TCI Global Toolkit: AdvocacyAdvocacy at the Sub-National Level
COVID-19 and Family Planning/Reproductive Health
The Challenge Initiative is working to provide additional resources and tools to help those working in family planning and reproductive health respond to the COVID-19 pandemic. LEARN MORE
What Is It?
Advocacy at the sub-national level is the process of getting buy-in and support for family planning and adolescent and youth sexual and reproductive health (AYSRH) among leaders and decision makers in discrete areas within the country (including regions, provinces, districts and counties). Such advocacy is especially important in countries with decentralized governments where decision-making power is spread throughout the system, rather than being concentrated at the national level.
What Are the Benefits?
- Provides current information on the economic and health benefits of family planning/AYSRH to elected officials at the local level
- Helps local leaders make informed choices about population and family planning/AYSRH policies using data from their own community
- Helps local governments make commitments to prioritize resources for family planning/AYSRH at the regional, provincial, district and/or village levels
- Ensures that governments follow through on family planning/AYSRH commitments at all levels of a country, reducing dependence on donors and national governments
- Builds a supportive environment for family planning/AYSRH by encouraging community ownership and by helping to scale-up effective programs in new areas
East Africa’s Advocacy for Support and Resources approach provides guidance and region-specific tools on how to advocate for increased resources for family planning/AYSRH at the city and facility levels.
In India, the Planning and Budgeting approach provides guidance for district officials and NGO partners on the specific steps of planning and budgeting for family planning/AYSRH by preparing, submitting and monitoring an annual Program Implementation Plan (PIP) for the district.
In Nigeria, advocacy at the sub-national level is separated into two approaches. The Enabling Environment approach includes advocacy efforts to assess the family planning landscape, coordinate family planning activities to reduce duplication, and ensure resource stewardship and accountability. The Resource Mobilization approach focuses on training relevant stakeholders on the strategic importance of securing a dedicated budget line for family planning, how to use grant management tools such as a performance-based tracker and dashboard, and forming a budget task team to monitor the release and expenditure of family planning budgets.
Francophone West Africa
In Francophone West Africa, TCI strengthens the advocacy capacity of the Technical Program Management Unit (UTG) and the Joint Steering Committee (CCP), which are established to oversee TCI implementation. TCI engages them in the Orientation de la Municipalité sur la PF/SSRAJ approach and then through regular coaching supports them in uncovering solutions to common challenges, such as limited financial resources. A government official of Ziguinchor explained the significance of TCI:
With TCI, our three city councils have pooled their funds to deliver FP and AYSRH services in some geographies. We will respond collectively… and this practice is unusual. All of the activities in the action plan are implemented at the same time in Bignona, Oussouye, and Ziguinchor.”
How to Implement
Identify key stakeholders at the defined sub-national level
- Include Ministry of Finance staff and others in charge of budget decisions.
- Include Ministry of Health staff and others who create policy related to family planning/AYSRH, health care providers and service delivery.
Form an Advocacy Working Group
- Referred to by different names – such as an Advocacy Working Group, Advocacy Core Group or District Working Group – this working group includes the individuals identified in Step 1 and will be the community voice for policy change. The working group will be a way to engage with key decision-makers, build consensus and secure funding and support for family planning and AYSRH.
- Within this group, form a budget task team to support and influence budget processes and decisions.
Convene regular meetings with the Advocacy Working Group
- Meetings should be held monthly, or more often if needed.
- During these meetings, share relevant data with the group including:
- Unmet need for family planning in the area
- Family planning commodity needs of the area
- Evidence related to infrastructure, facilities, equipment and human resources
- Evidence of impact of strengthening family planning services in nearby areas (if available)
- During these meetings, come to consensus about the important issues in the given area and for what the group will advocate such as additional funding.
Conduct formative research and analysis
- Conduct a Family Planning Effort Index assessment to understand the family planning environment. You can complete the tool with the Advocacy Working Group to understand how to communicate the family planning situation in your area and what to prioritize in the advocacy strategy.
- Conduct key informant interviews to better understand the policy environment for family planning. The Nigerian Urban Reproductive Health Initiative (NURHI) created a tool, which you can use or adapt, to conduct these interviews. In addition, TCI with support from the Reproductive Health Units of the States’ Ministries of Health has also employed the Policy Environment Score to serve as a baseline on how the policy environment supports effective policies and programs for reproductive health.
- Working with the budget task team, use the TCI budget tracking tool to identify and map out family planning allocations, release and expenditure for various components of a family planning program by financial year.
- Analyze the results from your formative research and determine main challenges to overcome during the design of the advocacy strategy.
Design and implement your advocacy strategy
- Convene the Advocacy Working Group and design a site-specific advocacy strategy.
- Based on the result of the budget questionnaire, develop specific goals related to family planning funding. For example, the first goal may be to establish a budget line item for family planning at the local level, followed by increased resource allocation. You may also want to include goals that address policy barriers, for example, allowing lower-level providers to deliver injectable contraceptives.
- Implement the specific activities of your advocacy strategy, which can vary widely depending on your strategy. For example:
- The budget task team members may meet with their Ministry of Finance colleagues to advocate a budget line item and increased funding for family planning.
- Other members of the Advocacy Working Group may organize sensitization meetings with other leaders (e.g., mayors, governors) to mobilize support and share information about the impact of family planning. One objective may be to include family planning within the integrated five-year plan at the province, village or district level.
- You and the other Advocacy Working Group members may hold community dialogues to exchange information about family planning services.
Hold advocacy trainings to increase skills and competencies of Advocacy Working Group members
- Training Advocacy Working Group members will help sustain the advocacy activities and ensure members can advocate on the behalf of young people, women and couples who desire family planning. The AFP SMART advocacy tools can be used in advocacy training.
- Training members on budgeting and financing, for example, with resources included in the guide Enhancing Contraceptive Security Through Better Financial Tracking, can help them better track resources for family planning commodities. Avenir Health also hosts the helpful SPECTRUM tools, which provide policymakers helpful analytical tools to support their decision-making.
Develop and use advocacy materials
- Prepare appropriate advocacy materials such as fact sheets, briefs and presentations that will meet the decision-makers’ needs, focusing on the latest evidence in your area. Meet the decision-makers where they are, and be creative. Think about using stories, photos, infographics or videos, along with data and facts, to communicate your message. Be specific, direct and succinct; many of these decision-makers may not have a strong technical background in family planning or have little time. Most importantly, concentrate on the “ask” – what do you want the decision-makers to do?
- Using data is a key element of advocacy materials. TCI has found much success in using data effectively for advocacy and decision-making.
- Advocacy materials can be city-specific and used to stimulate community dialogue.
- Think about when, where and how you will deliver the message. What kind of response do you expect from your audience and how will you address their concerns?
- For in-depth guidance on developing advocacy messages, see the box on p. 21 of the AFP guidance on developing a strategy.
Follow-up and monitor advocacy efforts
- Convene quarterly review meetings to assess achievements – and any setbacks – of the Advocacy Working Groups and the budget task team. Shift activities as necessary.
- Hold annual site-specific implementation review meetings.
- Scale up successful interventions, as they are identified, to other areas.
- Work with Advocacy Working Group members and others (e.g., community organizations, religious organizations) to ensure sustainability of advocacy efforts.
- Track budgets to assess inclusion of family planning/AYSRH as a budget line item.
- Use a budget tracking tool, such as the TCI budget tracking tool, to ensure funding allocated for family planning/AYSRH is being used appropriately. For additional resources and tools, see AFP Advocacy M&E Resources.
Sample Indicators to Track Advocacy Efforts:
- Inclusion of family planning/AYSRH as a budget line item
- Increased allocation of funds for family planning/AYSRH
- Inclusion of family planning/AYSRH in the integrated plan of the given area
What Is the Evidence?
Francophone West Africa
By the end of December 2019, the 11 geographies supported by TCI in Francophone West Africa had disbursed $114,380 in locally contributed funding. Although this may sound modest, it is quite significant both because the health budgets for this region are often lower than in other LMICs and because local mayor-level contributions are exceedingly rare, as opposed to national-level allocations. TCI builds local governments’ financial management capacity by requesting that they contribute their funds in a separate commercial account* along with TCI’s contribution. TCI then works with the geographies’ accountants to monitor commitments and release funds as they plan and implement activities receiving Challenge Fund support. Another novel and promising example of growing local government contributions can be seen in the Union of Zou Municipalities (UCOZ), where between 2018 and 2019, it went from zero communes contributing funds for family planning activities to nine out of nine. Read more in TCI’s PASS Learning Series #3 City-Led Health Programming Begins With Financial Commitment.
*Senegal and Bouake, Côte d’Ivoire, are exceptions in that the local governments have set up sub-accounts within their local treasury account, as required by local law and an expectation of transparent governance for public funds.
Kilifi County, Kenya has demonstrated its local ownership and political commitment to FP/AYSRH by increasing funding over the past three years. Since engaging with TCI beginning in 2017, Kilifi County’s budget commitment for FP has more than doubled from 2017-2019. Dedicated funds for AYSRH increased by 378% from 2018 to 2019, from $15,000 to nearly $72,000.
The Challenge Initiative for Healthy Cities (TCIHC as the project is known in India) “unlocks” Government of India monies from three accounts – urban health, family planning and maternal and child health – as well as other underutilized funds to sustainably scale up proven urban reproductive health solutions. Before TCIHC, cities had limited understanding of the budgeting process for family planning interventions through the National Health Mission’s Program Implementation Plan (PIP). Since the National Urban Health Mission is still a new program, cities often had not secured funds for urban health services or experienced low expenditures prior to TCIHC’s engagement. TCIHC staff supported a PIP orientation for city and district health officers coupled with data-driven planning on evidence-based family planning and maternal and child health approaches. Through this orientation, TCIHC ensures officials understand the procedures for requesting funds for expanding family planning services. As a result of these efforts, 31 TCIHC-supported cities have unlocked more than $89 million to support TCI proven approaches at the community and facility levels. As of December 2019, 70% of these funds have been spent. Read more in TCI’s PASS Learning Series #3 City-Led Health Programming Begins With Financial Commitment.
In Nigeria, TCI’s efforts to establish or strengthen Advocacy Core Groups has resulted in dedicated budget lines for family planning at the Ministry of Health in all TCI-supported states.
A recent webinar highlighted TCI’s innovative co-financing strategy in Nigeria, which has galvanized increased domestic financing commitments by state governments to proven family planning interventions and resulted in increased release of those funds and spending. Co-financing ensures financial sustainability from the outset through a graduated co-financing mechanism. TCI works with partner states to design a robust advocacy strategy which includes setting the appropriate policy framework and engagement plans to foster consistent and sustained financing for health. Finally, the co-financing strategy institutionalizes health financing transparency, accountability and good governance. As of June 2020, a total of $2,080,864 has been released by state governments as co-investment into family planning programs and interventions.
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- When local decision-makers are leaders of the Advocacy Working Group, the advocacy activities are likely to have more local ownership and be more sustainable.
- Avoid asking for too many things at once at advocacy meetings. Present one specific “ask” – for example, adding a budget line item to the district budget.
- Engage with community members about issues that may be unclear – for example, private provision of contraception, use of or demand for long-acting methods.
- Adapt your messages to the needs of different decision-makers.
- When working with decision-makers who are unsupportive of family planning/AYSRH, think about what might motivate them to change their mind. For example, you can frame family planning/AYSRH in terms of family health, child health or economic empowerment.
- Busy decision-makers are often influenced by those around them, such as their assistants or deputies. Build relationships with these people.
- To overcome barriers related to staffing changes with the government, you can advocate for inclusion of family planning/AYSRH in the sub-national five-year strategic plans. This can help ensure government commitments for family planning/AYSRH, even when new staff join.
- Advocacy is a continual process and you may not see immediate results. To keep up momentum, it is important to focus on “quick wins” – small achievements leading up to your larger goal.
- It can often be hard to get decision-makers to meet with you or listen to your message. Identifying the best messenger – perhaps it is someone on their staff – is often just as important as identifying the decision-makers themselves.