Robert Musoke, PATH Uganda; Bernard Byagageire, PATH Uganda; Jennifer Gaberu, PATH Uganda. Presentation made during Humentum's Capacity for Humanity conference, February 2018.

1. Strengthening Community Capacity for Effective
Advocacy: A Strategy Development Framework
Presentation made during The Humanity for Capacity Conference:
February 7 – 8 Arusha, Tanzania.
Robert Musoke, Bernard Byagageire & Jennifer Gaberu
Development Workers – PATH Uganda

2. Presentation Outline
 Brief about the Advocacy for Better Health Project
 Understanding Policy Advocacy: Project Experience
 A 10 Part Advocacy Strategy framework
 Community Experiences and Achievements
 Lessons
 Take away points
 Conclusion

3. Brief about the Advocacy for Better Health
Project
 This Presentation is based on experiences of the Advocacy for Better Health Project
(ABH) implementation in Uganda
 ABH is s a five-year initiative funded by the United States Agency for International
Development (USAID)
 The project’s goal is to improve the quality, availability and accessibility of health
and other social services.
 Project Theory of change- The project’s design is based on the belief that IF
citizens’ knowledge and awareness of their rights and responsibilities were
increased; and IF the capacity of CSOs was built to effectively empower and
represent communities, THEN, citizens would believe and have confidence that
they can hold their leaders accountable and influence their decisions and actions.
This empowerment and confidence would motivate citizens and CSOs to demand
for better health and social services from their decision makers/duty bearers. The
persistent collective voice and actions from citizens and CSOs would compel
decision makers to respond by changing the necessary policies and take other
actions that lead to improvements in the accessibility, availability and quality of
health and social services.

4. Brief Cont’d
 The entry point of the project is a community group.
 These groups do:
1. Reach out to wider community members with messages about health rights and
responsibilities 90:90:90 UNAIDS global targets while advocating for test and
start policy
2. Conduct health facility assessments (administer standard tool)
3. Use the assessment findings to develop community Advocacy action plans
4. Hold engagement meetings (at sub-county) with duty-bearers and citizens to
articulate and discuss the identified gaps
5. Duty bearers make commitments how they will address the gaps
6. Community groups with support from the partner organization follow up on the
commitments

5. Understanding Policy Advocacy: Project
Experience
Policy advocacy is the deliberate process of informing and influencing decision-makers in support
of evidence-based policy change and policy implementation, including resource mobilization.
•Policy advocacy is a deliberate process.
•It aims to inform and influence decision-makers.
•Policy advocacy seeks changes that are evidence-based.
•The ultimate goal of policy advocacy is to achieve a desired policy change or ensure that an
existing policy is implemented.

6. A 10 Part Advocacy Strategy framework
Part 1 Advocacy Issue
Part 2 Advocacy Goal
Part 3 Decision-makers and Influencers
Part 4 Decision-makers’ Key Interests
Part 5 Advocacy Opposition and Obstacles
Part 6 Advocacy Assets and Gaps
Part 7 Advocacy Partners
Part 8 Advocacy Tactics
Part 9 Advocacy Messages
Part 10 Plan to Measure Success

8. Community Experiences and Achievements
 The project used the 10 part framework to build the capacity of communities to
appreciate the need to have a systematic approach of engaging decision makers on
health and social services concerns.
 Community groups were able to develop advocacy action plans based on thorough
analysis of issues that required the attention of decision makers – these issues included
health work absenteeism, non functional Health Unit Management Committees, non
prioritization of health and social services during budgetary processes both at sub
county and district level.
 Dialogue opportunities were seized to allow communities present the issues of concern
and demand for duty bearers to take action – these included holding forums with duty
bearers, one on one follow up meetings and attending sub county and district planning
and budgeting meetings.
 The media was also brought on board to amplify citizens voices and here community
meetings and forums were attended by media

9. Community experiences cont’d
 Community groups were also trained in group dynamics, record keeping, documentation
and minute taking, evidence gathering and packaging.
 Groups were facilitated with stationary and other advocacy materials including Health
Facility Assessment tools, bicycles to easy mobility, patient charter translated in common
dialects for dissemination of rights and responsibilities of patients.
 Other approaches used by community groups include Use of both print and electronic
media, leveraging the role of advocacy champions and effective partnerships at sub
county and district level.

10. Achievements
 Revitalization of Health Unit Management Committees across the 479 Sub Counties
 Recruitment of health workers at facilities that reported deficit
 Increased budget allocation for health and social services at district and sub county
level.
 Greater adherence to staffing norms by health workers – issues of absenteeism, rude
health workers, opening and closing hours of health facilities addressed
 More participation of community members in the government participatory planning
and budgeting processes.
 Greater awareness on patient rights, roles and responsibilities.
 Improved relationship between health workers, community members and health office

11. Example of the outcomes of citzens’ led
Advocacy – Hamukungu Health Centre 11

12. PROGRESS AGAINST TARGETS
PERFORMANCE INDICATOR Baseline MTE
Target
MTE
Actuals
INDICATOR 1: % of men and women who say health
service delivery in public health facilities has improved in
target districts the last one year.
54.7% 62% 65%
INDICATOR 2: % health facilities that report
improvements in service delivery
0.0% 25% 49%
INDICATOR 3: % of citizens who report having
participated in an activity to demand for improved
health and social services in the last one year
29.6% 45% 48%
INDICATOR 4: % of citizens who demonstrate
understanding of rights and responsibilities related to
health and social services.
14.0% 32% 51%
INDICATOR 5: % of community groups whose action
plans advance into implementation phase.
0.0% 48% 128%
12

13. Lessons
 Through empowerment initiatives, citizens gained confidence to engage with duty bearers
and hold them accountable.
 Rather than 1 group per sub-county, 1 group per parish would work better
 Communities are able to use the acquired knowledge on policy advocacy to demand for
improved service delivery across the different sectors beyond health and social services
 Dialogue platforms have allowed government to disseminate information to communities
and hence increased uptake of government programs
 Changes in both political and technical decision makers slows the pace of advocacy since
relationships need to be built afresh.
 There is greater accountability because of the belief that ‘where everyone is accountable,
everyone wins’.

14. Take away
 Citizen empowerment efforts should emphasize rights and responsibility
 Identify and popularize tools and approaches to use in community mobilization
efforts
 Change in delivery of health and social services is a gradual process that can be
achieved overtime
 Creating avenues for dialogue promotes mutual benefits, citizens and duty bearers
take responsibility and agree on practicable solutions
 The role of the media is also critical and contributes greatly to amplifying advocacy
efforts
 Working with existing structures for example community groups and public health
facilities allows for sustained efforts beyond the life of a project

15. Conclusion
 For citizens to ably demand for better services, they need to understand the standards at
each of the different service delivery levels
 Citizens need to be awakened to understand their rights to regain their collective
consciousness and demand for services from duty bearers
 Once duty bearers realize that citizens understand the standards and know that they have
a right to access services of certain standards they become more responsive
 As we advocate for better services for the citizens, there is also need to understand the
challenges the staff face they require change so that we address them.
 We need to avoid blame game and propose possible solutions
 When local communities have the tools to effectively engage decision makers, positive
change occurs and this translates into improved service delivery.

16. THANKS
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Discussions?