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What is advocacy?

Why advocacy has a role to play in any eye care initiative.
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Dr Abbiyesuku: What is advocacy? Prof.
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Prozesky: For me advocacy means making something that is important to you, to people who could be assistant, can help you, in making that issue that’s important to you to progress. and that means you do advocacy in two directions You can take this issue that is important to you, upward, we say to people who are able to contribute resources. Whether it’s financial or of influence to making the issue that’s important to you to go forward well. And advocacy also goes, in a sense downward to the people who will be recipients, if you like, of the programme or the issue that you want to promote. So, there’s the influencers and there’s the receivers, they both receive advocacy
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Dr Abbiyesuku: So, in a sense it’s bi-directional? Prof.
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Prozesky: It’s bi-directional, yeah, it has to be, like like any other innovation With advocacy is also always about starting something, doing something new. When you plan something new, there’s the planning cycle. And so, advocacy inherently also contains a planning cycle. There’s an issue that you think is important and then there are potential solutions to it. and then you have to find a way of implementing these solutions. Decide what would be the best way of making your advocacy work, and then when you have put that into practice, your plan, then you evaluate it. It’s the typical planning cycle. So for me you can’t really think about advocacy without thinking of a cyclical process which resembles the planning cycle.
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Dr Abbiyesuku: Do you have one cycle for the people, the upper direction and another for the downward direction? Prof.
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Prozesky: No i think they would go together.
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Dr Abbiyesuku: okay Prof.
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Prozesky: You have to think about both.
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Dr Abbiyesuku: What do stakeholders need to do to advocate for ROP services? Prof.
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Prozesky: There are eight classical strategies, but the first one is building coalitions. The second one is networking. Both of those, have to do with finding people who have, are likely to have, similar interests to yours, in relation to this particular issue which is retinopathy of prematurity. It’s not only the clinicians and the ophthalmologists. There are other people who are also interested in it, like the neonatologists, midwives even, and then also to going on to developmental psychologists, or people who are child psychiatrist, if you like. There’s a lot of people who would be interested in this.
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So the first two strategies have to do with reaching out to them, networking, and then actually formally getting together to decide on a joint plan.
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Dr Abbiyesuku: Okay Prof.
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Prozesky: So, you’re not alone, you’re doing this with other people. So those are two of the strategies and the other strategies are the ones that this coalition would then try to implement. And the first one of those is well known to us from the political scene, in lobbying.
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Dr Abbiyesuku: Right Prof.
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Prozesky: And I think we have a reasonable understanding of what that means, it means approaching people who are in power, who have the potential to contribute resources. You lobby them to make your issue known to them and with that is attached a request for assistance of some sort or another. And very often after the lobbying comes a process of negotiation, because, as we know, particularly in, well in every country also, but particularly in developing countries, there’s a large, a small budget and large demand so negotiation is a particular skill to to set out a way of effectively negotiating for the things that you need with the powers that be.
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With the people who are able to supply the resources that you want. The other ones that are commonly used are position statements, where together as a group of professionals you’re able to make a statement which can then be delivered to the media about the problem. How important it is? What its effects are? and what it will need to deal with it? Formerly done by a group of respected professionals and delivered to the media, even delivered to the press. And certainly, delivered to the powers that be. Position statement. And then another one that’s used, now we talk this is all on the upward side right.
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Now the on the downward to the people who are going to be using the in this case it would probably be the ROP who would who would the target audience be
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Dr Abbiyesuku: mothers with children with ROP Prof.
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Prozesky: so you can you can, community mobilisation, mobilisation of people in the community who are likely to be beneficiaries of an improved programme that is another strategy. For if if they can get together and and agree that what you are trying to do is really important that can be another powerful help to support your advocacy. So you’re not only informing them of what the advocacy is likely to deliver to them but you’re using them to as a voice upward. Then there’s the usual other advocacy channels, the usual media that you can use the media whether it’s television, or the newspapers, or even scientific journals. The media can help you to advocate your issue upwards and downwards.
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Like like any decent plan, advocacy is dependent on really good and reliable information. So if you want to lobby for services for ROP you would have to have researched, you have to have very, very clear information about the extent of the problem and particularly the the economic implications of it. Why it would make economic sense to support a programme to minimise the effect of ROP or to make it not happen at all. Why it would make sense economically? There’s a there’s a wonderful article by a group of spanish epidemiologists who have investigated the effectiveness of advocacy for eye care.
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It was actually in response to a WHO questionnaire sent out to many countries about how they do advocacy and they found that the political issues going to politicians saying we need this is often used but the economic argument is hardly ever used but when it is used it’s extremely powerful. It has, it it carries a lot of weight if you can show that the economic benefits are significant.
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So so the kind of information that you need to support your advocacy would be the extent of the problem, the economic benefits and other benefits of the problem, evidence from other places in the world where ROP has been properly supported and the effectiveness of that has had that’s the kind of information you would need
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Dr Abbiyesuku: Thank you

Advocacy has a role to play in any eye care initiative. It can help individuals or organisations to obtain more resources, and it can support programme implementation and service delivery.

When planning an advocacy strategy aimed at improving eye care delivery, it is important to identify key groups of stakeholders who are in a position to make a difference. These are the targets for advocacy – the people at whom you need to direct your efforts. They can make important decisions that directly affect service delivery or simply influence others in a way that will improve the situation.

If these key target groups can see the benefits of what is being advocated, it will be easier to both get their support and ensure that this support is sustained. Hence, it is important that the design of an intervention or programme should offer benefits to all – it should be a ‘win-win’ solution. Those who are advocating for better delivery of eye health services (whether they are eye health providers, hospital managers, or national coordinators) should therefore clearly communicate these benefits – supported by the relevant evidence – to the groups that are the targets for their advocacy.

Advocacy target groups for ROP services include:

  • Political leaders.
  • Community leaders.
  • Local and international non-governmental organisations (NGOs) involved in child health and eye health
  • Health care professionals – neonatologists, ophthalmologists, heads of professional bodies, heads of training programmes for nurses, ophthalmologists.
  • Low vision and rehabilitation experts
  • Parents of children with ROP.

In the video on this step, Dr Jiba Abbiyesuku, Jos University Teaching Hospital, Nigeria and Professor Detlef Prozesky, University of the Witwatersrand, South Africa, discuss the principles of advocacy for health services and how these can be applied to ROP services.

As you listen to their conversation consider how to apply the eight steps of advocacy in your setting. Share your ideas and experiences in the Comments.

The eight steps of advocacy

  1. Building coalitions
  2. Networking
  3. Lobbying
  4. Negotiations
  5. Making a clear position statement
  6. Community mobilisation
  7. Use media
  8. Across all steps use key information and evidence to advocate.
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Retinopathy of Prematurity: Practical Approaches to Prevent Blindness

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