Main Article Content

Attaullah Jan
Syed Saleem Shah
Iftikhar Alam
Ishrat Ali Bhatti


Stakeholders’ Attributes, Child and Maternal Nutrition, MDGs, Pakistan


Malnutrition, a significant health problem of developing world including Pakistan, needs to be tackled with a multisectoral approach since no single agency is responsible for nutrition. The present cross-sectional observational study used the Millennium Development Goals (MDGs) era as a case study to retrospectively identify the key stakeholders’ characteristics related to nutrition for child and mother and how these characteristics influence stakeholders' salience. The study utilized mixed methodology that included review of published official documents and interviews of the relevant stakeholders. Utilizing the expertise of the experts, we retrospectively identified and examined stakeholders for child and maternal nutrition throughout the MDGs period in Pakistan. Based on the nature of their interactions, positions, and degree of participation, stakeholders' characteristics (power, legitimacy, and urgency) were evaluated. Planning and development (P&D), provincial governments (P-Gov), the media, the ministry of health (MoH), "Parliament," and non-governmental organizations (NGOs) were identified as the most significant stakeholder groups for MDGs related to maternal and child nutrition (n=16). In conclusion, stakeholders involved in the MDGs for child and maternal nutrition had different stakeholder characteristics (such as power, legitimacy, and urgency), which may have contributed to Pakistan's low performance on these topics.

Abstract 57 | Pdf Downloads 31


1. Zaheer, A., Qurrat-ul-Ain, A. B., Sharif, A., & Naseer, D. (2023). Malnutrition in Children of Growing Age and the Associated Health Concerns. one health perspective In: Abbas RZ, Saeed NM, Younus M, Aguilar-Marcelino L and Khan A (eds), One Health Triad.
2. Mwangome, M., & Prentice, A. M. (2019). Tackling the triple threats of childhood malnutrition. BMC medicine, 17(1), 1-3.
3. Rogdo, J.M., 2023. Multi-stakeholder governance in the SDG era: A case study of EAT’s role within global food systems governance (Master's thesis).
4. .Kapiriri L, Razavi SD. Salient stakeholders: Using the salience stakeholder model to assess stakeholders’ influence in healthcare priority setting. Health Policy OPEN. 2021 Dec 1;2:100048
5. Pourghaderi M, Omidvar N, Takian A, Ville AS, Kangarani HM, Eini-Zinab H. Who really counts in Iran’s National Food Assistance Program? Lessons from multi-stakeholder processes in the wicked policy area of food security. Cadernos de Saúde Pública. 2022 Jan 12;38:e00341820
6. Martin, D. K., Giacomini, M., & Singer, P. A. (2002). Fairness, accountability for reasonableness, and the views of priority setting decision-makers. Health policy, 61(3), 279-290.
7. Boivin A, Lehoux P, Burgers J, Grol R. What are the key ingredients for effective public involvement in health care improvement and policy decisions? A randomized trial process evaluation. The Milbank Quarterly. 2014 Jun;92(2):319-50.
8. Salam RA, Das JK, Bhutta ZA. Achieving Health-Related Sustainable Development Goals. Making Health Systems Work in Low and Middle Income Countries: Textbook for Public Health Practitioners. 2022 Dec 22:464.
9. Van Tulder, R. (2018). Business & the sustainable development goals: A framework for effective corporate involvement (p. 123). Erasmus University Rotterdam.
10. Ezekannagha, O., Adeyemi, O., Ajieroh, V. and Onabolu, A., 2023. Advancing a multisectoral platform for nutrition-sensitive agriculture in Nigeria: reflections on effectiveness and lessons learnt. Food and Nutrition Bulletin, p.03795721231179786.
11. MacDonald, A., Clarke, A., & Huang, L. (2019). Multi-stakeholder partnerships for sustainability: Designing decision-making processes for partnership capacity. Journal of Business Ethics, 160(2), 409–426
12. Rizvi A, Bhatti Z, Das JK, Bhutta ZA. Pakistan and the millennium development goals for maternal and child health: progress and the way forward. Paediatrics and international child health. 2015 Oct 2;35(4):287-97.
13. Dooms, M., 2019. Stakeholder management for port sustainability: moving from ad-hoc to structural approaches. In Green ports (pp. 63-84). Elsevier.
14. Eden, C. and Ackermann, F., 2021. Modelling stakeholder dynamics for supporting group decision and negotiation: theory to practice. Group Decision and Negotiation, 30(5), pp.1001-1025.
15. . Ansell, C., Sørensen, E. and Torfing, J., 2022. Convening, Empowering, and Integrating Relevant and Affected Actors. In Co-Creation for Sustainability: The UN SDGs and the Power of Local Partnership (pp. 73-90). Emerald Publishing Limited.
16. Brugha and Varvasovsk, 2000).(16) Tampio, K. P., Haapasalo, H., Haapasalo, H., & Ali, F. (2023). The stakeholder landscape in the public healthcare process—challenges, elements and impacts for stakeholder management. International Journal Papier Public Review, 4(2), pp.18-28.
17. Mitincu, C.G., Niţă, M.R., Hossu, C.A., Iojă, I.C. and Nita, A., 2023. Stakeholders’ involvement in the planning of nature-based solutions: A network analysis approach. Environmental Science & Policy, 141, pp.69-79
18. Oleksiv, I.B., 2013. Selection of important company stakeholders: theory and practice. Scientific Bulletin of National Mining University, (1).
19. Razali, R. and Anwar, F., 2011. Selecting the right stakeholders for requirements elicitation: a systematic approach. Journal of Theoretical and Applied Information Technology, 33(2), pp.250-257.
20. McGlashan, J., Nichols, M., Korn, A., Millar, L., Marks, J., Sanigorski, A., Pachucki, M., Swinburn, B., Allender, S. and Economos, C., 2018. Social network analysis of stakeholder networks from two community-based obesity prevention interventions. PLoS One, 13(4), p.e0196211
21. Hossain, S. M., Chou, V. B., Ibrahim, S., Alhilfi, R., Lami, F., Sarnak, D., ... & Ahmed, S. Child Mortality and Maternal, Neonatal and Child Health in Iraq in the Last Two Decades: Trends and a Way Toward the SDG Targets for Child Survival
22. Zaidi, S., & Nishtar, N. (2011). Access to essential medicines: in Pakistan identifying policy research and concerns.
23. Tseli, E., Sjöberg, V., Björk, M., Äng, B. O., & Vixner, L. (2023). Evaluation of content validity and feasibility of the eVISualisation of physical activity and pain (eVIS) intervention for patients with chronic pain participating in interdisciplinary pain rehabilitation programs. Plos one, 18(3), e0282780.
24. Okoli, C. and Pawlowski, S.D., 2004. The Delphi method as a research tool: an example, design considerations and applications. Information & management, 42(1), pp.15-29
25. Yap, M. B., Pilkington, P. D., Ryan, S. M., Kelly, C. M., & Jorm, A. F. (2014). Parenting strategies for reducing the risk of adolescent depression and anxiety disorders: a Delphi consensus study. Journal of affective disorders, 156, 67-75
26. Addington, D.E., McKenzie, E., Norman, R., Wang, J. and Bond, G.R., 2013. Essential evidence-based components of first-episode psychosis services. Psychiatric Services, 64(5), pp.452-457.
27. Diamond, I.R., Grant, R.C., Feldman, B.M., Pencharz, P.B., Ling, S.C., Moore, A.M. and Wales, P.W., 2014. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies. Journal of clinical epidemiology, 67(4), pp.401-409.
28. Akins, R.B., Tolson, H. and Cole, B.R., 2005. Stability of response characteristics of a Delphi panel: application of bootstrap data expansion. BMC medical research methodology, 5(1), pp.1-12.
29. Ross, A. H., Downey, L., Devonport, H., Gale, R. P., Kotagiri, A., Mahmood, S., ... & Jain, N. (2020). Recommendations by a UK expert panel on an aflibercept treat-and-extend pathway for the treatment of neovascular age-related macular degeneration. Eye, 34(10), 1825-1834
30. Castro‐Calvo, J., King, D.L., Stein, D.J., Brand, M., Carmi, L., Chamberlain, S.R., Demetrovics, Z., Fineberg, N.A., Rumpf, H.J., Yücel, M. and Achab, S., 2021. Expert appraisal of criteria for assessing gaming disorder: An international Delphi study. Addiction, 116(9), pp.2463-2475.
31. Alam, I., Jan, A., Shah, W.A., Amin, R.U., Khan, R., Jan, S., et al. 2023. Linking Health with Agriculture. Food and Nutrition to Achieve Sustainable Development Goals in Eco-Friendly Fashion–Proceedings of AN EXPO. Canadian Journal of Clinical Nutrition. 2023; 11 (2): 67-74. DOI: https://dx.doi.org/10.14206/canad.j.clin.nutr.2023.02.06
32. Jan, A., Shah, S.S., Almajwal, A.M. and Alam, I., 2023. Stakeholders’ Identification and Understanding of the Multisectoral Governance for Child and Maternal Nutrition During the MDGs Period–A Stakeholders’ Network Analysis of Khyber Pakhtunkhwa Province of Pakistan. doi.org/10.21203/rs.3.rs-3331937/v1
33. Buniamin S. Exploring Managers’ Perceptions on Stakeholders’ Attributes in ESG Reporting of Malaysian Companies. International Journal of Business Management (IJBM). 2020;3(1):33-47.
34. Mitchell, R. K., Agle, B. R., & Wood, D. J. (1997). Toward a Theory of Stakeholder Identification and Salience: Defining the Principle of Who and What Really Counts. Academy of Management Review, 22(4), 853-886.
35. Khan A. 1996. Policy-making in Pakistan’ s population programme. Health Policy and Planning 11: 30–51.
36. Collins CD, Omar M, Tarin E.. 2002. Decentralization, health care and policy process in the Punjab, Pakistan in the 1990s. International Journal of Health Planning and Management 17: 123–46.
37. Khan MM, Heuvel WVD.. 2007. The impact of political context upon health policy process in Pakistan. Public Health 121: 278–86
38. . Siddiqi S, Haq IU, Ghaffar A, Akhtar T, Mahaini R.. 2004. Pakistan’ s maternal and child health policy: analysis, lessons and the way forward. Health Policy 69: 117–30.
39. Sadiq, N., Qazi, U., Rahman, A., & Hafeez, A. (2019). Is health a priority among decision-makers of Pakistan? Evidence from parliamentary questions screening. Public health, 170, 140-145.
40. Jooma R, Sabatinelli G. Political determinants of health: lessons for Pakistan. Pakistan journal of medical sciences. 2014 May;30(3):457.
41. Eesley, C., & Lenox, M. J. (2006). Firm Responses to Secondary Stakeholder Action. Strategic Management Journal, 27(8), 765-781
42. Parent, M. M., & Deephouse, D. L. (2007). A Case Study of Stakeholder Identification and Prioritization by Managers. Journal of Business Ethics, 75(1), 1-23.
43. Neville, B. A., Bell, S. J., & Whitewell, G. J. (2011). Stakeholder salience revisited: Refining, redefining and refueling and underdeveloped conceptual tool. Journal of Business Ethics, 102(3), 357-378
44. Khavul, S., Chavez, H., & Bruton, G. D. (2013). When institutional change outruns the change agent: The contested terrain of entrepreneurial microfinance for those in poverty, Journal of Business Venturing 28 (2013): 30-50
45. Miller, C. C., Cardinal, L. B., & Glick, W. H. (1997). Retrospective Reports in Organizational Research:A Reexamination of Recent Evidence, Academy of Management Journal, 40, 189-204
46. Baskarada, S. (2014). Qualitative case study guidelines. Baškarada, S.(2014). Qualitative case studies guidelines. The Qualitative Report, 19(40), 1-25
47. Tiew, F., Holmes, K., & De Bussy, N. (2015). Tourism events and the nature of stakeholder power. Event Management, 19(4), 525-541.
48. Alam, I., Gul, R., Chong, J., Tan, C.T.Y., Chin, H.X., Wong, G., Doggui, R. and Larbi, A. (2019). Recurrent circadian fasting (RCF) improves blood pressure, biomarkers of cardiomet-abolic risk and regulates inflammation in men. Journal of translational medicine, 17, pp.1-29.
49. Ali, S., Alam, I., Obaid, R.S., Faris, M.E., Cheikh Ismail, L., Najah, F., Radwan, H., Hasan, H., Hashim, M., AlBlooshi, S. and Zeb, F., 2023. An innovative state-of-the-art health storytelling technique for better management of type 2 diabetes. Frontiers in Public Health, 11, p.1215166.
50. Alam, I., Ali, M. and Farooq, M. (2022). Assessment of healthy eating and active lifestyle on campus environment in a univer-sity setting as perceived by students using the innovative photo voice method, a healthy eating and active lifestyle (HEAL) study. Journal of Innovative Sciences, 8(1), pp.113-123.
51. Alam, I. (2013). Relationship between nutritional status and immune functions in elderly Pakistani men (Doctoral disser-tation, Dissertation, Tübingen, Universität Tübingen, 2013).
52. Gul, R., Khan, I., Alam, I., Almajwal, A., Hussain, I., Sohail, N., Hussain, M., Cena, H., Shafiq, S. and Aftab, A., 2023. Ramadan-specific nutrition education improves cardio-metabolic health and inflammation—a prospective nutrition intervention study from Pakistan. Frontiers in Nutrition, 10.
53. Alam, I., Ullah, R., Khalil, A.A.K., Naqeeb, H., Ali, A. and Zeb, F., 2022. Improvement in cardio-metabolic health and immune signatures in old individuals using daily chores (Salat) as an intervention: a randomized crossover study in a little-studied population. Frontiers in Public Health, 10, p.1009055.
54. Alam, I., Alam, I., Paracha, P.I. and Pawelec, G. (2012). Higher estimates of daily dietary net endogenous acid produc-tion (NEAP) in the elderly as compared to the young in a healthy, free-living elderly population of Pakistan. Clinical Interventions in Aging, pp.565-573.
55. Alam, I., Larbi, A. and Pawelec, G. (2012b). Nutritional status influences peripheral immune cell phenotypes in healthy men in rural Pakistan. Immunity & Ageing, 9, pp.1-10.
56. Alam, I., Shivappa, N., Hebert, J.R., Pawelec, G. and Larbi, A. (2018). Relationships between the inflammatory potential of the diet, aging and anthropometric measurements in a cross-sectional study in Pakistan. Nutrition and healthy aging, 4(4), pp.335-343.
57. Almajwal, A.M., Alam, I., Abulmeaty, M., Razak, S., Pawelec, G. and Alam, W. (2020). Intake of dietary advanced glycation end products influences inflammatory markers, immune phenotypes, and antiradical capacity of healthy elderly in a little‐studied population. Food science & nutrition, 8(2), pp.1046-1057.