UNIT

ADVOCACY
MUNANSANGU WILSON
 Unit Objectives
1. Define key terms in Advocacy
2. Describe Counseling
3. Demonstrate Skills in Collaboration and
networking
4. Apply Lobbying and Negotiating skills.
5. Describe Social Mobilization
 Definition of terms
• Advocacy is speaking up for, or acting on
behalf of, yourself or another person.
• Advocacy is speaking up for, or acting on
behalf of, yourself or another person (The
free Dictionary, 2013).
• The word “advocate” originally stems from
the Greek word “advokar”, meaning „one
who pleads on behalf of the other.
 Advocacy simply means actively
supporting a cause, and trying to get
others to support it as well.
 Advocacy is speaking up, drawing
attention to an important issue and
directing decision makers towards a
solution
 Model of advocacy
• The Model of Advocacy which is used is by
Fowler (1989) who described the four areas
of Nurse Advocacy in relation to Patient care.
These are;
1. A Nurse is a Guardian of Patient‟s Rights
2. A Nurse Preserves Patient Values
3. A Nurse is a Champion of Social Justice in
the provision of healthcare
4. A Nurse is a Conservator of the patient‟s
best interest
Role of a Nurse in Advocacy
• A Registered Nurses (RN) has a complex
role in advocating for patients.
• The definition of advocacy varies
according to who is providing the
definition and the health care setting in
which she acts.
• Advocacy ranges from speaking on behalf of
patients in relation to nursing activities, such
as hand washing and proper identification of
a client before treatment is administered to
arguing that an early discharge will harm the
patient's recovery.
• If a nurse observes a practice or procedure
she believes to be wrong, advocating for her
patient demands that she speaks out even if
that practice was carried out by her superior.
• This is not always easy and may have a cost
on the Nurse.
• Therefore the role of a nurse in advocacy
include;
 Up hold the rights of persons without
prejudice or discrimination
Acts always in the best interest of the
patient
Act as an intermediary in patient care.
 Forms of advocacy
• There are various forms of advocacy and
these include:-
• Ideological advocacy: in this approach,
groups fight, sometimes during protests,
to advance their ideas in the decision-
making circles.
• Mass advocacy: is any type of action
taken by large groups (petitions,
demonstrations, etc).
• Interest-group advocacy: lobbying is
the main tool used by interests groups
doing mass advocacy.
• It is a form of action that does not always
succeed at influencing political decision-
makers as it requires resources and
organisation to be effective.
• Bureaucratic advocacy: people considered
“experts” have more chance to succeed at
presenting their issues to decision-makers.
• They use bureaucratic advocacy to influence
the agenda, however at a slower pace.
• Legislative advocacy: legislative advocacy
is the “reliance on the state or federal
legislative process” as part of a strategy to
create change.
• Media advocacy: is “the strategic use of
the mass media as a resource to advance
a social or public policy initiative”
• Budget advocacy: Budget advocacy is
another aspect of advocacy that ensures
proactive
 Purpose of advocacy
1. Is to promote or reinforce a change in policy,
programme or legislation.
2. Rather than providing support directly to clients
or users of services, advocacy aims at winning
support from others, i.e. creating a supportive
environment.
3. The ever-changing science and technology
demands for changes in health care policies to
meet the needs of the clients.
4. Need for change of various practices which
influence and affect the health of specific age
groups and clients.
 Principles of advocacy
• Treat all those you serve with respect, and
dignity;
• Protect and enforce the legal rights of
those you serve;
• Act in a lawful manner;
• Represent individuals according to their
express choices;
• Only proceed in any action on behalf of an
individual with his or her permission;
• Teach skills by working "with" not "for" in
advocacy issues;
• Represent individuals to the best of their
ability in a timely and responsible manner;
• Continually improve your skills and
knowledge to best serve those you
advocate for;
• Fully inform an individual of all options
available to them to the best of your
knowledge;
• Fully inform those you are advocating for
of all possible implications and potential
results of advocacy action;
• Present facts accurately and honestly;
• Keep those you are advocating for
informed of progress in an advocacy
effort;
• Keep information received from or about
individuals in the strictest of confidence;
• Continue your efforts until a resolution is
reached;
• Be informed and knowledgeable of
changes in the laws or policies that effect
those you are advocating for.
 What to advocate for
• Supply of materials
• Improvement in infrastructure
• Change in policies
• Improvement in condition of service
• Change from harmful practices
 Who is an advocate
• Is a change agent who should be
conversant with the policy issues being
advocated for
 Qualities of an advocate
• Knowledgeable
• Assertive
• Good communication skills
• Focused
• Flexible but firm
• Accommodating (etc)
Knowledgeable
• An advocator must gather enough
information about the client and the other
party which will act as a basis for
negotiations.
• Lack of knowledge can lead to lead to
mispresentation of facts and unsuccessful
negotiations.
Good Judgement
• The ability to draw reasonable, logical
conclusions or assumptions from limited
information is essential to advocate.
• This will enable him or her look at issues
objectively as he or she advocates for the
client.
Accommodating
• This is being eager or willing to help other people
for example by changing one‟s plans.
• An advocator must be able to accommodate both
the client and the other party in order to strike a
balance.
Approachable
• An advocate must be friendly in order to be
approachable by clients.
• This quality will enable the clients to open up and
present their issues freely.
Empathetic
• Empathy is the ability to understand and
share the feelings of another.
• It is a form of communication which
involves listening to the client, clarifying
his concerns and communicating this
understanding to the client.
Patience
• This is the capacity to accept or tolerate
delay, problems, or suffering without
becoming annoyed or anxious.
• This is an important quality of an
advocator because some issues an
advocator may be advocating for the client
may take longer than expected
Good communication skills
• An advocator must have good
communication skills in order to both get
information and disseminate it to the two
parties.
• He/she must be a good listener in order
to carefully analyse information given to
him and must be a good speaker in order
to argue convincingly
 When do you advocate
• During formal and informal meetings
• During departmental collaborative
meetings
 Advocacy strategies
• They include:
 Lobbying
 Social marketing
 Information, education and
 communication (IEC)
How to succeed in advocacy
• Educate leaders and policy markers
• Reforming existing policies and laws
• Creating more democratic, open and
accountable decision making structures
and procedures
 Basic elements
• Selecting advocacy objectives
• Using data and research for advocacy
• Identifying advocacy audience
• Developing and delivering advocacy messages
that will make the audience act.
• Building coalitions
• Making persuasive presentations
• Fundraising for advocacy
• Evaluating advocacy effects to find out if you
have succeeded
1. Build and maintain trust. Trust is a
key element we all need to set aside
vulnerability, but it is hard to build, and
easy to lose. It is not built on words, but
through actions and evidence.
2. Expect conflict to reach consensus. A
conflict and a fight are not the same
thing.
• Conflicts are normal and required factual
push backs in business, whereas fights are
emotional, often personal, disagreements
which do not lead forward to consensus.
3. Embrace change.
• Change is the only constant in business,
so make it your competitive advantage.
• Initiate change rather than react to it, and
give clear instructions to help the team
understand why the change is necessary,
and how it will make the situation better.
4. Improve your self-awareness.
• Too often how we see ourselves different
from how we truly are, and how we are
perceived by others.
• If you are unclear on what you want and
need from others, you will rarely find it,
and can‟t lead others to help.
5. Establish a level of analysis,
structure, and control.
• The challenge is to strike the right
balance.
• With none, things fall into chaos, but too
much can have the effect of slowing
innovation, flowing forward movement,
and even hampering growth.
6. Make decisions.
• In general, any decision is better than no
decision.
• Usually a blended approach is the best,
between independent decisions, and
collaborative decisions factoring in the
best team input.
• Picking great team members is a required
first decision.
7. Foster continuous communication.
• Communication is the glue that forms the
bond between leaders and teams, and
holds great teams together.
• Actions are stronger than words as the
true evidence of the message we deliver.
Credibility is a required base.
8. Build championship teams.
• Winning teams evolve only from the right
players, the right attitude, and the right
coach.
• There has to be a cohesiveness and
common focus on shared values and a
commitment to reaching their shared and
personal goals.
9. Provide recognition and rewards.
• These drive human behavior, and human
behavior drives results.
• Recognition validates people, their
purpose, and their life.
• Intangible rewards can have an even
greater impact than tangible ones, but
they must be relevant.
10. Create learning experiences.
• We all have a desire to learn and grow, or
we and the team become bored and
lethargic.
• The best learning opportunities are
experience and sharing with focus on
three styles: see and read, hear and
repeat, and touch and feel.
 Advocacy steps
• Step 1 - Agenda
– Identification of issues requiring policy
action (gather information and analyze)
• step 2 – identification of target
audiences and key individuals who effect
change
• Step 3 – setting objectives
• Step 4 – development of action plan
• Step 5 – monitoring and evaluating
 Code of Practice for advocates
• Why have a code of practice for advocates
 It sets out an agreed standard of service
 It tells people who want to use an advocate
what they should be able to expect
 It tells other people (carers, family and staff)
who provide services to the person what and
advocate can be expected to do or not
 Cont’d
It can help advocacy groups to explain
what they are trying to do and can be
used as a training tool
It helps advocates to understand their role
and responsibilities
 Code of practice
• An independent advocate will not be a member
of staff of the organization providing the service
to the service user
• The role of advocate is to represent the views
and wishes of the service user accurately and
effectively
• Before agreeing to act as an advocate:
 Must check that the role of advocate is fully
understood,
• This is what the service user really want
 Cont’d
• An advocacy will last for as long as both parties
agree
• An advocate will agree in advance with the
service user how contact will be made, how
often and in what form it will take.
• An advocate has a right to raise any issue on
behalf of the service user
• An advocate will not take on someone's
responsibilities but may encourage them to do
their job more effectively
 Cont’d
• An advocate will always respect the service
users‟ right to privacy and confidentiality
• If the advocate is unsure of what to do because
of a conflict of interest, they should contact their
advocacy group or manager for support and
advice.
• Advocates will demonstrate respect for equal
opportunities in all that they do.
• Advocates first loyalty is always to the service
user they work with;
 Cont’d
• Advocates must demonstrate that they are
there to encourage and help the service
user manage their own affairs wherever
possible
• Advocate must be prepared to undertake
appropriate training and accept guidance
• Advocacy organizations should have
available copies of their Code of Practice
for the public
 Models of advocacy
• Self advocacy
An individual or group acts or speaks on
their own behalf
• Citizen advocacy
Someone else speaks up on behalf of the
service user or helps them speak for themselves
• Crisis advocacy
Helping with a one-off difficult situation or
crisis
 Cont’d
• Peer advocacy
Service users help others to speak out for
themselves
• Professional advocacy
Use of experts in professional field such as
lawyers
• Collective advocacy
A group of people campaign on behalf of
themselves or others to try and change
things
 Patient’s Charter
A right is a first claim to anything that is a
persons due.
It may be properly demanded on basis of
:-
Justice
Morally
legality
 Cont’d
Rights may be viewed from legal or
personal points of views
Legal view
• Rights provide people with a certain power
to control situation
• Right to be admitted and treated
– though they are obliged to pay for the
services and behave in an appropriate
manner.
 Cont’d
The personal concept of rights has much
to do with ethical development such as:-
The way one conducts oneself
with life
The decisions one makes
The concept of right – wrong or
good and evil
 Cont’d
A number of factors influence the
development of a personal concept of
rights :-
Social relationships
Parents
Culture
Information
 Cont’d
Patients have concerns about the services they
want and need.
They desire:
More accessible services
More coordinated services
More information about their illness and care
More participation in their care
More personalized service
 Cont’d
• The rights of patients have been influenced by
several factors such as:

Increased awareness by the clients about

their rights to health care and to greater
participation in planning their care.
 The increasing number of malpractice suits
that are receiving publicity and thus coming
into public‟s awareness
 Legislation to protect relationships: Human
rights etc.
 Cont’d
• Human rights refer to prerogatives of all
humans:-
– To express feelings
– Inclinations
– Compassions
– Sympathies
– Intelligence
– Thoughts
 Actual Patient’s charter
• The patient has the right to:-
 Considerate and respectful care.
 Obtain complete current information
concerning the diagnosis, treatment and
prognosis in terms that is easy to
understand.
 Cont’d
Receive information from physicians
necessary to make informed consent prior
to the start of any procedure and to
discuss the benefits, risks, and costs of
appropriate treatment alternatives.
Privacy concerning his own medical care
program
 Cont’d
 Confidentiality (all communications, records
pertaining his care).
 Continuity of health care.
 Have adequate health care.
 Refuse treatment to the extent permitted by law.
 Know what hospital rules and regulations apply
to his conduct as a patient.
 COUNSELING
• Is a method of approaching psychological
difficulties in adjustment that aims to help the
client work out his own problems.
• Is a direct care method that helps the client use
a problem-solving process to recognize and
manage stress and to facilitate interpersonal
relationships among the client, family and health
care team.
• It looks at changing behaviors, thoughts and
feelings.
 Cont’d
• Nurses provide counseling to help the
client accept actual or impending changes
resulting from stress.
• Counseling involves: -
– Emotional
– Intellectual
– Spiritual and
– Psychological support.
 Cont’d
• Counseling encourages individuals to
examine available alternatives and decide
which choices are useful and appropriate.
 Qualities of a counselor
• Good listener
• Empathetic
• Good communication skills
• Knowledgeable
• Trustworthy
• Good advisor
Responsibilities of counselor
• A counselor is responsible to:-
– Provide information
– Listen objectively and sympathetically
– Support the client
– Care for client
– Be trustworthy
– Clarify current problems of client
– Give advice
 Steps of counseling
• Choose a suitable location and sitting
arrangement that places all parties on equal
footing
• Be prepared mentally
• Focus the session on the process not people
• Focus on the interest of the parties not their
posession
• Always seek a win solution whenever possible.
COLLABORATION AND
NETWORKING
Introduction
• The Ministry of Health (MOH) is responsible
for policy guidance and strategic planning.
• It aims at providing cost effective and
quality health care as close to the family as
possible.
• It has the responsibility of resource
mobilization for the health sector, through
local and international co-operating
partners.
• It also collaborate with other sectors to
provide quality health services.
 DEFINITION
COLLABORATION
• Is a mode of interaction that occurs
among and between clinicians during the
delivery of care, it entails working in a
joint intellectual effort, i.e. team work and
partnership
 Cont.
• Is an interpersonal process in
which two or more individuals
make a commitment to interact
constructively to solve problems
and accomplish identified goals,
purposes or outcomes.
• Individuals recognise and
articulate the shared values that
make this commitment possible
Partners for health and their
contribution in Zambia
Local Partners
• Ministry of Education: It collaborates
with Ministry of Health in dissemination of
information to pupils and students.
• Pupils and students are taught on common
health problems and how to prevent them.
• Teachers are sensitized on health issues
through workshops and seminars.
• Ministry of Agriculture: Teach good
farming methods; involve community in
nutritional surveillance and food security.
• Ministry of Information and Broad
Casting Services: Disseminates health
information through print media
(newspapers) and electronic media such as
radio and TV.
• Ministry of Community and social
Development: Involved in various
projects, like caring for the vulnerable,
destitute, street kids etc.
• Social welfare officers are members of the
primary health care committees.
• Ministry of Works and Supply: Construct
health institutions and staff accommodation,
sinking bore holes in rural areas.
• Ministry of Local Government and House.
• Disseminates information or sanitation and also
collects garbage and disposes it.
International Partners
• WHO: Assists in human resource development,
health systems research, malaria control,
expanded program for immunization and
provision of vaccines and emergency drugs.
• UNICEF: Responsible for immunization
programs, maternal and child health, nutrition,
HIV/AIDS control, PHC strengthening and
control of diarrheal diseases.
• USAID: Responsible for family planning
programs, HIV/AIDS control and child
survival programs.
• DANIDA: Responsible for quality
assurance, district and provincial capacity
building and management of information
system.
• JICA: Assist in the provision of drugs and
vehicles to different institutions including
ministry of health.
• SIDA: Provide essential drugs, involved in
reproductive health, rehabilitation of rural
health centers, family planning and
management.
• CARE INTERNATIONAL: Food security,
family planning, road maintenance and
supply of treated mosquito nets.
• WORLD VISION: Builds clinics, HIV
counseling, training community health
workers + TBAs etc. etc.
INTERSECTORAL COLLABORATION
• Intersectoral Collaboration: Refers to
the act of working jointly with other sectors
in the provision of health care services.
• Primary Health Care is an Integral part of
the social economic process.
• It rests on proper co-ordination at all levels
between health and other sectors concerned.
• Health cannot be attained by the health sector
alone.
• Economic developments, antipoverty
measures, food production, water sanitation,
housing, environmental production and
education contribute to health and have the
same goal of human development.
• Health system support include facilities for
consultation in health problems, referrals of
patients to local and more specialized health
institutions, provision of supportive
supervision.
Role of a nurse as a collaborator.
Nurse needs the following characteristics
• Common Purpose.
• Collaboration involves a bond, a union
and a degree of client care that goes
beyond a single approach to care. Also
works independently with other team
members and combine skills
• Clinical Competence. Requires clinical
competency to collaborate with other
professionals and colleagues and
contribute effectively
 Cont.
• Interpersonal Competence.
• Have the ability to communicate
effectively with colleagues in a variety of
situations such as routine interaction,
disagreements, value, conflict, stress

• Humour. It serves to decrease

defensiveness, invite openness, relieve
tension and deflect anger as it sets the
tone for trust and acceptance and
resolves difficult situations among
colleagues
 Cont.
• Trust.
• There should be mutual trust,
respect and personal integrity.
Development of trust and respect
depends on clinical competence.
• Need for sharing in planning,
decision making, problem solving,
goal setting and assuming
responsibility to do this, the health
care team must believe in each other
and share the vision
 Cont.
• Valuing and respecting of
diverse, complementary
knowledge.
• There is need to respect others‟
practice and knowledge, ideas and
actions as well as personal belief
• Nurse needs to collaborate with
other members of the health care
team, governmental and non
governmental organisations
Networking, Advocacy and
Partnership for Health
Definition of terms
• Advocacy: Active support of an idea or
cause etc.; especially the act of pleading
or arguing for something on behalf of
some one.
• In Health, it is the process of promoting
patient's rights of se1f-determination.
• An advocator is someone who speaks
on behalf of those who, for what ever
reason, cannot speak for themselves.
• Networking: This refers to active
involvement and co-ordination between
DHMT NHCs, NGOS, CBD, and
maintaining dialogue on community
health programs.
• The Zambian government acknowledges
the importance of donor support for the
development and funding for the
implementation of health reforms and it
net works with these partners to
enhance support.
 Cont.
• In addition the Ministry of Health has a
role of advocacy when it mediates for
resource mobilization for health projects in
health institutions.
Partnership for Health
• The objective of the Ministry of Health is
to strengthen partnerships through
collaboration between autonomous
boards of management, health centers,
committees, communities, traditional
health practitioners, NGOs, the private
sector and donors to bring health care as
close to the family as possible, thus
creating health supportive environments
and communities.
 cont,.
• Thus the formation of partnership
between the health sector and other
stakeholders is a basic truth of the Health
Reforms.
• Under the reforms, partnerships have
been formed in each district at all service
levels between autonomous boards of
management, health centers committees
with communities, committees,
traditional health sector, NGOs, private
sector and donors.
Community Partnership in Health
• Community participation is the leading
Principle of Primary Health Care.
• Health Reforms starts with community
dialogue on health problems and services
offered by health care providers.
• This is followed by Social Mobilization.
• Social Mobilization is the process of
motivating members of the community to
actively participate in community health
programs.
• Gradually, this process move to issues of
community participation in management
of primary health care and communities
start accepting ownership and control
over the factors affecting their health.
END OF LECTURE