Strategic stakeholder engagement for injury care: building consensus in Ghana, Pakistan, Rwanda and South Africa

Abstract Injury care requires coordination between communities, health services, emergency responders and local authorities; however, actors rarely deliberate together and little is known about how stakeholders themselves prefer to engage. Policy change is more likely when problems, solutions and political support align, an alignment political actors can manufacture through statecraft. We present a participatory counterpart, building strategic stakeholder engagement in Ghana, Pakistan, Rwanda and South Africa. Eighty-seven injured people, community members, trauma care providers and decision-makers participated in six consensus-building forums, bringing together non-peer policy communities: lived experience of injury, practical knowledge of care systems, and formal responsibility for policy and resources. Stakeholders developed multilevel strategies connected to existing governance, community and data systems: legitimate local entry points linked with decision-making, resources to sustain participation, and explicit attention to exclusion. Political commitment, often considered a precondition for multisectoral action, emerged as something engagement itself can build. We term this participatory statecraft.