ADVOCACY

							     ADVOCACY

 Advocacy - a vital tool in
expanding and strengthening
        TB control!

 SEATC 2004, NTI Bangalore
What is ADVOCACY? - Some Ideas
 Action directed at             Pleading for,
 changing policies,             defending or
 positions or programmes        recommending an
 of any type of institution -   idea before other
 TB services, communities,      people
 private sector and other
 Governmental sectors
ADVOCACY? What is it?
  …is speaking up,       …consists of
  drawing community’s    different strategies
  attention, directing   to influence decision
  decision-makers to a   -making at the
  solution               organizational,
                         provincial, national
                         and international
                         levels
ADVOCACY: What is it?
  …is putting a          …can aim to change
  problem on the         an organization
  agenda, providing a    internally or to alter
  solution, building     an entire system
  support for action
  against the problem
  and for the solution
ADVOCACY: What is it?
  … Many different      Common elements
  interpretations BUT     … action focused
  with a common           … desires CHANGE
  framework!
                          … problem-focused
                          … solution-orientated
                          … directed at others
                          … organized process
                          … brings benefits
ADVOCACY:10 Key Elements
  1.…Objectives
    what to achieve, what problems to address
    e.g. community, private sector, access
  2.…Information to prove your case
    what is the data, what solutions are you
    advocating, advocating-problems, benefits,
    solutions
  3.…Audiences
     who will you target, who can solve the
    problem, cause change
ADVOCACY:10 Key Elements
  4.…Messages               5.…Presentation
    what to say about         How to convey your
    the data, the             messages; what
    problem and the           media, style or
    solution; what            formats
    appeals to the          6. …Evaluation
    audience, helps
    foster political will     checking results to
                              see progress and
    use data and human        change
    impact stories
ADVOCACY:10 Key Elements
  7.…Resource-raising
    finding funds and help for your advocacy
  8.…Partnerships
    Identifying others to help you advocate, fostering
    political will
  9…Perseverance
    Staying focused, not giving up
  10…Creativity
    Finding new and clever ways to advocate
ADVOCACY:Dynamic Process
  Stage 1 –              Stage 4 – Action
  Identifying Issues        Delivering messages
  for Action                Presenting solutions
  Stage 2 –                 Using political allies
  Developing Solutions
  to the Issue           Stage 5 –
  Stage 3 –              Evaluating action
  Building Political     …may all be happening at
                         once!
  Support
Advocacy objectives identify...
   WHAT CHANGE is needed
   WHO will make the CHANGE
   HOW MUCH CHANGE is needed
   WHEN the CHANGE will happen
Good Advocacy objectives:
   Is objective achievable? Time realistic?
   If the objective is achieved will the
   problem be reduced?
   Can many people support this effort?
   Can we raise funds/resources?
   Can we clearly identify responsible
   policy-makers?
Good Advocacy objectives:
  “In the next two years start a government
 sponsored programme to establish DOTS in
 my district.”

 “Increase funding for IEC activities for 3
 districts for the district DOTS programme.”
Using data effectively! Choose data
   ...Relevant to policy/decision-maker
   ... from a credible source and definitive
   …and present it according to different
   audience needs
   …make sure it reach target audiences
   from multiple sources
   ...in which the “findings” are clear to
   policy makers
Identifying 2 key audiences:

   Who is the PRIMARY target audience?
     Decision-makers with the authority to affect
     the outcome DIRECTLY.
     People who must ACTIVELY approve the
     policy change.
Identifying 2 audiences:
  Who is the SECONDARY target audience?
    All INDIVIDUALS that can influence the
    decision-makers.

    All GROUPS that can influence the decision-
    makers.
     • Their opinions and actions have a role to
       play.
     • SECONDARY AUDIENCES can be both
       POSITIVE and NEGATIVE.

     • OPPOSING FORCES also influence decision-
       makers!
Understanding audiences: Find out
  What do your target audiences
    …KNOW about TB?
     • Data; Facts; coverage, costs, impacts
    …BELIEVE about health service and TB ?
     • Beliefs; Opinions about the problem & solution
    …CARE ABOUT regarding the problem?
     • Values
     • Attitudes
        – may not be related directly to the issue but
          could be relevant
Developing effective messages and
delivery - 5 keys
   Content/Ideas    Facts to convey?
   Language         Words to use?
   Messenger        People to deliver?
   Format           Media to use?
   Time and Place   When and where is
                    best?
Some TB Advocacy Opportunities
   World/National/Local   National Media TB
   TB Day                 Seminar
   National TB            National NGO TB
   Programme Review       Seminar
   Ministerial Meeting    National Women’s
   on TB and National     Association Meeting
   Development
   National Medical
   Association Meeting
Successful National TB Days ...
   Require good “research” and planning
   Unites people in common interest
   Brings Partners on board
   Opportunity for “multi-media” events
   Creates momentum for future actions
   Shows achievements - future challenges
Successful Advocacy ...
   Is a continuous process. .…If a driver falls asleep
   at the wheel you drive off the road. If a pilot
   stops flying the plane you’ll crash
   Is an ORGANIZED and systematic process
   Targeted at key DECISION-MAKERS and
   LEADERS across all sectors
   Depends on good data and effective presentation
   to different audiences
   Identifies BENEFITS and SOLUTIONS to issues
   such as expansion of DOTS coverage, improving
   outcomes etc
Successful Advocacy ...

A successful TB programme has a continuous
advocacy strategy constantly evolving and
changing according to progress, set backs and
changing competitive conditions. Advocacy is
therefore a crucial programme investment.
Advocacy for TB

Some practical tips - messages and
media
Some Political Obstacles to Effective
TB Control
   No free TB service
   Poor people worst affected
   TB inevitable and unavoidable
   DOTS discredited as expensive, complex
   and labour-intensive
   Strong lobby for non-DOTS approaches
     What other political obstacles exist for you?
Choosing Data for TB Advocacy:
   Choose data to show:
     ...Severity and worsening trends
    ...Gains made through DOTS
    ...Why TB relevant to the powerful
    ...Economic sense of TB control
    ...Spin-offs/additional benefits
    ...What will happen without action
    ...Actions by respected others
The Written Message for Effective
TB Advocacy

  Poorly written advocacy message
    “264 HIV-positive patients in the north-
    west and central states were evaluated over
    a period of 18 months beginning in 1996. 91
    eventually died from TB, 42 from
    pneumonia. …”
The Written Message for Effective
TB Advocacy

  BETTER written advocacy message
    “In some parts of our country, 34 percent of
    HIV-positive patients are dying from TB. …”
The Written Message for Effective
TB Advocacy

   EVEN BETTER written advocacy message
     “In some parts of our country, one in every
     3 people with HIV are dying needlessly from
     TB. And, if they are not cured, they will
     infect scores of HIV-negative people with TB
     bacteria. ... …”
Tips - The Written Message for
Effective TB Advocacy
Use powerful language – personalize and give
a human face
Keep language simple
Convey something new and different
Keep the visual message interesting
Target your audience with right language
Targeting Messages for Different
Audiences
Decision-makers
and politicians                Possible messages
  Their concerns                 “Ignoring TB today
                                 carries a high price
   • Budget implications
                                 tomorrow”
   • Public opinion
                                 “TB is killing of the most
   • Opportunity to show         productive people”
     leadership and
                                 “DOTS works and is cost-
     success
                                 effective”
   • Liabilities of inaction
                                 “Citizens are demanding
                                 services TB services”
Targeting Messages for Different
Audiences
  Health practitioners
    Their concerns                  Possible messages
     •   DOTS feasibility             Technical data on the
     •   Financial implications       use and effectiveness of
                                      DOTS
     •   Legal concerns
                                      Stories from other
     •   Opportunities to use new
                                      practitioners about
         research and innovations
                                      successes
                                      Information about the
                                      latest advances and how
                                      to access them
Targeting Messages for Different
Audiences
   Corporations,
   businesses                   Possible messages
                                  TB primarily affects
     Their concerns               people in their most
      • Impact on workers         productive stages
      • Effects on markets        The burden of TB
      • Opportunities to show     weakens the economic
        responsible business      prospects of the
                                  community
        and corporate
        citizenship               Businesses can
                                  contribute by reducing
                                  discrimination and stigma
Categories of “TB Facts” for
Advocacy
TB general facts
TB and multidrug-resistance
TB and AIDS
Costs of TB
TB and DOTS
Economic benefits of DOTS – TB control
TB and women
TB and mobile populations
         – ( See TB advocacy – A practical guide – 1999 – WHO)
         – ( See stopping tuberculosis - WHO,SEARO, 1999)
(Correct) Message for the press…..
  Delhi, capital city of India (population >14 million)
  DOTS Programme in the city treats almost 40,000
  cases a year, has a cure rate of 84%, with a default
  rate between 5-10%, few % failures.
  However MDR-TB cases attracted to the health
  facilities in the city

So, what was the news headline?
“Government TB Programme fuels drug resistance” !!!
Radio and TV Formats for TB
Advocacy
  News and current events - about TB
  developments, new allies, progress reports
  Human interest stories - TB impact on individuals
  and families in magazines and women’s programmes
  Radio dramas - songs - including TB impacts on
  life at the local and personal level woven into story
  lines and songs
  Traditional arts and drama shows
Radio and TV Formats for TB
Advocacy
Quiz shows - TB questions - schools and adults
Personality interviews - celebrities, advocates,
  Interview programmes, women’s programmes
Information interviews with technical specialists
in:
  Science programmes, health programmes
  Economic programmes
General Tips: Using Radio and
TV for TB Advocacy
 Use language appropriate for targeted audience, simple
 is always better than complicated scientific language
 even in science programmes
 Present problems and available solutions
 Be very careful about disclosing privacy and increasing
 stigma against people with TB
 The “human face” of TB is the most accessible issue
 - lead with it and end with it
 Don’t forget to rehearse interviews and presentations,
 but not too much so as to be “unnatural”
 Advocacy for TB
Advocacy messages through the
mass media help build support for
controlling TB
THANK YOU