Curriculum and Tools for Advocacy at de-centralized Level ACSM sub Working Group meeting

1. Curriculum and Tools for Advocacy at de-centralized Level ACSM sub Working Group meeting December 2009 Beatrijs Stikkers Executive Secretary and Advocate Email: stikkersb@kncvtbc.nl

2. 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

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

4. 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

6. 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 • advocacyhas received attention at central levels

7. Cough-to-Cure: positioning Advocacy

8. Goals of (De-centralized) TB Advocacy TB Advocacy puts TB on the agenda and aimsto 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)

9. 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

10. Enabling Advocacy: Module Advocacy Module Part 1 Exploring concepts and conditions for advocacy Module Part 2 Getting prepared for advocacy, step-by-step Module Part 3 Draftingthe participant’s advocacy plan

11. Curriculum (cont.) Part 1 PART 1 Exploring concepts and conditions • Exploring the concepts ACSM & advocacy • Sharing experiences • Factors for successful advocacy

12. 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

13. Curriculum (cont.) Part 3 PART 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

14. the 10-steps to strategic advocacy A 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 district Step 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 plan Step 9: Carry out the advocacy action plan Step10: Monitor progress, evaluate results and adjust your plan

15. Step 10: a continuous process

16. 6 Effect on society Local TB program 1Community and patients 2 relation 4 relation 5 Decision-makers 3 Advocate organization Public Health Monitoring and Evaluationmeasuring the impact of advocacy

17. 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

18. Indonesia Workshop

19. 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

20. 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

21. Recommendation: from capacity building to doing Operational support structure

22. 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

23. 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