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Strengthening Community Capacity for Effective Advocacy: A Strategy Development Framework
The presentation outlines a strategy for strengthening community capacity for health advocacy, based on the Advocacy for Better Health project in Uganda, funded by USAID. It highlights the importance of empowering citizens and civil society organizations to hold government accountable for health services through a 10-part advocacy framework, resulting in improved community engagement and health service delivery. Key outcomes include increased awareness of health rights, greater participation in planning, and revitalization of health management committees, indicating the success of citizen-led advocacy initiatives.
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Strengthening Community Capacity for Effective Advocacy: A Strategy Development Framework
- 1. Strengthening Community Capacityfor 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 Briefabout 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 theAdvocacy 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 Theentry 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 PartAdvocacy 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 andAchievements 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 ofHealth 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 theoutcomes of citzens’ led Advocacy – Hamukungu Health Centre 11
- 12. PROGRESS AGAINST TARGETS PERFORMANCEINDICATOR 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 empowermentinitiatives, 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 Citizenempowerment 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 citizensto 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.
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