Advocacy Strategies

for Health and Development:

Development Communication in Action

A Background Paper to the

Inter-Agency Meeting on Advocacy Strategies
for Health and Development: Development Communication in
Action, Geneva, 9- 13 November 1992

Division of Health Education

World Health Organization
Geneva
 CONTENTS

Page

1. . Introduction

2. Concepts of advocacy and development communication:

influencing policy-makers

2.1 Scope of Advocacy

2.2 Advocacy for policy design and decision-making versus
advocacy for policy implementation
2.3 The crucial role of communication in advocacy

3. The decision-making process in policy development - how policy

decisions are made and the managementlintervening factors that
influence them

3.1 ConditionslRequirements for effective Decision-Making

and Decision-Reaching Process
3.2 Factors/forces which influence the decision-making process
3.3 Actors that influence the decision-making process

4. Strategies for Advocacy Interventions

4.1 The problem-solving basis for advocacy

4.2 Dimensions of advocacy suategies

5. The Challenge

Annex 1

Bibliography

The paper has been prepared by the Division of Health Education. WHO, Geneva.
with the collaboration of Dr Jan Servaes, Professor of International Communication.
Catholic University oi Nijmegen. The Netherlands
and visitins Professor at Cornell University, Ithaca, USA.
 Advocacy Strategies for Health and Development:
Development Communication in Action

Introduction

During the 3rd Inter-Agency Roundtable on Development Communication (FAO,

Rome, 3-6 September 1991) and earlier on many other occasions, it has been
observed that communication specialists spend much effort on development
programmes and projects but not enough on persuading the policy-makers and
decision-makers' in order to secure their support. Their support is essential for
shaping development policies and accelerating development actions. It has also
been noted that not enough systematic attempts are made to analyze the
decision-making process and to apply approaches based on audience analysis of
decision-makers in national institutions, UN agencies, donor agencies and NGOs.
Additionally, there appeared to be a need to identify andlor develop effective
suategies that can be used to effectively communicate with decision-makers and
enlist their support for development, regardless of the particular issue.

It is important to recognize that decision-makers are often vulnerable to political

change. This makes them a fleeting target. Their political survival may depend
on the results being quick. Therefore, appropriate strategies need to be developed
to reach decision-makers, communicate with them and enlist their support. The
programmes with popular demand that are social and politically viable, financially
feasible and sound in economic terms, and are capable of showing visible and
rapid progress are more likely to be acceptable.

In a period of rapid socio-economic changes within an increasingly interdependent

world, for the purposes of this paper, the concept of development is considered in
a broader context, that is. encompassing political, economic, environmental, social
and human dimensions.

The main purpose of this paper is to:

(i) Provide conceptual clarity on advocacy, on decision-making processes and

on communication strategies.

(ii) Identify key factors which lead and influence the decision-making process.

(iii) Describe the advocacy intervention strategies which influence

decision-making on health and development, based on selected experiences.

' The terms policy-makers. decision-makers, md/or policy rlites refer to political leaders and
or_ean~zauon~adrmnisuauve high level officials who have decision-making responsibilities m government and
related insututions. and whose decisions shape development policies and actions.
 This paper attempts to respond to the following questions:

(.i) How does a development issue get on the agenda of policy-makers in

different political and socio-cultural settings?

tii) How are policy decisions made on the issue(s)?

(iii) What are the mediatindintervening factors that influence these policy
decisions?

(iv) What considerations are important (political, institutional, social, technical

...) for facilitating or hindering the decision-making process?

(V) How is "professional evidence" (e.g. key facts and figures as well as
essential action-oriented research findings) best communicated to
policy-makers in order to generate effective policy decisions?

tvi) How can local organizations, the media and the public have an impact on
decision-making?

(vii) What are the essential components of selected advocacy strategies and how
can these strategies be effective?

2. Concepts of advocacy and communication processes: influencing

policy makers

2.1 Scope of Advocacy

Advocacy is a key action word in development. There is no single approach, nor

is there a common understanding on how to define advocacy or the process of
advocating. There are also distinct decision-making audiences in national
institutions, in international agencies, and in donor agencies. In this paper we are
primarily concerned with advocacy strategies targeted at policy-makers or
decision-makers at the national level. Thus, for the purposes of this paper, the
emphasis is on seeking the support of decision-makers in the hope that if they are
properly 'enlightened' or 'pressured', they will be more responsive. However, a
more general working definition of advocacy might be:

"Advocacy for development is a combination of social actions designed to gain political

commitment, policy support, social acceptance and systems support for a particular goal
or programme. It involves collecting and structuring information into a persuasive case;
communicating the case to decision-makers and other potential supporters, including the
public, through various interpersonal and media channels; and stimulating actions by social
institutions, stakeholders and policy-makers in support of the goal or programme. '

2.1.2 The primary aim of advocacy, as addressed in this paper, is to foster public
policies that are supportive to development programmes. Since the public policies
must be viewed in the broader context of the social and economic development
process, the lund of advocacy we would like to put forward is that which is
participatory. Indeed, advocates are usually issue or programme oriented. There
primary aim is to market the project, improve values and get the message across.
 The social and economic development issues, however, call for a panicipatory,
ideologicaYpolitical, advocacy involving various sectors of society.

The focus in participatory advocacy is on seeking "cooperation" and "listening"

rather than on "telling what to do" and presumes a dynamic two-way approach
towards communication.

In participatory advocacy, the advocate's role includes:

representation of speclfic ideas or issues under consideration

identification of stakeholder' groups and their values and interests

identification of potential allies and building alliances

identification of relevant policy and decision-making channels

collecting and providing information concerning the position on the issue

reasoning, influencing, lobbying, pushing and persuading decision-makers

and other stakeholder groups

organizing and attending meetings with stakeholder groups

creating a common understanding(s) among stakeholders concerning the

issue
negotiating action with stakeholders on the basis of common
understanding(s) on the problem

Advocacy is most effective when individuals, groups and all sectors of society are
involved. Therefore, three main interrelated strategies for action can be identitied:

(a) advocacy generating political commitment for supportive policies and

heightening public interest and demand for development issues;

(b) social support developing alliances and social support systems that
legitimize and encourage development-related actions as a social norm; and

(C) empowerment equippinp individuals and groups with the knowledge,

values and skills that encourage effective action ior development.

These strategies are being used for implementing the WHO health education
programme, in which the aims of advocacy are (1) to generate public demand, ( 2 )
place health issues high on the public agenda; and (3) effectively reach the
influential group of policy-makers, elected representatives, professionals, political
and religious leaders, power brokers and interest groups to act in support of health.

' Stakeholders are (any group ot7 people who have an interest or 'stake' in the issue. for example. citizens'
groups. labour untons. poiitical pmes, government agencies, elected leaders, and policy analysts themselves.
Strategies for strengthening social support are directed both ( 1) at community
organizations and institutions that legitimize and encourage healthy life-styles as
a social norm and foster community action for health, and ( 2 ) at systems that
provide the infrastructure for health-care services and related development activities
which influence health. Alliances must be established with all influential forces
in society, generating demand and pressure for health-supportive environment and
policies, and ensuring widespread and equitable attainment of health goals.

--

Box 1: China, Sri Lanka & Kerala, India: Interaction of health,

education and development policies

In China. Sri Lanka and Kerala the state and public agencies assumed an important
role in meeting the basic needs of the people. In China this was the norm, while in
Kerala and Sri Lanka the supply and distribution of certain goods and services
essential to basic needs occupied a central place in public policy and were not left to
market forces.

Development policies avoided the urban bias common to the strategies of many
developing countries in the early phases of their planning. Consequently, resources for
the social and economic infrastructure and investments in development were more
equitably distributed. The differences in living conditions between rural and urban
areas were not markedly widened by the development process. Civic amenities spread
to the rural areas. Sri Lanka, for example, was able to maintain a rurauurban balance
that limited the internal migration to metropolitan areas.

The political processes were designed in such a way that demands could be
formulated and responded to at the community level. In China, this was achieved by
decentralized decision-making in the communes and lower units. In Kerab and Sri
Lanka, a highly competitive democratic system from the local to the national levels
helped to give forceful expression to community needs and elicit responses from the
state.

In economic development programmes, strategies for raising productivity and income in

backward parts of the economy, which contained the poor majority, received priority.

In all three areas, high priority was given to education, policies were aimed at equitable
distribution giving the rural population access to education. The strategies pursued
brought education within reach of the whole school-age population through a system
that provided free or heavily subsidized education. In all three cases there was a very
high level of female participation in the school system.

The improvement in the status of women and the removal of forms of discrimination
against females - as in the case of education - played an important role in enhancing
the capacity of the population as a whole for social advancement.

Food security for all segments of the population became an essential objective of
public policy. Different policy instruments were used in each case, and included state
management of the trade in staple foods (China and Sri Lanka), food rationing with
food subsidies (Kerala, Sri Lanka), free food supplements for target groups (Sri Lanka),
and land reform to encourage food production in small allotments (Kerala).

Source: Gunatilleke. G., ed. Intersectoral linkages and health development. Geneva.
World Health Organization. 1984 (WHO Offset Publicat~onNo. 83).
 Strategies of empowerment for health should be directed at all people, the public
and policy-makers alike, using all available and credible channels and stressing the
importance of health as a personal and social value. They should be implemented
at all levels, local and national, as well as in the home, the school, the workplace
and other community settings.

In sum, the ability to advocate effectively for policies and programmes is an

essential part of the development process. Many countries are striving to implement
time-limited development plans which give priority to rapid economic gains
through industrialization. Resources are commonly diverted to activities that bring
in revenue and economic returns. Thus, the ability to advocate effectively for
health and social issues often holds a key to their success.

2.2 Advocacy for policy design and decision-making versus advocacy for
policy implementation.

Confusion remains also about what should be the main focus in the advocacy
strategies. In general, one can distinguish between (a) advocacy for policy design
and decision-making aimed at ensuring political, social and legislative support for
development issues (e.g. protection of the environment); and (b) advocacy for
policy implementation which requires intensive efforts for mobilizing social forces,
individuals and groups for development actions. Both are important and must be
addressed. . The aim in advocacy strategies is to foster political and public
engagement as well as professionals in development issues through the process of
social mobilization.

There is no universal approach which can be used in all circumstances, flexibility

is required in selecting appropriate strategies.

Advocacy is an ongoing process in which many informed actors at all levels and
sectors of society are engaged in building a consensus for action.

2.3 The crucial role of communication in advocacy

The communication media are critical in creating awareness, generating public

interest and demand, and placing the issue on public agenda and building social
support. Advocacy, political commitment and supportive policies are often
themselves a product of social support systems and empowerment of people.

The usual pattern for mass media has been predominantly the same: informing the
population about projects, illustrating the advantages of these projects, and
recommending that they be supported. Generally a number of media are used to
achieve a persuasive or informational purpose with a chosen population, the most
common examples being found in politics, advertising, fund-raising, and public
information for health and safety.

The conventional models view the communication process mainly as a "message"

-zoing from a "sender" to a "receiver". It can be summarized in Laswell's classic
formula, 'Who says What through Which channel to Whom with What effect'?'.
The diffusion model rhoush explains diffusion and adoption of innovations in a
more systematic and comprehensive way. But the main thrust remains on the
introduction of innovations from outside (top-down). But it is in the process of
interpersonal communication (through opinion leaders, gate keepers andlor change
agents) that the concerns of the people are identified, issues debated and decisions
to adopt or not to adopt are reached through interactive processes. It is through
such interactive processes that public pressure and demand are developed to
influence policy-makers.

If the media are sufficiently accessible, the public can make its needs known. At
the same time, the mass media can play a strong advocacy role in creating public
awareness and bringing about action for development, and often target
decision-makers. At the same time, the decision-makers too need this information
to reach a (socially acceptable) decision. Advocacy is most effective when, besides
mass media, individuals and groups and all sectors of society are engaged in this
process.

In brief, advocacy combines social networking and mobilization, interpersonal

communication and negotiation, as well as the use of media for generating public
pressure. The power of supportive evidence as generated by professionals and
academics must be effectively utilized through all these means in presenting a
powerful case for the issue.

The decision-making process in policy development. How policy

decisions are made and the mediatingfintervening factors that
influence them.

Policy-makers and decision-makers face the challenge of making among alternative

solutions and competing demands as well as providing for the implementation of
decisions made. Therefore, policy and decision-makers may feel the need for a
general conceptual and operational framework.
U

Every policy decision seems to go through a so-called 'policy life cycle' in which
Sour phases can be identified: (i) recognizing the problem; (ii) gaining control over
the problem; (iii) solving the problem; and (iv) maintaining control over the
problem (see Box 2)

It is important to recognize that decision-makers will only be willing to make a

decision or change a policy under a number of conditions: (1) when they consider
the issue economically or politically viable; (2) when there is enough public
pressure or support; and (3) when there is strong supportive evidence.
 --

)I BOX2: The phases of the policy life cycle.

Policy life-cycle Methods of communication

phase

Recognizing the regular opiniordattitude surveys

problem (mass) media content analysis
• analysis of communication-materials (newsletters.
leaflets) of NGO's, consumer groups
systematic and continuous network with NGO's,
interest groups, scientific institutions
regular briefingdinterviews and meetings with
interested groups

Formulation - Knowledge/Attitude/Practice('KAP') surveys

, gaining control of integrating communication in the mix of policy
the problem instruments
I
. design of communication strategy
informative extension/communication (to disclose
issues and policy options) to those who will get
involved

communication as an independent instrument

communication complementary to other instruments
informing groups on the use of other instruments
(new laws, subsidies, etc)
ex-ante evaluation through qualitative research

Maintaining public information

control of the informing on changes of policy design and
problem implementation
regular opiniordattitude surveys (since age-linked
target groups slowly will be replaced by younger
generations)

Source: Winsemius, 1986.

J
 Box 3: Juanita and the mayoral elections in Colombia

The Juanita campaign was based on the new focus for UNICEF's information work:

The design of information and advocacy strategies aimed at achieving

major impact. with their own objectives, specific audiences, instruments, and
diffusion channels.

Exploiting particular political and social situations in the country that were
considered opportune and favourable for presenting children's issues to
public opinion. However, applying pressure from children's themes to be
exposed at inappropriate moments would be avoided.

The design and production of instruments and materials that were lively,
direct, opportune, credible, and attractive, with clear messages to promote
action in favour of children, and which would facilitate the work of the mass
media, but without detracting from the basic role of journalists.

The Juanita campaign involved a series of overlapping and integrated

communication activities to open space for children in the new political agendas that
wouM resutt from decentralization. Given the important role that the first
popularly-elected mayors were to assume, its central thrust was an appeal to
mayoral candidates from a 10-year-oldgirl, Juanita, to include children's interests in
their electoral platforms. It also took into account that the challenge for survival,
protection, and development of children is political and social, rather than technical.
Certainly, it implies gaining the commitment of all those who represent the political
will of a country at the central level, but in particular, it implies gaining the
commitment of those who represent the will of the local communities, and of those
who work in concert with them.

Source: Fraser & Restrepo-Estrada, 1992

3.1 Conditions/Requirements for effecrive Decision-Making and

Decision-Reaching Process

Basically one can distinguish between two fundamentally opposite strategies, which
in practice should be viewed as extremes on a continuum: (a) strategies for
decision-making (top-down); and (b) strategies for decision-reaching (interactive).

3.1.1 Decision-making builds on a number of 'resources' as described below.

Decision-making ideally has to be based on knowledge/expercise and the technical
merit of the issues. Politics however will always play a role in the process and
outcome of decision-making.

(i) The knowledge/expertise needed for social problem-solving is diverse.

Multiple sources and forms of knowledge are needed to know more about
the nature of the problem in order to examine alternatives and make
choices. Each stakeholder group can make a valuable contribution in
creating knowledge about the social problem. from its own perspective and
experience. This includes the knowledge of local people, policy makers,
 social researchers, economists, health workers etc. This knowledge can help
define the nature of the problem and serve as a rational basis for the
decision-making process.

This knowledge can be communicated with the actors through information in

various communication forms. Not every message that is being communicated is
automatically information to the addressed person. The receiver or user decides
whether the content of the message is information or not. Data will become
information if they have a specific meaning to the receiver. Relevant information
reduces the uncertainty on the issue in the decision-making process and therefore
speeds up consensus building and action.

One could call attention to four major shortcomings of available analytic methods.
These are cogent reasons why we cannot expect the work of professional policy
analysts to eliminate the play of power and the bargaining that goes on among
contending interest groups:

(a) The professional analysts are fallible and power holders know it:

(b) The work of professional analysts is often very slow and costly;

(C) The professional analysts often have limited predictive evidence about the
value of various competing alternatives or priorities; and

(d) In the absence of 'harmony of interests or values among individuals or

contending groups' within the organization, the professional analysts may
find it difficult to propose a policy solution satisfactory to all parties.

Box 4: Planned research for advocacy in Nigeria

Probably one of the best examples illustrating the advocacy for planned research for
decision-making is an initiative of UNICEF in Nigeria.
To raise awareness and knowledge of the Guinea worm disease amongst
government policy-makers the Water and Sanitation Section planned a research
which investigated the causality between Guinea worm morbidity and the rice
production in a specific area. One of the major reasons why the rice production
decreased was that a part of the labour force got infected with the Guinea worm
disease and could not work. The results of the research were 'translated' into the
language of the policy-makers, this means in terms of economic benefits. The
research found that approximately $20 million profit per annum would be created in
additional rice sales alone, if the Guinea worm disease was controlled. The total
costs of an intervention would cost $ 36 million. The research itself cost about $
5.000. The information in the research report was presented clearly and simply.
Former president Carter presented the report to the presidents of Nigeria and
Ghana. who were convinced of the important need to eradicate the disease and
measures were taken.

Source: de Rooy, 1987

 iii) Information may become an instrument for advancing, attacking, or
defending status. The structural location of many decision-makers offers
them particular advantage with regard to the control over organizational
communications. In this regard, they are well positioned to take on the role
of technical gate-keepers. As such they are potentially able to influence the
resource allocation process in their organization through a process of
collecting, filtering and reformulating information. This may especially be
the case in the uncertain conditions surrounding innovative decisions.

(iii) In the decision-making processes the validity or weight of the evidence

may not always be the decisive factor. The amount of support a
decision-maker achieves is likely to be conditional on the structure and
nature of his direct and indirect interpersonal relationships.

(iv) The status of the decision-maker in the power hierarchy as well as the
consequence of decision on his future status will intluence the decision-
making process. The amount and kind of group support siven to the
decision-maker by his 'peers' and outside 'pressure groups' will be an
important factor in decision-making.

(V) Lastly, the socio-cultural and political environment, favourable or hostile,

will also have an impact on decision-making.

3.1.2 Decision-linked research for policy-making

Decision-linked research has to play a key role in the process of reaching informed
decisions. Such research must address the issues of concern to decision-makers
and ensure the involvement of stakeholders, planners and programme managers.
Research findings are often not used because the critical issues are not addressed
or often not utilized or the stakeholders are not involved as the findings are not
timely and well-communicated.
l-

Box 5: The environment of decision-making

Even when decision-makers are motivated to base their actions on the evidence that
social science provides, they may be checked by the nature of their environment:

1. Decision-making in public agencies is often a fragmented enterprise.

Decisions are not necessarily the province of a single individual or even of a
clearty defined set of individuals.
2. Decision makers change jobs with considerable frequency.
3. Decision makers tend to be in a hurry.
4. Decision makers have to deal with much of the wodd as given.
5. Policy issues shift rapidly.
6. Many decision-makers have been immersed in the substance of program
and policy issues for decades.
7. The findings and recommendations from social science research studies may
not match the jurisdiction and authority of any agency.
8. The findings and recommendations from social science research may call for
action that is beyond the sources (funds, staff, skills) of the cognizant
agency.
9. The findings and recommendations from social science research may
suggest changes in policy that are outside the ideological and philosophical
boundaries of the administration, the agency, or the attentive public.
10. Policy makers are interested not only in the application of the best evidence
to the resolution of problems but also in reconciling differences and teaching
compromises that maintain the stability of the system. In the interests of
responsiveness and consensus-building, they may be willing to sacrifice the
'best solution' offered by research.

Finally, there are limitations on the use of social research in decision-making that
arise from deficiencies in the transmission of communication. The formal and
informal bodies that are expected to communicate research to potential users may
fail to get the word through.

Source: Weiss & Bucwalas, 1980.

J

Each stakeholder group has its own perception of the nature of the problem and
its causes. All the stakeholders can contribute towards creating more insight. The
following considerations are important.

(i) Defining relevant stakeholder groups concerning the issue.

(ii) Involving those stakeholders in the research process.
(iii) Defining the problem for each stakeholder group.
(iv) Conducting a discussion amongst stakeholder groups towards a "shared
scope" of the problem.
(v) Developing a shared definition of the problem on the basis of which
questions will be designed whose answers are likely to shed more light on
the "solution" of the problem.
t vi) Conducting empirical research based on the designed questions.
cvii) Discussing the results of the empirical research with the stakeholders in
order to come to a basis on which possible policy and acuon can be
 negotiated.
(viii) Negotiating a plan of action and implementation.
iix) Performing and guiding action and implementation.
(X) Organizing cycles of monitoring, evaluation and possibly adoption of the
action in which all relevant stakeholders are involved.

This decision-linked research requires an interactive process towards developing

a shared understanding of the problem which is the basis for negotiation on action.

Box 6: The Sahel drought: the importance of timely agenda-

setting and action

The Sahel drought began in 1969, but was not publicly defined as a disaster until
March 1973, four years later. During this time more than 100,000 people died of
starvation. Very little was done to provide relief supplies by the six Sahel
governments or by international agencies. The disaster just did not exist in the
heads of those people who might have provided relief. This was not due to a lack
of information: reports about the advancing drought were filed regularly by local
government officials and by employees of FAO and USAID. The international press
just did not use the information. It was not until the end of 1972, that the Sahel
drought began to rise on the agenda of world 'news'; the event was gradually
defined as a disaster. Articles in Le Monde and the New York Times created the
disaster and set the issue on the political agenda. Action obviously was taken tca
late.

Source: Rogers & Kincaid, 1981.

Factors/forces which influence the decision-making process

The decision-making process must be considered in a structural-dynamic way by

viewing holistically at least five basic elements.

(a) content and its external or itzternal interpretations (objectives, goals,

resources and functions, ... );

(b) interrelated factors (economic, political, technological, socio-cultural, ...

sectors);

(C) actors (business, industry, institutions, public groups, academia, influential

personalities, etc.);

(d) a distinction at the level of analysis (local, national, u-ansnational,

international);

(e) the process of policy and planning making (policy formulation, planning,
implementation, evaluation, etc.), and

(0 the specific health arzd development problems inherent in any project .

 If. as is assumed, decision-makers are key actors in determining policy initiatives
and choices, it is important to cry to identify more specifically the criteria they use
in making decisions about major policy and institutional reforms. Basically four
types of factors influence the decision-making process: (i) the technical analyses
of the problem and advice about how best the particular problem could be solved;
(ii) the impact of choices on bureaucratic interactions; (iii) the meaning of change
for political stability and support; and (iv) the relationships with international
actors (see Box 7).

Box 7: Factors influencing policy and institutional reform

choice

Factors influencing Criteria of choice Influential actors

decision making

Technical analysis Information, analyses, and Technocrats, ministers and

options presented by other high level
technical advisors, experts bureaucrats; foreign
advisors
- - ~ - p ~ p

Bureaucratic Career objectives of Ministers and other high

motivation individuals: competitive level bureaucrats; middle
position of units; budgets level bureaucrats;
international bureaucrats
and advisors

Political stability and Stability of political Political leadership;

Support system; calculation of dominant economic elites;
costs and benefits to Leaders of class, ethnic
groups, classes, interests: interest associations;
military support or military
opposition
1
International leverage Access to aid; loans; IMF; USAID. World Bank;
trading relations governments of former
colonial powers; USA,
international banks

Source: Griile & Thornas, 1989.

I,

3.3 Actors that influence the decision-making process

Actors can be defined as public or interest groups which, by both direct andJor
indirect means, try to push their explicitly or implicitly set goals. Actors can also
be individuals like influential leaders. Many campaigns require the support of
political leadership, economic powers, and cultural authorities- (e.g., religious
oroups), if they are to make an impact in the short run and sustain their influence
t
in the long run.
.4dvocacy approaches can be initiated by governments, community organizations,
YGOs, media, universities, and UN agencies, etc. This means that actors operate
at different levels and from different perspectives.

Specifically in industrial marketing the concept of "Decision Making Unit" (DMU)

is frequently used to stress the fact that decision-making involves several actors
with different roles and interests in the issue. Identification and involvement of
people in the DMU is crucial for a salesman in order to be able to offer the right
product, price or service. This strategic approach increases the likelihood of
purchase and consumer satisfaction.

The DMU in industrial marketing consists of: users, influencers, deciders,

approvers, buyers and gatekeepers. It should be noted that gatekeepers often have
the power to prevent sellers or information from reaching members of the DMU,
e.g.: purchasing agents, receptionists and telephone operators may prevent
salespersons from W n g to users or deciders.

Decision-making process in business and industry has shown that several people
or stakeholders, with different interests and roles, are involved in shaping
decisions.

The network of actors in the decision making process on social issues is more
widespread and complex compared to DMU in an industrial context.

-
Box 8: Actors in a Brazilian breast-feeding program

Health education usually needs to involve and address more than one public
because the issues have implications for public policy, the media, and professional
relationships. In the Brazilian breast-feeding promotion program launched in 1982,
eight separate stakeholder groups were identified, each for reasons vital to the
objectives.

1. The doctor - to be informed of the benefits of breast-feeding and the

encouraged to engage in technical research
2. The health services - to be informed and educated on breast-feeding
practices and the health of the mother so as to become information vehicles
for the mother
3. -
The hospital to introduce new practices and to revise old ones
4. The infant food industry - to implement the objectives of the WHONNICEF
International Code for the Marketing of Breast-Milk Substitutes
5. -
Industry (in general) to comply with existing laws affecting breast-feeding:
provision of creches in commercial establishments with more than 30
employees and a three-month maternrty leave
6. The community - to offer psychological support for families and to provide
support facilities for breast-feeding mothers
1 7. Government officials - to initiate new policies
1 a.
l
The mother - to promote longer duration of breast-feeding and to encourage
its initiation among those who might be disinclined or discouraged to do so
by engaging the mass media and the educational system.
l
I Source: Mahoff, 1985.
4. Strategies for Advocacy Interventions

4.1 The problem-solving basis for advocacy

Advocacy interventions are often required to address specific socio-economic

problems. Before identifying the variety of available advocacy strategies, one
needs to be sure about the nature of the problem to be solved. In many cases
problems in developing countries are social problems, rather than individual
problems. Social problem-solving is complex because the causes and manifestations
of social problems appear on several levels, sectors and sites in the society and are
often interrelated. Complex problems are ill-structured as opposed to
well-structured "mathematical" problems. Box 9 (adapted from Dunn, 1981:103)
shows some implications related to the complexity of the problem.

Box 9:

Element Structure of the problem

Well-Structured Moderately Structured Ill-Structured

Decision one or few one or few many

maker(S)

Alternatives limited limited unlimited

Utilities (Values) consensus consensus conflict

Outcomes certainty or risk uncertainty unknown

Probabilities calculable incalculable incalculable

Problem-solving can be defined as an ongoing process which aims at improving

a (material or social) situation. This is done worldwide at policy, management,
community and individual levels. A problem is seldom wholly solved.

The traditional problem-solving model aims at solving a problem bv making a

rational choice between alternatives. It assumes that any logical individual will
make the same objective decision on the basis of facts. This model presumes a
top-down decision-malung process in which only one or a small group of decision-
makers take the right decision. The target audience is considered as an object in
policy-making.

The complexin, of social problem-solving, however, demands a collective

decision-making and decision-reaching model in which all relevant 'stakeholders'
interact to create a common understanding on the issue through interaction. This
approach is usually applied to negotiate alternatives for action. This common
understanding is based on the multiple perspectives and interpretations of the
stakeholders.
social problem-solving requires a collective decision-reaching process in which all
relevant stakeholders are meaningfully involved. This cooperative approach
improves the likelihood that action will be negotiated, implemented and accepted
on the basis of mutual understandings on the issue.

Solving social problems involves many decision makers who have an almost
unlimited range of alternatives for "solving" the problem. The plurality of
decision-makers and their preferred alternatives give rise to conflicts of ideas and
interests, specifically because the outcomes of implemented alternatives are hard
to predict (calculate) and therefore uncertain or unknown.

To investigate and attack the full scope of the problem and the interlinked
hierarchy of causes it is important to combine forces in society. Advocacy
strategies can play a catalyst role in participatory processes on issues which are
considered problematic and therefore need to be solved.

Box 10: Criteria to be considered when assessing the

symptoms of defective policy-making
l
l

Effective problem solving can be hindered by the following interrelated types of

constraints:

(1) limited resources, information and data that are essential for sound
decision-making;

(2) limited cognitive capabilities of the person or persons who make the policy
decision;

(3) limited time and sense of urgency;

(4) selective bias in gathering and processing of information;

(5) failure to reconsider originally rejected alternatives;

l

(6) failure to examine the major costs and risks of the preferred choice; and

(7) lack of planning.

Dimensions of advocacy strategies

There are a wide variety of advocacy strategies to influence development and

change. In any strategy three basic dimensiorzs of action can be distinguished: (a)
the organization of activities; (b) the substance of activities, and (c) the 'climate'
of human relations in which activities take place. At all these dimensions media,
public pressure and interest groups do play a major role.

Divergent theories in each of these three dimensions of action must be considered

and reviewed. Special attention should be given to (a) organization theory, (b)
knowledge utilization, and (c) policy analysis.
The choice of advocacy strategies will vary with the nature of the issue and the
expectation of the people or the stakeholders. Policy-makers and stakeholders often
respond in markedly different ways to the same information about a policy
environment. A policy environment, which is the specific context in which events
surrounding a policy issue occur, influences and is in turn influenced by policy
stakeholders. The objective and subjective dimensions in the policy-making process
are inseparable in practice.

In order to identify the appropriate advocacy strategy, one or more of the following
important characteristics of policy problems have to be considered:

(i) Interdependence of Policy Problems. This implies that one should use an
not only analytic but also a holistic approach.

(ii) Subjectivity of Policy Problems. Besides objective realities, subjective

judgements and values come into play in the decision-making process.
Advocacy strategies must address both.

(iii) Dynamics of Policy Problems. There are as many different solutions to a

given problem as there are definitions of that problem.

Advocacy and communication strategies have to be planned and targeted. Providing

information to decision-makers does not guarantee that something will be done.
The issue is not primarily "how to get the message across" but "how to improve
the use of the advocacy information in decision-making". In order to improve the
utilization of information and advocacy messages the following issues are
considered important:

Relevance: The issue has to be considered relevant by the several

stakeholder groups.

Timing: The issue has to be brought up on the right time.

Credibility: The information has to be credible to the several stakeholder

groups.

Validity: The information and statistics provided have to be valid.

Cultural sensitivity: The information should be tailored to the audiences

and be in line with the understandings and expectations of the people or
stakeholders.

Orientation of the relevant stakeholder goups: stakeholder groups have to

be trained in interpreting data, so that they are able to understand them.

Phnning: The advocacy strategies and communication should be planned

in advance to improve utilization of the information.

Communication: Interaction and reaching mutual understanding(s) between

relevant stakeholder groups.
 Action orientation: Advocacy strategies have to provide information for
concrete action.

Dissemination of information: Advocacy messages and information can

only be used by decision-makers if they are disseminated properly.

Once again it needs to be stressed that communication and dissemination are

important but not the only factors to improve the advocacy efforts towards
decision-making. The various elements in the advocacy act are interdependent.

In order to be effective advocacy strategies should focus on the users of the

information as well as on the message. The content and form of the advocacy
messages have to be adapted to the specific audience of decision-makers and be
based on their needs, issues, concerns and interests to be able to catch their interest
and potential engagement.

Coalition building and networking with various interest groups and actors in the
decision-making process are critical elements in advocacy strategies.

Box 11: Potential strategies for Private Voluntary

Organizations (PVO) Policy Intervention

Four broad strategies can be identified: demonstration, catalysis, information and

influence. In the first three cases, the PVO builds on its traditional grass-roots
connections to become an advocate for the interests of the poor; in the fourth,
the PVO deliberately co-opts powerful interests in the host country to seek
changes in govemment policy. In practice, many successful PVO initiatives in the
policy domain invoke a combination of these strategies:

(1) Demonstration: The demonstration approach presupposes that the PVO's

broad development objectives and priorities are consistent with those of
the host govemment and follows this progression.

(2) Catalysis: The catalyst approach is similar to demonstration but depends

on networking and facilitation and less on visible programme results.

(3) Information: The information approach also employs research but

emphasizes the PVO's unique capacity to provide relevant information
from its own experience base. It draws on the premise that poor policy is
a function of policy-makers lacking good data.

(4) Influence: In contrast to the other three, this approach calls for a targeted
effort to enlist one or more individuals from the host country elite to
sponsor and publicize efforts directed at changing policy. The cost
effective sponsors tend to be people whose influence and popular appeal
transcend politics, and who have no official role within the host
govemment structure.

Source: Vansant, 1989

 On the basis of research one could state that (1) symptoms of defective
dec~sion-makingare to be expected whenever poiicy-makers arrive at vital choices
pnmanly by relying upon simple decision rules t deal with the constraints that
beset them, and (2) those symptoms. in turn, tend to lead to undesirable outcomes.
If the assumptions are empirically valid, one can expect that when fundamental
interests of the organization or project are at stake, a chief executive or a project
committee will be more lrkely to regret policy decisions if arrived at by
high-quality procedures that eliminate symptoms of defective policy-making before
implementing policy changes.

5. The Challenge

In this meeting we will address the issue of advocacy strategies to influence

policy-makers in support of health and development. The challenge lies in
devising ways by which a development issue can be effectively brought to the
attention of decision-makers and policy decisions made which are supportive of the
cause.

How does an issue become a topic of public concern and win a place in the
national and political agenda? What factors do we consider and what forces do we
mobilize towards this end? What evidence must we gather and arguments do we
develop for making a powerful case for gaining priority and marshalling resources
to tackle the problem? Three streams of action are important:

S
Media must be activated to build public support and upward pressure for
policy decisions.

S
Interest groups must be involved and alliances established for reaching
a common understanding and mobilizing societal forces. This calls for
networking with influential individuals and groups, political forces and
public organizations, professional and academic institutions, religious and
cause-oriented groups, business and industry.

S
Public demand must be generated and citizens' movements activated to
evoke a response from national leaders. It may not always be easy to build
up a strong public movement around health and development issues - but
even a moderate display of interest and effort by community leaders could
stimulate the process for policy decisions and resource allocation for
combatting the problem.

Advocacy, in essence, implies gaining political commitment and policy support

through organized social action with the involvement of commited individuals,
support from influential forces and the involvement of concerned sectors of society.
But we will have to understand advocacy better in order to apply it.
 ANNEX 1

Critical Points for Consideration

1. Advocacy

(i) Advocacy with decision-makers is to gain political commitment and policy

support for health and development actions.

(ii) However, there is no consensus on a definition of advocacy or the process

of advocating.

(iii) One can distinguish between (a) advocacy for policy design and decision-
making; and (b) advocacy for policy implementation.

2. How to reach decision-makers: Channels of influence

Decision-makers can be reached through one or a mix of two or more of the

following channels

(i) through efficient advisers

(ii) through the media
(iii) through legislators and community representatives
(iv) through community action
(v) through local organizations and pressure groups
(vi) through outstandinglinfluential leaders and personalities
(vii) through social movements
(viii) through alliance building with stakeholders

3. Basic requirements for decision-making

(i) Political access and networks

(ii) Availability and control over information
(iii) Expertise and knowledge
(iv) Assessed stature in political and organizational hierarchy
(V) Group or community support
(vi) Favourable cultural environment

4. Essential conditions for effective advocacy with decision-makers

(i) Pertinence of the development issue/social problem and on

understanding of the key intersectoral linkages;

(ii) Collection and dissemination of important facts and figures to

concerned groups of policy-makers, decision-makers, and pressure
groups, as well as to the media;

(iii) Development of a systematic and comprehensive communication

strategy and social networking with an understanding of the political
and cultural context:
 (iv) Involvement of media, concerned organizations and professional
groups; and

(v) Generating public awareness and demand.

5. Towards effective communication for advocacy purposes

(i) Carefully plan the advocacy strategy with the involvement of potential uses
and target audiences.

(ii) Identify and involve the relevant stakeholder groups in creating and shaping
the message.

(iii) "Tailor the content and form of the message" to the specific stakeholder
groups.

(iv) Develop a mechanism for generating interest and the participation of people
in sharing and creating knowledge.

(V) Fit the communication forms and channels into the national and local
media-landscape; use the traditional media and both formal and informal
channels (e.g. face-to-face dissemination)

(vi) Involve people in the dissemination process. They know, for instance,
where to display posters, who are influential people speak with, and how
to get things done (cheaply). They know!
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