Malaria Policy & AdvocacyDRAFT

Matthew Lynch

Center for Communication Programs

Johns Hopkins Bloomberg School of Public Health

NetWorks Project

April 17, 2011

Advocacy Process

How can we go forward when we don't know which way we're facing?How can we go forward when we don't know which way to turn?How go forward into something we're not sure of?

John Lennon “How” 1971

What is Advocacy?

A strategic process of communication targeted to decision-makers designed to change the way they choose to allocate resources in order to increase program impact through improved policies and/or processes.

A strategic process…

• Planned in collaboration with other stakeholders in that issue

• Formed through a collaborative process developing a technical consensus on which to base messaging

• With clear objectives and an evidence base to support specific recommendations for action

…of communication…

• Using multiple channels to convey messages:• Interpersonal: networking from trusted

peers, celebrity/champions, “experts”• Printed: fact sheets, data presented as

information, compelling photos• Mass media: messages designed to create

perception of groundswell of opinion, or introduce an issue

…targeted…• Information designed and presented to

meet the needs of the decision-maker• Credible: based on evidence, or what

the decision-maker considers trusted sources

• Specific to the issue of concern, focused on specific, shared objectives

• Representing stakeholder consensus of appropriate action to be taken

…to decision-makers…

• Those persons with the authority to change the allocation of resources key to the resolution of the identified issue

• May also include those who act as “gate-keepers” to the authoritative decision-maker

…designed to change the way they choose to allocate…• Advocacy creates motivation within a

decision-maker to take a desired action- it sets the stage for a conscious choice to change the allocation of resources

• Note that motivation is internal- it cannot be “provided” from an external source, only catalyzed by external stimuli.

…resources…

• Money• Human resources/talent/

technical expertise• Commodities• Access to higher-level

decision-makers• Information • Policies

…to increase program impact…

• Advocacy is:– Embedded in program context with specific

recommendations for action– Linked to program cycle of planning,

implementing, monitoring, revising– Symbiotic with program success --

dependent on program outcomes to maintain advocates’ credibility

– More effective if linked to global priorities

…through improved policies and/or procedures.• Advocacy to change policy is not

sufficient to ensure improved impact- policies must be reflected in changed implementation procedures

• Often malaria policies are technically sound, but poorly implemented

“improved”

• Increasing program impact implies assessment in terms of clear objectives with measurable indicators

• For effective advocacy, the increased impact needs to be reported back to both the stakeholders and the decision-makers in meaningful terms

Effective advocacy is credible

• Based on available evidence• Not exaggerated• Starting from known resource allocations

How can we go forward when we don't know which way we're facing?

John Lennon “How” 1971

Credible Advocacy is…

• Presented by people considered authoritative by the target audience

• Consistent across presenters• Appropriate to the cultural and

situational context

Why Advocacy matters

• Decision-makers have variety of demands on resources they control, many with strong public health/ public good justifications

• Allocation decisions determine access to potentially life-saving prevention and treatment resources

Advocacy matters to them…

How does Advocacy work?

Take action to

move resources

Decide the issue is worth risking

putting your resources towards it

Realize that

other people care

about this

issue

Become aware of the issue

© Center for Communication Programs, JHBSPH

Problems/ Issues defined

Stakeholders identified & assembled

Targeted messages and channels designed for specific decision makers

Strategic Advocacy Cycle

Results monitored and reported back to

stakeholders for increased

accountability

Increased resources allocated within

program

Increased scrutiny on management

Improving Malaria Systems

Advocacy activities to:

• Activate leadership and strengthen commitment

• Facilitate partnership and collective action• Monitor and use data

Decision makers:• Aware of issues

and potential solutions,

• Motivated to take action

Decision-makers:• Allocate more

resources to address key problems and issues

Ensuring Decision-makers Take Action

Messages communicated to targets by:

• Champions• Mass media• Public events• News coverage• Peer networks

Catalyzing Change

© Center for Communication Programs, JHBSPH 2008

Setting the Agenda

Key Steps in Effective Advocacy

Setting the agenda

• Defining the issue• Identifying &

convening other stakeholders

• Building consensus• Clarifying strategy

steps

Need to Engage

Currently Engaged

Universities/ResearchInstitutes

Minister ofFinance

ProvincialAdministrators

GFATMCCMs/

PRs

• Bilateral• Donors

• Multilateral • Donors

• Technical• Agencies &• Paetners

• Private• Sector

• RBM • Partnership

• Global• Level

• NMCP

• NDRA

• Nat’l-level• Donors

• Privatre • Sector

• Community • Leaders

• District-level• Implementers

• Other MoH• Departments

• NGOs

• Country • Level

Partner constellations:

Catalyzing Change

Translation of Evidence

• Data needs to be analyzed into preliminary findings

• Consensus built within technical community for united front

• Translation into summaries and policy recommendations for each country

• Consolidation into summaries and recommendations for global level

Channels

Journal articlesNewspapers

Radio broadcastsInformational flyers

Meetings

Taking action

• Once messages are delivered, followup is required to ensure motivation to take desired action increased

• Additional messages may be needed, or reinforcement

Monitoring & Reporting

• Without monitoring there is no way to know if advocacy has achieved anything

• Monitoring itself is often a key issue for advocacy

POLICY ISSUES

Policy Issues- 2011

GMBP Exhibits (v1.0).ppt

3 Core Components of the Strategy

ELIMINATIONScale-up for impact(SUFI)

Sustained Control

CONTROL

RESEARCH

1 2

3

The Global Malaria Action Plan Process

In 2011 we’re starting to see change… • 11 endemic countries in Africa are close

to achieving Universal Coverage with LLINs

• Mortality is decreasing with increasing malaria control coverage

Global context

• Two-pronged strategy: elimination at the fringes, control in the center

• Control at the center is now more complex, and requires:– Complete Scaling-Up in many countries– Transition to Sustained Control in those

who have scaled-up

Scaling up is conditional

• Universal coverage more common in LLINs, but less so in diagnosis /treatment and IPTp

• Coverage varies geographically within countries

• Coverage is fragile, and tends to decay with time

Scaling up is conditional

• Filling gaps:– completing scaling-up of key interventions

(LLINs, IPTp, diagnosis & treatment)– maintaining universal coverage

• continuous distribution of LLINs• IPTp in ANC services promotion• Behavior change communication to create and

sustain demand for malaria prevention and treatment services

Integrating malaria and health services• Integrating and strengthening related

services is both desirable and feasible– ANC– Health facility management, especially

stock management– Education: school programs and school-

based commodity distribution– IMCI and RDTs + antibiotics/ACTs

Monitoring & Evaluation

• Surveillance and monitoring is critical for identifying gaps, responding to resurgence, targeting resources, and to reporting success justifying investment

• Increasing efficiency: not enough to demonstrate efficacy and coverage, donors will now want to see gains in efficiency and cost-effectiveness

Monitoring & Evaluation

• Reporting results is critical to sustaining donor commitment and an integral part of strategic advocacy

• Reports are particularly important to target to audiences, and credibility is key

• Increasing need for both hard data, cost data, and success anecdotes

Challenges & Opportunities

• Retaining adequate funding• Laying the foundation for critical

capacities to support sustained control• Maintaining universal coverage where

achieved• Filling gaps where UC not yet

accomplished

Funding: need for diversification

• US Congress votes on funding for:– 1/3 of GFATM– President’s Malaria Initiative– USAID non-PMI malaria programs– substantial portion of World Bank malaria

funding• Funding is year-by-year, not guaranteed

Additional funding sources

• New international donors- BRICS countries, UNITAID, Gulf states

• Endemic country health budgets• Private sector

– Multinational corporations– Endemic country businesses

• Households (already pay large share)

Opportunities for PCVs

Some suggestions for consideration

Increasing resources

• Leveraging private sector capacitiesContributions in kind more likely than cash:

• Transport & logistics• Communications and mass media• Distribution via retail networks• Training in management skills

Improving collaboration

• Adding advocacy skills and actions to bilateral development projects– Building stakeholder coalitions at local

level is difficult for national-level stakeholders

– Incorporating local variations to fit local context is critical, but not feasible without local contacts and knowledge

District level advocacy

• Government-funded projects often have difficulty funding “advocacy” activities, although there are clear mutual benefits to doing so. Opportunities exist to supplement USAID and other bilateral projects with small grant support to produce advocacy events, providing positive feedback to donors

Facilitating scale-up

• LLIN distribution– Mass campaigns require intensive micro-

planning at local level, logistic support– Continuous distribution to maintain high

LLIN coverage is likely to be most effective when channels are identified locally and reflect varying capacities

Promoting integration

• Facilitating adoption of diagnostics and revised IMCI algorithms at health facilities

• Encouraging households to demand diagnosis and appropriate treatment

• Building demand for LLINs through routine distribution channels

• Strengthening surveillance and monitoring

Behavior change communication

• Training CHWs in interpersonal communication skills

• Field-testing and adapting messages

• Gathering insights into barriers to effective control

Documenting best practices

• Projects often lack resources to document their successes and are eager for opportunities to do so

• Identifying and justifying “best practices” is valuable and best done at local level to provide the evidence base

…and many more only you can provide.

Resources for Advocacy

– Advocacy support from key RBM units• Malaria Advocacy Working Group (MAWG)• Sub-regional networks (SRNs)

www.rollbackmalaria.org

– Advocacy support from International NGOs• FBOs and mission hospital organizations• USAID implementing partners in malaria• Advocacy oriented NGOs- Friends of the

Global Fight, ONE, Malaria No More, Global Health Council