Stage 2: Support stakeholder engagement, ownership, and leadership

An important early stage in the OPQ process is to determine the key stakeholders and decision-makers who must be involved throughout the process, including those whose performance is hindered or facilitated by the system in question.

  • Stakeholders: Those groups who influence and/or could be affected by an organization’s activities, products, or services and associated performance

Depending on the level that the OPQ process will target (service delivery point, organization, system), the stakeholders may include health facility staff, clients, community representatives, managers, policy-makers, regulatory body representatives, training institution representatives, religious and community leaders, and others. Meaningful participation of women is particularly important as women make up the majority of health service end users as well as providers of both formal and informal health care.

Copyright IntraHealth International 2014Think of stakeholders as strategic partners. They may be key decision-makers, implementers, or customers of your services and activities. They include those who have a stake in the issue you are tackling, those who could be important contributors to solutions and facilitators of change, or those who could potentially block action in certain areas. In selecting and assembling stakeholders, it is important to be inclusive, while balancing the principle of inclusion with the practicality of having a manageable and effective group.

For the OPQ activities to be successful, it is essential that the stakeholder group be engaged, actively participate, feel ownership over the process and outcomes, and lead the team—in agreement with the decisions made and actions taken. As their leadership capacity grows, stakeholders can continue to sustain the cyclical OPQ process.

  • Engagement: The extent to which people are involved in a particular activity
  • Ownership: The state of having complete commitment to something
  • Leadership: Influencing and organizing a group to achieve a common goal

Importance of Stage 2:

  • Stakeholders’ engagement builds their ownership of the process
  • Stakeholders’ ownership fosters realistic and appropriate solutions
  • Stakeholders’ leadership helps remove obstacles to organizational change; helps identify essential information and resources; increases the likelihood of achieving goals and continuous improvement; builds capacity and sustainability

Goals of Stage 2:

Stage 2 begins early in the OPQ process and continues throughout the other stages. In the beginning of Stage 2, the goal is to involve key decision-makers in a transparent, participatory process that should result in a written agreement—such as an e-mail, letter of agreement, or memorandum of understanding (MOU)—about the following:

  • The general issue to be addressed
  • The organizational goal to be reached
  • The stakeholder group members that will be involved
  • Expected outcomes of the OPQ process
  • Roles and responsibilities
  • Timing and next steps in the process

TO reach agreement, the Sample Questions for Stakeholders in the Tools section provides questions that can be discussed in individual interviews with stakeholders or as a group. See also Sample Stakeholder Agreement Letter for a sample letter of agreement that can be used to share written agreements with stakeholders.


Describing the context (Stage 1) and forming the stakeholder group often occur simultaneously, with stakeholders providing important contextual information and names of other key stakeholders who should be involved.

Follow the steps for getting started with and sustaining stakeholder groups, described in the Guidelines for Forming and Sustaining Human Resources for Health Stakeholder Leadership Groups produced by CapacityPlus. These Guidelines can be adapted for different types of stakeholder groups and purposes. They offer useful suggestions for:

  • Forming a stakeholder group
  • Planning and conducting meetings
  • Developing and agreeing on key operating procedures
  • Ensuring the necessary support
  • Using effective communication practices
  • Sustaining clear goals through planning and monitoring progress

The Guidelines also suggest key leadership competencies and helpful initiatives to build the capacity of stakeholder group members.

Introducing and Monitoring Organizational Change and the Monitoring Change Checklist in the Tools section contain information about introducing and monitoring organizational change, including assessing organizational readiness for change. These tools and the stakeholder leadership Guidelines described above are useful references when transitioning leadership of the OPQ process to an internal team or stakeholder group.