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HopeLVB Toolkit

Table of Contents

Section 5: Tools for PHE Advocacy

Advocacy is an integral part of ensuring the PHE approach is successfully implemented and scaled up to new areas and populations as well as institutionalized in policies, programs, budgets, and more. The HoPE-LVB project invested heavily in advocating for the PHE approach at multiple levels. Section 5 is written for development professionals and field practitioners engaged in PHE work who are interested in similarly positioning integrated PHE programs as a useful approach for achieving broader global health and sustainable development goals.

The HoPE-LVB project had two main advocacy-related objectives:

HoPE-LVB used a variety of advocacy strategies locally, nationally, regionally and globally to support its activities. Successes were achieved at all of these levels and momentum was built entering into and throughout Phase II, but with one challenge: the advocacy work kept multiplying with heavy demands on staff time/level of effort. This is a concern that PHE programs should keep in mind.

The efforts of HoPE-LVB champions complemented those of the project team. They lent their voices and credibility to support the project’s efforts. For example, the Lake Victoria Basin Commission, which began as an important policy target for HoPE interventions as a critical regional intergovernmental body working on sustainable development basin, became a strong and vocal partner and champion. This transition was key to elevating the visibility of PHE at the East Africa regional level.

The following sections offer tools for successful PHE advocacy modeled on HoPE’s experience.

5.1 The HoPE-LVB Local, National, and Regional Advocacy Strategy

Projects aiming to advocate for PHE should carefully document their implementation design and activity planning process. From the early design phase, this should be done in close partnership with multiple stakeholders—communities, local and national governments, and regional groups, among others—that share common concerns, are working in the relevant sectors, and/or are able to influence relevant policy, program, and budgetary decisions now and in the future. Additionally, in order for the results of your early pilot test to influence stakeholders in supporting action at scale, the results must convincingly demonstrate that the model is feasible, that it makes sense in the local and general contexts, and that it confers meaningful benefits to the targeted beneficiaries. The information you choose to share about the model must be relevant to stakeholders, and must be communicated within a timeframe that allows for sustained and scaled actions to avoid a loss of momentum. You may have one key message to convey to various stakeholders but will frame it differently for each of them depending on their interest, background and priorities.

Additionally, the rationale for model interventions that are integrated across sectors needs to be communicated in ways that facilitate understanding and which clearly identify “next steps” for sustaining and scaling integrated actions to multiple stakeholders and beneficiaries.

5.2 The HoPE-LVB Advocacy Strategy: Theory of Change

The diagram below shows how we envisioned the HoPE-LVB advocacy work to benefit local communities through the implementation and scaling up of direct service delivery and capacity building, but also to maintain a strong focus on policy advocacy that creates long-lasting change from local, sub-national, national, regional and global change towards the fulfillment of Sustainable Development Goals.

5.3 “Beginning with the End in Mind:” Advocacy for Scaling-Up

A key HoPE-LVB partner, ExpandNet, supported our project in engaging in advocacy for scaling up. Other PHE programs might consider adopting some of these steps in their scale up advocacy. For HoPE-LVB, a core team for the project was developed with the key project and technical partners. This core team then mapped out who the key focal points were from the larger external user organizations (entities that could adopt and scale-up the project in the future) nationally from ministries and other government agencies, and then the external stakeholders including regional and global players such as the Lake Victoria Basin Commission, the Lake Victoria Fisheries Organization, UN agencies, and donors.

A very intensive process of community engagement took place especially in the start-up phase, but also continuing through the project as new community members became involved. A network of PHE champions drawn from community leaders, fisher folk affiliated with beach management units, local women’s groups, government policy makers, NGOs, young people in and out of school etc., were trained and maintained as critical advocates and messengers for the project interventions and related educational messages. Results were presented during various opportunities, from community meetings to higher-level briefings involving District Councilors, County Governors, and Members of Parliament to report on progress and project achievements. Potential donors were also actively contacted with attractive and professionally developed communication materials.

Momentum was built surrounding the excitement of the PHE integrated approaches—at the local level, the project made the right conceptual linkages that captured the imagination of local leaders and community members, and motivated them into taking concrete and voluntary actions.  Even as the project was in its initial phase, there was always the scaling up “end in mind” with an eye towards community ownership and the idea of embedding the project activities into various ongoing and existing initiatives. Communities were made aware that the project would eventually leave them with the knowledge and the capacity, but not continued funding or new donors. Some of the community members began looking for sources of funds that could be tapped, such as community development funds and seedlings for their agricultural activities in model households.

Furthermore, working on policy changes, however local, was important to the concept of sustainability and institutionalization of the project. The project team uncovered some possible quick wins and were able to affect some local ordinances and service delivery guidelines that would help communities achieve better outcomes in health and environmental conservation. The communities were also connected to larger global movements and events, such as Earth Day, World AIDS Day, World Population Day, etc. to understand their local challenges in a more global context. A critical step in the journey towards scaling up was to reach consensus on the expectations for scale up. Different stakeholders have different—often sectoral—perspectives and expectations for future targets for scaling up. This requires much discussion and clarification, first within the core team members, and then within the Steering Committees and then involving the larger group of stakeholders. This process is often overwhelming and consensus building is challenging given that hundreds of good ideas and possible paths are raised, discussed and prioritized, while the project implementation is still ongoing and staff are tasked with present pressing duties as well as laying the groundwork for the future. Consider implementing one or more of the HoPE-LVB approaches for scale up advocacy, as is relevant to and feasible for your project.

 

The Homa Bay County PHE Steering Committee.

In Kenya, a PHE Steering Committee was established as shown in the photo above. The County leadership decided it was to be founded not as a project-specific entity, but rather as institutionalized from the outset in the county government system. This was a big advocacy win for HoPE in ensuring its continuity.

5.4 Illustrative Advocacy Successes of HoPE-LVB

The sections below highlight HoPE-LVB advocacy successes in relevant PHE domains to provide some examples.

5.4.1 Reproductive Health

  1. Through the training on PHE and sensitization on the importance of reproductive health services, health workers and other community groups have recognized the need for more training and commodities in reproductive healthcare. In response, the project team supported several health facilities in both countries to advocate at higher levels of the health system for more health staff and in one site in Uganda, have secured the housing needed to retain them.
  2. One of the project’s key donors, the MacArthur Foundation, connected us to the agency We Care Solar, based in the US. This organization was impressed with the HoPE-LVB project team and agreed to install “Solar Suitcases©” in the HoPE-LVB project site health facilities in both Uganda and Kenya, which greatly increased the motivation of the staff, and saved the lives of pregnant mothers because they could deliver at health facilities that had access to electricity for the first time.
  3. Service delivery of long-acting methods of contraception increased based on increased community demand. Deliveries in health facilities, especially among young mothers—a previously underserved and neglected group—increased. Young mothers became advocates who actively educated community members on healthy reproductive health practices.
  4. A Beach Management Unit in Uganda rallied to collect funds from community members to pay for boat transport costs for at-risk pregnant women.

Solar Suitcases© support deliveries at night.

5.4.2. Environment

  1. In 2012, authorities in Uganda’s Wakiso District worked with HoPE-LVB to draft local ordinances to curb forest degradation.
  2. The project has identified and demarcated several fish nurseries and has suggested feasible strategies for community members to monitor them.
  3. The project has worked with various village environmental committees to establish or strengthen by-laws that support national laws and policies related to environmental conservation. We also worked with Beach Management Units to help them enforce existing laws, which is their established role. Beach Management Units have made arrests of illegal fishers.

5.4.3 PHE Integration

  1. During the project’s first phase, we facilitated media study tours for journalists to visit project sites. Our advocacy activities led to interviews of PHE champions, project staff, and other community members, resulting in a TV station and four radio stations in Uganda, and one TV station and five radio stations in Kenya airing stories about HoPE-LVB in their primetime or evening news during Phase I.
  2. Even at the start of the project, there were many “paper policies” in the various government ministries recognizing the interplay between poverty, population, health, and environmental factors. HoPE-LVB was able to provide successful examples to serve as implementation models, by showing how dedicated staff and budgets for integration could facilitate work across sectors. The Homa Bay County government incorporated PHE into their County Development Plan, and Siaya County government – which was an expansion site – incorporated PHE in theirs during a midterm review in late 2015.
  3. In September 2015, the Lake Victoria Basin Commission organized and convened a regional PHE conference in Kisumu, Kenya to advocate for scale up and adoption of the PHE approach in five East African Community countries (Kenya, Uganda, Tanzania, Rwanda, and Burundi), as well as Ethiopia and Madagascar as a means of attaining sustainable development. The conference participants agreed and recommended for action by governments, development partners, civil society, private sector, and the East African Community to adopt 16 resolutions. A critical first step was the resolution to “mainstream PHE programming into national and institutional plans and set aside funds for PHE integration and implementation of the East African Community PHE strategic plan (2015-2020) by leveraging on internal resources in development programming in the region.”

The project produced two Advocacy Briefs to document the latest successes for the project in Kenya and Uganda, and the briefs can be accessed in Section 6 of the Toolkit.

Looking for More Resources?

To see all HoPE-LVB tools, visit Section 6 of our Toolkit.

5.5 Describing and Disseminating the HoPE-LVB Advocacy Work

Population Reference Bureau, a technical partner for the project, worked with HoPE-LVB staff in 2015 to create infographics (see below) to explain the steps taken to achieve outcomes from local, sub-national, national, regional, and global advocacy. These infographics were used for presentations to global and regional audiences, and in the HoPE-LVB Advocacy documentary produced by DevCom consultants in 2015. Other PHE programs should adopt these infographics if they are relevant to their projects.

Produced by Population Reference Bureau©, 2015, with inputs from HoPE-LVB team. See HoPE-LVB advocacy video for a narrated presentation of these slides.

5.6 Guidance on Advocacy from HoPE-LVB’s Experiences

Among the many lessons that were learned during the implementation of HoPE-LVB Phase I, some that relate to the advocacy work are shared below.

  1. While the project Steering Committee invited key stakeholders to participate in learning about the project and improving the project design and implementation from the start, more formal and concrete agreements with relevant government agencies (connected to health, fisheries—e.g. Lake Victoria Fisheries Organization, forestry, livelihoods, as well as agriculture) perhaps two years into project demonstration, could have fostered more ownership by these key stakeholders in embedding the project into their ongoing programs. The aim would have been to solicit their support to serve as strong partners in data collection, monitoring and supervision, and data verification as the project expands and grows.
  2. Advocacy takes time and is labor-intensive, especially for project managers, as it requires high-level engagement. The heavy demands of project implementation compete with the need to conduct advocacy and follow-up meetings. Proper staffing of the advocacy component needs to be well thought out, and roles and responsibilities should be clearly stated, while still remaining flexible and team-oriented.
  3. The project raises expectations as advocacy work raises the project’s profile and visibility, and the governments make commitments stating that the policy environment is ready for replication. However, implementation is complex and capacity building, as well as fundraising for scaling-up, takes time.
  4. Fundraising for project implementation, including the advocacy component, must be done early and often to keep up the momentum, especially during the scaling-up phase.
  5. Site visits for advocacy purposes are effective but very time-consuming for all staff, and sometimes requests for high-level visits happen with short notice but are too important to refuse. Budgets should have some flexibility to accommodate these unexpected requests.
  6. In decentralized settings such as Uganda and Kenya, working with district and county level officials to influence budgets, procurements, and other sectoral processes was essential as implementation of national policies are determined at this level and systems capacity needs support/strengthening. Understanding how these systems work in each setting is vital. That multiplies the number of advocacy meetings to be conducted.
  7. Researchers contracted for M&E should receive detailed orientation to the project’s advocacy objectives, strategies and activities, in order to fully capture outcomes and impacts.
  8. Advocacy to help shift social opinion regarding gender roles, such as identifying ways to positively engage community males in decisions related to family size, healthy timing and spacing of pregnancy, and contraceptive use, needs to be emphasized from the start especially to take advantage of the special ability of PHE programs to achieve this outcome.
  9. High-level advocacy for cross-boundary projects such as HoPE-LVB requires sensitivity to local customs and norms, and understanding of public sector processes and diplomacy, to yield positive outcomes. The signing of the Memorandum of Understanding between Pathfinder and the East African Community LVBC on June 30, 2015 took a three-year effort and was a testament of the skills, perseverance, and professionalism of all field staff who were involved in that process.

5.7 Conclusion

Advocacy is an important component of PHE programs. Other projects should apply the lessons learned by the HoPE-LVB project to the extent helpful to advance their work and PHE as a movement to address the Sustainable Development Goals. The HoPE-LVB project believed that the support and capacity required for key stakeholders to adopt integrated PHE interventions in the LVB at meaningful scale would be achieved through:

  1. implementing a pilot project in two LVB countries—Uganda and Kenya;
  2. advocating for the benefits of such an approach at multiple levels throughout the life of the project, including with regard to regional influencers such as the LVB Commission; and
  3. carefully documenting the process and results achieved, in order to support both advocacy and adaptive project management.

According to plan, the cross-sectoral implementation teams were able to implement, advocate, and document processes successfully enough to achieve the required support and capacity to implement this model at a broader scale in the Lake Victoria Basin and beyond.

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