the participant a concrete tool to use in analyzing the roles various stakeholders play in public policy and program development.
The idea is to go beyond making a list of all the stakeholders (which is still where we begin) to analysis of how to work with the various stakeholders to achieve a successful intervention and work to improve the health of our communities.
This approach proposes that the list of stakeholders is often more expansive than first thought – there are key people in the community who are influential and important for the success of an initiative even if they know nothing about it! They are important because of the power or influence they have over the success of the initiative, even if they have little interest in the specific program or intervention.

2. The Public Health Policy Analysis/Program Development Framework
Identify and define the public health policy issue
Understand the economic and political context
Identify the stakeholders, their values and interests
Determine potential options for policy action
Analyze strengths and weaknesses of options regarding science and values
These are the key steps in any policy analysis initiative or any other approach to community public health interventions.
The first step is critical in that public health leaders need to make a distinction between the issue or problem under consideration (high rates of illness or infection among children in your community might be a good example to use) and the action to be taken to improve the situation (a program to increase immunization rates among the target age groups and/or community health education campaigns). The second step suggests that such issues or problems exist within a specific community context, and this also needs to be understood.
Then comes the crucial step of stakeholder identification – here it is suggested that key considerations include their values and their interests.
Such analysis can lead to the final two steps in any action plan.
But as we suggested, there is more that needs to be considered with the identified stakeholders.

3. Key Steps in the Policy Development/Public Health Program Intervention Process
What is the issue?
Who are the stakeholders?
What are their interests?
What are the policy options?
What are the pros and cons?
What are the unintended effects?
At this point in the process, it would be a useful exercise for the department’s senior management team (or the director of the department or program with key staff) to begin the process of listing all the potential stakeholders who should be involved in considering a campaign to increase immunization levels among kids in your community (for example). These might include:
the faith community
the media
social and health services
the local political structure
the schools
businesses
recreational facilities in the community
patients and their families in clinical settings
the board of health
adjacent health departments
community health centers
other community-based organizations
Who else?

4. Stakeholder Identification
People impacted
People with influence over the issue/problem at hand
People interested in success or failure
Internal and external
Only people decide, not organizations
Here are some points to keep in mind as you brainstorm the list of stakeholders in the immunization campaign:
Impact – who is affected by the issue under consideration?
Influence or power – who can make things happen or not happen?
Interest – who has interest in this issue? Who might have interest in making sure the initiative fails (groups with concerns the safety of vaccines?)
And remember stakeholders are within your own organization as well as in the community

5. Stakeholder Analysis High POWER Low Low High INTEREST
Now it is time to place your stakeholders within the four cells of this grid:
Those who have low interest in the issue and low level of power to influence the success of the program (in the lower left cell – these might include the general public, individuals without children, or others who aren’t directly affected)
Those who have high power to influence the program but low interest (in the upper left cell – these might include the newspaper editor or mayor who is unfamiliar with the issue)
Those who have high interest in the success of the program but low power to make things happen (in the lower right cell – these might include family members, the kids themselves, low-income community residents)
Those who have high interest in the program and high power to influence the program (in the upper right cell – these might include your board of commissioners, the medical and hospital community, leadership in the faith community – note that you must consider stakeholders with high power who may have a high interest in the failure of your initiative!
Low
Low
High
INTEREST

6. Stakeholder Analysis High POWER Low Low High INTEREST
The placement of the key stakeholders within the cells of the grid should suggest some strategies for community collaboration and mobilization. You might want to think about strategies in a slightly different order. For example:
Those with high power but low interest must be educated about the importance of the program to whatever it is that they do have interest in!
Those with low power and low interest should at a minimum be kept informed about the progress of the program (through the press, s, whatever community mechanisms are in place) and you should watch to see if they gain interest in the issue (in which case they move to the lower right cell, about which see below)
Those with low power and high interest should become a key target group, as they might become better organized through coalition development or better community education; as they become better organized they have the potential of movement to the final cell
Those with high power and high interest hopefully are the “movers and shakers” you need for success; keep them engaged! As stated above, this cell would also include those with high power and high interest in making sure your program does not succeed (not always the case, but more often than not). You will have to work with your supporters to develop strategies directed toward this group!
Low
Low
High
INTEREST

7. Stakeholder Analysis High POWER Low Low High INTEREST Newspaper
Publisher
Mayor
Providers
Business
BOH
Conservative
Politicians
Business
Neighbors
High
POWER
“Average”
Citizen
Neighbors
Families dealing
With addiction
And HIV/AIDS
Individual
Community
activists
As an example of this approach, let’s consider the stakeholders involved in an initiative to establish a needle exchange program
HIGH POWER/LOW INTEREST
Major community leaders with influential, but little knowledge or interest in the initiative
LOW POWER/LOW INTEREST
Residents and neighbors should get basic information about the initiative, most of whom will not have personal interest in it
LOW POWER/HIGH INTEREST
Families dealing with HIV/AIDS, individual activists, also residents of identified neighborhood site (may be for or against the initiative
HIGH POWER/HIGH INTEREST
Pro – advocates, providers, hopefully your board of health!
Anti – conservative politicians, organized neighborhood opposition
A SUGGESTED MOBILIZING STRATEGY
Secure support of HIGH POWER/LOW INTEREST leaders by involving influential supporters; keep others in a neutral position
Organize key LOW POWER/LOW INTEREST folks to raise their interest level, then organize the LOW POWER/HIGH INTEREST folks to collectively move to the HIGH INTEREST/HIGH POWER cell to support the initiative;
Use HIGH INTEREST/HIGH POWER supporters to move the initiative forward
Low
Low
High
INTEREST

8. Here is a “true life” example – the Washington State Department of Health uses a similar grid to assess stakeholders in development of legislative strategies
This example had to do with proposed lead abatement legislation
Note how they define the categories – a little different from the descriptions I have used (less formal identification of opposition, for example

9. Small Group Exercise
You are working with a group of students and parents who want to start a school-based clinic in a local high school. While there is excitement about this prospect from your constituents and other community leaders, there is also a lot of opposition. Some religious groups are afraid that such a clinic will counsel about or even offer abortions. Some of the school nurses worry that the clinic will undermine their roles in the schools. Other community leaders think that the purpose of schools is education – period – and it is the role of the parents to worry about such things as child health. The local health department seems supportive of this initiative, but the board of health has never taken a stand on such a proposal. Local media has been silent also to date. The school board and the city council seem supportive, but, again, they haven’t had to take a stand. There are probably other community influentials who need to be brought in on this and others who need to be kept informed. So who are all these stakeholders and where might they “fit” in the stakeholder grid? And when you array all the stakeholders, what does that tell you about a community mobilization strategy?
If this is being used in a group training, here is a possible scenario to use in a small group exercise
If this is used on-line, best to stop with the previous slide

10. A political closer!