Welcome to our course on Understanding and Strengthening Health Systems for Global Health. During the course we will provide you with an overview of the main elements or building blocks of a health system based on the World Health Organization’s guidance. You will have the opportunity to explore four main areas of health systems in global health with particular reference to low and middle income countries. The first area focuses on understanding health service organizations, the challenges. Our second module looks at WHO’s six major building blocks or health systems components with particular reference to primary health care and the need for community participation in planning, delivery and assessment of these systems components. in our third module we examine the specific systems component of human resource development and capacity building. The fourth area consists of health policy making and advocacy with stakeholders. This course is geared toward learners who are already involved in managing health and development programs on the ground in low and middle income countries or who are preparing for such a management role. The main lectures will span a four-week period with approximately 2-4 hours of viewing learning materials per week. We have one peer graded essay wherein you will use skills in ‘organizational’ diagnosis to better understand a challenge in an organization where you are or have worked. There are also quizzes. We hope you will engage with your fellow learners in discussion forums to learn from each other.
Advocacy
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Understanding and Strengthening Health Systems
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Health Systems Policy Development and Advocacy Approaches
Health and development organizations and systems are created and funded through policy decisions. Within organizations there are policies that procedures that determine the actually functioning or the organization. This module looks at stakeholders in the policy process and helps the learner consider advocacy strategies to influence healthful policy change.
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William Brieger, DrPHProfessor, Health Systems Program of the Department of International Health
Bloomberg School of Public Health
The issue that was noted in the Mexican example is not necessarily different than
it is another countries.
And the question arises is to what degree do the ultimate recipients
of the benefits or effects of policy have in defining policy?
Is their role simply to vote for
a surrogate who will once reaching a legislature or a county council vote for
policy supposedly in the interest of a constituency?
What is done to ensure that this constituency constantly has the ear
of the policy maker is in constant communication.
And here is where the importance of advocacy comes in.
Several definitions are offered.
Advocacy is an action directed at changing policies, positions and programs.
Advocacy is pleading for, defending, recommending an idea before other people.
The word advocate is often used for lawyer in other countries.
And here again we can see the role of a change agent in public health,
helping mobilize, helping organize, especially in the context of
social action type change, community action type change to help
the community have a voice, speaking on behalf of the community.
Advocacy is speaking up, drawing a community's attention
to an important issue and directing decision makers toward a solution.
Advocacy requires working with other people and
different organisations coming together in coalitions to make a difference.
Advocacy involves putting a problem or an issue on the agenda.
Priorities can't be set until people recognize a problem exists.
Advocacy offers solutions.
Advocacy builds support among community groups for
both addressing and solving a problem.
Advocacy is aimed at changing systems, organizations,
government decision-making bodies.
Advocacy is undertaking strategies that influence decisions at all levels.
Strategies in advocacy include lobbying, social marketing,
information, communication, community organizing.
Advocacy enables people to participate in the decision-making processes that
affect their lives.
In order for advocacy to work five particular components or
elements are needed.
One is clearly people, community groups, community based organisations,
professional groups need to come together.
Here is an example of the coalitions that were formed in Lagos.
That included both heath care providers and
community based organizations, civic groups.
Civic groups brought with them perceptions of need,
manpower, resources, skills and organizing.
The professionals had ideas on specific strategies for
solving health problems together, they formed a powerful lobbying group.
Beside people, advocacy also requires fundraising, to gather information,
to analyze it, to communicate it or share it with the policymakers.
This may involve buying television time, etc.
As we said, the fundraising can support data collection.
We also need information that convinces people of the problem that exist,
that it is a serious problem, that it does need to be prioritized, and
also research on evaluating different alternative solutions.
Advocacy also needs to identify specific audiences who can bring about the change.
So we said the policy makers and the administrators who interpret policy.
And advocacy also needs appropriate media through
which one communicates with policy makers.
One needs to understand their media use habits,
how they can be reached, do they watch television?
Do they have members of staff clip newspaper articles?
Once these elements are known, the organizations, the money, the knowledge or
data, the audience, and the media, then an advocacy strategy can be planned.
Particular form of advocacy is media advocacy.
Using the media to grab the attention of policy makers,
help them become aware of a current problem and encourage them to take action.
Media advocacy sees community members as advocates,
it can advance healthy public policies.
It's decentralized and opportunistic,
using events that occur, staging rallies, etc.
It changes the environment.
It uses news and paid advertising.
It targets people who have the power to make change, and addresses the power gap.
Now, very interestingly, a few years ago,
a WHO research group called together people to develop guidelines and
policy statements about advocacy for the Ivermectin Distribution Program.
They brought together scientists, they brought together researchers who have
worked in the field, they brought together administrators from different donor
organizations, and they brought together people from the mass media.
The document that resulted interestingly enough to find advocacy as
the process of creating demand in the public.
And in fact what the APOC had discovered, the African Program for
Onchocerciasis Control, is that the drug was quite popular.
The problem was not in creating demand.
The problem was in the health system being able to deliver the drug at
the right time, in the right quantities.
What was needed was advocacy that let the policy makers know that
the community wanted this drug and they wanted them to reorganize
themselves to guarantee the drug could be made available.
So advocacy was needed to focus on policy makers.
Otherwise, this approach to creating demand would have relied on
social marketing that looked only at the intrapersonal level,
at the individual level.
Looking at the individual was the focus of the program, not looking at the policy
makers who were supposed to provide the resources to make the program succeed.
Social marketing can be contrasted with media advocacy.
Whereas media advocacy sees the individual as an advocate,
social marketing sees the individual as the audience, to receive messages.
Media advocacy advances public health policy,
social marketing develops health messages, again focusing on individual
behavior change as opposed to public policy enabling environment changes.
Whereas media advocacy is decentralized communities can organize their
own activities.
It's opportunistic when events occur in the community they can take
advantage of it.
Social marketing because it relies on the media has a fixed set of problems and
approaches.
It's already predetermined what the behaviors are going to be.
The approach through the educational radio spots, etc, or
pamphlets as already been determined.
Media advocacy takes advantage of current news and well, by advertising in
the paper they will stage news conferences to point out pollution,
to draw attention to cases of young people starting to smoke, etc.
Social marketing often relies on public service spots and so is not as flexible.
Media advocacy targets the person with the power to make change whereas social
marketing targets the person with the perceived problem, or
the person at risk of a health problem.
Whereas media advocacy addresses the power gap,
social marketing addresses only the information gap,
thinking that information alone is enough to change people's behavior.
In the next slide we see a page from a magazine, from Greenpeace,
and one can see in these different pictures that the organization has used
opportunities to draw attention to environmental problems.
When dangerous shipments like nuclear waste are being shipped,
they go to the place and they get the various news agencies
throughout the world to record on what they're doing.
They draw attention to the problems, the problems of whaling,
problems of nuclear testing etc.
So they're using, taking advantage, being opportunistic,
whatever is happening, to draw media attention.
And the assumption then is that key policy makers and
administrators are watching and they will see the issue.
They will see the levels of public support and concern about this, and
may be influenced to make different decisions.
The next slide shows the problem of Guinea worm that we've been talking about and
hopefully people by now would have accessed different websites to learn more
about the problem.
Guinea worm affects neglected populations,
it had been a neglected disease up until 1985 when attention was
drawn throughout the world to the disabling effects of the disease.
The next slide shows the cover of a Nigerian news magazine.
And a major article inside there talks about how government had made promises but
it never fulfilled to provide water supply to people.
This type of national circulation is clearly designed to embarrass
policy makers and government officials that they have not
paid attention to the needs of the rural people.
The wording is quite blunt, Guinea Worm is the Shame of Nigeria.
The national eradication task force spent quite a lot of time involving
people from the mass media to enhance their media advocacy program.
They provided opportunities for journalist to visit various effected communities.
The next slide shows a news article that appeared in one of
the most respected newspapers in the country that are read
by most government officials, university staff, etc.
It's very well read.
This type of attention pointing out areas where the disease has erupted again
during the beginning of the rainy season.
The lack of materials to solve the problem,
the economic impact being reported, all of these are efforts and
media advocay to draw attention to the policy makers to where they have
not been addressing the health needs of communities.
Media advocacy was even used at the international level.
The following slide shows an article from the New York Times.
People in the Carter Center who were spearheading efforts around
the world to get attention to the diseased used various fora in national and
international media to draw attention to the problem.
People can say well, I've never heard of this Guinea worm,
you can send them reprints of the articles and they spell out what needs to be
done in terms of water supply, in terms of simple procedure such as filtering water.
With this background, having created attention, the World Health Assembly
was encouraged to pass subsequent resolution, various resolutions.
The information was used to influence various corporations to donate.
The American Cyanamid company who was convinced to give free
supplies of the chemical abate or temephos that was used to kill the cyclops.
It's also used to kill mosquito larvae and
also used to kill the eggs of larvae of black fly that carry Onchocerciasis.
But particularly small quantities if put in the pond where Guinea worm is will kill
the cyclops and within a few hours the pond water will still be safe to drink.
Donations were able to be gathered from Georgia Pacific for
poster paper and a subsidiary of Dupont company provide a filter cloth.
So all of this was made possible by media advocacy because people were aware it
was an international problem.
It wasn't just something that people from the Carter Center were talking about on
a personal level, but these people had read about it and seen it in the news and
therefore responded.
This was an example of course of positive corporate response to a health issue,
this doesn't always happen.
You can see examples of manufacturers of infant food promoting these at
the expense of breastfeeding.
Tobacco and alcohol industries are another
example of corporations that promote illness.
It often was the case in inner city neighborhoods that advertising for
alcohol products was quite common.
Billboards here and
there that would never have been allowed in middle class neighborhoods.
Here again, was a need for advocacy on the part of the communities to stand up and
draw attention.
Why was city hall allowing these billboards in port communities?
What was happening with the industry standing by as if they were innocent of
the whole process?
Getting them to be responsible, and now we can see that advocacy has worked.
They're going through legal system, using various opportunities
to sue tobacco manufacturers, gun manufacturers, etc.
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