Mitigate the effects of stakeholder turnover

If key stakeholders leave their positions during the policy-making process, one should consider whether and how to orient newcomers while maintaining the process, or whether to start the process anew. A lot will depend on the stage in which the transition of key stakeholders takes place—from evidence dissemination and review, recommendations-setting, and advocacy to final decision-making on policy issues. The loss of continuity and institutional memory resulting from turnover of key staff, as well as the frequent changeover of health sector management positions and political appointees, can disrupt the ongoing discussions that are necessary for a policy’s eventual implementation (McCabe et al. 2008). Turnover can also contribute to lost momentum. Any of these factors may prevent HRH strategies from moving forward. An HRH TWG’s secretariat function, which is important more generally (Gormley and McCaffery 2011), is critical to ensure that changes in membership are appropriately addressed. To maintain the TWG’s institutional memory, it is important to document issues, meetings, and discussions as appropriate. Responsibilities and accountability measures for these actions could be made official within a stakeholder leadership group’s bylaws, and could help to mitigate the effects of stakeholder turnover.


In Uganda, when individuals representing a key stakeholder left that organization and thus the HRH TWG, a new representative was not always named. This resulted in the loss of that organization’s engagement in the issues under discussion. Key informant interviews with the Uganda HRH TWG revealed several recommendations for mitigating such negative effects of turnover: first, a TWG secretariat could be vigilant to request (or require) the organizations with departing members to name a new organizational representative to the group (Howard-Grabman and Jaskiewicz 2013). In addition, acting members could be named when it is anticipated that permanent members may take more time to be identified. Whenever possible, outgoing members should orient the incoming representative. Further, if key members are frequently absent, the secretariat could send them notices to remind them of the importance of their organization’s participation (ibid.). The Uganda MOH (2013) Guidelines for Governance and Management Structures clearly stipulate the purpose, responsibilities, and membership of TWGs and provide guidance on the functions of the chairperson, secretariat, and members. With this new definition and protocol, the HRH TWG is working to improve its governance mechanisms and mitigate the effects of stakeholder turnover.

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