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Malaria Policy and Advocacy


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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.

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Malaria Policy and Advocacy

  1. 1. Malaria Policy & Advocacy DRAFT Matthew Lynch Center for Communication Programs Johns Hopkins Bloomberg School of Public Health NetWorks Project April 17, 2011
  2. 2. Advocacy ProcessHow can we go forward when we dont know which way werefacing?How can we go forward when we dont know which way to turn?How go forward into something were not sure of? John Lennon “How” 1971
  3. 3. What is Advocacy?A strategic process of communicationtargeted to decision-makers designedto change the way they choose toallocate resources in order toincrease program impact throughimproved policies and/or processes.
  4. 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. 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. 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. 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. 8. …designed to change the waythey 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. 9. …resources… • Money • Human resources/talent/ technical expertise • Commodities • Access to higher-level decision-makers • Information • Policies
  10. 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. 11. …through improved policiesand/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. 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. 13. Effective advocacy is credible• Based on available evidence• Not exaggerated• Starting from known resource allocationsHow can we go forward when we dont know which way were facing? John Lennon “How” 1971
  14. 14. Credible Advocacy is…• Presented by people considered authoritative by the target audience• Consistent across presenters• Appropriate to the cultural and situational context
  15. 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. 16. Advocacy matters to them…
  17. 17. How does Advocacy work? Realize Decide the that issue is Take otherBecome worth action to peopleaware of risking move carethe issue putting your resources about resources this towards it issue © Center for Communication Programs, JHBSPH
  18. 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 SystemsResults monitoredand reported back Advocacy activities to: Messagesto 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 networksresources 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. 19. Key Steps in EffectiveAdvocacy
  20. 20. Setting the agenda• Defining the issue• Identifying & convening other stakeholders• Building consensus• Clarifying strategy steps
  21. 21. Partner RBM Partnershipconstellations: 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. 22. Catalyzing Change
  23. 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. 24. Channels Journal articles Newspapers Radio broadcasts Informational flyers Meetings
  25. 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. 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
  28. 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. 29. In 2011 we’re starting to seechange…• 11 endemic countries in Africa are close to achieving Universal Coverage with LLINs• Mortality is decreasing with increasing malaria control coverage
  30. 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. 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. 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. 33. Integrating malaria and healthservices• 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. 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. 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. 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. 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. 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. 39. Opportunities for PCVs Some suggestions for consideration
  40. 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. 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. 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. 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. 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. 45. Behavior change communication • Training CHWs in interpersonal communication skills • Field-testing and adapting messages • Gathering insights into barriers to effective control
  46. 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. 47. …and many more only you canprovide.
  48. 48. Resources for Advocacy – Advocacy support from key RBM units • Malaria Advocacy Working Group (MAWG) • Sub-regional networks (SRNs) – 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