Forming Partnerships to Influence Health Policy  Policy Advocacy: The Fifth ‘P’ of Health Marketing August 13, 2009
Presenters Bryan provided support for strategy development, branding, and materials development for the launch of Preventi...
Policy Advocacy: The Fifth ‘P’
Traditionally Health Marketing Has Operated with “Four P’s” <ul><li>Product   The health commodity or health behavior that...
What are the differences between  policy advocacy and health marketing?  <ul><li>Health Marketing </li></ul><ul><li>Consum...
What are the similarities between  policy advocacy and health marketing?  <ul><li>Health Marketing </li></ul><ul><li>Simpl...
“ I don’t care  what you tell me about the female condom.  I’ve heard that  women don’t like it .   Until I hear different...
The Female Condom: From Concept to Reality® 1981 MMWR  identifies AIDS in U.S. gay men 1988 ●  Heterosexual transmission s...
<ul><li>In 2008, 33 million people worldwide were living with HIV or AIDS. </li></ul><ul><li>The global pandemic is center...
Women and HIV/AIDS: A Growing Pandemic <ul><li>By 2006, ~50% of all PLWHA worldwide were women. </li></ul><ul><li>By 2006,...
An epidemic at home among Black & Latina women <ul><li>In 2007, females accounted for 26% of U.S. HIV diagnoses in 34 stat...
But little movement to equip women with the only woman-initiated HIV prevention method available <ul><li>Despite strong cl...
Female Health Company response, 2001-2006 <ul><li>Invested in the development of FC2 Female Condom, which could be manufac...
Creating an advocacy movement: The launch of Prevention Now! in 2006 <ul><li>By 2006, FHC had all of the evidence it neede...
Building an effective advocacy NGO Partnership <ul><li>CHANGE capabilities: </li></ul><ul><li>Relevant media & influencer ...
Creating clear, distinct, and credible messages Woman-initiated HIV prevention methods are essential to stopping HIV/AIDS....
Developing a strong brand &  21 st -century campaign platform
360° Communications Coalition Building Third-Party Initiatives  (e.g.; School-based program) Promotions and Special Events...
Strategic Approach Key Decision-Makers at the International and Country Levels Regional Organizations Global Organizations...
Prevention Now! policy advocacy <ul><li>Prevention Now! Structure </li></ul><ul><li>An initiative of the Center for Health...
Prevention Now! policy advocacy <ul><li>International Advocacy </li></ul><ul><li>Key partners:  UNFPA, Universal Access to...
Prevention Now! policy advocacy <ul><li>U.S. Advocacy on U.S. Global AIDS Policy </li></ul><ul><li>Researched and publishe...
Official launch of Prevention Now! Toronto IAC, 2006
Female Condom Rally Mexico City IAC, 2008
<ul><li>Comparing 2004 and 2008,  positive coverage  of the female condom in global media  increased from 18% to 57%. </li...
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Nchm Deck Policy Advocacy Callahan Whipkey Final

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This presentation provides an overview of the role that policy advocacy has played in activating greater visibility for the female condom and increased procurement in the developing world. It highlights the important role that third-party partnerships play in mobilizing evidence of need and demand for health products in the developing world. The presentation identifies policy advocacy and social marketing as essential complements to a comprehensive marketing and promotion strategy.

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  • David Ogilvy said it first and we have stood by his words “We exist to build the business of our clients.” If at the end of the day, your business is not better off as the result of having worked with us, then we have failed to do our job. Our success is wholly-measured by our client’s success in solving the problems presented to us. Our efforts can never be separated from your overall marketing goals; our job is to help you get there.
  • Nchm Deck Policy Advocacy Callahan Whipkey Final

    1. 1. Forming Partnerships to Influence Health Policy Policy Advocacy: The Fifth ‘P’ of Health Marketing August 13, 2009
    2. 2. Presenters Bryan provided support for strategy development, branding, and materials development for the launch of Prevention Now! and continues to provide senior counsel to the campaign. Kim manages the day-to-day operations of Prevention Now!, spearheading advocacy initiatives and providing technical assistance for Prevention Now! activities worldwide. Bryan Callahan, Ph.D. Social Marketing Practice Ogilvy Public Relations Worldwide Washington, DC [email_address] Kimberly Whipkey Sr. Associate, Advocacy and Outreach Center for Health & Gender Equity Washington, DC kwhipkey@genderhealth.org
    3. 3. Policy Advocacy: The Fifth ‘P’
    4. 4. Traditionally Health Marketing Has Operated with “Four P’s” <ul><li>Product The health commodity or health behavior that you are seeking to market to consumers </li></ul><ul><li>Price The real cost of the item, or the cost/benefit equation used to engage consumers </li></ul><ul><li>Place The physical placement of the item to raise visibility among consumers </li></ul><ul><li>Promotion The promotional tactics used to raise awareness, engagement, and behavior change </li></ul>Increasingly, global health and development organizations – from the Bill & Melinda Gates Foundation, to the World Health Organization, to the World Bank – are recognizing the need for Policy Advocacy as an essential Fifth P for health marketing. <ul><li>Policy Advocacy </li></ul><ul><li>To promote important changes in health behavior, advocates must engage key decision-makers with evidence that demonstrates the costs and benefits of specific health interventions. Policy advocacy is essential to secure the required funding, institutional support, and dedicated human resources to make health interventions accessible to those who need them. </li></ul><ul><li>Primary Audiences : Heads of state, members of Congress or Parliament, Ministers of Finance, Ministers of Health, Bilateral Aid Agencies </li></ul><ul><li>Secondary Audiences : Scientists, researchers, think tanks, foundations, other policy advocates, the media </li></ul>
    5. 5. What are the differences between policy advocacy and health marketing? <ul><li>Health Marketing </li></ul><ul><li>Consumer oriented (often general population) </li></ul><ul><li>Promotes health behavior change at the personal, </li></ul><ul><li>family & community levels </li></ul><ul><li>Delivers message with low-literacy materials </li></ul><ul><ul><li>Information designed to demonstrate personal </li></ul></ul><ul><ul><li>benefit </li></ul></ul><ul><ul><li>Information designed to be accessible to all </li></ul></ul><ul><ul><li>audiences </li></ul></ul><ul><li>Engages information gate-keepers and key </li></ul><ul><li>influencers at the community level </li></ul><ul><li>NGOs support community-level programming </li></ul><ul><li>focused on consumers </li></ul><ul><li>Policy Advocacy </li></ul><ul><li>Focused on key decision-makers and their key </li></ul><ul><li>influencers </li></ul><ul><li>Promotes policy change at the national, state, </li></ul><ul><li>municipal, and district levels </li></ul><ul><li>Delivers message with high-literacy materials </li></ul><ul><ul><li>Scientific evidence </li></ul></ul><ul><ul><li>Evidence of need and demand </li></ul></ul><ul><ul><li>Cost-effectiveness evidence </li></ul></ul><ul><ul><li>Demonstration of civil society support </li></ul></ul><ul><li>Engages key influencers and key decision-makers </li></ul><ul><li>at the national, state, municipal and district levels </li></ul><ul><li>NGOs support advocacy by targeting key </li></ul><ul><li>decision-makers with evidence of need and </li></ul><ul><li>demand </li></ul>
    6. 6. What are the similarities between policy advocacy and health marketing? <ul><li>Health Marketing </li></ul><ul><li>Simple messages </li></ul><ul><li>Based on credible evidence </li></ul><ul><li>Framed by a clear call to action </li></ul><ul><li>Delivered by trusted intermediaries </li></ul><ul><li>Key intermediaries are often grassroots NGOs </li></ul><ul><li>Policy Advocacy </li></ul><ul><li>Simple messages </li></ul><ul><li>Based on credible evidence </li></ul><ul><li>Framed by a clear call to action </li></ul><ul><li>Delivered by trusted intermediaries </li></ul><ul><li>Key intermediaries are often grassroots NGOs </li></ul>
    7. 7. “ I don’t care what you tell me about the female condom. I’ve heard that women don’t like it . Until I hear different, don’t call me back .” — Senior Health Reporter Associated Press October 2005 Policy Advocacy for the Female Condom: Changing the Conversation, 2005-2009
    8. 8. The Female Condom: From Concept to Reality® 1981 MMWR identifies AIDS in U.S. gay men 1988 ● Heterosexual transmission seen as dominant vector in Africa ● Women account for 5% of diagnosed AIDS cases in U.S. ● Wisconsin Pharmacal announces development of Female Condom 1993 FDA approves FC1 by narrow 4-3 vote 1994 2001 ● FC1 fails to take off in U.S. & Europe cost and product characteristics play role ● First ARVs become widely available ● NSC declares AIDS global security threat ● UN creates Global Fund ● Bush Admin. Commits $15 billion to PEPFAR ● UNFPA begins targeted FC1 distribution ● FHC commits to developing lower-cost FC 2005 ● FHC introduces FC2 (2005) ● WHO includes FC2 in EPL (2006) ● IAC “Time to Deliver” (2006) ● Women ~50% of PLWHA (2006) ● Prevention Now! launched (2006) ● FDA approves FC2 by 14-0 vote (2008) 2009
    9. 9. <ul><li>In 2008, 33 million people worldwide were living with HIV or AIDS. </li></ul><ul><li>The global pandemic is centered in southern Africa. </li></ul><ul><li>In other regions of the world, HIV and AIDS disproportionately impact MSM, CSW, IDU, and women. </li></ul><ul><li>In many regions of the world, marriage is the #1 HIV risk factor for women and young girls. </li></ul><ul><li>Source: UNAIDS, 2008 </li></ul>A Growing Global HIV Pandemic
    10. 10. Women and HIV/AIDS: A Growing Pandemic <ul><li>By 2006, ~50% of all PLWHA worldwide were women. </li></ul><ul><li>By 2006, nearly 60% of PLWHA in sub-Saharan Africa were women. </li></ul><ul><li>Women and girls between the ages of 15-24 accounted for 76% of all new infections. </li></ul><ul><li>Source: UNAIDS, 2008 </li></ul>
    11. 11. An epidemic at home among Black & Latina women <ul><li>In 2007, females accounted for 26% of U.S. HIV diagnoses in 34 states where surveillance was conducted. </li></ul><ul><li>In 2007, high-risk heterosexual contact accounted for 83% of HIV diagnoses in U.S. females. </li></ul><ul><li>Black women account for the largest share of new HIV infections among women – 61% </li></ul><ul><li>Black females account for 69% of new AIDS cases among young women. </li></ul><ul><li>The AIDS case rate among Latina women is 5 times higher than among White women (suggesting late diagnosis). </li></ul><ul><li>Source: CDC data. </li></ul>High-Risk Heterosexual Contact = 83% IDU = 15% HIV Transmission among U.S. Women - 2007 Transmission Route Male Female Total Male/Male Sexual Contact 22,472 - 22,472 Injection Drug Use 3,133 1,806 4,939 Male/Male Sexual Contact & Injection Drug Use 1,260 - 1,260 High-Risk Heterosexual Contact 4,551 9,076 13,267 Other/Risk Not Identified 102 96 198 TOTAL 31,518 10,977 42,415
    12. 12. But little movement to equip women with the only woman-initiated HIV prevention method available <ul><li>Despite strong clinical evidence that the female condom had high rates of acceptability as a prevention method, </li></ul><ul><li>only 12 million units were sold and distributed to prevention programs worldwide in 2005. </li></ul><ul><ul><li>Global distribution of male condom vs. female condom in 2005 was 6-9 billion vs. 12 million </li></ul></ul><ul><ul><li>Just 1 FC available for every 100 women of reproductive age </li></ul></ul><ul><li>The high cost of the female condom – which was up to 20 times more expensive per unit than the male condom – </li></ul><ul><li>made the method inaccessible to many prevention programs in the developing world. </li></ul><ul><li>When FC was available, it was only programmed to specific high-risk populations (e.g., commercial sex </li></ul><ul><li>workers). </li></ul><ul><li>Many reproductive health advocates saw the development of a safe and effective microbicide as possible by </li></ul><ul><li>2011, and their commentary suggested that the FC was strictly a second-tier alternative as a woman-initiated </li></ul><ul><li>method. </li></ul><ul><ul><li>Many influencers in global health stressed the need for a method that women could keep secret from their </li></ul></ul><ul><ul><li>husbands and partners. </li></ul></ul><ul><ul><li>Women’s ability to initiate or negotiate safer sex with female condoms was described as problematic. </li></ul></ul><ul><ul><li>Education programs designed to sensitize women to female condom and teach partner negotiation skills </li></ul></ul><ul><ul><li>went unfunded or underfunded. </li></ul></ul>
    13. 13. Female Health Company response, 2001-2006 <ul><li>Invested in the development of FC2 Female Condom, which could be manufactured with the same cost-efficient </li></ul><ul><li>methods used to make male condoms. </li></ul><ul><li>Commissioned cost-effectiveness study by Dr. David Holtgrave of Johns Hopkins University. </li></ul><ul><li>Partnered with University of the Witwatersrand to conduct effectiveness and acceptability comparison studies of </li></ul><ul><li>FC2 and FC1 in Kwazulu Natal. </li></ul><ul><li>Introduced FC2 in 2005 at global forum on female condom sponsored by PATH and UNFPA in Baltimore. </li></ul><ul><li>Sought inclusion of FC2 in WHO’s Essential Products List for reproductive health commodities. </li></ul><ul><li>Engaged public relations counsel (Ogilvy PR) to raise visibility for FC2 among U.S. and international stakeholders </li></ul><ul><ul><li>Baltimore press release (unsuccessful) </li></ul></ul><ul><ul><li>World AIDS Day 2005 media relations (more successful, indicating new strategy) </li></ul></ul><ul><ul><ul><li>Engaged Musimbi Kanyoro, General Secretary of World YWCA as spokesperson </li></ul></ul></ul><ul><ul><ul><li>Engaged six African national affiliates of World YWCA to issue Call to Action statement </li></ul></ul></ul>
    14. 14. Creating an advocacy movement: The launch of Prevention Now! in 2006 <ul><li>By 2006, FHC had all of the evidence it needed for effective policy advocacy. </li></ul><ul><ul><li>Data on acceptability (~ 200 studies on four continents) </li></ul></ul><ul><ul><li>Data on cost effectiveness (Holtgrave et al.) </li></ul></ul><ul><ul><li>Data indicating that availability of FC in prevention programs diversifies prevention options, decreases unsafe sex, and decreases incidence of new STIs (Madagascar study) </li></ul></ul>So what was lacking? We had plenty of evidence of NEED . But the AP reporter convinced us that what we really needed was evidence of DEMAND for the female condom – not from study subjects, represented as data points – but from REAL WOMEN . And that’s how was born.
    15. 15. Building an effective advocacy NGO Partnership <ul><li>CHANGE capabilities: </li></ul><ul><li>Relevant media & influencer contacts </li></ul><ul><li>Respect among policymakers and advocates </li></ul><ul><li>Staff dedicated to raising visibility and support for </li></ul><ul><li>comprehensive programming of woman-initiated methods </li></ul>Organization advocating for universal access to prevention options for women Organization that is recognized as an independent, credible voice Organization with capacity to engage and activate reproductive health advocates globally Organization capable of maintaining sustained engagement
    16. 16. Creating clear, distinct, and credible messages Woman-initiated HIV prevention methods are essential to stopping HIV/AIDS. The FC Female Condom has been proven safe, effective, and acceptable. And the female condom is the only women-initiated method available NOW. Women and men need access to woman-initiated HIV and STI prevention. The female condom remains the only safe, effective, and acccepted method available NOW. The development of the second-generation FC offers an opportunity to drive down cost & increase access. Expanded access to the FC, and training on its use, will prepare women at risk of HIV for new methods as they become available.
    17. 17. Developing a strong brand & 21 st -century campaign platform
    18. 18. 360° Communications Coalition Building Third-Party Initiatives (e.g.; School-based program) Promotions and Special Events Earned Media/Media Relations Social/”New” Media Crisis Management Issues Management Family Advocacy Groups Digital Influence Friends Neighbors Faith Community Local, State and Federal Agencies Workplace (Employers, Co-workers, Unions) Community Leaders/Groups Schools, Libraries, Other Community Resources Partnership Support Guerilla Marketing Grassroots Outreach Sports and Entertainment Outreach NGOs Word-of-Mouth/ Social Media Traditional Media (print and broadcast) Advertising Direct Marketing
    19. 19. Strategic Approach Key Decision-Makers at the International and Country Levels Regional Organizations Global Organizations Country-Level Organizations Individual Influencers / KOLs Think Tanks, Foundations Name Technical Assistance Media Outreach Research Reports Leader Engagement Events & Public Testimony
    20. 20. Prevention Now! policy advocacy <ul><li>Prevention Now! Structure </li></ul><ul><li>An initiative of the Center for Health and Gender Equity (CHANGE) </li></ul><ul><li>U.S. and international campaign </li></ul><ul><li>More than 215 organizational endorsers across 47 countries, including 9 regional/global networks </li></ul><ul><li>Engages multiple audiences </li></ul><ul><li>Key decision-makers, policymakers, funders </li></ul><ul><li>Grassroots and grasstops advocates and partners </li></ul><ul><li>Scientific/expert community </li></ul><ul><li>Media </li></ul><ul><li>Prevention Now! Goal </li></ul><ul><li>Expand global access to female condoms </li></ul><ul><ul><li>How? </li></ul></ul><ul><ul><ul><li>Network-building, information sharing, advocacy training </li></ul></ul></ul><ul><ul><ul><li>Consistent, evidence-based messaging </li></ul></ul></ul><ul><ul><ul><li>Demonstrate evidence of need/demand to key powerbrokers and constituencies </li></ul></ul></ul><ul><ul><ul><li>Informed advocacy at international and country level </li></ul></ul></ul>
    21. 21. Prevention Now! policy advocacy <ul><li>International Advocacy </li></ul><ul><li>Key partners: UNFPA, Universal Access to the Female Condom Initiative </li></ul><ul><li>Key targets: UNAIDS, Global Fund for HIV/AIDS, TB, and Malaria </li></ul><ul><li>Important events </li></ul><ul><ul><li>International AIDS Conference in Toronto (2006) and Mexico City (2008) </li></ul></ul><ul><ul><li>UN Special Session of the General Assembly on HIV/AIDS </li></ul></ul><ul><ul><li>Commission on the Status of Women </li></ul></ul><ul><ul><li>World AIDS Day (sign-on statement) </li></ul></ul><ul><li>Country-Level Advocacy: Uganda </li></ul><ul><li>Civil society support for Ministry of Health’s reintroduction of FC in 2009 </li></ul><ul><li>Workshop trained 30 civil society leaders </li></ul><ul><li>Working coalition formed </li></ul><ul><li>Met with MoH, UNFPA, Health Development Partners Group (USAID, UNFPA, Danish & Swedish aid </li></ul><ul><li>agencies) </li></ul>
    22. 22. Prevention Now! policy advocacy <ul><li>U.S. Advocacy on U.S. Global AIDS Policy </li></ul><ul><li>Researched and published Saving Lives Now report on female condom programming needs </li></ul><ul><li>Advocacy for FC around PEPFAR reauthorization </li></ul><ul><li>2008 authorizing law replaced references to “condoms” with “male and female condoms,” </li></ul><ul><li>a critical change in wording that will raise visibility for FC while allowing individual country </li></ul><ul><li>programs more latitude in procuring FC for HIV/AIDS prevention </li></ul><ul><li>USAID meeting in 2009 produced interest in scaling up FC2 promotion in Lesotho and </li></ul><ul><li>development of FC fact sheet for circulation to all USAID missions </li></ul><ul><li>Support for FDA Approval of FC2 Female Condom </li></ul><ul><li>CHANGE coordinated internal communication among advocates </li></ul><ul><li>Preparation of supporting statements at hearing </li></ul><ul><li>Sign-on statements from 170 organizations </li></ul><ul><li>Unanimous vote to recommend FC2 for approval (14-0) </li></ul><ul><li>Prevention Now! spokespersons prominently featured in follow up Reuters and AP coverage </li></ul><ul><li>Co-chair of FDA panel remarked that the civil society presence at the hearing was the most organized and </li></ul><ul><li>engaged of any he had seen in two decades of panel participation </li></ul>
    23. 23. Official launch of Prevention Now! Toronto IAC, 2006
    24. 24. Female Condom Rally Mexico City IAC, 2008
    25. 25. <ul><li>Comparing 2004 and 2008, positive coverage of the female condom in global media increased from 18% to 57%. </li></ul><ul><li>Comparing 2004 and 2008, positive or balanced coverage of the female condom in global media increased from </li></ul><ul><li>66% to 96%. </li></ul><ul><li>Comparing 2004 and 2008, negative coverage of the female condom in global media decreased from 12% to 3% . </li></ul><ul><li>While there was no significant increase in overall coverage between 2004 (n = 409) and 2008 (n = 413), the tone of </li></ul><ul><li>media coverage of the female condom shifted significantly in favor of positive coverage . </li></ul>Positive B/N Negative  2004  2008 Outcomes: The power of policy advocacy Year Positive (%) Balanced/ Neutral (%) Negative (%) 2004 (n = 409) 18 48 12 2008 (n = 413) 57 39 3 Difference 2004 > 2008 +39 -9 -9

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