Launched in January 2015, Advocacy for Better Health (ABH) is a five-year project implemented by PATH in collaboration with Initiatives Inc., with the goal to improve the quality, availability, and accessibility of health and other social services in 35 districts in Uganda. The project seeks to increase citizens' voice for quality service delivery by: empowering citizens to demand improved quality services by providing information, skills, and tools to carry out effective advocacy; strengthening the capacity of civil society organisations (CSOs) to effectively advocate for issues of citizens’ concern in the health and social sectors through training and the creation of advocacy platforms; and strengthening the institutional capacity of CSOs to obtain, manage, and implement advocacy projects. ABH is funded by the US Agency for International Development (USAID) and is working with 20 local implementing partners to achieve its objectives.
ABH was born out of concern about inefficiencies in health service delivery and other weaknesses in the health system that negatively impact on the quality, accessibility, and availability of health and social services in Uganda. ABH is grounded in the belief that if citizens' knowledge and awareness of their rights and responsibilities were increased to stimulate collective consciousness, and if the capacity of CSOs was built to effectively empower and represent communities, then citizens would believe and have confidence that they can hold their leaders accountable and influence them to change health and social policies in their favour. More specifically, the project involves the following:
Empowering citizens - ABH increases citizens’ awareness of their rights and responsibilities related to health and social services, as well as the mechanisms to hold duty-bearers accountable. Citizens collectively give voice to their health needs and contribute to effective solutions by developing community action plans, engaging with health providers and decision-makers at community forums, and participating in facility- and district-level planning and monitoring.
Strengthening CSO advocacy - ABH partners with and strengthens the capacity of CSOs to effectively influence national and district policymaking, budgeting, and service planning and implementation in alignment with community-identified needs. CSOs gain the skills, tools, relationships, and alliances to develop and implement evidence-based advocacy strategies that catalyse action and accountability and result in meaningful change.
Building organisational capacity - ABH bolsters the operational capacity of local implementing partners to obtain, manage, and implement long-term, sustainable advocacy projects. Technical assistance results in CSOs with stronger organisational and financial management, governance, administration, and human resources processes - and that are better able to achieve advocacy objectives.
ABH partners are meant to advance policies, budgets, and programmes for a variety of health and social protection topics, including: education of orphans and vulnerable children (OVC); HIV and AIDS; malaria; tuberculosis; nutrition; maternal, newborn, and child health; and sexual and reproductive health - with a special focus on gender, and on policies that affect adolescents, youth, and marginalised and at-risk groups.
In addition, ABH focuses on the following cross-cutting priorities:
- Domestic health financing - Public expenditure on health and social service delivery remains far below current commitments. Project partners therefore advocate for an efficient, sustainable health financing mechanism and overall increased government investment in the health sector.
- Commodity security - In Uganda, up to 40 percent of health facilities experience persistent stock-outs of life-saving medicines. Partners therefore advocate for increased funding for essential medicines and strengthened supply chains, as well as improved forecasting and accountability to ensure commodities are available when needed.
- Human resources for health - Frequent health worker absenteeism significantly undermines health service delivery throughout Uganda. ABH empowers community groups to hold local service providers and decision-makers accountable for their roles, while also advocating across levels to fill vacant posts, monitor health worker performance, and improve worker retention and motivation through strengthened remuneration.
- Orphans and vulnerable children (OVC) - Education is an important factor in determining health. Yet more than two out of three Ugandan children leave primary school before reaching the final grade, and OVCs are especially at risk of limited education and poor health. Partners promote policies, investments, and interventions to address drop-out rates, absenteeism, and poor performance, as well as prevent child abuse and adolescent pregnancy, especially among the most vulnerable.
ABH employs the following strategies to bolster citizen demand and strengthen CSO capacity to advocate for improved health and social service delivery:
- Organizational and Advocacy Capacity Assessment (OACA) - PATH and Initiatives, Inc. have developed this tool for jointly assessing and fostering both organisational and advocacy capacity development. The facilitated self-assessment enables organisations to identify capacity gaps and develop customised plans to improve organisational systems, practices, and tools to achieve advocacy priorities. It is being used with advocacy organisations annually to assess capacity development progress and nurture a cadre of local, sustainable CSOs ready to obtain, manage, and implement advocacy projects moving forward.
- Advocacy strategy development - Building on PATH’s 10-part framework for advocacy strategy development and the Stronger Health Advocates, Greater Health Impact tool and training series, ABH provides partner CSOs with a variety of on-the-job mentoring and strategic support in the capture and use of evidence for advocacy, policy communications, coalition-building, engagement with decision-makers, and policy-making and planning processes. CSOs in turn spread these capacity-building efforts to other partners and more than 400 community groups working to influence change at both the local and point of service delivery levels.
- Advocacy and Grants Management Collaborative - ABH’s more than 20 partners co-create advocacy strategies, messaging, and accountability tools, as well as package and share data and evidence and participate in coalition-based activities. They also routinely participate in an advocacy and grants management collaborative to identify common problems, collectively test solutions, share lessons and results, and adopt successful practices in both advocacy and organisational capacity development.
- Accountability champions - ABH recognises the potential of community members, service providers, and the media as well as decision-makers, such as local leaders and members of parliament, to each act as change agents. The project facilitates multiple, integrated community platforms to engage diverse stakeholders in mutual accountability activities to improve the quality of health and social services.
An example of an initiative that arose out of the ABH programme in late 2015 addressed a severe shortage of anti-TB and HIV drugs face by health facilities in Uganda. Concerned that the government might not respond fast enough to avert a crisis, ABH assembled a coalition to urge the government to take immediate action to prevent the stock-out. The coalition disseminated evidence on district stock-outs, conducted radio spots and press conferences, and met with top government officials. Within a month, the government responded with both short- and long-term measures. The advocates’ swift action and partnership with decision-makers averted a major public health crisis and has led to ongoing dialogue and funding to prevent future stock-outs.
HIV and AIDS; Malaria; Tuberculosis; Nutrition; Maternal, Newborn, and Child Health; and Sexual and Reproductive Health
The project has shown a number of successes. Due to the vigilance of citizens, in many health facilities, health workers are no longer perpetually absent from duty. In other facilities, district officials have stationed more health workers, especially midwives, and decision-makers have committed to address gaps affecting the delivery of high-quality services. In some communities, new cadres of health care workers have begun work in facilities that were previously understaffed.
PATH; Initiatives Inc.; USAID; Action for Community Development; Action for Rural Women’s Empowerment; Center for Health, Human Rights and Development; Communication for Development Foundation Uganda; Community Integrated Development Initiatives; Family Life Education Program; Coalition for Health Promotion and Social Development; Integrated Development Options; Jinja Area Communities Federation; Kabarole Research and Resource Center; Kalangala District NGO Forum; Kapchorwa Civil Society Organizations’ Alliance; Literacy Action and Development Agency; Mbale Area Federation of Communities; Multi-Community Based Development Initiative; National Forum of PLHA Networks in Uganda; Reproductive Health Uganda; Rural Action Community-Based Organization; Straight Talk Foundation; Uganda Debt Network; and Uganda Red Cross Society.