HWAI Advocacy Toolkit

ADVOCACY
TOOLKIT
Addressing the Health Workforce Crisis

A resource developed for the Health Workforce Advocacy Initiative
Advocacy Toolkit
The Health Workforce Advocacy Initiative

The Health Workforce Advocacy Initiative (HWAI) is a broad-based network of civil society
organizations that work to realize a world where everyone has access to a skilled, motivated
health worker within a robust health system. Member organizations in the HWAI network work in
tandem to advocate for increased investment in human resources for health (HRH) on the country,
regional, and global levels. HWAI Members as of 2014 include:
Abt Associates; Accordia Global Health Foundation; ACOFEN; Act Now to Stop War and End
Racism (ANSWER); Action Group for Health, Human Rights and HIV/AIDS (AGHA); Africa Center for
Development Communication; Africa Health Placements; African Center for Global Health and Social
Transformation; African Public Health Association (APHA); AMREF Health Africa; American College of
Healthcare Executives; American College of Nurse Midwives; American Heart Association; Association
pour la Solidarit et lAssistance Socio-Sanitaire; Bill & Melinda Gates Foundation; The Benjamin William
Mikapa HIV/AIDS Foundation (BMAF); BRAC; Brot Fuer Die Welt (Bread for the World); Brown University;
CapacityPlus; CARE; Centers for Disease Control and Prevention; Center for Health Education
and Appropriate Health Technologies (CESTAS); Center for Health Sciences Training Research and
Development (CHESTRAD/ ACOSHED); Chicago CHW Local Network; Chor Unnayon Society; CleanBirth.
org; Community of Health Research and Consultancy; Consbllio Nauomou Saude-Brasil; CORE Group;
Crigler Global Consulting; Development Organization of the Rural Poor (DORP); East, Central and
Southern Africa Health Community (ECSA-HC); Elizabeth Glaser Pediatric AIDS Foundation; Eminence;
Family Care International; Federacion Enformas; Foundation for the Advancement of International
Medical Association and Research (FAIMER); FueSalud.Co; Glasgow Caledonian University; Global
Alliance to Prevent Prematurity and Stillbirth (GAPPS); Global Health Systems Philanthropy; Global
Health through Education Training and Services (GHETS); Global Health Workforce Alliance (GHWA);
Global Healthcare Information Network; Goal4.org; Health Alliance International; Health GAP; Health
Rights Education Programme (HREP); Health Poverty Action; Human Resources for Health Coalition;
Helen Keller International; Hesperian Health Guides; IMA World Health; Instituto de Cooperacion
Social Integrare; Instituto Hondureno de Seguirdad Social; International Agency for the Prevention of
Blindness (IAPB); International Childrens Heart Foundation; International Confederation of Midwives;
International Council of Nursing; International Medical Corps; IntraHealth International; Jacaranda
Health; Jhpiego; Johns Hopkins School of Public Health; Malaria Consortium; Management Sciences
for Health; Medicins du Monde; Medicus Mundi International Network; McKinsey; McMaster University,
Canada; Merlin; Ministry of Health Brazil; Ministry of Health-DRH/Santi-Mali; Ministry of Health, Sri Lanka;
Mutah Univeristy, Jordan; Non Communicable Diseases Forum (NCD-F); Northern Regional Alliance;
One Million Community Health Workers Campaign; Pathfinder International; Paths2 (Abt); Peoples
Health Movement (PHM Global); Physicians for Peace; Population Communication; Population
Services International (PSI); Prisma; Public Health Institute; The Regional Network for Equity in Health in
Southern Africa (EQUINET); Secretaria de Gestao do Trabalho-Brasil; RESULTS UK; ReSurge International;
Royal College of Nursing; Save the Children; Secretaria Saude-Tocaims Brasil; Shehu Idris College of
Health Sciences and Technology (SICHST) Makarfi, Kaduna State, Nigeria; Siertana de Saude do Olinda
PE-Brasil; South Africa Independent; Terre Des Hommes Germany; Training for Health Equity Network; The
Unions International Management Development Programme (IMDP); Universidad Nacional Autonoma
de Honduras; University of Utah, College of Health; University of Washington, HAI; University Research
Co.- Nutri Salud; Uttar Pradesh Health Systems Strengthening Project; VSO International; Wellshare
International; Wemos; White Ribbon Alliance for Safe Motherhood; WHO; Women and Health Alliance,
International; Womens Refuge Commission; The World Medical Association.
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Advocacy Toolkit
Acknowledgements
This Advocacy Toolkit was developed by Sarah Roma, with contributions from the HWAI Capacity
Building for HRH Advocacy Working Group:

Heather Teixeira, IntraHealth International

Mary Mikhail, Global Health through Education, Training and Service (GHETS)
Laura Hoemeke, IntraHealth International
Deepanjali Jain, IntraHealth International
Stephan Rabimov, The Unions International Management Development Programme (IMDP)
Maziko Matemba, Health and Rights Education Programme (HREP)
HWAI would also like to thank those who contributed case stories for the toolkit: Zubaida Akbar (Save
the Children); Rebeca Berner (El Poder Del Consumidor); Christina Godfrey (Benjamin William Mkapa
HIV/AIDS Foundation); Maziko Matemba (Health and Rights Education Programme); Julia Robinson
(Health Alliance International); and Zubair Mohammad Shirzay (Save the Children).
This toolkit was based on an earlier version created by HWAI members:

Pat Daoust, Physicians for Human Rights

Lisena DeSantis, Physicians for Human Rights
Eric Friedman, Physicians for Human Rights
Sarah Kalloch, Physicians for Human Rights
Jirair Ratevosian, Physicians for Human Rights
Emily Bancroft, Action Group for Health, Human Rights and HIV/AIDS (AGHA) Uganda
Dr. Nelson Musoba, Action Group for Health, Human Rights and HIV/AIDS (AGHA) Uganda
Paul Davis, Health GAP (Global Access Project)
Jennifer Flynn, Health GAP
Dr. Jen Cohn, University of Pennsylvania
Anne Sosin, Johns Hopkins School of Public Health
Dr. Ambrose Agweyu, Medical Intern, Bungoma District Hospital, Bungoma, Kenya
Produced 2014
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Contents
CHAPTER 1: INTRODUCTION........................................................................................................................................5

Purpose of this Toolkit and Who it Is For.............................................................................................................5
How the Toolkit is Organized..............................................................................................................................5
CHAPTER 2: INTRODUCTION TO ADVOCACY............................................................................................................7

What is Advocacy?.............................................................................................................................................7
The Importance of Advocacy in Solving the Global Health Workforce Crisis..............................................7
Advocacy and Related Concepts...................................................................................................................8
Assessing Your Advocacy Capacity.................................................................................................................9
Tool: Advocacy Capacity Assessment...........................................................................................................11
Steps in the Advocacy Planning Process.......................................................................................................12
HWAI Advocacy Planning Cycle.....................................................................................................................12
Factors Shaping an Advocacy Strategy........................................................................................................13
CHAPTER 3: UNDERSTANDING THE CONTEXT...........................................................................................................15

Global Overview...............................................................................................................................................15
Understanding the HRH Context in Your Country..........................................................................................17
CHAPTER 4: DEFINE THE PROBLEM AND ADVOCACY ISSUE...................................................................................21

Defining the Problem, Solution, and Advocacy Issue...................................................................................21
Tool: Problem and Solution Tree.......................................................................................................................22
Tool: Choosing an Advocacy Issue Checklist................................................................................................23
CHAPTER 5: DEVELOP ADVOCACY GOAL AND OBJECTIVES.................................................................................25

Tips for Developing Advocacy Goals and Objectives.................................................................................25
Example Advocacy Goal and Objectives.....................................................................................................26
Case Story: National Orientation Practice for Newly Recruited Health Workers in Tanzania...................27
CHAPTER 6: BUILD PARTNERSHIPS.............................................................................................................................29

The Importance of Engaging Others..............................................................................................................29
Benefits and Challenges of Working with Others...........................................................................................30
Tips for Developing Coalitions..........................................................................................................................31
Case Story: The NGO Code of Conduct for Health Systems Strengthening..............................................32
Tool: Partnership Mapping................................................................................................................................33
CHAPTER 7: GET THE FACTS.......................................................................................................................................35

Why Gather Evidence?....................................................................................................................................35
Information Gathering......................................................................................................................................36
Case Story: Malawis Global Human Resources for Health Commitment..................................................38
Tool: Mapping Evidence...................................................................................................................................41

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CHAPTER 8: UNDERSTAND THE POLICY PROCESS....................................................................................................43

Understanding the Policy Context..................................................................................................................43

Understanding Power.......................................................................................................................................43

Influencing Health Budgets..............................................................................................................................44

Example Policy Process Map...........................................................................................................................45
Case Story: The Mexican Tax on Sugar Sweetened Beverages: A Victory in Progress.............................47
Tool: Policy Process Map...................................................................................................................................50
CHAPTER 9: IDENTIFY AND ANALYZE TARGETS........................................................................................................52

Identifying Your Targets.....................................................................................................................................52

Analyzing Your Targets......................................................................................................................................54

Case Story: A Community Advocates for Local Level Health Coverage in Afghanistan........................55
Tool: Identifying Primary and Secondary Targets...........................................................................................57
Tool: Stakeholder Mapping..............................................................................................................................58
CHAPTER 10: DEVELOP AND DELIVER MESSAGES....................................................................................................60

Advocacy Messaging.......................................................................................................................................60

Message Delivery and Channels of Communication...................................................................................60

Engaging Mass Media for Advocacy.............................................................................................................61

Example Public Testimony: HWAI Statement at the 2014 World Health Assembly.....................................63
Using Social Media for Advocacy...................................................................................................................64
Example Tweets for World Health Worker Week............................................................................................65

Lobbying and Communication with Decision-Makers.................................................................................66
Tool: Message Development...........................................................................................................................69
CHAPTER 11: DEVELOP AND IMPLEMENT ACTION PLAN.........................................................................................71

Choosing Advocacy Tactics and Actions......................................................................................................71

Identifying Moments of Opportunity...............................................................................................................72

Developing the Action Plan.............................................................................................................................72

Example of the Importance of Timing: AIDS Drugs for Africa.......................................................................73
Tool: Action Plan................................................................................................................................................74
CHAPTER 12: MOBILIZE RESOURCES.........................................................................................................................76

Budgeting and Getting Resources for Advocacy Work...............................................................................76

Legal Issues in Fundraising for Advocacy.......................................................................................................76
CHAPTER 13: MONITOR, EVALUATE AND LEARN.....................................................................................................77

Tips to Address the Challenges of Monitoring and Evaluating Advocacy Work.......................................77

Five Questions for Planning Advocacy Monitoring and Evaluation............................................................78

A Sample Advocacy M&E Framework...........................................................................................................79

Tool: Monitoring and Evaluation Plan.............................................................................................................80
APPENDIX 1: ADVOCACY STRATEGY TEMPLATE......................................................................................................81

GLOSSARY OF ADVOCACY TERMS..........................................................................................................................87
ADDITIONAL ADVOCACY RESOURCES....................................................................................................................88
HWAI RESOURCES......................................................................................................................................................90
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Advocacy Toolkit
ADDRESSING THE HEALTH WORKFORCE CRISIS
Chapter 1: Introduction
Purpose of this Toolkit and Who it Is For
The purpose of this toolkit is to assist health professionals, health professional associations, and civil
society organizations to translate firsthand experience and technical knowledge into effective
advocacy strategies to influence human resources for health (HRH) policies at local, national,
regional and global levels.
How the Toolkit is Organized

This toolkit is organized into chapters that correspond to the basic steps of developing an advocacy
strategy. Each chapter contains explanations of key advocacy concepts and specific tools to help
you plan your advocacy work. The chapters may be used independently or used together to
create one overarching advocacy strategy. The actual process of developing an advocacy
strategy is rarely linear. This toolkit is meant to be a basic guide, but you will likely move back and
forth between chapters and steps as needed to meet your needs. All of the individual tools throughout the chapters willwhen put togethercomprise your overall advocacy strategy (see Appendix
1: Advocacy Strategy Template).
Because the policy and advocacy environment in each country or region is different, this toolkit
contains flexible and adaptable tools that advocates can use to develop their own targeted
strategies, and to affect the change most needed in a specific context. The information in this
toolkit provides a general background and adaptable tools and techniquesit is up to you to
put this toolkit into action, identifying your countrys needs, your solutions, and how to make
them happen.
Throughout the toolkit, the following icons will draw attention to specific examples and tools to help
you understand and plan for advocacy:
Case Story or Example

This icon is used to denote case stories or examples that illustrate advocacy in action.
Tool
This icon is used to mark specific templates and worksheets to help you plan for
your advocacy work.
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Advocacy Toolkit
Photo courtesy of IntraHealth International.
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Advocacy Toolkit
Chapter 2: Introduction to Advocacy

What is Advocacy?
HWAI defines advocacy as a deliberate process based on evidence and experience, directed at
impacting the policies, positions, or programs of influential institutions in order to create systemic
and long-term solutions to the HRH crisis. There are many definitions of advocacy and many
contexts in which advocacy can be used, but this toolkit is specifically concerned with influencing
policy changes.
There are a range of approaches to advocacy, some of which are confrontational, while others
involve collaboration, education, outreach, meetings and more collegial approaches to changing
power and policy dynamics. Each advocacy strategy will depend on the specific issues and context.
The most important thing is to lend your voice, your expertise, and your passion to making change
that is the essence of advocacy.
The Importance of Advocacy in Solving the

Global Health Workforce Crisis
Health workers are necessary for the delivery of essential health services for maternal and child
health, HIV/AIDs, tuberculosis, malaria treatment, family planning, noncommunicable disease treatment and prevention, and other global health issues. A lack of investment in HRH has been identified
as a major barrier to achieving both robust health outcomes and universal health coverage (UHC).
HWAI member organizations recognize the need for advocacy in order to influence policies that
will create systemic and long-term solutions to the HRH crisis. Members advocate at local, national
and global levels to increase investment and political will to address
the crisis-level global health workforce shortage, a necessity for
sustainable progress on critical health issues.
Advocacy
A deliberate
process based on
evidence and
experience,
directed at
impacting the
policies, positions,
or programs of
influential
institutions in
order to create
systemic and
long-term
solutions to the
human resources
for health
(HRH) crisis.
In order to achieve a world where everyone has access to a skilled,

motivated health worker within a robust health system, HWAI
advocates to influence and galvanize support for strong global
and regional level health workforce policies, including through
global compacts like the Sustainable Development Goals. HWAI
members further advocate at national and local levels, to influence
governments to strengthen their health workforce policies, and then
to hold them accountable to commitments they have made to
improve HRH. HWAI also advocates for the implementation of the
WHO Code of Practice on the Migration of Health Personnel, a landmark code of practice outlining the ethical recruitment of health
workers. Additionally, HWAI advocates for the inclusion of health
workforce language and focus within different vertical global
health issue areas, such as HIV/AIDS and maternal and child health.
Importantly, this advocacy has led to increased political will and
funding for HRH, resulting in very real positive health outcomes for
people all over the world.
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Advocacy Toolkit
Advocacy and Related Concepts

What Advocacy Is and Is Not: A Comparison of Advocacy and Related Concepts
Advocacy is often confused with other approaches that share common elements. To achieve
a clearer understanding of what advocacy is, it is helpful to clarify what advocacy is not. All of
these related concepts may be tactics within an advocacy strategy, but would not be considered
advocacy in and of themselves. Use the chart below to compare and contrast advocacy with
related concepts.
CONCEPT
OBJECTIVE
TARGET AUDIENCE
TYPICAL TACTICS
Advocacy
Development, change,
Policy-makers

and/or implementation
and other key

of policies; change in
decision-makers/leaders.

resource allocation

Lobbying, community
mobilization, coalition building,
mobilizing stakeholders, public
relations, IEC, research,
use of media, etc.
COMPARING
ADVOCACY TO:

SIMILARITIES AND
DIFFERENCES IN
TYPICAL TACTICS
SIMILARITIES AND
DIFFERENCES IN
OBJECTIVES
SIMILARITIES AND
DIFFERENCES IN
TARGET AUDIENCE
Information,
An IEC approach seeks to
The target audience of IEC
Education,
raise awareness and
is individuals and segments
Communication increase understanding
of a community (men,
(IEC)
among its target audience.
women, and youth).

Although an advocacy

strategy may raise awareness
strategy may have

as one of its tactics, it will
some of these same

always ultimately seek to
audiences as its secondary

develop, change, and/or
targets, the primary target

implement policies and/or
audience of an advocacy

change resource allocation.
strategy must always be

a decision-maker.

Typical tactics of IEC include

material development and
dissemination, use of multiple
media channels, and
workshops and trainings.
Advocacy may use IEC as
one of its many tactics to
raise awareness, but would
not stop at just raising
awareness. IEC would be
part of a larger strategy,
involving multiple tactics
to influence policy decisions.
Public Relations Public relations strategies seek

The primary target audience

to improve the organizations
of a public relations strategy

brand, image, and support
is typically donors, general

and increase program coverage
public and stakeholders,

and credibility. Although an
media, community leaders,

advocacy strategy may also try
and other nongovernmental

to increase credibility and support
organizations (NGOs).

as one of its tactics, it will always

ultimately seek to develop, change, strategy may have some

and/or implement policies and/or
of these same audiences,

the primary target audience

of an advocacy strategy must

always be a decision-maker.

Typical tactics of public

relations include advertising,
outreach to stakeholders,
and media outreach for
coverage. Advocacy may
use public relations and many
of these same activities as
one of its many tactics to
increase credibility and
support, but would not stop
there. Public relations would
be part of a larger strategy,
involving multiple tactics to
influence policy decisions.
Castro, Maria Antonieta Alcalde, and Gabriela Cano Azcrraga. 2010. Handbook for advocacy planning. New York, NY: International
Planned Parenthood Federation, Western Hemisphere Region.
https://www.ippfwhr.org/sites/default/files/Advocacy%2520Planning%2520web%2520version.pdf (accessed December 3, 2014).
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Advocacy Toolkit
Community
Community mobilization seeks
The primary target audience
Mobilization
to build a communitys
of community mobilization

capacity to rank needs and
strategy is typically community

take action. Although an
members and/or leaders.

advocacy strategy may also
Community mobilization

try to build a communitys
may or may not target a

capacity to take action as
decision-maker, but when

one of its tactics, it will
it does may overlap with

always ultimately seek to
advocacy. However, the

develop, change, and/or
primary target audience of

implement policies and/or
an advocacy strategy must

always be a decision-maker.

Lobbying
Similar to advocacy,
Similar to advocacy, the

lobbying seeks to change
primary targets of lobbying

opinions, gain support,
include policy-makers

and convince a specific
and other key decision-

policy-maker to take action
makers/leaders.

or address an issue. However,

this is the sole objective of

lobbying. An advocacy

strategy may employ

lobbying as one of its many

tactics, but would also involve

a broader strategy beyond

just seeking to convince
decision-makers.
Typical tactics of community

mobilization include organizing
and conducting community
meetings, workshops, etc.
Advocacy may use community
mobilization as one of its
many tactics to mobilize a
community towards its goal
and objectives, but would
not stop there. Community
mobilization would be part
of a larger strategy, involving
multiple tactics to influence
policy decisions.
Typical tactics of lobbying
include meetings, conferences,
petitions, and dinners/
receptions. Advocacy may
use lobbying as one of its many
tactics to convince decisionmakers to take action, but the
lobbying would be part of a
larger strategy, involving
multiple tactics to influence
policy decisions.
Assessing Your Advocacy Capacity

Advocacy requires specific capacities at both an individual and organizational level, and it is
important to have a realistic understanding of what capacities you have, and what needs strengthening. You do not have to be an expert in every area in order to undertake advocacy, but the more
capacity you and your organization have, the more chances you have of being successful in your
advocacy efforts. Part of effective advocacy includes continued capacity-building, and once you
have a sense of where you may need to strengthen your capacity, it is important to plan for how you
will do this, and also how you will monitor progress.
Individual Capacity: Individual advocates need the ability to work in the following areas:
Understand and analyze the larger context: Assess the larger context, understand problems and
what is causing them, and develop and assess possible solutions.
Conduct and share policy research and analysis: Undertake policy research and analysis
to assess the policy environment and generate evidence about and analyze specific policy
problems and solutions. The evidence generated from policy research must also be interpreted
and communicated at the correct time to the relevant audiences and in the appropriate
manner. That means using the best format so that the knowledge is clearly communicated,
can be absorbed, and will have the desired impact.
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Advocacy Toolkit
Understand, analyze, and navigate the policy and political landscape: Understand and
analyze the policy process and political environment to assess when and how to influence
it and respond to changes.
Identify, analyze, and influence key targets: Understand and analyze relevant decisionmakers in order to build relationships and influence. Navigating relationships with decisionmakers necessitates understanding the dynamics of power and having the capacity to engage
them through multiple platforms.
Develop and deliver advocacy messages: Develop, tailor, and communicate advocacy
messages through multiple channels and with multiple audiences.
Work with others: Work with key allies and partners, including relevant coalitions, networks,
and other public constituencies.
Plan and implement an action plan: Strategically plan for advocacy activities and tactics,
including an understanding of how to assess timing and required resources; and capitalize
on key windows of opportunity for action.
Monitor, evaluate, and learn: Monitor, evaluate, and learn from advocacy and incorporate
learning to inform current and future advocacy efforts.
Organizational Capacity: In order to be most effective in their advocacy work, organizations
should have:
Synergy with organizational vision: Is advocacy part of the organizations mission, vision, and/or
theory of change? Is there strong leadership in the organization for advocacy, including support
from senior management? Is there a clear understanding of advocacy across the organization?
Sufficient resources: is the organization actively seeking ways to mobilize additional resources for
advocacy, both financial and nonfinancial (e.g., time, skills, and knowledge)?
Organizational processes: These may include deliberate mechanisms to help the organization
plan, monitor, evaluate, and learn from advocacy work; coordinate advocacy efforts across
various program areas and/or departments; integrate advocacy into resource mobilization
efforts; and build and sustain advocacy capacity.
Credibility with governments and other partners Is your organization perceived as objective,
trustworthy, and politically neutral?
Cohen, David. 2010. Essay on Advocacy. NY, New York: Encyclopedia of Social Sciences, Sage Publications Inc.
Print (accessed Dec. 1, 2014)
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Advocacy Toolkit
Tool: Advocacy Capacity Assessment
On a scale of 1 (no capacity) to 5 (expert), rate each of the individual and organizational capacities
listed in the table below to determine where you may need to strengthen your capacity. To see this
visually, plot your ratings on a spider diagram like the example below.
Individual
Capacity
or
Organizational

Ranking
Please check one
number on a scale of 1
(no capacity) to 5 (expert)
1 2 3 4 5
Individual

Understand and analyze the larger context

Conduct and share policy research and analysis
Understand, analyze, and navigate the policy
and political landscape

Identify, analyze, and influence key targets
Develop and deliver advocacy messages
Work with others
Plan and implement an action plan
Monitor, evaluate, and learn
Organizational
Fit with organizational vision
Resources

Organizational processes
Credibility
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Advocacy Toolkit
Steps in the Advocacy Planning Process

Advocacy is rarely an orderly and linear process and, as a result, is often conducted in an ad hoc
way, responding to opportunities as they arise. This toolkit is intended to help you plan for your
advocacy work more strategically to ensure that you have the greatest possible impact on the
policies you are trying to influence, and so that you use your time, energy, and resources as effectively as possible. The following are a series of advocacy planning steps to provide a framework to
help you develop an advocacy strategy. Although these steps might not always occur in the same
order and are often iterative, each step is an integral piece of planning for your advocacy work. The
following chapters will describe each of the planning steps in greater detail and provide specific tools
to help you plan. All of these tools will then fit together to comprise your overall advocacy strategy
(see: Appendix 1: Advocacy Strategy Template).
HWAI Advocacy Planning Cycle
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Advocacy Toolkit
Factors Shaping an Advocacy Strategy3

Advocacy and the kind of strategy you develop will be shaped in large part by your context, the
timing, and the risk involved. It is important to consider some key factors at the outset:
Context: Every political environment is different. Each presents its own opportunities and
constraints. Governments have varying degrees of legitimacy and power vis--vis civil society, the
private sector, and transnational and international organizations and institutions. Political decisions
are made differently depending on the nature of the state, politics, media, and civil society. In
some places, the legislature has more authority. In others, the Minister of Finance dominates policy-making. Countries have different levels of freedom and access to the public sector. People use
these opportunities differently depending on literacy, poverty, and social relationships. A societys
mix of culture, religion, ethnicity, race, and economic development affects the level of tolerance
and openness to social change. In some countries, advocacy at the local or the international
level may be more feasible than at the national level. (For more information on assessing the
political environment and players, see Chapter 8: Understand the Policy Process and Chapter 9:
Identify and Analyze Targets).
Timing: Each historic moment presents distinct political opportunities and constraints. International
economic trends may make a country tighten or expand political space. Elections or international
conferences may provide opportunities to raise controversial issues. At some moments, a march
or demonstration will draw attention to an issue. At others, a march may provoke repression.
Risk: Not all advocacy strategies can be used universally. In some places, a direct action aimed
to reach a key decision-maker may be politically dangerous, or may lessen the potential for
long-term change. In some countries, pushing for change that affects cultural beliefs may
provoke a backlash. Challenging relationships of power often generates conflict and advocates
must have ways of dealing with this without taking unnecessary risk. In more closed environments,
advocacy often takes the form of community action around basic needs and is not publicly
referred to as political advocacy. Whatever the context, sometimes risks need to be taken
because there are no other options. In these cases, everyone involved must understand the
implications of those risks.
Miller, Valerie. 1994. NGOs and grassroots policy influence: What is success? Institute for Development Research, Vol. 11, No. 5 1994.
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Paul Joseph Brown/ GAPPS.
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Chapter 3: Understanding the Context

An essential prerequisite to any advocacy planning is having an in-depth understanding of the
overall context of the issues and environment in which you are working. Advocacy on HRH issues
will require both an understanding of the global context of HRH and the specific HRH situation and
challenges to address in your particular country and environment. The following sections provide a
big-picture overview of HRH and the current global landscape and provide guiding questions to help
assess the HRH situation in your own country context.
Global Overview
The World Health Organization (WHO) defines a health worker as all people engaged in actions
whose primary intent is to embrace health. This definition includes doctors, nurses, midwives, and
community health workers (CHWs), but also includes support workers such as public health professionals, pharmacists, and others.
Health workers are the backbone of health systems. National and global efforts to achieve ambitious
improvements in health outcomesincluding a push to end preventable maternal and child deaths
and reach the goals of an AIDS-free generation and UHCcannot be realized in the absence of an
adequately equipped, trained, and supported health workforce.
In the report A Universal Truth: No Health Without a Workforce, the Global Health Workforce Alliance
(GHWA) and the WHO estimate a gap of 7.2 million health workers in 2012, set to rise to 12.9 million
across the next decade. In 2012, the majority of countries below the WHO threshold of 22.8 skilled
health workers per 10,000 population and with a coverage of births by skilled birth attendants below
80% were in sub-Saharan Africa (31 countries, 57.4%) followed by Southeast Asia (7 countries, 12.9%).
Although most countries with available data have shown growth in the number of midwives, nurses,
and physicians since 2004, this growth has not kept pace with population growth, demographic
changes, and a shifting disease burden.
Some countries, however, are beginning to demonstrate the far-ranging impact that investment
in health workers can create. Ethiopia, for example, was able to reduce by more than two-thirds
their under five mortality rate and achieve MDG 4. Through their health extension worker program,
the Ethiopian government has dramatically increased the provision of health services to its rural
population. Since 2003, more than 38,000 government salaried health extension workers, the
majority of them young women, have been deployed to over 15,000 health posts right across
the country. This expansion of services is frequently credited with the success Ethiopia has had
in reducing child mortality.
Challenges to achieving a sustainable workforce are numerous and varied. In Universal Truth: No
Health Without a Workforce, GHWA and other partners highlight some of the HRH development
challenges, including:
The health workforce is aging, and replacing retired health workers is often difficult because of
worker shortages, governmental policies, and lack of recruitment incentives.
The aging of the health workforce is of particular concern in high-income countries, demonstrating that although low- and middle-income countries have a more acute health workforce gap,
Campbell, J.G. Dussault, J. Buchan, F. Pozo-Martin, M. Guerra Arias, C. Leone, A. Siyam, and G. Cometto. A universal truth: No health without a workforce. Forum Report, Third Global Forum on Human Resources for Health, Recife, Brazil. Geneva: Global Health Wofkroce Alliance
and World Health Organization, 2013. http://www.who.int/workforcealliance/knowledge/resources/GHWA_AUniversalTruthReport.pdf
5
2013. Ethiopia meets MDG 4 by cutting Under 5 mortality By Two-Thirds Since 1990 Unicef-Ethiopia. http://www.unicef.org/ethiopia/
events_13459.html (accessed December 3, 2014)
6
World Health Organization, Regional Office for Europe. Health workforce data and statistics 2014. http://www.euro.who.int/en/health-topics/
Health-systems/health-workforce/data-and-statistics (accessed Dec. 3, 2014)
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HRH issues are important globally. In Denmark, France, Iceland, Norway, and Sweden, where
fewer and fewer health professionals are entering the workforce, the average age of employed
nurses is 41-45 years.
Skills-mix imbalances persist and advanced practitioners, such as clinical officers, are used
inefficiently in many settings.
Task shifting is an effective and important policy option to reduce health workforce shortages
and skills-mix imbalances. Task shifting, as defined by the WHO, involves the rational distribution of
tasks among health workforce teams. In middle- and low-income environments, task shifting often
involves the transfer of appropriate tasks to workers with less specialized training. Examples include
the utilization of CHWs to provide basic HIV/AIDs treatment and care in several countries in
sub-Saharan Africa. Studies indicated no difference in patient outcomes between those treated
in community-based settings by lesser trained providers, such as CHWs, and those receiving the
same treatment by higher trained professionals in clinical settings.
There is often inequitable geographic distribution of health workers within countries due to
difficulties in recruiting and retaining workers to work in more remote settings.
Many countries suffer from an uneven distribution of health workers, with a high concentration of
workers in urban areas and an acute shortage in rural areas. Health professionals settle in urban
areas because of convenience, better opportunities for themselves and their families, and generally better equipped facilities. There are several policy options to address this disparity including
financial incentives, professional development opportunities, and nonfinancial incentives.
Attrition of health workers due to migration out of the country exacerbates shortages,
particularly in low-resourced countries and areas with the greatest need.
Out-migration of skilled health workers further increases the shortage in many low- and middle-income countries. Several causes of out-migration have been identified including the lack of
options for career and professional development, poor management, and a heavy workload.
There is often a lack of an enabling environment to encourage retention, productivity,
and performance of health workers.
An enabling environment for health workers has been shown to improve health worker engagement in the delivery of quality care. Evidence has shown that several key variables impact health
worker performance and productivity and thus affect the quality of services delivered and the
improvement in health outcomes. These key variables include clear health worker roles and
performance expectations, supportive supervision, regular feedback, career path opportunities,
incentive structures (financial and nonfinancial), objective performance evaluations, and safe
and enabling working environments. Many countries, particularly low-resourced countries, do not
offer these support systems to health workers.
There is a need for strengthened human resources information data and systems for
decision-makers.
Strengthened systems for data collection and reporting mechanisms will allow monitoring and
evaluation of HRH development and its impact on health outcomes. Up-to-date and comprehensive information on HRH is essential for effective management and decision-making on health
workforce issues. However, not all countries have an accurate account on metrics related to the
health workforce, and indicators, such as quality of care, are often ignored entirely.
World Health Organization. 2008. Task Shifting: Global recommendations and guidelines. Geneva, Switzerland: World Health Organization.
http://www.who.int/healthsystems/TTR-TaskShifting.pdf
8
Buckley, G.J.; Lange, J.E.; Peterson, E. A. 2014 Investing in global health systems sustaining gains, transforming lives. Institue of Medicine
of the National Academies, The National Academies Press, Washington DC
9
Fulton, B; Scheffler, R; Sparkes, S; Auh, E.Y.; Vujicic, M; Soucat, A. 2011 Health workforce skill mix and task shifting in low income countries: a
review of recent evidence Human Resources for Health. 9:1
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Efforts to build the capacity of the health workforce and to support health workers need to be multisectoral and consistently implemented over the long-term. HWA found that countries that have
demonstrated progress towards reducing their health worker deficit have several commonalities:
An integrated approach to improve human resources for HRH by linking together workforce
development initiatives and broader health systems strengthening actions
Demonstrated continuity in the implementation of their health workforce development
strategies
Sustained political will and commitment to bolstering the health workforce, demonstrated through
targeted policies and investment of financial resources.
For more information about the global health workforce, please use the following resources
(for more resources, please see the list of HWAI Resources at the end of this toolkit):
The Global Health Workforce Alliance (GHWA)
http://www.who.int/workforcealliance/en/
The WHO Office for Health Systems
http://www.who.int/healthsystems/en/
The Alliance for Health Policy and Systems Research
http://www.who.int/alliance-hpsr/en/
Health at the World Bank
http://www.worldbank.org/en/topic/health
Understanding the HRH Context in Your Country

Countries have their own unique context and HRH challenges to address. Developing an effective national advocacy strategy requires an understanding of the country context. Below are a list
of questions to guide your initial research and conversations with policy-makers, stakeholders, and
community members and leaders. For a fuller discussion of the importance and process of gathering
evidence, please see Chapter 7: Get the Facts.
Government Plans and Policies on HRH
Are health workforce strengthening activities included in your countrys strategic plan for health?
Does your country have a specific health workforce development plan?
Are government policies on health workforce development consistent across various plans and
ministries? If there are inconsistencies, what are they?
If your country has an HRH development plan, is it funded? Is it currently being implemented?
What position is responsible for the implementation at national and subnational levels? How
does that position disseminate updates on progress? What are the reporting and accountability
mechanisms?
What bodies are responsible for developing and enforcing the norms and standards for health
worker cadres, including pre-service education curricula, licensing and registration requirements,
tracking of licensing renewals, and regulatory oversight? What are the reporting/enforcement
mechanisms for these bodies?
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What are some specific policies that attempt to stem attrition of health workers? Do they address
salaries and benefits, working conditions, professional development, and supportive supervision?
How are they implemented? Is there a mechanism in place to monitor and evaluate the impact/
effectiveness of retention strategies?
Are there specific policies that govern the deployment of health workers? How are they
implemented?
What policies are in place to increase access to and the utilization of health services, especially
among underserved groups? How are they implemented? Is there a process for measuring the
effectiveness of these policies?
Does the government have structures in place to enable health workers and nongovernmental
organizations (NGOs) to contribute to health workforce planning and monitoring
and evaluation?
Health Workforce Accounting
How does the government track the number of health workers? If tracked, what are the
numbers of health workers (physicians, nurses, midwives, community health workers) present
in your country, state, and/or community?
What is the gap between the health workers that are present and employed and the number
needed to deliver essential health services?
Is there an up-to-date account of the licensed and registered health workers in each cadre?
If so, how many are there in the country, region, or district?
Has the government utilized tools or technologies to map health workers and support them in their
work? This might mean utilizing human resources information systems (HRIS) or putting in place an
HRH Observatory.
Health Financing
What percent of the gross domestic product goes towards health expenditure? How much of
this expenditure is out of pocket?
Has your country estimated the total funding needed to provide everyone with access to
essential health services? What is the gap between the estimate and current spending?
How much of the health budget goes toward HRH?
Does your country receive multilateral, bilateral, or other outside aid? What percentage of
the health budget comes from international aid? How much of this money is spent on HRH
strengthening?
Are programs implemented by international donors streamlined within the Ministry of Health in
your country? If not, what effect is that having on health workers in the public sectors?
Have there been budgetary decisions over the past few years that have significantly altered
the ability to recruit health workers (i.e., a hiring freeze)?
Are there wage ceilings or health sector budget ceilings? How does the government justify
these ceilings?
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Production, Retention and Deployment of Health Workers

Does your country have a significant problem related to health worker attrition? If so, what is
the cause?
Does your country have significant disparities in access to and utilization of health services?
Do these disparities break down geographically between certain populations?
How many professional schools or universities are there that train health workers? Where are these
schools located? How many licensed /certified professionals do these schools graduate?
Is your country increasing the number of health workers educated in pre-service educational
institutions? If it is expanding, is the quality of training being maintained? Is there an accreditation
process in place?
How are health workers compensated? Are they compensated by the government or NGOs?
Is compensation scaled or are there added benefits for health workers in more remote or less
desirable locations?
What are some of health workers biggest concerns in their place of employment? Is it safety from
infectious diseases, violence from the community, lack of adequate supplies, or unsafe working
conditions?
Are students recruited from rural areas for health professional training? Is the health worker recruitment process perceived as being fair and transparent?
Are incentive packages in place to retain health workers, especially in rural areas?
Are CHWs and mid-level health workers such as clinical officers being used to help fill skills gaps
and address shortages, especially in rural areas?
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Chapter 4: Define the Problem and Advocacy Issue

Defining the Problem, Solution and Advocacy Issue
Once you understand the overall context of HRH globally and in the context of your country, the next
step is to define a specific problem that you think is critical to address, and then identify the specific
causes of that problem in order to help you decide which advocacy issue to focus on. As you
assessed the context of HRH in your country in Chapter 3: Understanding the Context, you may have
already identified some clear problems that you think are important to address. Using the Problem
and Solution Tree Tool can help you more thoroughly analyze the causes and consequences of the
problem and possible solutions.
Most problems are quite complex, and have many interconnected
causes and consequences. Among the many causes, you will want
to make sure that you consider if there are specific policy barriers
that are causing this problem. For instance:

What relevant policies exist/dont exist and what is needed:
o A new policy?
o Change in an existing policy?
o Enforcement or implementation of an existing policy?
o Resources?
The Importance
of Evidence
It is critical to gather
specific evidence of the
problem and its causes,
consequences, and
possible solutions.
This is discussed more
fully in Chapter 7:
After you have identified some specific causes of your problem, the
next step is to figure out possible solutions and which one to focus
Get the Facts.
on. It will be important to assess which causes and solutions may
be addressed by using advocacy to influence policies, positions,
or programs of influential institutions. These are your possible
advocacy issues. For instance, you might have identified health worker attrition as a problem in your
country. You may have further identified one of the many causes to be the lack of a national HRH
strategic plan that takes a comprehensive approach to addressing the health workforce shortage.
Thus, one solution and advocacy issue you might consider is how to get a national HRH strategic plan
in your country.
An organization should choose issues that are aligned with their mission and values and have
resources, value-add, and a chance of success. Once you have identified several possible
advocacy issues, the Choosing an Advocacy Issue Checklist Tool will help you think through
various criteria to help determine what issue to work on.
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Tool: Problem and Solution Tree
1. List the central problem that you wish to analyze on the trunk of the tree.
2. Brainstorm a list of the causes of the problem and write them on the roots. To get to the real
roots of the problem, keep asking yourself WHY?
3. Brainstorm a list of the consequences of the problem and write them on the branches.
4. Discuss the interconnections and how various causes are related.
5. Highlight which causes may be addressed by using advocacy to influence policies, positions,
or programs of influential institutions.
6. Turn the causes of the problem into solutions. For example, if the problem is health workforce
attrition and one of the causes is that government spending on the health sector is lower than
the 15% that is needed, one solution, and your advocacy issue, would be to convince the
government to commit to increasing the health sector budget.
7. As a next step, for each possible advocacy issue you have identified, you can use the
Choosing an Advocacy Issue Checklist Tool to assess if your organization is well placed
to work on a particular advocacy issue.
Consequences
Problem
Cause
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Tool: Choosing an Advocacy Issue Checklist
For each advocacy issue that you are considering working on, please consider the following criteria
to help determine if you are well positioned to move forward with advocating on this issue.
Advocacy Issue:
Criteria to Consider
Comment
Does it Meet the

Criteria? (yes/no)
The issue is relevant to the

organizations or coalitions
mission and strategies.
The issue is important to the people
that you are working with and
they have identified it as a priority.
Your organization is well placed
to work on this issue and has
something to add.
Documentation and research
are available.
You have a clear position on the issue
and a positive alternative that you
can communicate.
There is a chance for success.
The timing is right and there are
strategic opportunities for influencing.
There are few and/or carefully
considered risk factors to people
and/or your program.
There are opportunities to build
strategic alliances.
You have adequate resources
and staff.
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Courtesy Jhpiego/ Kate Holt.
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Chapter 5: Develop Advocacy Goal and Objectives

One of the most important, but also most difficult aspects of
developing an advocacy strategy is setting a clear and strong
goal and measurable objectives. An Advocacy Goal describes
your vision and what you want to accomplish in the long-term,
whereas your Advocacy Objective describes the smaller, more
specific policy changes that you wish to accomplish. Coming to
consensus on the goal and objectives can take a considerable
amount of time and effort, especially when you are trying to
address a broad and complicated issue like the health workforce.
Now that you have defined the problem and advocacy issue,
you will focus on refining these issues into clear attainable goals
and objectives for a successful advocacy initiative.
Tips for Developing Advocacy Goals

and Objectives
1. Make sure your objectives include clear policy changes and that
you identify who should make the change, by how much, and
by when.
2. Your advocacy concerns may be too broad to be contained
in one single venture. Do not hesitate to consider having 2-3
advocacy objectives per goal.
3. Frame goals and objectives in terms of the results you want to
see, not in terms of what you will do.
4. Advocacy Objectives should be Specific, Measurable,
Achievable, Realistic and Time-bound (SMART):10

Advocacy Goal
Describes your vision

and what you want
to accomplish over
the long-term.
Advocacy Objective
Describes the smaller,

more specific policy
changes that you
want to accomplish.
Objectives should
clearly state what it is
you want to change,
who will make that
change, by how much,
by when, and should
be SMART.
Specific
Measurable
Achievable
Realistic
Time-bound
Specific
Say what you mean in the clearest terms possible. Avoid jargon and vague wording, and be
exact in the specific change you are seeking. For instance, terms such as empower or sensitize
are not precise and open to interpretation.
Measurable
Be as exact as possible about who, what, where, when, and how.

Achievable
The clearer you are about who, what, where, when, and how, the more achievable your
objectives will be. Objectives should be achievable in the planned time frame and reflect
the limits of your resources.
Realistic
Try to be as realistic as possible when you decide on your objectives, and take into account
the limits of available time, funding, and staffing. The more information you have about
your political context, target, and issue, the more realistic you can be.
Time-bound
Objectives should include a clear time frame within which change should be achieved.
VeneKlasen, Lisa; Miller, Valerie. 2007. A new weave of power, people and politics: The action guide for advocacy and citizen
participation. Warwickshire, UK: Practical Action Publishers.
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Example Advocacy Goal and Objectives
In this example, an organization in Uganda identified the problem of a weak health workforce
in their country. They further identified some of the many causes of this problem to be a lack of
country-wide HRH plans and the lack of a regulatory function and HRIS to monitor and regulate
the heath workforce. As a result, they decided to focus on two solutions and advocacy issues to
influence the establishment of (1) national HRH plans and (2) mechanisms to monitor and regulate
the health workforce.
After assessing that their organization was well placed to work on both of these issues, they created
their advocacy goal, describing their vision and what they wanted to accomplish in the long-term
and two SMART advocacy objectives to articulate the specific policy changes they wanted to
achieve. They made sure that their objectives clearly stated what they wanted to change, who
would make that change, and by when.
Advocacy Goal:
Strengthen Ugandas health workforce by supporting policies to produce adequately trained,
equipped, and supported health workers.
Advocacy Objectives:
The Ministry of Health develops costed HRH plans that integrate the health workforce into
strategic health plans by 2012.
The Ministry of Health establishes subnational regulatory functions of the health professional
councils and the use of HRIS data and tools to strengthen the monitoring and regulation of its
health workforce by 2012.
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Case Story: National Orientation Practice for Newly Recruited Health

Workers in Tanzania (Benjamin William Mkapa HIV/AIDS Foundation)
Background and Context: Inadequate staffing of health workers is one of the main impediments
of health sector performance in Tanzania, with a 72% shortage in the health workforce (Ministry
of Health and Social Welfare 2006).11 Orientation of new public service employees in Tanzania
is mandatory. The formulation of the Public Service Management Strategy for Public Service in
1998, and Act number 8 of 2002 recognizes the importance of orientation for newly recruited staff.
However, a study conducted by Benjamin William Mkapa HIV/AIDS Foundation (BMAF) revealed
that orientation for health workers does not often take place and, if it does, it is only partially
conducted. Furthermore, they found that there was no guide or package to deliver consistent
orientations. However, BMAF understood that orientation of newly recruited staff promotes
retention, a key factor in ensuring a stable health workforce.
Advocacy Goal and Objectives
Advocacy Goal: Ensure better health outcomes in Tanzania by creating a more stable health
workforce.
Advocacy Objective: The Ministry of Health and Social Welfare (MoHSW) adopts and implements
by 2013 a national on-job orientation package to be used within Local Government Authorities in
order to promote effective staff settlement, ethical conduct, performance excellence, and staff
motivation.
Process: In 2010, BMAF developed an orientation package, with the review and inputs of several
stakeholders, including: Prime Ministers OfficeRegional Administration and Local Government,
MoHSW, the Tanzania Public Service College, the Local Government Training Institute, the Local
Government Authorities, and District Hospitals of Njombe, Tandahimba, and Newala. The review
also gathered some inputs from independent human resources consultants. BMAF also worked with
IntraHealth to compile the inputs from various stakeholders and incorporated them into the design
of the Orientation Package.
To build local evidence with the orientation package, BMAF conducted knowledge-sharing forums
where 54 Local Government Authorities exchanged ideas about how the orientation package
could improve the retention of health workers. This evidence was compiled into a document that
was shared at a policy table discussion with key policy-makers in September 2012. As a result, the
MoHSW made a resolutions to work with the Presidents OfficePublic Service Management to
adopt and enforce the new Orientation Package through existing structures.
The advocates kept a consistent message throughout their advocacy, emphasizing that the adoption and implementation of the Orientation Package would add unique and practical value to the
existing initiatives on managing, retaining, and making productive human resources for health by
creating a conducive environment before, during, and after reporting to the workstation.
Outcomes: The National Orientation Package for Newly Recruited Health Workers in the Health
sector at the Local Government Authorities was then piloted by BMAF in collaboration with
IntraHealth within the 54 districts. The monitoring and evaluation data of the pilot programs
showed that it contributed to the retention of health workers, which improved from an average of
75% in 2010/11 to 91% in 2011/1212. Following the pilot, the Orientation Package was endorsed by
the MoHSW in 2013 and was disseminated to all Local Government Authorities in Tanzania for use.
Lessons Learned: It is important to involve the government and other stakeholders from the onset
of development of any policy document to ensure their buy-in and ownership from the beginning.
2013. Human Resources for Health Strategic Plan 2008-2013.Genva, Switzerland: Global Social Service Workforce Alliance. Geneva, Switzerland. http://www.socialserviceworkforce.org/resources/human-resource-health-strategic-plan-2008-2013 (accessed December 4, 2014)
12
Macias, Jennifer 2012. BMAF-Three years Performance report: 2011 June - 2014 June. IntraHealth International. Chapel Hill, North Carolina.
http://pdf.usaid.gov/pdf_docs/PA00JZGP.pdf (accessed December 4, 2014)
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Chapter 6: Build Partnerships

The Importance of Engaging Others
At some point early in your advocacy planning, you will
want to start thinking about who else you should bring to
the table to be part of both the planning and the actions.
This is important in building support for your advocacy
work and engaging other resources and skills. Building
partnerships may be an ongoing process throughout your
advocacy. You may invite some organizations and/or
individuals to be part of the development of the goal and
objectives for the advocacy work. Once the objectives
are set, you may realize that there are additional allies that
you would like to work with.
As you consider what partners to work with, it will be
important to:
Kenyan health professional students during the

2007 AIDS Week of Action.
Get to know/consult with other stakeholders and create partnerships: Set up networking meetings
with a variety of groups working on your issue or similar issues to see what they do, what has been
successful for them, and how you might work together. This can result in information sharing, invitations to events, brainstorms, etc. that can help your advocacy work.
Identify and establish a presence in existing networks: Join existing networks that relate to your
advocacy issue and be part of their work and their collaboration. For instance, many countries
have AIDS coordinating bodies, NGO councils, and human rights networks. Identify relevant existing networks and figure out if it might make sense to collaborate or support one anothers work.
One example of an existing network is the HRH technical working groups that exist in many
countries. In Uganda, for example, the HRH Technical Working Group includes stakeholders from
various sectors, including NGOs, local nonprofits, international organizations, and development
partners, and government representatives from the ministries of health and/or finance. The HRH
technical working group directly advocates to the Ministry of Health by providing strong technical guidance on how to create stronger health workforce policies. They played an active role in
helping to shape the political commitment to strengthening the health workforce that Ugandas
government made at the 3rd Global Forum for Human Resources for Health in November 2013 in
Recife, Brazil.
Build new partnerships: If groups coming together believe they have long-term interest in working
together, you may want to formalize your coalition and actually create a new organization or
formal network. For instance, AIDS and health rights groups in Kenya have come together to form
the United Civil Society Coalition on AIDS, TB and Malariawhich itself is made up of a variety of
coalitions of PLWA groups, health workers, NGOs and activists. This network creates an opportunity
for all civil society to come together on issues around the Global Fund in Kenya, among others.
This is a major step, and not one to be entered into immediately.
There are many different forms of collaboration, and partnerships may be formal or informal, temporary or permanent. It is important to determine what kind of partnership makes the most sense for
your advocacy strategy and to be deliberate about whom you partner with and the type of collaboration that makes sense. The Partnership Mapping Tool will help you think through possible partnerships. The following provides a few examples of different types of partnerships:
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Different Types of Partnerships13

Type
Characteristics
Network
Networks are often informal or with a limited structure and emphasis is mostly on
the exchange of information and less on joint work.
Coalition
Coalitions usually have a more formalized structure and involve joint work, often among
fairly diverse civil society organizations around a single event, issue, or campaign.
The different organizations divide the tasks in the most appropriate manner.
Alliance
In alliances, trusted partners have long-term agreement on common ideals.

Strategies and plans may be jointly developed and implemented.
Mobilizing the public may also be an important avenue for influencing policy decisions, since policymakers often respond when there is great public support for an issue. Mobilizing people in your
community to be involved in your advocacy work is also critical in making change sustainable
and responsive to the needs of people directly affected by the problem. Part of your strategy may
include building the capacity of and empowering certain constituencies to be more involved in or
take on more leadership for your advocacy work.
Benefits and Challenges of Working with Others

There are both benefits and challenges to working with others, particularly in a more formal coalition, to achieve your advocacy objectives. A coalition may help you win what you would not be
able to win alone by increasing the impact of an individual organizations efforts, as well as increase
resources. On the other hand, working in a coalition means that you may have to compromise on
some of the issues that you take on in order to build consensus. Keep the needs of your advocacy
initiative paramount. The following are some examples of the benefits and challenges of working
in a coalition.
Benefits
Challenges
Unified voice: Having a unified voice

can be stronger and more powerful.
Turf issues: Organizations and individuals may

be sensitive about sharing their work.
Increases the resource base: Often

organizations may have complementary
skills sets, expertise, and resources and
can fill each others gaps.
Domination by one group or organization: When

starting a coalition, it is important to create a participatory atmosphere and encourage everyone to give
their ideas and time so no one group dominates.
Avoids competition and duplication
Failure to provide and create leadership within

the coalition: Coalitions demand a very special kind
of collaborative leadership, which can harness the
strength of everyone involved.
Wider audience base: Organizations

may have different constituencies,
which can widen the audience and
support for the advocacy work.
Time consuming: Coordination among coalition

members can be time-consuming.
Difficulty coming to agreement: It can sometimes
be hard to agree on goals and may require some
compromises.
Gosling, Louisa and Cohen, David. 2011. Advocacy matters: Helping children change their world :An International Save the Children
Alliance guide to advocacy.London, UK: The International Save the Children Alliance. http://www.unicef.org/adolescence/cypguide/files/
Advocacy_Matters_Participants_Manual.pdf (accessed December 3, 2014)
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Tips for Developing Coalitions

1. Choose unifying issues. The most effective coalitions come together around a common issue.
Make sure the development of group goals is a joint process.
2. Understand and respect each groups self-interest. There must be a balance between the goals
and needs of the coalition and of the individual organizations.
3. Respect each groups internal process. It is important to understand and respect the differences
among groups. These differences are often apparent in processes or chains of command for
decision-making. Make a commitment to learning about the unique values, history, interests,
structure, and agenda of the other groups and organizations.
4. Acknowledge and use the diversity of the group. Every group has something similar and different
to offer, and every groups ideas and influence can help the coalition succeed. Not everyone
will always agree with everything the coalition does or wants to do. Make sure to take everyones opinion and restraints into account and to use diversity as a spur to discussion, rather than a
source of division.
5. Communicate openly and freely with everyone. Ensure that the lines of communication within
the coalition and among the coalition, the media, and the community are open. Open communication will ensure that no one feels left out and that everyone has the information necessary to
make coalition efforts successful.
6. Structure decision-making carefully. Finding consensus is very important when making decisions
as a coalition. Every group must listen to each other, debate, and discuss until they can find
common ground.
7. Distribute credit fairly. Recognize that contributions vary. Each organization will have something
different to offer. Each one is important, so be sure to acknowledge them all, whether they
contribute volunteers, meeting space, funding, copying, publicity, passing resolutions, or
other resources.
8. Be inclusive and participatory. Work at making sure everyone feels welcome. Try to involve everyone in the coalition in generating vision and mission statements, planning, and making major
decisions. The more people feel ownership of the collation itself, the harder they will work to
achieve its goals.
9. Give and take. It is important to build on existing relationships and connections with other organizations. Dont just ask for or expect support, be prepared to give it.
10. Develop a common strategy. The strength of a coalition is in its unity. Work together with other
organizations to develop a strategy that makes sense for everyone. The tactics you choose should
be ones that all the organizations can endorse. If not, the tactics should be taken by individual
organizations independent of the coalition.
11. Be strategic. Building coalitions in and of themselves requires a good strategy. Which organizations you ask, who asks them, and in which order are all questions to figure out. Are there organizations that have particular skills or perspectives that the coalition would benefit from? Or particular constituencies or relationships that would strengthen the coalition?
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Case Story: The NGO Code of Conduct for Health Systems

Strengthening (Health Alliance International)
Background and Context: The NGO Code of Conduct for Health Systems Strengthening developed
as a response to growing awareness of the harm that international NGOs were inflicting on host
countries in which they worked. This harm, though sometimes unintentional, includes NGO hiring
practices which distort local health worker salary scales (by offering up to ten times what local ministries of health were offering), poaching the highest qualified health workers from public sector health
systems, and creating a huge management burden for host governments to coordinate myriads
of donor-funded projects. As a result, there was a desire to provide a guide for international NGOs,
donors, and ministries of health to limit the harm that current international aid funding schemes can
inflict and which could be used to commit to best practices and for advocacy.
Advocacy Goal and Objectives:
Advocacy Goal: Improve country-level health systems by ensuring that international NGOs and
donor policies are committed to best practices surrounding hiring, compensation policies, capacity-building, and support for public sector systems building.
Advocacy Objectives: 150 international NGOs sign on to the NGO Code of Conduct by 2016.
Ten major donors and five ministries of health sign on to support the NGO Code of Conduct and
make adherence to the code a condition of funding or allowing an international NGO to operate
within a host country by 2016.
Process: The NGO Code of Conduct is truly a collaborative project. It was born when a consortium
of NGOs, including Health Alliance International (HAI), ActionAid, Partners in Health, Health GAP,
Oxfam International, and others met up at a health conference to brainstorm advocacy initiatives
to address issues related to bad NGO practices. Over the course of several months of teleconferences, email exchanges, and draft revisions, the consortium finalized the draft code and published it
online on the NGO Code of Conduct website. In 2014, the drafters reconvened to refocus the target
audience to include the donor community and ministries of health. The original drafters engaged
in conference calls and meetings at international conferences to map donor and ministry of health
contact networks. A major goal of the code is to raise awareness and outreach to organizations and
donors, so the drafters and especially HAI are focusing on presenting it in journals, at international
forums, and other media outlets.
Outcomes: To date, approximately 60 international NGOs and one donor has signed on to the
NGO Code of Conduct. The code was featured on a radio interview (Against the Grain), a podcast
(Humanosphere) and a comment was published in the Lancet in August 2014. The code has been
presented at two international conferences in 2014. Progress towards the objectives is primarily
due to renewed outreach and a refresh of publicity materials (including the website) undertaken
in early 2014.
Lessons Learned: Specific lessons learned from this work include the importance of strong, sustained
collaborations (including face-to-face meetings, regular emails, and conference calls) among likeminded groups to keep momentum for advocacy efforts going. Strong network mapping has also
been critical to growing support for this effort.
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Tool: Partnership Mapping
Please list the potential partners that you are already working with or are planning to work with to
carry out your advocacy strategy.
Partnerships (Local, National, Regional or International)

Name

Goal of
Partnership
Partners Position on
Advocacy Issue
1.
2.
3.
4.
5.
6.
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Type of Partnership and

Tactics for Collaboration
Advocacy Toolkit
Photo courtesy of Jhpiego.
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Chapter 7: Get the Facts

Advocacy must be grounded in evidence about the problem you are focusing on and the feasibility
and value of your proposed solution. You will also need to collect information throughout the
advocacy planning cycle in order to understand the policy process, your targets, and to monitor,
evaluate and learn from your advocacy work.
Why Gather Evidence?

Three important reasons to gather evidence include: to ensure an accurate and full understanding
of the change you are trying to influence; to help persuade others to make or support that change;
and to monitor, evaluate, and learn from your advocacy work.
1. Understanding and Analysis
Your advocacy work needs to be grounded in solid evidence and policy analysis to fully understand:
The context of HRH globally and in your country (for more information, see Chapter 3:
Understanding the Context)
The problem, the problems scale and severity, and the impact on peoples lives
The feasibility of possible solutions including their costs and effectiveness, examples of what works,
innovations that can be tested, and the likely impact of change
If you are accurately representing needs, priorities, and interests of your constituencies
The policy and decision-making process, who is responsible to make the change you seek to
influence, and what their interests are (for more information, see Chapter 8: Understand the Policy
Process and Chapter 9: Identify and Analyze Targets).
2. Persuasion
The evidence you gather will be critical for convincing the key decision-makers and others why the
change you are advocating for is important and will enhance your credibility and professionalism. For
example, it is one thing to say that the distribution of health workers is a problem. It is far more powerful to say that a certain district has ten times fewer health workers per capita than another district. It
is one thing to say that more health workers are needed. It is far more powerful to point out that your
country has only one-third the number of health workers that the World Health Organization considers
a minimum requirement.
When gathering or generating evidence it will be important to consider how to:
Tailor your evidence to the interests of your targets: It will be important to understand who the
key decision-makers are and what kind of evidence will be persuasive to them (for more information, see Chapter 9: Identify and Analyze Targets and Chapter 10: Develop and Tailor Messages).
You may tailor the kind of evidence you collect to fit their interests. For instance, are the main
priorities of the key decision-maker(s) dealing with economic growth? National security? Social
equality? Depending on their priorities and interests, different kinds of evidence will be needed
to convince them.
Demonstrate support for change: It may also be important to collect evidence about current
support for change from those affected by the problem, those with power, and other interested
stakeholders.
3. Monitoring, Evaluation, and Learning
You will also be gathering evidence along the way to monitor, evaluate, and learn from your
advocacy work (this will be discussed more fully in Chapter 13: Monitor, Evaluate, and Learn).
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Information Gathering
In order to gather the information you need to begin your advocacy work, you will want to consider
what information you need, where you can find that information, and who will help you gather that
information. The Mapping Evidence Tool will help you think through:
What information do you need?
It is useful to think of this in terms of what questions you need
answering. Where are the gaps in your knowledge? What are all
the policies relevant to your issue? What demographic statistics
will help make your case? Breaking down the required information
into parts will help you plan to research it, particularly helping you
to distinguish between information that will be easy to obtain and
information that requires more effort.
Where can you find the information?
Partners and Stakeholders: Some of your partners and stakeholders might have information
that you need, such as:
Understanding
the Context
As a first step, you will
need to gather
information on HRH,
both globally and in
the context in your
country. This is discussed
more fully in Chapter 3:
Understanding
the Context.
o Relevant Ministries (e.g., Ministry of Health or Ministry of Finance)

This information may be gathered through meetings or obtaining documents from ministry officials.
You may also find needed information in official policies, strategies, and reviews. The availability of
public documents will vary by country, with a growing amount of this information also publicly available through the Internet.
o Other NGOs, CBOs, and Coalition Partners
It will be important to leverage the varied strengths of your partners. For example, an NGO that works
on budgets might have information on health spending, and an NGO that works on HIV/AIDS might
know whether money from the US global HIV/AIDS program, PEPFAR, is being used to support human
resources or who you can meet with in order to learn about PEPFAR policies.
o Other International Organizations and/or Development Partners.
Online Resources: Various online resources exist to find HRH-related data. For more information,
see the HWAI Resources at the end of this toolkit.
Conducting Your Own Research: You may also consider conducting your own research.
Advocacy-focused research is different than academic research, as its purpose is to directly
influence policy change and policy decision-making. Several factors promote strong, effective
advocacy-focused research and should be discussed before research begins so that you can
proceed most strategically. Research is often most effective when:
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o The information needs of the policy-maker are taken into account when designing the study.
o Research is conducted by an organization that policy-makers perceive as credible and reliable.

o Research is focused on a few questions that can be answered.
o Findings are presented in multiple formats tailored to each audience.
o Findings are disseminated to multiple audiences using a variety of channels.
o Audiences receive the same message from diverse sources.
o Presentations of findings to policy-makers emphasize the important lessons that were

learned rather than the need for more research.
Who will contribute to your information gathering?

Your efforts to find useful information can be a great way to reach out and network with other
organizations and policy-makers. You can call on other organizations to see what data they may
have; link with members of your own organization to share their stories; and interview key policymakers, patients, and health workers to share information.
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Case Story: Malawis Global Human Resources for Health

Commitment (Health and Rights Education Programme)
Background and Context : The shortage of trained health workers is the most significant barrier to
improving health status in Malawi. Although the number of health workers posted has increased
since 2009, current staffing levels still do not meet minimum requirements to support the health
care system. There are shortages of nearly all cadres, with just one doctor for every 70,000
Malawians (Ministry of Health/Malawi 2012). In 2010, there were 0.24 nurses and 0.016 generalist
doctors per 1,000 population (Republic of Malawi 2010), below the WHO-recommended minimum
threshold of 2.28 health care professionals per 1,000 population (WHO 2006). Half (51%) of general
doctor positions remain unfilled, along with 80% of specialist doctor positions and 68% of nurse
technician positions. These shortages are partly due to the failure to train adequate numbers of
health workers but are exacerbated by challenges with retention.
Health workers are disproportionately located at the central and district hospital levels. This means
that rural areaswhere 80% of the population livesare underserved, and primary or community-based services are not always available. Health workers find little reason to work in rural areas
due to inadequate housing and lack of incentives. But the reality is that rural areas are where
services are needed most. As a consequence of health workforce shortages, task shifting has
become a necessity but does not always follow national policy. Malawi lacks capacity in human
resources for health (HRH) planning, management, training, development, and leadership
including implementation of structural, management, and policy-related reforms. More partnerships as well as monitoring and evaluation at all levels are needed. The lack of evidence-based
planning impedes the countrys ability to project long-term HRH needs.
The Third Global Forum on Human Resources for Healthwhich took place in Recife, Brazil in
November 2013provided HRH advocates in Malawi with a great opportunity to influence the
Government of Malawi to step up globally to make and implement specific commitments on HRH.
With over 1,800 participants and attendees from 93 member states, including over 40 ministers
and deputy ministers, the forum was the largest-ever global assembly focusing on HRH, and asked
country representatives to adopt the Recife Political Declaration on Human Resources for Health
and develop specific country commitments to achieve global health goals.
Advocacy Goal: Strengthen Malawis health workforce in order to improve health outcomes.
Advocacy Objective 1: The Government of Malawi makes specific and focused global commitments, based on the current HRH need, for the Third Global Forum on Human Resources for Health
(HRH) in 2013.
Advocacy Objective 2: The Government of Malawi implements all of its commitments made
during the 2013 Third Global Forum on Human Resources for Health (HRH) by 2015.
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Process and Outcomes (In Two Parts)

Advocacy Objective 1
Process: Prior to the 2013 Third Global Forum on HRH in Recife, Brazil (2013 Global Forum), Malawi
had started to develop a draft strategic plan for HRH, which was still quite broad and without
specific areas for intervention. This 2013 Global Forum provided an opportunity to influence the
Government of Malawi to develop more specific commitments that met the needs of the HRH
issues in Malawi. In the lead-up to the 2013 Global Forum, the Global Health Workforce Alliance
(GHWA) developed a template for governments to use to help them prepare their commitments.
The Health and Rights Education Programme (HREP), a Malawian nonprofit organization, saw an
opportunity to work with the Ministry of Health (MOH) to support them in creating their commitments, to ensure that they were specific and met the needs in Malawi. In June 2013, HREP met with
the head of the MOH, the Secretary for Health, and agreed to provide technical support to the
MOH to develop their commitments using the GHWA template. In order to do this, HREP worked
with the Department for Human Resources for Health within the MOH, and engaged the Human
Resources Technical Working Group, comprised of representatives from government, civil society
organizations (CSOs), NGOs, and international organizations, to provide input into the process.
Outcomes: Collaborators finalized the process in the summer of 2013 and presented Malawis
commitments at the 2013 Global Forum. An important by-product of this process was the real feeling of mutual accountability that developed between the government and civil society to address
health workforce issues. CSOs engaged in this process also held themselves accountable alongside
the government for making sure Malawis commitments were followed through with.
Advocacy Objective 2
Process: Now that the Government of Malawi had taken the important step of developing
and making the commitments for the 2013 Global Forum, the next step was to ensure that the
Government of Malawi was on track with implementing the commitments. In order to help track
progress of the implementation of the commitments to date, HREP, with technical assistance
from Health Workforce Advocacy Initiative (HWAI) and InterHealth International, developed and
produced a Progress Report.
Overall, they found that Malawi was on track with many of its commitments and that these
commitments have played a clear role thus far in influencing HRH national policy. Importantly, they
found that the Malawi government, through the MOH, took a leading and championing role in this.
The report also outlined areas that still needed to move forward and some barriers to progress. For
instance, they highlighted poor coordination between partners and the MOH in monitoring implementation of health workforce initiatives; the fact that the ministrys HRH Department does not
have earmarked financial resources to regularly monitor HRH partner activities or partner adherence to commitments; and overall lack of government financing to follow up on implementation
of HRH commitments.
Bisson, Cristina; Heather Teixeira, and Matemba, Maziko. 2014. Human resources for health country commitments: Case studies of
progress in three countries. Washington, DC: Health Workforce Advocacy Initiative. http://www.who.int/workforcealliance/forum/2013/
HWAIadvocacy_report_final.pdf
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HREP shared this information both nationally and internationally. HREP uses the information to
continue to work collaboratively with the MOH on moving forward with implementing their commitments. They met with the MOH and the HR Technical Working Group prior to and after the Progress
Report was produced, and HREP continues to offer technical support. HREP, in collaboration with
HWAI partners, also presented updates on the progress of Malawis commitments at the 2013 East,
Central and Southern Africa (ECSA) Health Community Meeting and presented the Progress Report
at the May 2014 World Health Assembly and the 2014 ECSA Health Community Meeting.
Outcomes: HREP is now using the information from the Progress Report to inform their next steps and
what still needs to be done in Malawi to keep forging progress on HRH. For instance, HREP is now
moving forward with more budget monitoring and advocacy in Malawi to ensure increased money
for HRH. HREP and their HWAI partners continue to reach out to many with the Progress Report and
will possibly reach out to the media to continue to increase awareness. Their work is ensuring that
Malawi is tracking progress and, as a result, continues to move forward in making progress in implementing their commitments.
Lessons Learned: HREPs good relationship with and understanding of the MOH was helpful in being
able to work collaboratively with them and provide technical assistance as a trusted partner. As
an organization, HREP has also had a long history and reputation as an organization that keeps a
strong focus on the issue at hand, regardless of which political party was in charge. The Progress
Report has also been a very helpful tool,and has enabled HREP to have strong and clear evidence
to present to key policy-makers and stakeholders both in Malawi and internationally.
Bisson, Cristina; Heather Teixeira, and Matemba, Maziko. 2014. Human resources for health country commitments: Case studies of
progress in three countries. Washington, DC: Health Workforce Advocacy Initiative. http://www.who.int/workforcealliance/forum/2013/
HWAIadvocacy_report_final.pdf
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Tool: Mapping Evidence
Please list what evidence you will need for your advocacy, what is already available, what you still
need, and where you will get it. Please consider all of the aspects of your advocacy work that you
will need to collect information on such as: the overall context of HRH in your country; the scale,
severity, and impact of the problem you are focusing on; the feasibility and value of your proposed
solution; the policy process; and your targets.
Type of Evidence
Evidence
Gaps to

Needed
Available
Address

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Possible Sources
of Information
to Fill Gaps
Person
responsible for
taking forward
Advocacy Toolkit
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Chapter 8: Understand the Policy Process

In order to effectively target your advocacy, you need to understand the policy-making process,
how decisions are made, who has influence, and what structures exist for asserting influence. The
policy-making process, in whatever governance context it takes place, is complex. There are a
number of overlapping phases, and within them many sublevels. It is often subject to pressure,
power, and politics and likely involves different groups with competing agendas.
Understanding the Policy Context

When you analyze the way in which power is exercised, it is useful to be clear about the political
environment in which you are working and the different stages of the policy process.
First determine where in the policy process it makes the most sense to intervene in order to
influence your advocacy objective. Then map out and analyze that particular decision-making
process, considering the following (see also Example Policy Process Map below):
What are the policy-making structures and what policy-making body or bodies will make the
decision you are trying to influence?
What are the formal decision-making processes, and when do they occur?
What are the informal processes for decision-making?
Five Stages of the

Policy Process
1. Agenda Setting
Getting issues on the
policy agenda
2. Policy Formulation
Developing a policy
Who are the key decision-makers at each stage?

What are the opportunities and timing for input into
policy-making?

How do global, national, and community-level political

and economic structures like PEPFAR or the IMF affect the
decisions that policy-makers make?
Understanding Power
3. Policy Enactment
Getting a policy passed
Understanding who has power within the policy processboth

formally and informallyis key to understanding how to have influence. At each stage of the policy process there are different forms
of power that exert influence on the process, often described as:
4. Policy Implementation
and Enforcement
Putting a policy into
Visible Power: Observable decisionmaking, including formal

rules, structures, authorities, institutions, and procedures
Hidden Power: Certain powerful people and institutions

often operate behind-the-scenes and control the agenda
and who is at the decision-making table. Less powerful
groups are often excluded.
Invisible Power: This shapes values, norms, and what is

acceptable. Socialization, culture, and ideology define
what is acceptable, and often perpetuate exclusion.
action and enforcing it
5. Policy Monitoring
and Evaluation
Monitoring and
evaluating the policys
implementation
and impact
VeneKlasen, Lisa, with Valerie Miller. 2007. A new weave of power, people and politics: The action guide for advocacy and citizen
participation. Warwickshire, UK: Practical Action Publishers. http://practicalaction.org/newweave (accessed December 3, 2014).
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In order to plan your advocacy and how to influence specific policy processes, it is important to
analyze and understand all of these different forms of power. You need to know who is formally
making the decision that you are trying to influence, and others who may have power and are
influencing the decision process both formally and informally (this will be discussed further in the
following Chapter 9: Identify and Analyze Targets).
The Role of Development Partners

In many countries there is no one single actor who develops and determines the HRH policies. While
the Ministry of Health may be tasked with developing a comprehensive HRH plan, donorsalso called
development partnersand other major actors may be intricately involved in the process. The number of actors involved in the process will have a direct effect on your HRH advocacy work. For example, development partners may be implementing emergency hiring plans that create parallel human
resources systems, or perhaps even draw health workers away from jobs in other private or faith-based
facilities, contributing to what some call internal brain drain.
Most ministers of health negotiate directly with foreign bureaucrats, or Mission or Embassy staffed
offices that distribute funding from major unilateral programs such as the U.S. Presidents Emergency
Plan for AIDS Relief for HIV/AIDS (PEPFAR). The planning bodies that create and submit country applications to the Global Fund to Fight AIDS, Tuberculosis and Malaria (CCMs) are
supposed to be independent and include representation from civil society groups and people living with HIV, tuberculosis, and/or malaria. As of 2008, they are also supposed to include people with
expertise in health systems.
It is important to gather all the facts necessary to fully understand the impact of donor-driven
HRH programs in your country and to decide how best to incorporate development partners into your
advocacy work. Every actor involved in the process and implementation of HRH strategies, policies,
and programs can be an effective part of the solution to the health workforce crisis in your country.
Influencing Health Budgets

If you want to address health workforce issues, you will most likely want to influence the health
budgeting process. Policy decisions such as budgets are often made on a set annual timetable. If
you are asking for money from the government to fund a policy, such as more health workers, then
you need to understand the governments budget process. The budget is more than one document,
but a year-long cycle with opportunities to influence throughout. Typically, this process takes a good
portion of the year, starting with the release of a proposed budget, followed by negotiations amongst
the various policy-setting bodies, and concluding with a final published budget before the start of the
new fiscal year. Once a budget is approved, you must also ensure that it is executed as planned.
The International Budget Project17 describes the budget cycle in four major events or stages:
Formulation: when the executive branch puts together the budget plan
Approval: when the legislature debates, alters (if it has the power to do so), and approves the
budget plan
The International Budget Project2011. Why Are Budgets Important? HYPERLINK http://internationalbudget.org/getting-started/
why-are-budgets-important/ \l budget-cycle http://internationalbudget.org/getting-started/why-are-budgets-important/#budgetcycle (accessed December 3, 2014).
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Execution (implementation, monitoring, and control): when the government implements the
policies in the budget
Oversight (auditing and legislative assessment): when the national audit institution and the
legislature account for and assess the expenditures made under the budget.
In order for civil society and the public to be able to influence budget decisions and provide
effective independent oversight throughout the process, there are a set of documents that should
be produced and made public at each stage. The information in these documents should be
comprehensive and accessible, and they should be made available in a timely way to support
effective public participation.
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Example Policy Process Map18
A Policy Process Map helps to outline exactly how a specific policy decision is made, including formal
and informal decision-making processes, decision-makers involved, opportunities and timing for input,
and how you may influence the policy process. This is an example map for the first agenda setting
stage in the policy process, in which advocates had the following advocacy goal and objective:
Goal: Reduce under-five childhood malnutrition in order to reduce child mortality and morbidity and
improve child development.
Advocacy Objective 1: The Ministry of Food and Agriculture in cooperation with the Ministry of Health
will start a national program to fortify salt with iodine in the next two years.
In addition to the following map, advocates would also create subsequent maps for different stages
of the policy process as their advocacy progressed. It can also be helpful to draw a visual map to
help illustrate exactly how the policy process happens and who is involved. This may be particularly
useful for parts of the policy process in which there are many steps and players involved.
Stage 1: Agenda Setting

Institution/Organization
Ministry of Health
Formal
Process

Proposal for a national salt fortification program is generated by

the Nutrition and Child Health Offices in the Ministry of Health.
One or two people from these offices is assigned with the task to
develop the proposal fully.
Informal
Process

Informal discussions among the Child Health Office, Nutrition

Office, Ministry of Food and Agriculture, salt producers,
childrens organizations and health organizations take place.
Elements of the policy are proposed and discussed.
Decision-Makers
Involved
Directors of the Child Health and Nutrition Offices at the

Ministry of Health
Approximate Date
of Action
January and February. Offices at the Ministry of Health are most

open to new ideas at the start of the fiscal year.
Possibilities to Influence
the Process at this Stage
Meet with child health and nutrition officials to introduce our

proposal and to gain their interest, support, and enthusiasm.
Be helpful to these offices with other issues they are working on,
when appropriate.
Become knowledgeable about the issues in which the key
decision-makers in these offices are interested.
Meet with groups that might support the program, such as salt
producers, childrens health organizations, and health organizations
to enlist their support.
Work closely with the person or people tasked with developing the
proposal. Offer assistance, ask to see drafts of the program and
give comments.
Sharma, Ritu. 1999. An Introduction to Advocacy: A Training Guide. Washington, DC: AED. http://www.aed.org/ToolsandPublications/
browser.cfm?FieldID=1026&FieldValue=Training (accessed December 1, 2014)
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Advocacy Toolkit
Case Story: The Mexican Tax on Sugar Sweetened Beverages:

A Victory in Progress (El Poder Del Consumidor)
Background and Context: Mexico has one of the highest rates of overweight and obesity in
the world (Food and Agriculture Organization 2013); one of every three children and seven of
every ten adults are overweight or obese (National Survey on Health and Nutrition 2012). The
resulting noncommunicable diseases (NCDs) are alarming, for example, 14% of Mexican adults
have diabetes (National Survey on Health and Nutrition 2006) and Mexico has one of the highest
rates of mortality from diabetes internationally, with 500,000 deaths from diabetes during the last
administration.19 The problem has reached epidemic proportions and the costs are jeopardizing
family economies and the nations public health system. The fact that Mexicans have the highest
consumption of soda in the world, with an average consumption of 163 liters per person per year,20
is an important causal factor, with 22,000 deaths per year associated with sugar-sweetened beverage (SSB) intake alone.21
Nevertheless, until just recently, government action for prevention and control of obesity and associated chronic disease arose slowly and was largely reactive in nature. Between 2008-2010, the
government issued a series of recommendations, guidelines, and industry self-regulation, which
were not compulsory and comprehensive and lacked accountability, enforcement, and sanctions
for noncompliant; instead of the aggressive legislation, formal policies, and statutory regulations
that were needed. A new federal administration and legislators took office in 2012 providing advocates a fresh opportunity to influence policymaking.
Advocacy Goal: The Mexican government and legislature formulate and pass comprehensive
national obesity prevention laws, policies, regulations, and programs that effectively prevent and
curb malnutrition, obesity, and chronic disease.22
Advocacy Objective 1: The Mexican government implements a national two peso per liter excise
tax on SSBs by 2015.
Advocacy Objective 2: The Mexican government allocates the revenue from the national SSB tax
to obesity and NCD prevention and healthcare, beginning with the installment of drinking water
fountains in schools nationwide by 2015.
Process: One of the first steps to contribute to an enabling environment for the full policy agenda,
starting with the SSB tax, was to build a national coalition of academic advocates, diverse public
interest organizations, and social movements concerned about malnutrition and obesity called
the Alianza por la Salud Alimentaria (Alliance for Health and Food), which developed a joint
policy agenda and collective voice seeking to engender broad-based support, public debate,
and political pressure.
Johnson, N; Hayes, L; Brown, K; Hoo, E; Ethier, K. 2013. Mortality Database 2006-2010, Geneva, Switzerland: Secretariat of Health, http://
www.who.int/healthinfo/mortality_data/en/ (accessed December 4, 2014)
19
Calculation by Dr. Kelly Brownell, Rudd Center for Food Policy & Obesity, Yale University, based on data from Datamonitor 2009,
Euromonitor 2009, and Andreyeva et al 2011.
20
Mozaffarian et al 2013. 180,000 deaths worldwide may be associated with sugary soft drinks, Dallas, Texas: American Heart Association
(accessed March 19, 2013)
21
The Alliances eight point policy agenda has eight different topics of advocacy objectives in addition to fiscal measures, such as school
food policy, breastfeeding, universal access to water, a ban on child targeted marketing, food labeling, among others.
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The Alliance grounded its policy agenda in academic research, science-based policy proposals, and recommendations developed by key national actors, such as the National Institute of
Public Health (INSP), the National Academy of Medicine, and the National Autonomous University
of Mexico (UNAM), who produced a peer-reviewed policy agenda on obesity. The INSP also
conducted soda tax modeling, demonstrating the expected impact from a 10%, 20%, and 30%
tax. Other international organizations, such as the World Health Organization/Pan American
Health Organization, United Nations Special Rapporteur on the Right to Food, Organisation for
Economic Co-operation and Development, and International Obesity Taskforce, also spoke
out in support of an SSB tax.
In order to raise awareness of this issue both with the public and with policy-makers, the alliance
made concerted efforts to foster public debate on obesity and the soda tax, positioning messages
and arguments in the media through a consistent earned media strategy, conducting press activities and public stunts on a weekly basis during the most heated moments of the debate on the
tax. Forums with invited national and international experts served to inform the media and policymakers about the harms of sugar-sweetened beverages and the health merits of soda taxes.
Mass media campaigns were one of the alliances main forms of action to expose the human
trauma of diabetes in Mexico, educate the public and stigmatize SSBs, promote the soda tax,
warn the public about health risks, and support the need for public drinking fountains. For example,
the 12 spoonfuls of sugar campaign on the streets of Mexico City was a groundbreaking public
health campaign to inform the public about the quantity of sugar in soda. The For a healthier
Mexico campaign warned the public Soda is sweet, Diabetes isnt and urged public support
for the soda tax and drinking water fountains in schools. The alliances public health campaigns
have also had active opponents, and have been censored by different TV networks and outdoor
media companies, for fear of offending the industry and losing marketing revenue from food
and beverage companies.
One of the most important components of this process was a customized lobbying strategy,
starting with actor mapping and the identification and close collaboration with key legislative
champions. The Alliances lobbyingspearheaded by the public interest lobbying group Polithink
and the Contrapeso networkwas effective in informing legislators and rallying support from
diverse Congressional committees, parties and political fronts, even in the face of a powerful
industry lobby by food and beverage companies. A special communications campaign in the
press and Congress targeted legislators, asking Whose side are you on? and calling upon them
to vote in favor of public health over private interests.
The food and beverage companies publicly questioned the evidence of health harms from SSBs,
claimed jobs would be lost, and insisted there would be no health benefit from the tax. They also
developed mass media campaigns to promote their products, developed industry front groups,
deployed a strong Congressional lobby, and engaged store owners and sugar cane producers
against the tax. Advocates countered this opposition by staying focused on people, health, and
the science, reminding opinion leaders and decision-makers that the tax is about health and
follows the recommendation of international and national health experts.
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Outcomes: A peso per liter federal excise tax on SSBs was passed in the Mexican Congress on
October 31, 2013, and entered into effect on January 1, 2014. Despite the Alliances call for the
revenue to be earmarked for prevention and health care, and the Executive Branchs and legislators expression of political will towards the goal of water fountains for children, revenue was
not directly earmarked. Nevertheless, as a result of successfully influencing public debate and
policy-makers, in May 2014, a national law was passed making the installation of water fountains
obligatory in all schools throughout the country; the law references use of SSB tax revenue and
advocates are currently urging tax revenue allocation for prevention.
Evidence suggests that the SSB tax is working. Firstly, consumers are starting to switch to healthier
options: in the first quarter of 2014, there was a 10% decline in the purchase of taxed beverages
and an overall 13% increase in bottled water (INSP/Carolina Population Center 2014). Secondly,
the tax is effectively generating revenue: 7.2 billion pesos 540 million USD in the first half of 2014
(Secretariat of Finance and Public Credit-SHCP), even more revenue than had been projected, so
that authorities and legislators cannot claim that action is impossible due to a lack of funds. And
finally, a national opinion poll demonstrated an initial shift in cultural norms, as the public increasingly identifies the health risks of consuming SSBs and claims to be consuming less soda and SSBs,
due to the combined effects of the mass media campaigns, public debate, and passage of the
tax (Alianza por la Salud Alimentaria/DINAMIA 2014).
Lessons Learned: From the beginning, advocates realized the importance of gauging the political context and timing appropriately to determine the viability of one of the Alliances first joint
advocacy objectives: the SSB tax. Advocates recognized several political dynamics that made
the timing right to advocate: the Executive branch of government was looking to find sources of
revenue and obesity prevention measures and The Pact for Mexico had been agreed among
political parties to foster decision-making on priority issues including fiscal reform. An equally
important component of the process was educating the public about the human toll of diabetes
and how much sugar soda contains and its risks to health, prior to the soda tax debate. Engaging
the public in this way brought more voices and awareness to the issue, putting additional pressure on policy-makers to make changes. Framing messages around societys concern for children
and the diabetes epidemic, and linking the tax revenue to a specific causethe call for water
fountainswas an effective way to increase political and public support for the tax. In addition,
bringing diverse, solid expert academic and civil voices to support the tax provided greater legitimacy with the media and key stakeholders. Permanent media presence through mass media
campaigns and a continuous earned media strategy positioned the issue in the public eye, and
in the face of the avalanche of industry publicity and arguments, advocates stayed focused on
health and science-based policy recommendations. Finally, the consistency of the legislative
champion and lobbying team, and their capacity to use political timing, strategizing and messaging, was essential from beginning to end. The national SSB tax is a victory in progress for Mexico,
as the Alliance continues to advocate for effective and sufficient allocation of the tax revenue to
obesity and diabetes prevention and control measures and works towards passing additional laws
and policies that are guided by unbiased experts to address this problem.
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Tool: Policy Process Map23
For each objective, create a policy process map for each stage of the policy process and for each
institution involved. Please list the formal and informal decision-making processes, decision-makers
involved, opportunities and timing for input, and how you may influence the policy process. You may
also wish to visually map out the policy process.
Advocacy Objective:
Policy Process Stage:
Institution
Formal Process
Informal Process
Decision-Makers
Involved
Opportunities and
Timing for Input
Sharma, Ritu. 1999. An Introduction to Advocacy: A Training Guide. Washington, DC: AED. http://www.aed.org/ToolsandPublications/
browser.cfm?wFieldID=1026&FieldValue=Training (accessed December 1, 2014)
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Photo courtesy of Stuart Sia/International Medical Corps.
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Chapter 9: Identify and Analyze Targets

Identifying Your Targets
Once you have established your specific advocacy objectives and collected the facts on both the
issue itself and the power structures and decision-making processes behind it, it is critical to understand WHO and HOW you influence:
Who is the decision-maker that has the power to make the
change you want?
Who can influence the decision-maker?
How can we reach the people in power?
Primary targets are the specific people who will make the decision
that you are seeking to influence. Your targets should be specific
individuals and not an institution (see text box below for Some
Typical Primary Targets in Health Workforce Decision-Making).
Secondary targets may be anyone who can influence the primary
target, and will vary in every setting and for every issue.
It will be important to determine whose opinion the primary target
will care about. Some examples include:
Primary Targets
The person(s) who
have the power to
make the desired
change.
Secondary Targets
Those who can
influence your
primary target(s).
Leaders of primary targets party

Business associates of the primary target
Personal assistants or staff
Formal or informal advisors to the primary target
Relatives (spouses, children, uncles)
Career middle management officers (technocrats)
National opinion leaders
Other ministers may often be influential with your primary target. For instance, if the target is the
minister of finance, and there is a Ministry of Health official who is also an economist, he/she may
be able to influence. Or if there is a member of parliament who used to work at the Ministry of
Finance, they may have influence there and can be a secondary target.
Media
Other NGOs
Religious or traditional leaders
Citizens
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Some Typical Primary Targets in Health Workforce Decision-Making

Presidents or Prime Ministers
Questions to ask before you choose the president or prime minister (PM) as a target:
Is there a more accessible target who can give us what we want without being
overruled by someone higher up?
If president/PM controls the budget, who does she or he get advice from?
Is the spouse of the national leader a better potential target?
Ministry of Health Officials
Planning Department or the HRH department
Commissioner or Director
Minister of Health
Ministry of Finance Officials
Minister of Finance
Head of Macroeconomics
Health desk officer at the Ministry of Finance
Members of Parliament
Parliamentary leaders
Key Committee Chairs or Members: Budget, Finance, Social Services
Members of Parliament who are health workers themselves: doctors, nurses, etc.
Representatives of Donors and Development Partners
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Analyzing Your Targets

Your targets will be Allies, Opponents, or Neutral, and it will be important to understand all of them
especially those with a lot of power - and the impact they may have on your advocacy work. For
each target, you should consider: what they already know about your advocacy issue, what their
attitude about the issue is, and what else they care about. The Identifying Primary and Secondary
Targets Tool and Stakeholder Mapping Tool will help you identify and analyze your targets.
Allies: People who are on your side either because they will benefit directly or because they
share the same objectives and want to help bring about change as part of a broader movement.
These are the people and groups who are already active on your issue or those you want to enlist
and you think you can get on board.
Opponents: People who are opposed to what youre trying to do and are likely to actively
oppose you. Some of these people could become allies in time with greater understanding of
the issues or could be standing in the way of what youre trying to do. Adversaries can become
targets of your advocacy work if you are planning a series of activities to win them around. Also,
it is useful to not allow your advocacy to get distracted by passive opponentsopponents who
will not actively oppose you or opponents who do not have the ear of your targets.
It will be important to consider how you can ensure the opposition stays at least neutral and
that your actions do not inflame them to put opposing pressure on policy-makers. If your
opponents are active, how can you counter some of their arguments? Can you make any
opponents into allies with specific outreach strategies?
Neutrals: People who do not necessarily have an opinion either way on the issue you are advocating for. These may be valuable people to educate and win over if you determine that they
may be a powerful voice or decision-maker to influence the change you are seeking.
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Case Story: A Community Advocates for Local-Level Health

Coverage in Afghanistan (Save the Children)
Background and Context: Save the Childrens Local to Global approach aims to provide communities with tools and strategies to help demand access to quality health services and hold government and other stakeholders accountable. It seeks to secure improvements for childrens and
mothers survival and health by linking community-level approaches to national- and global-level
advocacy work. The project in the Yakawlang district of Bamyan, Afghanistan, focuses on building
communities capacity to identify and analyze health problemsparticularly childrens health
problemsand to empower them to advocate for better health care at district and provincial
levels. Community health councils (shuras) are established and supported with training to help
identify the causes of maternal and child health problems within the community, develop possible
solutions ,and implement community-led action plans.
In the Dar-E Ali valley, there had been a mobile health clinic that served twelve villages every
month through the summer, but in the fall of 2011 it stopped without notice. To have health care
coming to their village is crucial to the survival of the villagers. The village is 12 kilometers from
the main asphalt road. The valley road is muddy in this season and when it snows it is impassable.
There are only two vehicles that provide public transport to Yakawalang, leaving at eight in the
morning and returning in the afternoon. The cost per person one way is 100 Afghanis (about 2
dollars). If villagers miss this vehicle they must arrange a private car from the bazaar in Yakawalang
that costs between 3,000 and 4,000 Afghanis (60 to 80 dollars) a fortune for everyone in the
valley. The only other options are to walk or go by donkey which takes five hours each way.
Bamyans winters are cold; children and old people in particular suffer from the cold and many
die. Mohammed Matin, the community health worker said: We knew that with the winter ahead
we would have more diseases. So the health shura decided to use its new skills to identify health
problems and address them with higher authorities.
Advocacy Goal and Objective
Advocacy Goal: To ensure health and well-being for the people in the Dar-E Ali valley.
Advocacy Objective: The Provincial health director (PHD) resumes the mobile health clinic and
provides health services in Dar-E Ali by the winter of 2012.
Process: Mohammed Matin worked with the community to write a petition asking that the mobile
clinic start coming again. He first needed to understand whom he should direct the petition to in
order reach the primary decision-maker who could answer his request. We went to the hospital
and asked Ghulam, the vaccinator. He guided us to Dr. Khayum, a doctor in the hospital and
responsible for implementing the Basic Package of Health Services in Yakawalang. Dr. Khayum
said he would follow up at the provincial level. He submitted the proposal to the Provincial
Health Directorate.
2013. Empowering communities: Better health care for villages - The local to global project in Bamyan. London, England:
Save the Children Afghanistan http://www.ohchr.org/documents/issues/children/technicalguidance/savechildren2.pdf
(accessed December 1, 2014)
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The petition reached Dr. Rahana Haidary. At that time, she had been Bamyans provincial health
director (PHD) for about nine months, and she had noticed more petitions of late. In the past,
communities never addressed her or her predecessors directly, but she is glad that the communities
are voicing their concerns and is happy to get petitions. They help her push for better health care
for Bamyan at higher levels. She passes them on to the Ministry of Public Health in Kabul where
decisions about health facilities are made.
Outcomes: Although Dr. Haidary decided that they did not have enough staff to continue the
mobile clinics for Dar-e Ali, she found another way to provide health services for Dar-E Ali by
establishing a Family Health House in Dar-e Ali with a midwife available to take care of pregnant
women and small children and also give vaccinations.
Lessons Learned: Mohammed Matin and the people of Dar-E Ali learned that if they wanted to
make changes in their community it was important to voice their concerns, and it was especially
critical to ensure that their concerns reached the primary decision-maker. It was only through
asking others in the community that they were able to reach the provincial health director, who
was ultimately able to make the change they were seeking.
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Tool: Identifying Primary and Secondary Targets
For each objective, please list the Primary and Secondary Targets, their level of influence and
support, and how you will engage them. Make sure to list individuals and not organizations.
Advocacy Objective:
Who?
What is Their Position
Interest and Level
How Will You
of Power/Influence?
of Support for
Engage Them?
Advocacy Issue?
Primary Targets (Main decision-makers)

1. 1.
1. 1.
2. 2.
2. 2.
3. 3.
3. 3.
4. 4.
4. 4.
5. 5.
5. 5.
Secondary Targets (Those who can influence the decision-makers)

1. 1.
1. 1.
2. 2.
2. 2.
3. 3.
3. 3.
4. 4.
4. 4.
5. 5.
5. 5.
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Tool: Stakeholder Mapping
This exercise will help you map your stakeholders, both primary and secondary targets, on two axes:
the level of power they have, and their level of support for the desired change.
Start by placing your primary target on the below matrix, based on your perception of their power
and support. Make sure you identify specific people and not institutions.
Next, do the same with your secondary targets. Represent your primary and secondary targets in
different colors or with different shapes so they are easily distinguishable on your map.
You may also use this as an advocacy monitoring tool, and update this map as you move forward
in your advocacy work to assess if you are making progress and moving your targets towards
higher levels of support.
Power
+
High Power
Low Support
High Power
High Support
Low Power
Low Support
Low Power
High Support
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Chapter 10: Develop and Deliver Messages

Advocacy Messaging
Once you have chosen your primary and secondary targets, your key messages will need to be
framed or tailored according to the audiences you want to reach. While your overall position on
the advocacy issue does not change, you should seek to adapt the way you present your message
to achieve the greatest impact on a particular audience. An advocacy message should inform,
persuade, and move to action.
Inform
Persude
Move to Action
Crafting the Message

You need to decide what your message is, who it is for, and how and when you will deliver it. The
Message Development Tool will help you develop your messages for various target audiences.
Developing your core message: Your core message will include:

o A description of the problem and solution
o Evidence and examples of the problem, solution, and why change is important
o The action your are asking your target to take to bring about this change.
Tailor the message for a particular audience: Your target analysis in Chapter 9 will determine how
you present your core message for each particular audience. What is the most persuasive way
to present your core message to the target audience? What information do they need and what
dont they need? What key action do you wish for them, in particular, to take? How you present
your message to a decision-maker versus to the media versus to the community will vary widely.
Effective framing: Which practical frame will make your message more effective? What should
it contain? In what format should it be delivered? Length, images, and even messenger are
important.
Message Delivery and Channels of Communication

There are many different mediums with which to deliver messages, and which options(s) you choose
will depend on the purpose of your message, your audience, and context. For each audience, you
will need to understand their primary sources of information and what appeals to them. For instance,
if you want to reach as many people as possible, you may engage some form of mass media. However, if you want a minister of health to change his/her mind, you may conduct a lobbying visit and/
or target a specific media outlet they read or listen to.
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Some options for delivering messages include:25

Person-to-Person
Lobbying visits
Community meetings
Seminars, workshops, conferences
Public hearings, debates, or testimony
Press conferences
Protests and public demonstrations
Print
Newspapers and magazines
Journals, bulletins, newsletters
Posters, leaflets, fliers, pamphlets, action alerts, bumper stickers
Billboards, banners, public transportation
Reports, studies
Letters to decision-makers
Electronic
Radio
Television
Video and films
Internet
Text messages
Drama and folk art forms
Street theater
Songs, music, poems, dance
Engaging Mass Media for Advocacy

Using mass media to get your message across is often a key tactic in advocacy. It is important to
be deliberate about the objectives of using mass media, identify which media outlets will most
effectively reach your advocacy targets, and know how you will engage with the media. Some
examples of ways to engage mass media to cover your issue include:26
Issue a press-release
VeneKlasen, Lisa; Miller, Valerie. 2007. A new weave of power, people and politics: The action guide for advocacy and citizen participation. Warwickshire, UK: Practical Action Publishers.
26
Gosling, Louisa and Cohen, David. 2011. Advocacy matters: Helping children change their world: An International Save the Children
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Take a journalist to see the issue for him/herself

Release some new and compelling statistics that illustrate the seriousness of the issue
Hold a demonstration or photo stunt, which could include handing in a petition, that would draw
media attention
Prepare a newsworthy event
Write an opinion-editorial for publication in a newspaper
Hold a debate, seminar, or press conference and invite keynote speakers and the media
Write an open letter to the government and try and get it published in a newspaper
Pay for advertising space in a newspaper
Prepare some materials for journalists to help them cover the story, such as a background briefing
on the issue, some photography, some video footage, or some case studies
Give a television or radio interview.
In order to get media coverage, it is important to remember that you need to be issuing news and
you need to give the media a reason to cover the issue. Look for key dates and events that lend
themselves to discussion of the issue, present a credible spokesperson, and avoid using jargon
and acronyms.
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Example Public Testimony: HWAI Statement at the

2014 World Health Assembly
At the 2014 World Health Assembly, HWAI decided to use the medium of a public testimony to
clearly outline the action points that they wanted key decision-makers to move forward with.
May 22, 2014

Statement on item A67/34, Follow-up of the Recife Political Declaration on Human Resources for
Health: Renewed Commitments towards Universal Health Coverage
To be delivered by Chantal Baumgarten, Save the Children
Honorable chair, director-general, delegates, and colleagues, Save the Children welcomes the
opportunity to address the WHA on this important issue.
I am speaking on behalf of the Health Workforce Advocacy Initiative, a global civil society
network working to ensure that there is a health worker for everyone and all countries have
the health workforce they need to achieve universal health coverage (UHC).
During the 3rd Global Forum on HRH last November, the message echoed loudly that a strong
health workforce is essential for achieving UHC and all health and development goals.
HWAI therefore welcomes the Recife Political Declaration on HRH and commitments made by
governments and other partners to build health workforces needed to achieve UHC.
HWAI calls upon Member States to adopt Resolution EB134.R15 andwith the support of
development partnersto implement, without delay, commitments made in the Recife Political
Declaration as well as past commitments made here at the World Health Assembly, including
implementation of the Code of Practice on the International Recruitment of Health Personnel.
HWAI is gratified to note that Dr. James Campbell has recently been named as the new director
of GHWA. We call upon the WHO and GHWA to take the lead on developing a robust accountability mechanism to monitor the progress of Member States and other partners towards agreed
HRH commitments.
We also welcome efforts to develop a global HRH strategy that will guide and support HRH
strengthening efforts in coordination with the post 2015 development agenda. We welcome
the proposal for GHWA to take on the leadership for the global HRH strategy and encourage
all Member States to actively engage in this process.
Finally, we call on Member States, WHO, and GHWA to ensure that the health workforce is
included as a target, subtarget, or indicator in the post-2015 development framework so that
this crucial issue remains high on the political agenda and progress monitored at all levels.
Thank you.
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Using Social Media for Advocacy

Depending on the objectives of your message and the audience you are trying to reach, social
media can be an effective tool for getting your message out. For example, if you determine that an
important part of your advocacy strategy is to mobilize the public in order to raise awareness and
put pressure on your targets, social media can be an effective way to engage more people in your
advocacy work and build momentum.
Tips for Using Social Media for Advocacy27
1. Know your objective and audience
Be clear about why you are using social media as a strategy and whom you are targeting.
Are you targeting specific policy-makers to influence a particular policy debate or bring their
attention to certain facts related to your advocacy? Or are you trying to get a specific message
out to mobilize citizens to engage in your advocacy work, or ask them to reach out to a
policy-maker?
2. Choose the appropriate channel of communication
Depending on your objective and audience, it is important to choose social media channels that
your audience is already engaging with and is able to convey your message effectively.
3.

Tailor content for different platforms

Once you determine whom you are trying to reach, for what purpose, and the appropriate social
media channel, it is important to tailor content for different social media platforms. You should not
just copy your traditional content, but adapt your messages to appropriately fit the specific social
media platform.
4.

Be authentic and responsive

Maintain an authentic and consistent voice and ensure that you monitor and respond to your
audience to encourage sustained conversations. You should also incorporate and use responses
as a source of information for your advocacy work and make adjustments as needed. Success
in social media not only has to do with the number of followers or likes, but the level of
genuine engagement that you can foster.
5.

Dont neglect offline interactions

Social media is best when it complements offline discussions and builds sustained relationships.
Ultimately, changing policy will require in-person discussions and interactions. It is also important
to be aware that often only a minority of people have and use social media, and you need to
think deliberately about how to reach those without social media as well.
6.

Social media requires dedicated resources

Engaging in social media requires significant time and resources and should be built into your
overall advocacy resource planning. In order to do it well, you need to ensure that you have
the staff capacity to plan for, monitor, and engage with social media in a strategic way.
Custer, Jon. 2012. Ways to use social media for economic reform and democracy advocacy.Washington, DC: Center for International
Private Enterprise Development Blog http://www.cipe.org/blog/2012/02/16/five-ways-to-use-social-media-for-economic-reform-anddemocracy-advocacy/#.VIcZ_jHF-So (accessed December 4, 2014)
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Example Tweets for World Health Worker Week

In order to engage people, build momentum and encourage specific actions on the issue of
health workforce, the Engagement Toolkit for 2014 World Health Worker Week provided examples
of tweets and tips and tactics for tweeting:
Monday, April 7: Share inspirational stories of frontline health workers.
Example: @theREALawards Honoree, Mairamou Hamandjouma, educates her community about
HIV prevention. #WHWWeek
Tuesday, April 8: Share evidence of frontline health workers impact on global health progress,
progress toward MDGs.
Example: How #Ethiopias focus on frontline #healthworkers helped it achieve #MDG4 child
mortality target early: http://uni.cf/1mxRIJR #WHWWeek
Wednesday, April 9: Share statistics and consequences of the health workforce crisis.
Example: Countries w/20 highest child mortality rates all classified health workforce crises countries
by @WHO. #WHWWeeek #healthworkerscount
Thursday, April 10: Day of Action. Ask your community to take action, provide links and/or specific
instructions on how to do so, tell them how their actions will make an impact.
Example: Tell your lawmakers how US investments in frontline #healthworkers improve #globalhealth: http://bit.ly/1gLNn5l #WHWWeek
Friday, April 11: Provide a vision for the future, what the community wants for front line health
workers and what it would mean (such as a health workforce target in the post-2015 development
framework).
Examples: US can further leadership in making #healthworkerscount w strategy to maximize
investments in #globalhealth workforce strengthening #WHWWeek
#Post2015 framework should include concrete #healthworker targets to ensure everyone has
access to essential health services. #WHWWeek
Saturday, April 12: A day to close the week and thank the community for participating.
Example: Its the end of another amazing #WHWWeek and we want to thank all of you for taking
action and hearing our stories about the role of health workers in our fight to save more lives.
#healthworkerscount (thank you image).
Tips and Tactics

Use large/high quality images or infographics in your social posts.
Ask the community to share, like, and retweet your posts to show their support.
Use the hashtag #WHWWeek in all posts to categorize them and make your posts easy to
find for others interested in the weeks messaging. Also use #healthworkerscount when there
is enough room in the post. This hashtag is also the hashtag to use year round to support
health workers.
Follow other related organizations, retweet, and share their posts to extend the reach of the
#WHWWeek message.
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Lobbying and Communication with Decision-Makers

Lobbying involves direct communication with the primary decision-makers in order to educate and
persuade them of the importance of your advocacy objective and convince them to take action.
How to Meet with a Policy-Maker28
Although norms and customs about how to meet with policy-makers vary across different cultural
contexts, the following are some general guidelines that are similar in many environments:
Before the Meeting
Do your homework and learn about the policy-maker, his/her background, their constituency
(if an elected official), and whether or not they have a stated position on the issue.
Know who/what influences your target. Is your policy-maker most influenced by public opinion,
their friends, or spouse? Understanding these relationships can help you uncover a link (and
potential pressure point) with the policy-maker.
Be familiar with the opposing argument. Gain an understanding of the views and position of the
opposition so that you can better answer questions. Find out what their goals are and why they
feel the way they do.
Make an appointment before you go to an elected officials office. Explain your purpose and
who you are.
Limit the size of the group. Set objectives for the meeting and make sure that your entire group
agrees on specific talking points so that your message is clear during the meeting. Designate a
lead spokesperson for your group.
Prepare your three strongest talking points. Your meeting may only last a short time. With that in
mind, keep these strongest talking points within five minutes to allow time for interruptions and
questions. Make sure your information is accurate and be prepared to answer questions. Anticipate weaknesses in your argument and rehearse difficult questions.
Prepare materials to bring to the meeting and leave with the policy-maker or their staff: copies
of relevant literature, a memo or fact sheet summarizing your main concerns. Be familiar with
Internet sites and resources where more information can be found. Your material must be
consistent with your message.
During the Meeting
Be prompt and patient. You might meet with a staff person instead of the policy-maker. This is
valuable because staff are often responsible for making recommendations to the policy-maker.
Introduce yourself and start on a positive note. If s/he is supportive of your issue, thank him/her.
Make clear the issue you want to discuss and state the position of the group or organization you
are representing.
Explain your position with the facts, but also use personal stories when possible. Let the policymaker know the personal ramifications or benefits resulting from their actions. Never speak ill of
another policy-maker, staff member, NGO, or organization.
Ask for an explanation if you dont understand something. You should also ask the policy-maker or
staff to clarify their position on the issue.
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Ask the policy-maker or staff to take some specific actions such as sponsoring a bill, voting for or
against a pending measure, or convening a future meeting on the issue.
If you dont know the answer to a question, say so, but offer to get an answer.
Share your informative materials and leave them with the policy-maker and his or her staff.
Offer to be a source of information on the issue. Leave your contact details, and thank the
policy-maker and staff as you leave.
After the Meeting
Write or call your policy-maker and staff to thank them for their time. Use the opportunity to
reiterate the major point of the meeting, remind them of anything they may have agreed to do.
Send along any additional materials that were requested.
Share the results of your meetings with your team and keep a written record of the visit for further
reference.
Find out when the policy-maker will be in your area and, if relevant, coordinate a meeting with
the policy-maker and other pertinent staff of the organization or a visitation to programs.
Maintain communication with policy-makers and staff through letters, calls, and visits when
relevant. Follow up on any actions they may have agreed to.
Tips for Messaging to Decision-Makers
Policy-makers are very busy and always have many advocacy groups vying for their attention. As a
general rule, policy-makers are most likely to listen and respond to you if your issue is:
Supported by their constituents: When possible, use statistics or stories that relate specifically to
their constituency or their main areas of interest. Find health workers in their region who can add
testimonials or help collect data to make the presentation memorable and impactful.
Related to pending legislation, ordinances, and budgetary items: Include details on the policy,
deadlines, timelines, international conferences (such as the Global Health Workforce Alliance
Forum)anything to give urgency to your demands and tie them to their responsibilities and
public opinion around the issue.
Presented to them succinctly, using current data and simple language: Policy-makers are busy
and will not read 100 page academic reports but will read shorter fact sheets and policy briefs.
Linked to them in a personal way: If you can find a hook that gets policy-makers to understand
the issue in a personal way, they will be much more likely to take ownership of the issue and
support your efforts. Policy-makers in different arenas often have widely divergent views and
interests in the same subject. The Ministry of Health may respond to different messages than the
Ministry of Finance, and Parliament may in turn be looking for different information.
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Different Frames for Different Audiences

Consider advocacy on improving infection prevention and control in hospitals in order to protect
providers and patients alike and improve working conditions to halt brain drain. Your message to
various targets is likely to be different, depending on their interests and responsibilities:
1. To the Minister of Health: The minister of health might be most interested in how low staffing
levels may prevent them from meeting MDG goals and how better infection prevention and
control can boost health worker retention and productivity.
2. To the Minister of Finance: The minister of finance is focused on economic development and
growth: pinpointing how brain drain hurts the economy and how improving working conditions
in health settings, starting with infection prevention and control, can help retain health workers
and contribute to positive health outcomes. Remember, health is a productive sector and
ministries of finance must see the facts to prove this. Dont be afraid to use statistics on how
AIDS has slowed the economy, on how malaria decreases productivity, etc.
3. To the President: The president may be most interested in the region s/he is from, or in international perceptions, or in meeting the MDGs, or in economic development, or in an upcoming
international forumwhatever s/he is most focused on is how you should tailor your message.
4. To a Member of Parliament (MP): An MP may want to hear specific statistics and stories about
their home district. Depending on which committee they are on, they may also be interested
in getting budget or health or labor information. Again, an analysis of your target will help you
figure out what themes and messages will move them.
5. To the Media: The media tends to gravitate towards sensational stories as opposed to dry
statistics. Giving them an example of poor infection control that resulted in death or injury may
get them interested, at which point you can emphasize your policy demands and get the
coverage you need.
As you can see from these different messages, audiences are motivated by different facts so
know your audience, which facts will move them, and craft your messages to be most impactful.
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Advocacy Toolkit
Tool: Message Development29
For each target audience, please outline the specific message, format(s) and timing of delivery,
and messengers.
Target Audience
Message
Description of
Problem and Solution
Evidence and Examples)

(quantitative or qualitative)
Action Requested
Format and Timing

for Message Delivery
Messengers
29
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Chapter 11: Develop and Implement Action Plan

Choosing Advocacy Tactics and Actions
The next thing to consider are your tactics or actions. Actions are steps in carrying out your advocacy
work and specific activities that will be planned strategically to meet your overall advocacy goal
and objectives. Your analysis of the policy process and targets will help determine what activities will
be most effective when. Tactics should not be chosen haphazardly or based only on what you or
your organization has expertise in, but should be selected very deliberately based on how you think
change will most likely happen. This is often called a theory of change, in which you spell out exactly
what sequence of actions will ultimately lead to the change you seek.
Below is a list of just some of the possibilities, but you should be creative and choose the actions that
will help you meet your advocacy objectives.
Examples of Advocacy Actions

Conduct research
Develop a policy proposal or policy brief
Conduct meetings with elected officials or other policy-makers to discuss the issue
Hold a forum on a topic to educate the public or policy-makers, or bring your group
members to one of your targets public meetings to raise questions
Stage a protest, rally, march, or vigil
Conduct outreach or educational activities on the topic
Write a press release and distribute it to media contacts
Hold a press conference
Create a scorecard which rates the performance of your target or of the government
on the issue
Write a shadow report which presents civil societys evaluation of the issue
Conduct monitoring by collecting information on your issue which can be written into
a report or other publication
Organize a debate on the issue to be held on the radio or TV
Write a letter to the editor or an article for the newspaper or a journal
Write a sign-on letter or petition to submit to public officials
Hold a radio talk show or some other media event to raise awareness about your position
Participate in formal negotiations, such as collective bargaining for worker contracts
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Identifying Moments of Opportunity

When creating your action plan, you will need to think strategically about how to time your actions
to be most effective. In order to do this, it is important to determine if there are specific opportunities
and key moments you can leverage. You should develop and maintain a calendar of key dates that
may be relevant to your advocacy. Some questions to consider include:
When are relevant policies being developed and when are the key decisions you need to
influence being made (for more information on the policy process and budget decisions, see
Chapter 8: Understand the Policy Process)?
When are budget decisions made? When do the ministries of health and education submit
budgets to Parliament? When do ministries submit budgets to the minister of finance?
What are the upcoming external events that would help you raise awareness about human
resources and the need for health care workers in the public, the media, and among policymakers? What are the public events where your target will be present?
Are there key days of local, national, or international importance that you may wish to time
certain advocacy actions with? For example:

o World Health Day (April 7)
o Human Rights Day (December 10)
o World AIDS Day (December 1)
o International Workers Day (May 1)
o International Nurses Day (May 12)
Developing the Action Plan

The next step is to put everything together into one coherent action plan which charts out the
sequence of your activities, and then for each activity, determines: what resources are needed,
who is responsible, and the timeline. The Action Plan Tool will help you map out all of these pieces.
As with other aspects of your advocacy plan, this will likely be modified and updated as your
advocacy work progresses, but will provide you with an initial roadmap to help guide your work.
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Example of the Importance of Timing: AIDS Drugs for Africa
US Vice President Al Gore was the primary target of a campaign to win AIDS drugs for Africa in
1999 because he was running for higher office and needed to look good to his constituency of
progressives and African American votersexactly who the activists were able to mobilize to
demand the new trade policy necessary to make AIDS drugs more accessible and affordable in
developing countries. Candidate Gore was held accountable for demands that were also the
responsibility of several US Congress members, the US Trade Representative, or the President of
the United States. But the activists saw Gore as most vulnerable simply because he was running
for office and therefore would be out in public where AIDS activists knew they could hold him
accountable.
Vice President Gore chaired the US-South Africa Bi-national Commission and had used his power
to punish early efforts by the South African Government to promote availability of affordable
generic drugs. US AIDS activists checked in with South African civil society allies who were
launching similar efforts. The groups decided to seize the opportunity to use Gores campaign
announcement tour around the United States to publicize his harmful role and demand that he
change US trade policy to allow generic drugs in the Global South.
To start the campaign, a small group of activists drove to Gores hometown and held signs up
that simply read AIDS Drugs for Africa. The next day, another small group of activists drove to
another state where Gore would be campaigning. They got there early enough to get seats on
stage and held up a banner behind Gore that read, Gores Greed Kills, AIDS Drugs for Africa.
On the same day, a different set of activists joined a third campaign stop and held up signs that
read AIDS Drugs for Africa. Activists in South Africa had demonstrations with similar messages
outside of US embassies. These actions together led to an unprecedented wave of media
coverage about the AIDS pandemic outside of the US and the Vice Presidents role in limiting
affordable generic drugs in South Africa.
Activists usually have little access to senior US officials like the Vice Presidentexcept for direct
access afforded by campaign stops. By drawing media attention to the Vice Presidents negative
role at an extremely important moment for his campaign, the activists gained a great deal of
power very quickly. They were quoted in news articles and quickly invited to high-level meetings
to discuss the issue.
Within seven months from the start of the campaign, the very small group of activists had won a
new Presidential Executive Order which lifted the central barrier to generic competition in developing countries. The cost of AIDS medicine quickly fell from $10,000 per patient per year to $350,
and this price has continued to fall ever since.
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Advocacy Toolkit
Tool: Action Plan
For each advocacy objective, please list the key activities and tactics for your advocacy work. For
each activity, describe what resources are needed, who is responsible, and by when.
Objectives Key

Advocacy
Objective 1:
Activities
Resources
Needed
1.
2.
3.
4.
5
6.
Advocacy
Objective 2:
1.
2.
3.
4.
5
6.
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Person
By
Responsible When
Advocacy Toolkit
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Chapter 12: Mobilize Resources

Budgeting and Getting Resources for Advocacy Work
Advocacy requires significant resources in time, skills, and
money and often over a long period of time. It will be
important to include in your action plan (Chapter 11) an
accurate assessment of what resources are needed, and to
plan from the beginning for how you will acquire resources
that you may not already haveboth from donors and from
partners. As mentioned in Chapter 6: Build Partnerships, one
benefit of working with others is the ability to pool resources,
both human and monetary.
Ideally, in budgeting for advocacy, you should think about
both core costs of maintaining and strengthening advocacy
staff and capacity as well as resources needed for specific
actions associated with the activities in your action plan.
Examples of Resources
Needed for Advocacy
Staff salary and fringe
Team functioning costs,
including conference calls,
staff recruitment, development,
and capacity-building
Attending policy-maker events,
conferences, policy-maker trips
Membership of selected
networks or coalitions
Organizing and conducting
research to support advocacy
Legal Issues in Fundraising

for Advocacy
Laws that govern the giving and receiving of donations vary
from country to country. You will need to find out the relevant laws in your country. Think about:30
What laws govern the asking and receiving of funds in
your country?
Are there any legal/ethical or technical restrictions to the
use of money for advocacy and policy change goals?
Is there a maximum amount that individuals and organizations can contribute for advocacy and policy change?
Writing, editing, publishing, and

printing policy briefs, reports,
flyers, posters, newsletters, etc.
Producing and editing videos
Tools such as constituent relation
or target tracking software
Conferences, meetings,
or events
Lobbying
Social and public media
Travel
What are the reporting requirements?
30
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Advocacy Toolkit
Chapter 13: Monitor, Evaluate, and Learn

Advocacy is both unpredictable and a long-term endeavor, often
requiring considerable time to reach your ultimate policy change
objective. For this reason, advocacy monitoring and evaluation has
some unique challenges and also makes it especially important to
have a plan to know where you are going and monitor this plan
along the way to chart your progress, learn, and adapt to
changing circumstances.
Tips to Address the Challenges of Monitoring

and Evaluating Advocacy Work
Monitoring
Periodic and planned
collection and
aggregation of data,
nterpreted through
comparison to targets
or standards, to assess
performance, learn, and
make corrections.
Evaluation
Build a monitoring and evaluation (M&E) plan around a conceptual
Structured analytic
framework of how short-term objectives/benchmarks are expected
effort undertaken
to lead to long-term policy change outcomes (see Sample
selectively to answer
Advocacy M&E Framework below).
specific
questions, such
Since your ultimate advocacy objective of policy change may take
as whether the advocacy
a long time to be realized, it is important to develop a framework
goal and objectives have
from the beginning, showing your expected short-term, intermedibeen achieved.
ate, and long-term outcomes determining specific milestones and
indicators to regularly show progress on the way. This framework will
help you track and demonstrate progress given the complex and
unpredictable nature of advocacy. Most importantly, it will enable you to learn from your work as you
go and adapt your advocacy strategy accordingly.
Include ways to monitor and evaluate other results of your advocacy beyond the specific
policy change.
Although a specific policy change may take a long time to realize, there will likely be many other
important but related outcomes that may ultimately strengthen or build momentum for your current
and future advocacy work. For instance, this may include results such as building advocacy capacity,
creating increased space for civil society,; changing the policy-making process, or strengthening
a coalition.
Focus on meaningful contributions, instead of trying to distinguish changes that can be
directly attributed to a single organization.
Many different stakeholders are involved in advocacy and it is hard to make causal attributions
and to attribute the work to just one player.
Focus on formative evaluation, not just impact evaluation.
For advocacy, formative evaluation is more common, measuring the strategys effectiveness and
whether strategies achieved their policy change objectives rather than the larger impact of whether
more people were better off as a result of achieving your advocacy objective (for instance, if more
people had better health outcomes because of a changed policy). Assessing this larger impact, and
the implementation and sustainability of a policy is important too, but a much harder endeavor, and
less likely the main focus of advocacy M&E.
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Advocacy Toolkit
Assess progress, and continually use real-time monitoring data to learn and adapt your advocacy
strategy as needed.
Since advocacy happens in a constantly shifting policy and political environment, it is particularly
important to regularly monitor your progress and use learning to adapt your advocacy strategy
as needed.
Focus on quantitative and qualitative indicators.
In advocacy, it is particularly important to have both quantitative and qualitative indicators. Given
the complex nature of advocacy work and many constant shifts in the policy and political environment, sharing the story of your advocacy work helps you to understand whether and why a particular
strategy was successful and draw lessons for your current and future advocacy work.
Five Questions for Planning Advocacy Monitoring and Evaluation31

As you begin developing your advocacy M&E plan, you should consider answers to the following
key questions:
1.

Who are the monitoring and evaluation users?

It is important to start with an understanding of who will use the M&E information and how they
will use it. This will help you target your efforts to collect the right information. For instance, will the
information be used by your organization, by external donors, by other external actors
2. How will monitoring and evaluation be used?

Some possibilities would include: accountability, informing decision-making, or learning.
3.

What evaluation design should be used?

Nonexperimental designs are most common for advocacy evaluation, since they do not require
counterfactuals that control subjects or conditions. Although nonexperimental designs may
therefore have threats to validity, these designs can still be strong and rigorous. Experimental
and quasiexperimental designs make less sense in advocacy, since random assignment and
control groups do not work well with advocacy.
4.

What should be measured?

You must next decide what in your advocacy strategy should be measured. For each activity,
you will not only measure the final achievement of your advocacy objectives (long-term
outcomes) and possibly the advocacy goal (impact), but will also likely choose to measure
benchmarks along the way (outputs, short- and intermediate-term outcomes) to assess and
track your progress. See the Sample Advocacy M&E Framework and Advocacy M&E Tool for
more information.
5.

What data collection tools should be used?

This will determine how the data will be collected. You may draw on both traditional data
collection tools such as surveys, interviews, document review, observation, and focus groups.
Additionally, there are some specific tools that have been developed for advocacy M&E, which
are described more fully in some of the Additional Advocacy Resources listed at the end of
this toolkit.
Cohen, D; Bhandari Karkara, N; Stewart, D; Rees, N; Coffman, J. 2010. Advocacy toolkit: A guide to influencing decisions that improve
childrens lives. NYC, New York: UNICEF http://www.unicef.org/evaluation/files/Advocacy_Toolkit.pdf (accessed December 4, 2014)
31
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Advocacy Toolkit
A Sample Advocacy M&E Framework

Below are some sample advocacy M&E indicators for specific activities that you might conduct as
part of an advocacy strategy. As mentioned above, for each activity, you will not only measure
the final achievement of your advocacy objectives (long-term outcomes) and possibly the advocacy goal (impact), but should also measure benchmarks along the way (outputs, short and intermediate-term outcomes) to assess and track your progress. This will allow you to demonstrate the
progress you are making along the way to achieving (or not) your policy change objective, which
is helpful to demonstrate both for yourself, your partners, and supporters. If you do not achieve your
policy change objective in the timeframe you had hoped, this will allow you to see the shorter-term
outcomes that you did achieve, which may ultimately allow you to realize your policy change objective on the next try. It will also give you the opportunity to incorporate learning as you go and be able
to adapt your advocacy strategy as needed to be more effective. The Monitoring and Evaluation
Plan Tool will help you create a similar framework for your advocacy strategy.

Activities
Outputs
Short- & Intermediate

What you
Direct results of
-Term Outcomes
actually do.
your activites
Short- and intermediate

-term changes resulting

from your activities.

Meetings with Number of meetings

Policy-Makers Number of policymakers reached
Petition
Number of signatures
on the petition
Number of policy-makers
who publically support
advcoacy issue
Policy developed, changed or

implemented
Number of policy-makers
voting for or sponsoring a
specific policy
Increased funding
Petition received and

acknowledged by
policy-maker
Policy-maker increases
public support of issue
Advocacy
Training
Workshop
Number of workshops
Media
Outreach
Number of outreach
attempts to reporters
Number of participants
Coalition
Building
Increased knowledge
and skills in advocacy
Increased active engagment in advocacy work
by those trained
Number of press
releases developed
and sent
Number of coalition
members
Number of coalition
meetings held
Long-Term Outcomes
Long-term changes
resulting from your.
activities.
Achievement
of advocacy
objective.
Number of stories
successfully placed in
media
Number of times
advocacy research is
mentioned in media
Improved alignment of
coalition efforts (e.g.,
shared pirorities, goals,
common accountability
system)
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Impact
Sustainable changes
in addressing
the overall problem.
Achievement of
advocacy goal.
Number of health
workers increases
More people
receive health care
Health outcomes
improve
Everyone has
access to a skilled,
motivated health
worker within a
robust health system
Advocacy Toolkit
Tool: Monitoring and Evaluation Plan
For each objective, include the list of activities from your Action Plan, and then for each activity, map
out what you will measure, how, when, and who will be responsible.
Advocacy Goal:
Objective 1:
Key Activities
(please copy
thesedirectly
from your
Action Plan)
What We Will
Measure?
Outputs
Short- and

Intermediate-

term Outcomes

How We Will
Measure?
Long-term
Indicators
Outcomes: Policy
and Institutional
Change
1.1
1.2
1.3
1.4
1.5
1.6
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When Will We
Who will
Collect Data? Collect Data?
Means of
Frequency
Verification
Person
Responsible
Advocacy Toolkit
Appendix 1: Advocacy Strategy Template

The below template pulls together the various worksheets from each chapter in this Advocacy Toolkit
into one coherent advocacy strategy framework. If you have already worked through the toolkit, you
should be able to cut and paste your work directly into this format. Pulling all of your work together
into one strategy will be helpful for your own planning and to track your work, and can also be useful
to communicate and work with partners.
HWAI Advocacy Strategy Template

Key Components
1. Description of Problem and Advocacy Issue
2. Goal and Objectives
3. Partnerships
4. Evidence
5. Policy process
6. Target audience
7. Messages
8. Action Plan
9. Monitoring and Evaluation Plan
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Advocacy Toolkit
Section 1. Problem and Advocacy Issue

Please provide a description of the context in which your advocacy is taking place, the problem that
your advocacy work will address,your advocacy issue, and how it evolved from this problem.
Section 2. Goal and Objectives
Please list your goal and SMART objectives for your advocacy work.
Advocacy Goal
SMART Advocacy Objectives

Objective 1:
Objective 2:
Objective 3:
Section 3. Partnerships
Please list the potential partners that you are already working with or are planning to work with to
carry out your advocacy strategy.
Partner Organizations, Coalitions, or Networks (Local, National, Regional, or International)
Name
Goal of
Partners Position

Partnership
on Advocacy Issue

1.
2.
3.
4.
5.
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Type of Partnership
and Tactics for
Collaboration
Advocacy Toolkit
Section 4: Mapping Evidence

Please list what evidence you will need for your advocacy, what is already available, what you still
need, and where you will get it. Consider all of the aspects of your advocacy work that you will need
to collect information on such as: the overall context of HRH in your country; the scale, severity, and
impact of the problem you are focusing on; the feasibility and value of your proposed solution; the
policy process; and your targets.

Type of Evidence
Evidence
Gaps to
Needed and
Available
Address
for Whom?
Possible Sources
of Information
to Fill Gaps
Who is
Responsible for
Taking Forward?
Section 5. Policy Process

For each objective, create a policy process map for each stage of the policy process and for each
institution involved. Please list the formal and informal decision-making processes, decision-makers
involved, opportunities and timing for input, and how you may influence the policy process. You may
also wish to visually map out the policy process.
Advocacy Objective:
Policy Process Stage:
Institution
Formal Process
Informal Process
Decision-Makers Involved
Opportunities and Time
for Input
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Advocacy Toolkit
Section 6. Targets
For each objective, please list the Primary and Secondary Targets, their level of influence, support,
and how you will engage them. Make sure to list individuals and not organizations.
Advocacy Objective:
Who?

What Is Their Position

of Power/Influence?
Interest and Level of Support

for Advocacy Issue?
How Will You

Engage Them?
Primary Targets (Main decision-makers)

1.
2.
3.
4.
5.
Secondary Targets (Those who can influence the decision-makers)
1.
2.
3.
4.
5.
Section 7. Messages
For each target audience, please outline the specific message, format(s) and timing of delivery, and
messengers.
Target Audience
Message
Description of Problem
and Solution
Evidence and
Examples (quantitative
or qualitative)
Action Requested
Format and Timing for
Message Delivery
Messengers
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Advocacy Toolkit
Section 8. Action Plan

For each advocacy objective, please list the key activities and tactics for your advocacy work. For
each activity, describe what resources are needed, who is responsible and by when.
Advocacy
Key Activities
Objectives
Advocacy
Objective 1:
Resources
Needed
1.
2.
3.
4.
5.
6.
Advocacy
Objective 2:
1.
2.
3.
4.
5.
6.
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Person
Responsible
By
When
Advocacy Toolkit
Section 9. Monitoring and Evaluation Plan

For each objective, include the list of activities from your Action Plan, and then for each activity, map
out what you will measure, how, when, and who will be responsible.
Advocacy Goal:
Objective 1:
Key Activities
(please copy
these directly
from your
Action Plan)
What We Will
Measure?
Outputs
Short- and

Intermediate-

term Outcomes

How We Will
Measure?
Long-term
Indicators
Outcomes: Policy
and Institutional
Change
1.1
1.2
1.3
1.4
1.5
1.6
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When Will We
Who will
Collect Data? Collect Data?
Means of
Frequency
Verification
Person
Responsible
Advocacy Toolkit
Glossary of Advocacy Terms

Activities or Tactics: The specific actions you take as part of your advocacy strategy to bring
about change.
Alliance: Type of partnership that typically involves a long-term agreement on common ideals
among trusted partners. Strategies and plans may be jointly developed and implemented.
Allies: People who support your advocacy work.
Advocacy: A deliberate process based on evidence and experience directed at impacting the
policies, positions, or programs of influential institutions in order to create systemic and long-term
solutions for the human resources for health (HRH) crisis.
Advocacy Goal: Describes your vision and what you want to accomplish in the long-term.
Advocacy Objective: Describes the smaller, more specific policy changes that you want to
accomplish. Objectives should clearly state what it is you want to change, who will make that
change, by how much, by when, and should be SMART.
Coalition: Type of partnership that usually has a more formalized structure and involves joint work,
often among fairly diverse civil society organizations around a single event, issue, or campaign.
Different organizations divide the tasks in the most appropriate manner.
Evaluation: Structured analytic effort undertaken selectively to answer specific questions, such as
whether the advocacy goal and objectives have been achieved.
Lobbying: A tactic to convince others to support the change you seek that involves direct
communication with decision-makers and those that influence them.
Monitoring: Periodic and planned collection and aggregation of data, interpreted through
comparison to targets or standards, to assess performance, learn, and make corrections.
Network: Type of partnership that is often informal or with a limited structure. Emphasis is mostly
on the exchange of information and less on joint work.
Opponent: People who oppose your advocacy work.
Primary Targets: The person(s) who have the power to make the desired change.
Secondary Targets: Those who can influence your primary target(s).
Stakeholder: General term that includes all people who can affect or be affected by your
advocacy work.
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Additional Advocacy Resources

Other Advocacy Manuals and Resources
Chapman, J., A. Pereira Jr., L. P. Uprety, S. Okwaare, V. Azumah, V. Miller, and A. Mancini. Critical
webs of power and change: Resource pack for planning, reflection and learning in people-centered
advocacy. http://www.alnap.org/resource/8096
Alcade Castro, Maria Antonieta, and Gabriela Cano Azcarraga. Handbook for advocacy planning. International Planned Parenthood Federation, https://www.ippfwhr.org/en/publications/handbook-for-advocacy-planning
Arroniz Perez, Rodrigo. Handbook for political analysis and mapping. International Planned
Parenthood Federation, https://www.ippfwhr.org/en/publications/handbook-for-political-analysis-and-mapping
Cohen, David, Rosa de la Vega, and Gabrielle Watson. Advocacy for social justice. OXFAM. http://
lastradainternational.org/doc-center/1135/advocacy-for-social-justice-a-global-action-and-reflection-guide
Cohen, David, Neha Bhandari Karkara, David Stewart, Nicholas Rees, and Julia Coffman. Advocacy
toolkit: A guide to influencing decisions that improve childrens lives. UNICEF .http://www.alnap.org/
resource/19137
Cokelet Emeline, and Rachel Wilson. Advocacy to improve global health: Strategies and stories from
the field. PATH.http://www.path.org/publications/files/ER_advo_wrkbk_stories_field.pdf
Edleston, James, et al. Youth advocacy toolkit: The education we want. PLAN USA. http://www.
planusa.org/docs/Youth-Advocacy-Toolkit-2.pdf
Gosling, Louisa, and David Cohen. Advocacy matters: Helping children change their world. An
International Save the Children Alliance guide to advocacy [Participants and Facilitators Manual].
http://www.unicef.org/adolescence/cypguide/files/Advocacy_Matters_Participants_Manual.pdf
International HIV/AIDS Alliance. Advocacy in action: A toolkit for NGOs and CBOs responding to HIV/
AIDS. http://www.iasociety.org/Web/WebContent/File/Alliance%20-%20Advocacy%20in%20Action.
pdf
Miller, Valerie, and Jane Covey. Advocacy sourcebook: Frameworks for planning, action and reflection. Boston, MA: Institute for Development Research. http://books.google.com/books/about/
Advocacy_Sourcebook.html?id=md3lHAAACAAJ
Program for Appropriate Technology in Health. Stronger health advocates, greater health impacts: A
workbook for policy advocacy strategy development. PATH. http://www.path.org/publications/files/
ER_app_workshop_workbook.pdf
Policy Project. Networking for Policy Change. http://www.policyproject.com/pubs/
AdvocacyManual.cfm
Ruthrauff, John. Influencing institutional decision making: An introduction to designing advocacy
strategies. Center for Democratic Education.http://www.path.org/publications/files/ER_app_workshop_curric.pdf
Schnell, Ana, and Erika Coetzee. Monitoring government policies: A toolkit for civil society organizations in Africa. CAFOD, Christian Aid and Trocaire. http://commdev.org/files/1818_file_monitoringgovernmentpolicies.pdf
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Sharma, Ritu. An introduction to advocacy: Training guide. Academy for Educational Development
(AED). http://ictlogy.net/bibliography/reports/projects.php?idp=1105
Shultz, Jim. The democracy owners manual: A practical guide to changing the world. Rutgers
University Press. http://bit.ly/1yyNTbn
Sprechman, Sofia, and Emily Pelton. Advocacy tools and guidelines: Promoting policy change.
CARE. http://www.impactalliance.org/ev_en.php?ID=4303_201&ID2=DO_TOPIC
Union for International Cancer Control. UICC advocacy toolkit. http://www.uicc.org/advocacy-toolkit-0
Unsicker, Jeff. Confronting power: The practice of policy advocacy. Kumarian Press. http://books.
google.com/books/about/Confronting_Power.html?id=v5_5ugAACAAJ
VeneKlasen, Lisa, with Valerie Miller. A new weave of power, people and politics: The action guide for
advocacy and citizen participation. http://www.justassociates.org/en/resources/new-weave-power-people-politics-action-guide-advocacy-and-citizen-participation
Monitoring and Evaluating Advocacy
Aspen Institutes Global Interdependence Initiative. Advocacy progress planner: An advocacy &
policy change composite logic model. http://planning.continuousprogress.org/
Aspen Institutes Global Interdependence Initiative. Continuous progress evaluation guide for advocates. http://www.aspeninstitute.org/policy-work/apep/tools
Aspen Institutes Global Interdependence Initiative. Continuous Progress evaluation guides for grantmakers. http://www.aspeninstitute.org/topics/monitoring-evaluation
Beer, T., and E. Reed. A model for multilevel advocacy evaluation. The Foundation Review http://
scholarworks.gvsu.edu/cgi/viewcontent.cgi?article=1131&context=tfr
Coe, Jim, and Juliette Majot. Monitoring, evaluation and learning in NGO advocacy: Findings from
Comparative Policy Advocacy MEL Review Project. OXFAM America. http://www.oxfamamerica.
org/static/media/files/mel-in-advocacy-inquiry-executive-summary.pdf
Coffman, J. Framing paper: Current advocacy evaluation practice. The California Endowment.
http://www.calendow.org/uploadedFiles/Evalua
Budget Analysis and Advocacy
International Budget Partnership: internationalbudget.org
International Budget Project. 2001. A guide to budget work for NGOs.
Ramkumar, Vivek. 2008. Our money, our responsibility: A citizens guide to monitoring government
expenditures. International Budget Project.
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Advocacy Toolkit
HWAI Resources
The Health Workforce Advocacy Initiative (HWAI) website and twitter account is the best resource
for current information about HWAI, recent publications, and upcoming activities.

o Website: www.hwai.org
o Twitter: @healthworkers
The Global Health Workforce Alliance (GHWA) website and twitter account includes information
about GHWA, the HRH Global Strategy, and other global initiatives on health workforce. GHWA is
also a resource for recent reports and data on health workforce.

o Website: http://www.who.int/workforcealliance/en/
o Twitter: @GHWAlliance
The World Health Organization (WHO) Health Workforce website includes general and technical
information, links to policy briefs, and links to data and statistics on health workforce.

o Website: http://www.who.int/topics/health_workforce/en/
The World Bank health website includes a brief on human resources for health, recent publications, case studies, and upcoming events. The World Bank health twitter has current news from
World Banks initiatives on health.

o Website: http://www.worldbank.org/en/topic/health
o Twitter: @worldbankhealth
The HRH Global Resource Center is a global library of human resources for health (HRH) resources
focused on developing countries.

o Website: http://www.hrhresourcecenter.org
o Twitter: @hrhGRC
The Frontline Health Workers Coalition (FHWC) has several policy briefs and other resources
available and featured on its twitter account and website.

o Website: http://frontlinehealthworkers.org/
o Twitter: @FHWCoalition
CapacityPlus, a USAID global project focused on health system and health workforce strengthening, has a knowledge library containing technical briefs, issue briefs, journal articles, video,
and other resources. The CapacityPlus twitter account is also a good resource for up-to-date
information concerning project courses, recent publications and other HRH news.

o Website: http://www.capacityplus.org/knowledge-library/all
o Twitter: @CapacityPlus
Page 90
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ADVOCACY

Addressing the Health Workforce Crisis

The Health Workforce Advocacy Initiative

Heather Teixeira, IntraHealth International

Pat Daoust, Physicians for Human Rights

Purpose of this Toolkit and Who it Is For.............................................................................................................5

How the Toolkit is Organized..............................................................................................................................5

CHAPTER 2: INTRODUCTION TO ADVOCACY............................................................................................................7

The Importance of Advocacy in Solving the Global Health Workforce Crisis..............................................7

Advocacy and Related Concepts...................................................................................................................8

Assessing Your Advocacy Capacity.................................................................................................................9

Tool: Advocacy Capacity Assessment...........................................................................................................11

Steps in the Advocacy Planning Process.......................................................................................................12

HWAI Advocacy Planning Cycle.....................................................................................................................12

Factors Shaping an Advocacy Strategy........................................................................................................13

CHAPTER 3: UNDERSTANDING THE CONTEXT...........................................................................................................15

Understanding the HRH Context in Your Country..........................................................................................17

CHAPTER 4: DEFINE THE PROBLEM AND ADVOCACY ISSUE...................................................................................21

Defining the Problem, Solution, and Advocacy Issue...................................................................................21

Tool: Problem and Solution Tree.......................................................................................................................22

Tool: Choosing an Advocacy Issue Checklist................................................................................................23

CHAPTER 5: DEVELOP ADVOCACY GOAL AND OBJECTIVES.................................................................................25

Tips for Developing Advocacy Goals and Objectives.................................................................................25

Example Advocacy Goal and Objectives.....................................................................................................26

CHAPTER 6: BUILD PARTNERSHIPS.............................................................................................................................29

The Importance of Engaging Others..............................................................................................................29

Benefits and Challenges of Working with Others...........................................................................................30

Tips for Developing Coalitions..........................................................................................................................31

Tool: Partnership Mapping................................................................................................................................33

CHAPTER 7: GET THE FACTS.......................................................................................................................................35

Why Gather Evidence?....................................................................................................................................35

Case Story: Malawis Global Human Resources for Health Commitment..................................................38

Tool: Mapping Evidence...................................................................................................................................41

CHAPTER 8: UNDERSTAND THE POLICY PROCESS....................................................................................................43

Example Policy Process Map...........................................................................................................................45

Tool: Policy Process Map...................................................................................................................................50

CHAPTER 9: IDENTIFY AND ANALYZE TARGETS........................................................................................................52

Tool: Identifying Primary and Secondary Targets...........................................................................................57

Tool: Stakeholder Mapping..............................................................................................................................58

CHAPTER 10: DEVELOP AND DELIVER MESSAGES....................................................................................................60

Example Tweets for World Health Worker Week............................................................................................65

Tool: Message Development...........................................................................................................................69

CHAPTER 11: DEVELOP AND IMPLEMENT ACTION PLAN.........................................................................................71

Example of the Importance of Timing: AIDS Drugs for Africa.......................................................................73

Tool: Action Plan................................................................................................................................................74

CHAPTER 12: MOBILIZE RESOURCES.........................................................................................................................76

Tool: Monitoring and Evaluation Plan.............................................................................................................80

APPENDIX 1: ADVOCACY STRATEGY TEMPLATE......................................................................................................81

How the Toolkit is Organized

Case Story or Example

Photo courtesy of IntraHealth International.

Chapter 2: Introduction to Advocacy

The Importance of Advocacy in Solving the

In order to achieve a world where everyone has access to a skilled,

Advocacy and Related Concepts

Typical tactics of IEC include

Public Relations Public relations strategies seek

Typical tactics of public

Typical tactics of community

Assessing Your Advocacy Capacity

Tool: Advocacy Capacity Assessment

Understand and analyze the larger context

and political landscape

Steps in the Advocacy Planning Process