Table 2.
Description of key decision-making points in the development of the UCMI engagement program in the STP, including the decision-making path, end point decisions, and the involvement of end users in the decisions
| Initial Work/Pre-Conditions Creation of Internal Field Site Dossier – Literature Review and Field Site Scoping Trip Established Points for Contact with National Malaria Control Program in STP during Initial Scoping Visit | ||||
|---|---|---|---|---|
| Decision Point/Question(s) | Decision-Making Path | Decision-Making Authority | Decision End Point | Stakeholder Involvement in Decision |
| Who is the decision-making authority in the STP that the UCMI should contact for permission to conduct research and establish a partnership agreement? | The UCMI program contacted National Malaria Control Program, which referred the program to the Minister of Health. The UCMI met with the Minister of Health. The Minister of Health suggested stakeholder workshops in the STP. The UCMI co-hosted stakeholder workshops with the Ministry of Health. |
Ministry of Health | Minister of Health established a collaborative partnership agreement with UCMI to conduct field and laboratory research, provide training and capacity building, and conduct engagement. | STP stakeholders: Ministry of Environment, WHO, United Nations Development Program (UNDP), National Malaria Control Program, health delegacy, University of the STP, Ministry of Agriculture, national NGOs, private advisors to the Minister of Health, and the national media participated in the stakeholder workshops and provided input and opinions regarding the UCMI program, objectives, and scope of the partnership agreement. |
| How should the UCMI program establish an engagement program in the STP? | Dialogue was initiated in the stakeholder workshops and in meetings with Minister of Health. Stakeholders suggested additional workshop with STP malaria control partners and managers of existing engagement efforts. Workshop was conducted with engagement stakeholder group and UCMI. The UCMI presented RBM model and commitment to local partners leading engagement. Met with health delegacy and mapping of STP health system and existing public health engagement. |
Ministry of Health | UCMI engagement program will be national, use the existing engagement structure within the health districts, and work in direct collaboration with the health delegacy. | Dialogue among national stakeholders identified engagement strategies and practitioners in the STP and their scope of work, training, funding, and areas of expertise. From these discussions came a recommendation for integration of the UCMI engagement program with the health delegacy and its teams of community health agents who conducted public health engagement and awareness activities for local and international health initiatives. |
| What should the UCMI engagement strategy look like? | The UCMI asked health delegates this open-ended question in a meeting to discuss engagement team structure. Health delegates suggested developing a proposal for the Ministry of Health. Health delegate from largest district put together a draft document outline with a phased plan for engagement. The document was reviewed by all delegates, UCMI team, and engagement stakeholder group. Final document was shared with Ministry for approval. |
Ministry of Health Health Delegates |
A general plan for the engagement strategy was described, outlining an iterative and phased approach to engagement for both stakeholder and community groups, building on existing knowledge and relationships and further defined by the engagement team and the communities where these teams worked. | Health delegates and the stakeholder engagement group developed the document with technical input from the UCMI. The general strategy was based on their own knowledge and experience working with stakeholders and community members in the STP. The Ministry of Health reviewed the document, provided suggested edits, and approved the final draft. |
| How is the UCMI engagement team structured? What are the roles and responsibilities? | UCMI met. with the health delegacy and engagement stakeholder group to build UCMI team capacity and understanding surrounding current engagement in STP, including roles, responsibilities, budget, knowledge, and existing resources. Community engagement practitioners met with UCMI to share perspectives about community knowledge and perceptions related to malaria, existing challenges, language requirements, engagement methods and materials, and differences among communities. UCMI met with health delegates to discuss initial funding availability and areas where the program could lend support for training and capacity building. UCMI met with UNDP administrators and Ministry of Health representatives to discuss national compensation rates and financial expectations and requirements to support engagement work in STP. Health delegates met with UCMI to discuss strategy, team composition, roles, and responsibilities, training requirements, and team selection process. UCMI team and engagement manager met with Ministry of Education about involvement of teachers |
Ministry of Health, Ministry of Education, Health Delegates |
Ministry of Health approved a UNDP-developed budget for engagement activities using the model that the health delegates proposed. A two-phased approach to the UCMI engagement team was established. The team was distributed among all seven health districts in the country and was developed based on available funding, population size within each district, and community distribution within each district. Phase one was developed considering the initial UCMI engagement budget, and phase two was developed to request additional funds to support advancement of engagement in the STP. Term of reference was established for all roles, and the recruitment process and training needs were identified. |
Engagement practitioners participated in open dialogue with health delegates and the UCMI team. They contributed important information about how engagement was being conducted, what was working and what was not, and what kind of language and materials should be used in different districts/communities. This information was used by the health delegates in the development of the term of reference and team size and distribution within the districts. Health delegates directly determined the size and distribution of the engagement team, term of reference, and recruitment process of team members. The Ministry of Health assigned specific teachers to the engagement team based on term of reference, previous experience, and areas of expertise. The UNDP and Ministry of Health contributed national compensation rates, per diem, and travel rates for engagement partitioners, and they shared financial expectations and requirements needed to support capacity building and engagement activities based on similar international partnerships and national government standards. (The UNDP has historically been an important partner to the Ministry of Health in management of malaria projects and other health-related projects). |
| How do we develop the initial engagement activities? | Recruitment and hiring of engagement manager and identification of district-specific community health agents (CHAs) were conducted after a process outlined by the health delegation and engagement stakeholder group. Health delegation met with engagement manager and UCMI team; UCMI asked this open-ended question, which initiated group discussion. Engagement manager and engagement team workshops and trainings were conducted that included discussions regarding experiences with district and community-specific engagement activities in the past (what worked/challenges/community preferences). Suggested first step was to conduct assessment in all districts to guide development of activities. It was also suggested that activities be developed by district-level teams, acknowledging that communities and populations across the country were different and had different priorities and preferences. |
Engagement Team | A National community assessment was conducted to determine district-specific gaps in knowledge about malaria, perspectives about malaria, and preferences regarding information sharing and engagement. Assessment results were used by each district-level engagement team to determine a first-phase engagement activity plan and activities. |
Engagement team members worked together to arrive at decision end points. Decision process, end point, and subsequent decisions about how to conduct the assessment, where to conduct it, and its development were all determined by the engagement team. |
| How do we develop initial training for the engagement team, and who should be involved? | Health delegation made initial suggestions. Suggestions were shared with engagement team members, and team members provided input about their own preferences. The UCMI, health delegation, engagement manager, and engagement stakeholder group discussed potential STP collaborators with expertise in subject areas. Stakeholders contacted STP professionals and invited them to participate. Health delegates contracted STP public health professionals who had previous experience facilitating communication and group exercises. The UCMI provided content and material related to the project and the technology. The engagement manager met with the health delegacy to finalize agenda and practical components for the training. |
Engagement Team, Collaborators/ Experts in STP |
Training was conducted over 4 days with a focus on general UCMI program information, objectives, and activities, malaria biology, malaria control in the STP, malaria detection and treatment, and review of general communication and engagement skills with practical components. STP collaborators who were experts in these areas were involved in developing the content and material for training and provided presentations. |
The health delegation, engagement manager, and engagement stakeholder group worked together to identify collaborators, agenda development of practical group activities and application of skills, and evaluation tools for the training. Collaborators (e.g., national malaria control entomologists, malaria focal point, and RN responsible for malaria treatment, medical doctor, NGO technician responsible for IRS, etc.) developed presentations and materials for training components and questions and activities for evaluation. |
| With whom are we engaging? | General engagement strategy identified “communities,” all of which were impacted by project work, equaling all residents of the STP and “stakeholders” as group(s) of individuals who are not only impacted by the project work but who are involved in the project and will define the level of community acceptance required for this project and provide oversight and direction of project. Discussions and engagement mapping of stakeholders were led by engagement manager, expanded on early STP stakeholder list provided by Ministry of Health. Collaborators and partners including CHAs and health delegacy asked for input and suggestions. Stakeholder list and engagement groups determined in engagement team meetings. |
Engagement Team | The engagement plan included three specific groups, with a specific plan for each group: 1. Stakeholders 2. Schools (primary to university) 3. Communities. |
Full participation and decision-making of the engagement team in the final decisions and planning surrounding who is engaged with, and the who, how, what, and when questions within the plan for each specific group. |
| How do we engage with communities? | Engagement team meetings were conducted to discuss this question. The CHAs, health delegacy, and engagement manager shared their historical knowledge and experience conducting engagement in their communities in the STP. The CHAs discussed with community members and leaders in their districts how they wanted to be engaged. Information and ideas from communities within each district were shared with the larger team. Engagement activities were planned with this information. |
Engagement Team, Communities |
Engagement in communities is ongoing, and the plan included monthly activities and participatory meetings. Each district was different, and some of the activities included community-based meetings led by community leaders, individual visits at community members’ homes, meetings at health centers, participatory radio programs, social media, health fairs, and pop-up demonstrations in community centers. The UCMI project has an office in a central location where community members can drop in and speak to project team members, share information, and express concerns/questions. |
Community members and leaders discussed and shared with the CHAs who lived and worked in their communities/district. This information was taken back to the district team and the larger national team. Plans and activities were determined by the engagement team and integrated the input and preferences shared with the CHAs who worked and lived in these communities. These activities and plans were tailored to each district by the district-level engagement teams. Plans and activities were continuously adjusted and improved based on this input. |
| How do we engage with stakeholder groups? |
Engagement team meetings were conducted to discuss this question. The engagement manager conducted meetings with engagement stakeholder group to discuss this question. STP stakeholders were identified from earlier mapping exercises engaged. Stakeholder groups requested specific methods of information sharing and engagement. The engagement team developed a plan for engagement using requests from each group. |
Engagement Team, Stakeholder Groups |
Engagement with stakeholders is ongoing and has included different activities for each group depending on preferences. Activities included information sharing meetings and workshops, scientific training and capacity sharing activities, public consultation events for open dialogue and questions and answers, monthly activity planning meetings and review of project data, protocols, and engagement plans. Meetings were held to develop engagement material content, bi-monthly newsletters, publications in national news, videos and interviews on national TV and radio, social media, E-mails, and quarterly project progress reports. | Stakeholder groups in the STP participated in discussions with the engagement team to share preferences and opinions about how they wanted to engage with and be engaged by the project. This information was integrated into the stakeholder engagement plan. Regular feedback and dialogue with stakeholders drove continuous adjustment and improvement of stakeholder engagement activities. |
| How do we engage with the schools? | The UCMI team and engagement manager had initial meetings with Ministry of Education leaders. Ministry of Education presented a proposal for specific teachers to integrate into the engagement team. Teachers met with the engagement team. Teachers developed a proposed plan for engagement in schools. Teachers and the engagement manager met with school administrators to refine the engagement plan in schools. |
Engagement Team, Teachers, Ministry of Education |
School engagement activities were conducted during the regular school year in the STP and included a variety of activities depending on the school and educational level of students. Activities included individual classroom demonstrations, participatory learning exercises with scientific models, malaria activity booklets and other visual aids, school assemblies, informational booths and tables, malaria-related coursework and classes, educational contests, and take-home activities. | The school engagement plan was developed by teachers and school administrators who had knowledge and expertise working in the schools in the STP. Regular feedback and input from these groups drove continuous adjustment and improvement of activities that occurred in the schools. Student assessments and participatory activities have been conducted to integrate student perspectives and feedback into the decision-making surrounding future activities and materials used for school engagement activities. |
| How do we define community acceptance of the UCMI technology? | The UCMI asked this question of STP stakeholders, specifically government leaders. The government made clear that it will make this decision. Path to making this decision will be determined by STP leaders and is under consideration. |
STP Stakeholders, Government Leaders | Final decision end point to be determined. | Stakeholders in the STP who will make decisions about the UCMI technology will determine the answer to this question. Stakeholders have requested that the UCMI project continue to support ongoing engagement activities. |
| What is the objective of UCMI engagement? | The UCMI developed early objectives within the program plan and funding proposal. The UCMI team and engagement stakeholder group had initial discussions to refine and adjust the UCMI objectives to fit the STP goals. Early objectives determined with stakeholder group were later refined with the engagement team members. |
UCMI Team, Stakeholder Group, Engagement Team |
This was a national engagement effort with the intent of reaching all members of society using a phased approach to ensure that informed decisions about the technology (acceptance and use of) could be made and to ensure transparency at every stage of the project. Opportunities for information sharing and dialogue were available to all. | The stakeholder engagement group refined the original objective of UCMI engagement to specifically include all members of society, to clearly define a phased approach and the phases, and the importance of creating opportunities for all members of society to engage and share information. |
| How will the success of engagement be measured or evaluated? | The engagement stakeholder group developed integration of annual assessments to evaluate engagement. The engagement team developed assessments and tools (online surveys/games) to evaluate activities, messages, materials, and understanding at each phase. The engagement team developed a timeline for assessments and target goals; goals were refined based on assessment results and community feedback. External social science team engaged to conduct national assessment at the end of year 3 to evaluate overall knowledge, perception, and acceptance |
Stakeholder Group, Engagement Team |
Assessments (annual) and online surveys (quarterly) were to be conducted nationally to adjust engagement strategies and respond to community knowledge, understanding, perceptions, and concerns. Measures of success were determined by question type/category (e.g., knowledge of malaria, project work, and objectives – 80%). Success goals are to be measured at the end of 2024: access to engagement, overall understanding of UCMI objectives and goals, understanding of technology, perception and acceptance of technology. |
The engagement stakeholder group initially suggested assessments to evaluate knowledge, understanding, and perceptions of engagement for each phase. The engagement team further refined assessments, timeline for conducting assessments, and the target goals for each assessment. The engagement team refined activities and strategies based on results. Assessment results determine whether adjustments to target goals need to be made and when and how to integrate new information. |
CHA = community health agent; IRS = indoor residual spraying; NGO = nongovernmental organization; RN = registered nurse; RBM = relationship-based model; STP = Democratic Republic of São Tomé and Príncipe; UCMI = University of California Malaria Initiative; UNDP = United Nations Development Program.