Health Education, Advocacy and Community Mobilisation Module: 17. Advocacy

Study Session 17  Advocacy

Introduction

Advocacy is an important part of your work as a health worker. As a Health Extension Practitioner, you will be able to use some of the skills of advocacy during your routine work with people in your locality. This session will provide you with an overview of advocacy, its goals, objectives and practices, all of which will help you improve the health of people in your community.

Learning Outcomes for Study Session 17

When you have studied this session, you should be able to:

17.1  Define and use correctly all of the key words printed in bold. (SAQ 17.1)

17.2  Identify the goals and objectives of advocacy. (SAQ 17.2)

17.3  Describe the advantages of advocacy. (SAQs 17.3 and 17.4)

17.1  Advocacy

Advocacy sounds like a really complicated thing to be undertaking, but actually it is just the act of delivering an argument so that you can gain commitment from your political and community leaders, and help your community organise itself to face a particular health issue.

Advocacy involves the selection and organisation of information to make sure that your argument is convincing. Advocacy is not just one thing or one way of doing things; it can be delivered through a variety of interpersonal and media channels. Advocacy also includes organising and building alliances across a wide variety of stakeholders.

Advocacy is strategic and it should be geared to using well-designed and organised activities in order to influence policy or decision makers about all the important issues that you think will affect the health of your community. This might include a wide range of possible issues, including health policy, laws, regulations, and programmes or funding from the public and private health sectors.

Advocacy can address single or multiple health issues, during which time-limited campaigns as well as ongoing work may be undertaken on a range of health issues. Advocacy can be conducted at national, regional or community woreda level, (Figure 17.1) — or at all levels at the same time.

Figure 17.1  In every community there are issues that are larger than the individual, such as the provision of clean water, and that will require detailed advocacy work. (Photo: Ali Wyllie)

You might already be involved in advocacy to improve the lives of your own community. For example, some cultures impose on their communities the practice of female circumcision or female genital mutilation (FGM). However, governments can act as advocates themselves in this area by passing laws that prohibit this practice, and also laws to protect those members of the community who refuse to have their female children circumcised.

17.1.1  Purpose of advocacy

The main purpose of advocacy is to bring about positive changes to the health of your population. Sometimes advocacy will address health issues through the implementation of a national health policy, or through the implementation of public health policy — and it can also address health issues related to harmful traditional practices. Moreover, advocacy could help to meet the goals of health extension programme policies, where specific resource allocation and service delivery models are formulated for advocacy campaigns.

Advocacy is about helping you to speak up for your community; to make sure that the views, needs and opinions of your community are heard and understood. It should always be an enabling process through which you, as a Health Extension Practitioner, together with individuals, model families and others in your community — take some action in order to assist the community to address their health needs. Advocacy is person-centred and people-driven. It is always community-rights based. That is to say that advocacy is dealing with what your community needs to improve its health. You could also say that advocacy is the process of supporting people to solve health issues. It includes single issues and time-limited campaigns, as well as ongoing, long-term work undertaken to tackle a range of health issues or health problems.

Remember, advocacy is your opportunity to influence polices or programmes of health. It also means putting important health problems on the agenda. Advocacy may be able to provide a solution to specific health problems, and build support and networks that can tackle health issues that are affecting the health of your community (Figure 17.2).

Figure 17.2  This picture shows a community ceremony to bless the work of voluntary community health workers. (Photo: Last Ten Kilometres Project)

‘Speaking up’ operates both at an individual level, with organisations and at governmental level. It has the potential to be extremely influential in your health education work.

17.2  The goals and objectives of advocacy

The goals and objectives of advocacy are to facilitate change and the development of new areas of policy, in order to tackle unmet health needs or deal with emerging health needs in a given community.

A goal is the desired result of any advocacy activity. An advocacy goal will usually be a long-term result, and it may take three to five years of advocacy work to bring about the desired result. It is unlikely that your advocacy network can achieve a goal on its own; it will probably require other allies to bring about the required change. It is vital to know what you are trying to do before you start your advocacy work. This involves developing a goal that applies to the situation that needs to change.

Important points to note about goals are as follows:

• A goal is the overall purpose of a project. It is a broad statement of what you are trying to do.
• A goal often refers to the benefit that will be felt by those affected by an issue.
• A goal is long term and gives direction — it helps you know where you are going. It needs an accompanying route map or strategy to show you how to get there.
• Without a goal, it is possible to lose sight of what you are trying to do.
• A goal needs to be linked to the mission and vision of your organisation.

Moving on from goals, an advocacy objective is measurable, realistic, and time-bound. While setting your objectives, remember that your objectives should be ‘SMART’ (Box 17.1).

An objective is the intended impact or effect of the work you are doing, or the specific change that you want to see. The word ‘objective’ often refers to the desired changes in policy and practice that will be necessary to help you and your community meet that goal. It is the most important part of your strategy, and is the next step after developing the goal itself. It is worth spending time writing clear objectives, because you will find you are able to write the rest of the advocacy strategy much more clearly — and you are likely to be more effective in achieving change.

When you set an advocacy objective, always consider or keep in mind the resources available in your locality. It is important that an advocacy objective identifies the specific policy body in the authority that should be approached to fulfil the objective, as well as detailing the policy decision or action that is desired. For example, if you want to overturn the ban on community-based distribution of contraceptives, then the right target to direct your advocacy towards would be the Ministry of Health.

In contrast to a goal, an advocacy objective should be achievable by the network on its own. It is a short-term target, which means it should be achievable within the next one or two years. The success of your advocacy objectives should always be measured. For example, if the objective of an advocacy programme is to ask the woreda Health Office to fund a specific health programme, then the success of the objective can be measured quite easily by finding out whether or not the woreda Health Office has allocated money for that programme.

All your advocacy objectives should be specific, measurable, achievable, realistic and time-bound. The objectives should always be linked to the available resources. In a sense, this is part of the feature of achievability. Unless you have available resources, you will not be able to achieve your objectives.

To understand the differences between goals and objectives, remember that an advocacy issue is where there is a problem. Perhaps in your community there has been low immunization coverage due to inaccessible services for mothers with young children. This is an issue that advocacy might be able to tackle.

In this example, an advocacy goal would be gaining the commitment of kebele leaders for better access to immunization for the people in their community. In contrast, an advocacy objective would be to identify that you should conduct meetings with kebele leaders in order to discuss this problem.

17.3  The advantages of advocacy

The success of advocacy as a method of problem solving or resolution is tied in part to the advocates’ philosophy of searching for solutions rather than problems. As a health worker acting as an advocate, you may be able to find ways to resolve the community’s health-related problems. In some situations you may have to act as a health advocate and provide ongoing representational advocacy for your community. Advocates should be particularly good at identifying the strengths of their own community, and should help them find ways of solving health-related problems.

There are several benefits of advocacy:

• Advocacy helps your community’s voice to be heard
• It provides you with information, support, and services to help you make choices.

Advocacy also:

• Helps you to get people to understand your point of view
• Makes it easier for you to get information in a way that you can understand
• Helps you to see what other services are available
• Helps you choose what you want to do
• Helps with expressing your views effectively
• Represents your community’s views faithfully and effectively
• Helps influential people understand the issues.

It is important to remember that advocacy is not about being a friend or counsellor, or about persuading other people to agree with your views. Nor is it about the advocate deciding what is in another person’ best interests.

Advocacy is not an alternative complaints procedure, but may involve the advocate in supporting the person in making a complaint effectively. In addition, it is not campaigning, although it may highlight problems and gaps in particular services. Above all, advocacy is not providing social support, for example, managing someone’s financial affairs or organising transport for them, nor is it a long-term service.

Summary of Study Session 17

In Study Session 17, you have learned that:

1. Advocacy is speaking up, and drawing policy makers and the community’s attention to an important health issue.
2. Advocacy is working with other people and organisations to improve the health of the community.
3. The first two steps in any advocacy campaign are selecting the health issue that needs advocacy work, and then developing the goals and objectives.
4. Without a clear, articulated issue and well-defined goals and objectives, the remaining steps of the advocacy campaign will lose focus.
5. You also need to remember that the goals and objectives of your advocacy work are to facilitate changes and new policy developments, in order to tackle unmet health needs or any emerging health needs of your community.

Self-Assessment Questions (SAQs) for Study Session 17

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.