Advocacy is really a behavior change strategy aimed an policy makers and policy implementers. As such it turns the tables on the traditional behavior change communication approaches that target the community and consumers. Instead the community and consumers through advocacy try to educate the policy makers. At minimum there are three basic components to advocacy:
- Promoting enactment of policies, laws, standards, guidelines
- Ensuring that policies are actually funded
- Monitoring approved policies to be sure they are fully implemented
Galer-Unti and colleagues outline several advocacy strategy approaches to make sure policies are enacted and their benefits reach the public. These strategies involve individual and as well as community commitment for action.
- VOTING for officials who are likely to enact and uphold policies that promote public health
- ELECTIONEERING and campaigning for candidates who promise to support public health
- LOBBYING elected officials and decision makers to follow through on promises to promote public health
- MOBILIZING THE GRASSROOTS to petition, meet and influence decision makers
- USING THE INTERNET to draw attention to public health concerns
- ADVOCATING THROUGH THE MEDIA either by writing news and opinion pieces, serving as a resource for reporters or even better, by staging events that will attract media attention and thereby, that of policy makers
What does this mean for malaria? These days most countries have received guidance from WHO and the Roll Back Malaria Partners in developing national malaria treatment and prevention guidelines and policies. For example, these policies spell out national support for the use of Artemisinin-based Combination Therapy (ACT) for first line case management. It is therefore often at the second and third levels – budgetary support and implementation support – where much of the advocacy is needed.
An example of the follow through needed to make policies a reality comes from Nigeria’s ITN Massive Promotion and Awareness Campaign (IMPAC). The federal government rallied donor support and some domestic funds to acquire seed stocks of ITNs. Memoranda of Understanding (MOUs) were signed with most state and local government (LG) officials indicating that they would supplement ITN stocks to ensure all in need were reached. Unfortunately after the initial federal stocks were exhausted, no further supplies were provided by states and LGs. The federal government continues to mobilize donor support for ITNs, for example through Global Fund, USAID and DfID, and some corporate philanthropic and foundation efforts contribute additional nets, but supplies have been limited.
Fortunately the National Malaria Control Program (NMCP) had budgeted some funds for advocacy. Visits to selected states yielded some results. For example even though it was not a donor recipient, the Niger State Government after an advocacy visit actually purchased nets and undertook distribution. More work is needed to mobilize the grassroots so that they demand nets from their local health departments, but at least we can see that advocacy can work in an African setting. Hopefully this will inspire NMCPs in other countries to get on the advocacy bandwagon.