Presentation by Matthew Lynch, Center for Communication Programs at Johns Hopkins Bloomberg School of Public Health, Networks Project on Malaria Policy and Advocacy for Stomping Out Malaria in Africa's Boot Camp training.

1. Malaria Policy & Advocacy
DRAFT
Matthew Lynch
Center for Communication Programs
Johns Hopkins Bloomberg School of Public Health
NetWorks Project
April 17, 2011

2. 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

3. 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.

4. 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

5. …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

6. …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

7. …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

8. …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.

9. …resources…
• Money
• Human resources/talent/
technical expertise
• Commodities
• Access to higher-level
decision-makers
• Information
• Policies

10. …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

11. …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

12. “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

13. 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

14. Credible Advocacy is…
• Presented by people considered
authoritative by the target audience
• Consistent across presenters
• Appropriate to the cultural and
situational context

15. 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

16. Advocacy matters to them…

17. How does Advocacy work?
Realize
Decide the
that
issue is Take
other
Become worth action to
people
aware of risking move
care
the issue putting your resources
about
resources
this
towards it
issue
© Center for Communication
Programs, JHBSPH

18. Strategic Advocacy
Cycle Setting the Agenda
Stakeholder Targeted messages
Problems/
s identified and channels
Issues defined
Improving & designed for specific
assembled decision makers
Malaria
Catalyzing Change
Systems
Results monitored
and reported back Advocacy activities to:
Messages
to stakeholders for communicated to targets
increased • Activate leadership and strengthen
commitment by:
accountability
• Facilitate partnership and collective action
• Monitor and use data • Champions
Increased • Mass media
scrutiny on • Public events
management • News coverage
Increased • Peer networks
resources allocated
Ensuring Decision-makers Take
within program
Action
Decision-makers: Decision makers:
• Allocate more • Aware of issues
resources to and potential
address key solutions,
problems and • Motivated to
issues take action
© Center for Communication
Programs, JHBSPH 2008

19. Key Steps in Effective
Advocacy

20. Setting the agenda
• Defining the issue
• Identifying &
convening other
stakeholders
• Building consensus
• Clarifying strategy
steps

21. Partner RBM
Partnership
constellations:
Bilateral Private
Donors Sector
Global
Level
Universities/
Research
Institutes NGOs
Technical
Multilateral
Other MoH Agencies &
NMCP Donors
Departments Paetners
Country District-level
NDRA
Level Implementers
Minister of
Finance
GFATM
Nat’l-level Community CCMs/
Donors Leaders PRs
Privatre
Sector
Provincial
Administrators
Currently Engage
Need to Engage

22. Catalyzing Change

23. 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

24. Channels
Journal articles
Newspapers
Radio broadcasts
Informational flyers
Meetings

25. Taking action
• Once messages are
delivered, followup
is required to ensure
motivation to take
desired action
increased
• Additional
messages may be
needed, or
reinforcement

26. Monitoring & Reporting
• Without monitoring
there is no way to
know if advocacy
has achieved
anything
• Monitoring itself is
often a key issue for
advocacy

27. POLICY ISSUES

28. Policy Issues- 2011
The Global Malaria Action Plan Process
3 Core Components of the Strategy
1 CONTROL
2
Scale-up for impact Sustained ELIMINATION
(SUFI) Control
3 RESEARCH
GMBP Exhibits (v1.0).ppt

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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)

39. Opportunities for PCVs
Some suggestions for
consideration

40. Increasing resources
• Leveraging private sector capacities
Contributions in kind more likely than cash:
• Transport & logistics
• Communications and mass media
• Distribution via retail networks
• Training in management skills

41. 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

42. 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

43. 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

44. 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

45. Behavior change communication
• Training CHWs in
interpersonal
communication skills
• Field-testing and
adapting messages
• Gathering insights
into barriers to
effective control

46. 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

47. …and many more only you can
provide.

48. 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