Advocacy for health

and social change

The role of ICTs

By Andrew Chetley

Director of Programmes

Healthlink Worldwide

Global Forum for Health Research

October 2006

What is advocacy?

Process to: influence policy and decision makers, fight for social

change, transform public perceptions and attitudes, modify behaviours, or mobilise resources. (GAVI)

use information strategically to change policies that affect the lives of disadvantaged people. (BOND)

change attitudes, actions, policies and laws by influencing people and organisations with power. (India HIV/AIDS Alliance, 2002)

change the policies, positions and programmes of any type of institution and plead for, defend or recommend an idea before other people.. (SARA Project)

speak up, draw attention to an issue, win the support of key constituencies in order to influence policies and spending, and bring about change. (WHO TB Programme)

Advocacy is about influencing or changing relationships of power (World Bank)

Whose voices are heard?

Representation: speaking on behalf of the voiceless (for)

Mobilisation: encouraging others to speak with you (with)

Empowerment: supporting the voiceless to speak for themselves (by)

What are ICTs?

Definition: tools that facilitate communication and the processing and transmission of information and the sharing of knowledge

Types: radio, TV, internet, email, websites, digital video and audio, print, interpersonal communication

Communication is central

Information

Communication

Technology

Using ICTs in the health sector

Literature review, interviews, discussion, scan of websites, practitioner review

More that 4000 articles and 50 websites

Not much ‘reliable’ evidence – 28 RCTs, most on information systems and biomedicine

Review of more than 100 case studies found examples of use of ICTs for advocacy

Examples of advocacy

and social change

Women’s Voices in Kenya – empowerment, confidence and government action

Using multimedia in Nicaragua, South Africa, Rwanda, Somalialand and Cambodia – awareness, attitude change, policy action, mobilisation, empowerment, social change

Mobile phones in South Africa and the Philippines – adherence to ARVs and TB medicines, awareness, care, mobilisation, empowerment

Combinations of media in Peru, Egypt and Uganda – reductions in maternal mortality, improvements to health systems, better interaction between health workers and communities

Key findings

Keep technology simple, relevant and local

Build on what is there and being used

Involve users in design (by showing benefit)

Strengthen capacity to use, work with and develop ICTs

Increase M&E, particularly participatory M&E

Include communication strategies in the design of ICT programmes

Continue to research and share learning about what works and what does not.

Not just technology

‘many innovative ICT uses in the heath sector are based on pilots and I would be very wary about making any recommendations where evidence is based on pilots, case in point being the Indian Institute of Technology, which has lots of interesting initiatives but their broader applicability is a problem. For example, they have an interesting telemedicine initiative, a remote sensor that takes temperature, BP, ECG, and stethoscope. The doctor at the other end of the computer line can read the indicators and speak to the patient, but the whole thing is let down by the inability of the doctor being able to prescribe a course of treatment.’ – Andrew Skuse, University of Adelaide

A major challenge

Too little priority has been placed using ICTs to increase the voice of people directly affected or threatened by health issues in policy development, programme review, critical thinking and programme management roles.

ICTs lend themselves to pushing information to intended beneficiaries.

Much less work has been done to enable those most affected by ill health to share their knowledge, understanding, experience and ideas for change.

More information

www.healthlink.org.uk

www.asksource.info

(Source is an international information support centre which strengthens the management, use and impact of information on health, disability and other development topics.)