Curriculum and Tools forAdvocacy at de-centralized LevelACSM sub Working Group meeting

December 2009Beatrijs StikkersExecutive Secretary and AdvocateEmail: stikkersb@kncvtbc.nl

KNCV Tuberculosis Foundation Established in 1903 in the Netherlands

KNCV Tuberculosis Foundation is an NGO: – Origins in domestic TB control– Focuses on all aspects of TB control management

– TA, capacity strengthening & HRH, policy development– Operational and epidemiological research

– Co-developed DOTS, standardized TB control method

KNCV Mission: Global elimination of tuberculosis through the development and

implementation of effective tuberculosis strategies

Active in more than 40 countries in Europe, Africa, Asia and Latin-America

Active in more than 40 countries

Content De-centralized

Advocacy Why? Enabling de-centralized

advocacy: – Defining the challenge – Module – Toolkit

Example Indonesia: developing the curriculum

Recommendation on follow-up:– Support structure

Why focus on de-centralized advocacy?

Over-dependence on external Funding– Exposes program to funding fluctuations– Weakens sustainability (no government budget lines)– Weakens self-reliance

De-centralized government budgeting– Advocate for resources where decisions are taken– De-centralized levels have gained importance

Health vs TB funding– A shift to non-earmarked funding– Priority for health system strengthening vs. disease specific

ACSM: Communication and Social Mobilization– advocacy has received attention at central levels

Cough-to-Cure: positioning Advocacy

The Cough to Cure Pathway was developed as a diagnostic and planning tool by the Academy for Educational Development.

Goals of (De-centralized) TB AdvocacyTB Advocacy puts TB on the agenda and aims to improve

the supply of TB services Quality Funding Infrastructural basics (Diagnostic and treatment) Supplies

TB Advocacy targets decision makers Government authorities and decision makers Political decision makers Medical service providers

TB (A)dvocacy builds on: Community perceptions and community demand for TB (SM) Individual’s know-how / affinity with TB control (C)

Enabling advocacy: the agent’s context The Agents:

– De-centralized Advocacy will be done by health administrators, – Not by professional advocates

Professional context of TB and Health Administrators:– They have opportunities – they meet the right people – They need to recognize opportunities – They need to be equipped to use the opportunities– Multiple demands in busy daily professional life

Need for conceptual guidance:– Have the advocacy objectives at hand– Know what needs to be achieved when– Have their messaging ready

Curriculum and Advocacy Toolkit

Enabling Advocacy: Module Advocacy

ModulePart 3

Drafting the participant’s advocacy plan

ModulePart 2

Getting prepared for advocacy, step-by-step

ModulePart 1

Exploring concepts and conditions for advocacy

Curriculum (cont.) Part 1

PART 1 Exploring concepts and conditions

– Exploring the concepts ACSM & advocacy– Sharing experiences– Factors for successful advocacy

Curriculum (cont.) Part 2 PART 2 Getting prepared for advocacy,

step-by-step Step 1: Who are you as advocate of TB control? Step 2: What are the local barriers to better TB control? Step 3: Know the actor environment

– Map the stakeholder environment – Develop your network– Become aware of potential opposition

Step 4: Identify the barrier you want to overcome and how Step 5: Define phased advocacy objectives Step 6: Prepare your institution for advocacy

Curriculum (cont.) Part 3PART 3 Participants draft their advocacy plan Towards a plan: objectives and a plan to get there Step 7: Develop appropriate advocacy messages Step 8: Make an advocacy action plan Step 9: Practicing how to carry out advocacy Step 10: Monitoring & Evaluation and

Adjustment of the advocacy action plan

Closing the workshop: Future steps, agreements for the way forward Evaluation and closure of the workshop

the 10-steps to strategic advocacyA 10 – step model

Step 1: Know who you are as an advocate for TB control / health Step 2: Pinpoint the barriers to better TB control in your districtStep 3: Know the actor environment Step 4: Identify a possible solution (advocacy ask)Step 5: Translate your solution into phased advocacy objectives Step 6: Prepare your institution for advocacy Step 7: Develop appropriate advocacy messaging Step 8: Make an advocacy action planStep 9: Carry out the advocacy action planStep10: Monitor progress, evaluate results and adjust your plan

Step 10: a continuous process

DefineAdvocacyObjective

MODULE

Plan and do

ADVOCACYPLAN &TEAM

TOOLS

Reflectand

Redefine

FOLLOW-UP

Monitoring and Evaluationmeasuring the impact of advocacy

5Decision-makers

1Community

and patients

Public Health

Local TB program

3Advocateorganization

2relation

4relation

6Effect on society

The Advocacy toolkit – overview Curriculum The 10-steps to develop strategic advocacy Guiding the steps:

– Types of barriers: $$$, service quality, commitment, systems, infrastructure– Stakeholder mapping– Understanding motivations– Power analyses– Drafting an advocacy action plan

Guiding the implementation:- Messaging: shaping advocacy messages for different target audiences

- Use of the Media- Generic Powerpoint to advocate for resources- Preparing and training for approaching decisionmakers

Guiding monitoring- Monitoring and evaluation of Output and Outcome- Monitoring and evaluation of Advocacy

Indonesia Workshop

Experience in Indonesia Description:

– Participants– Presentations from the districts– Exchange of experience– All participants had acsm experience, but not

always seen as advocacy Observations:

– The hierarchy at local levels is tremendous– Personal contacts and inventiveness can help – The ask often is rather concrete– Teaming up in broader (health) context

The gains– Differentiating a,c, sm was a valuable step– Looking at it from a strategic dimension– Enthusiastic sharing of ideas

Experience in Indonesia The Challenges encountered in running the curriculum:

– Language– A full program, curriculum too ambitious– KISS, less is more– Varying levels of acsm understanding

A mix of methodologies:– Awareness building through sharing of experiences– Inter-active presentation of theoretical concepts – Group work in exercises – Group presentations and feedback– Role play

Recommendation: from capacity building to doing Operational support structure

Conclusions Importance of de-centralized advocacy Positioning TB control and Health in de-centralized

budgets Equipping TB/health program managers for

advocacy:– Awareness of their task– Awareness of importance strategic action– Tools to do so

Module and toolkit Recommendation: support structure to move

from planning to doing

Acknowledgements USAID, Stop TB Partnership, DGIS Indonesia NTP and ACSM group KNCV Jakarta Office

And:Jan Voskens, Netty Kamp, Huub Sloot, Bert Schreuder, and

Nonna Turusbekova