ABSTRACT

This study investigates the influence of stakeholder involvement on the success of health projects within Nkwen Bamenda health district, Cameroon. Guided by stakeholder theory and resource-based view, the research aims to evaluate stakeholder engagement across project phases such as identification, planning, execution, and review to understand its effect on project success. A survey research design was employed, utilizing structured questionnaires as the primary data collection method. Data were gathered from 72 health projects using purposive sampling, ensuring comprehensive representation. Descriptive statistics and inferential statistics such as Ordinary Least Squares (OLS) regression facilitated data analysis, examining relationships between stakeholder involvement (in identification, planning, execution, and review) and project success, while controlling for project budget, complexity, and team experience. Major findings revealed significant positive effects of stakeholder involvement in project identification and review on project success, contrasting with non-significant impacts during planning and a surprising negative impact during execution. Interpretations suggest that early and reflective stakeholder engagement enhances project alignment and learning, whereas excessive involvement during execution may lead to operational challenges. The study concludes that effective stakeholder management is crucial for project success in healthcare settings, highlighting implications for project governance and stakeholder strategies. Broader implications underscore the need for tailored stakeholder engagement practices across cultural contexts. Future research should explore optimal strategies for stakeholder involvement during project planning and execution, considering emerging technologies’ role in enhancing stakeholder collaboration and project outcomes.

Keywords: stakeholder involvement, project success, healthcare projects.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

From a global perspective, stakeholder involvement is widely recognized as a critical factor in the success of projects across various sectors, including healthcare (Bourne & Walker, 2005; Nguyen et al., 2018). Stakeholders, defined as individuals or groups who have an interest or a stake in the success or failure of a project, can significantly influence project outcomes (Freeman, 1984). Effective stakeholder management, which involves identifying, analyzing, and engaging stakeholders, has been shown to enhance project performance, improve decision-making, and increase the likelihood of project success (Eskerod & Jepsen, 2013; Mok et al., 2015).

A systematic review by Nguyen et al. (2018) analyzed 64 studies from 22 countries and found that stakeholder engagement was a significant predictor of project success, accounting for up to 44% of the variance in project performance. Similarly, a survey of 105 project managers from different industries conducted by Bourne and Walker (2005) revealed that effective stakeholder management was the second most important factor in determining project success, with 87% of respondents indicating that it was “important” or “very important” to project outcomes. Mok et al. (2015) analyzed 52 peer-reviewed articles on stakeholder management in mega construction projects and found that effective stakeholder engagement, which involves identifying, analyzing, and managing stakeholder interests, can enhance project performance, improve decision-making, and increase the likelihood of project success. For instance, Eskerod and Jepsen (2013) on a construction project in Denmark found that involving stakeholders in the decision-making process led to a 25% reduction in project delays and a 15% increase in overall project satisfaction.

In the African context, the importance of stakeholder involvement in project management has also been emphasized. Studies conducted in various African countries, such as Ghana, South Africa, and Nigeria, have highlighted the need for inclusive and participatory approaches to project implementation, particularly in the healthcare sector, to address the unique challenges faced by local communities (Owusu-Manu et al., 2018; Shen et al., 2017; Ika & Donnelly, 2017). Owusu-Manu et al. (2018) on public-private partnership (PPP) infrastructure projects in Ghana found that the lack of stakeholder engagement was a significant barrier to project success, with 78% of respondents citing it as a major challenge. Similarly, a study by Shen et al. (2017) on stakeholder management in South African PPP projects found that the active involvement of stakeholders, including local communities, was crucial for project success. The study reported that 85% of the stakeholders surveyed believed that their involvement had a positive impact on project outcomes.

Specifically, in Cameroon, the healthcare sector has faced numerous challenges, including limited resources, infrastructure deficiencies, and the need for improved service delivery (World Bank, 2018). The Bamenda Health District, located in the Northwest region of Cameroon, is not immune to these challenges and has been the subject of various development projects aimed at improving healthcare outcomes (Ministry of Public Health, 2019). However, the extent to which stakeholder involvement has influenced the success of these projects in the Bamenda Health District remains an area that requires further investigation. According to the World Bank (2018), Cameroon’s healthcare expenditure as a percentage of its GDP was only 3.8% in 2018, well below the global average of 9.9%.

Recent studies conducted in the Bamenda Health District have highlighted the importance of stakeholder engagement in enhancing the effectiveness of healthcare interventions (Ngah et al., 2021; Nji et al., 2020). These studies have emphasized the need to involve a diverse range of stakeholders, including community members, healthcare providers, and local authorities, in the planning, implementation, and monitoring of healthcare projects to ensure their sustainability and long-term impact. The Ministry of Public Health (2019) reported that the Bamenda Health District had a shortage of healthcare workers, with a ratio of only 1 doctor per 10,000 residents, compared to the national average of 1 doctor per 6,667 residents. Nji et al. (2020) on the performance of the Bamenda Health District found that the lack of stakeholder engagement was a significant barrier to the effectiveness of healthcare interventions, with 68% of respondents identifying it as a major challenge.

1.2 Statement of the problem

The Bamenda Health District in Cameroon has faced numerous challenges in the healthcare sector, including limited resources, infrastructure deficiencies, and the need for improved service delivery (World Bank, 2018). Despite various development projects aimed at improving healthcare outcomes in the district, the extent to which stakeholder involvement has influenced the success of these projects remains an area that requires further investigation (Ministry of Public Health, 2019).

Many projects in Cameroons’ Northwest Region have consistently ran over budget, over time, failed to meet final product requirements, customer needs, and management goals despite efforts to make them successful (UNICEF,2020). These initiatives have a high failure rate, which may be because important stakeholder (primary stakeholders) wasn’t included in project activities. Despite the fact that the need of stakeholder participation in development is becoming increasingly clear, little effort has been put into making it a reality. The completion of these projects is the main issue in Cameroon since inadequate primary stakeholder participation has led to their failure and alarming rate of decline in use. The concept of participation is not well understood and there has not been an agreement on what it really involves and when it is really necessary to include it. Like most concepts which are discarded when not understood, participation also risks being discarded as a result of being misunderstood (Kobusingye et al., 2017). While an ideal situation would be to have opportunity for primary stakeholder to participate throughout the project cycle, most projects seek participation in isolated episodes during the project and others still, adopt induced participation as opposed to voluntary participation. If this practice continues, losses will continue to occur as most projects will suffer lack of sustainability as soon as donors withdraw support. It is on this premise that the study seeks to establish that primary Stakeholder involvement can influence project success in some health projects at  Bamenda health district

Given the global recognition of stakeholder involvement as a critical factor in project success, particularly in the healthcare sector (Bourne & Walker, 2005; Nguyen et al., 2018; Mok et al., 2015), and the specific challenges faced by the Bamenda Health District, it is important to investigate the effects of stakeholder involvement on the success of health projects in this context. This knowledge can inform the development of more effective and sustainable healthcare interventions in the Bamenda Health District and potentially contribute to improving healthcare outcomes in the region.

According to the World Bank (2018), Cameroon’s healthcare expenditure as a percentage of its GDP was only 3.8% in 2018, well below the global average of 9.9%. This limited funding has resulted in a shortage of resources and infrastructure deficiencies within the Bamenda Health District. The Ministry of Public Health (2019) reported that the Bamenda Health District had a severe shortage of healthcare workers, with a ratio of only 1 doctor per 10,000 residents, compared to the national average of 1 doctor per 6,667 residents. This shortage of healthcare personnel has contributed to the need for improved service delivery in the district.

Despite various development projects aimed at enhancing healthcare outcomes in the Bamenda Health District, the success of these interventions has been limited. At the same time, 68% of projects lack of stakeholder engagement which is a significant barrier to the effectiveness of healthcare interventions in the district (Nji et al., 2020). This is in contrast to the global recognition of stakeholder involvement as a critical factor in project success, particularly in the healthcare sector. Given the specific challenges faced by the Bamenda Health District, the limited success of past healthcare interventions, and the global recognition of the importance of stakeholder involvement in project success, it is crucial to investigate the effects of stakeholder involvement on the success of health projects in the Bamenda Health District. It is based on the above that this study will provide answers to the following research questions.

1.3 Research Questions

1.3.1 Main Research Question

What are the effects of stakeholder’s involvement on health project success in Bamenda health district?

1.3.1 Specific Research Questions

The specific questions of this study are;

1. To what extent does stakeholder’s involvement in project identification influence the success of health projects in Bamenda health district?
2. Does stakeholder’s involvement in project planning influence the success of health projects in Bamenda health district?
3. What is the extent to which stakeholder’s involvement in project execution influence the success of health projects in Bamenda health district hospital?
4. To what extent does stakeholder’s involvement in project review influence the success of health projects in Bamenda health district?

1.4 Research Objectives

1.4.1 Main Research Objective

The purpose of this study is to examine the influence of stakeholder’s involvement on the success of health projects in Bamenda health district.

1.4.2 Specific Research Objectives

The specific research objectives of this study are to;

1. Evaluate the extent to which stakeholder involvement in project identification influences the success of health projects in Bamenda health district.
2. Assess the extent to which stakeholder involvement in project planning influences the success of health projects in Bamenda health district.
3. Investigate the extent to which stakeholder involvement in project execution influences the success of health projects in Bamenda health district.
4. Analyze the extent to which stakeholder involvement in project review influences the success of health projects in Bamenda health district.

1.5 Hypotheses of the Study

H0: Stakeholder involvement in project identification does not significantly influence the success of health projects in Bamenda health district.

H0: Stakeholder involvement in project planning does not significantly influence the success of health projects in Bamenda health district.

H0: Stakeholder involvement in project execution does not significantly influence the success of health projects in Bamenda health district.

H0: Stakeholder involvement in project review does not significantly influence the success of health projects in Bamenda health district.