|Holding the GHI Accountable|
Developing a GHI Advocacy Campaign Plan
Also Available in [PDF] format.
What is the GHI?
The U.S. Global Health Initiative (GHI) is a new umbrella program for over 80 percent of existing U.S. government global health programs, including the largest programs such as the President’s Emergency Plan for AIDS Relief (PEPFAR); the President’s Malaria Initiative (PMI); the Feed the Future Initiative (FtF); U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria; and smaller bilateral initiatives focused on reducing tuberculosis; improving maternal , newborn, and child health; and increasing knowledge and use of family planning methods.  While the U.S. Congress will still provide funding for each of these separately, U.S. government (USG) agencies responsible for their implementation will coordinate efforts in order to work towards overall health outcomes, instead of condition-/program-specific targets. The GHI applies in every country where the U.S. makes global health investments, though some countries, known as GHI Plus Countries, will receive more technical assistance in exchange for serving as “learning laboratories. 
The GHI provides “performance-based” incentives, whereby donor countries/institutions identify their end results, and allow partners (recipient countries/institutions) to determine the best way to use available resources to achieve those particular targets.  What differentiates the GHI from historical USG global health programs is that while it will still be driven by quantitative targets (what the GHI accomplishes), it will also prioritize processes that maximize resource use both for short-term achievement and long-term sustainability (how the GHI accomplishes its goals). In other words, the incentive for access to U.S. resources is to perform well, not simply to guarantee the distribution of resources (inputs).
Why is youth advocacy essential to the success of the GHI?
The GHI represents immense promise for improved health care programs, participatory policy-making and program implementation, and significant progress in economic development and good governance due to strategic achievements in public health. However, as with any well-intentioned and ambitious government program, it will depend on citizens to ensure that the GHI achieves its potential. With today’s generation of young people being the largest in history, youth in particular have an unprecedented opportunity to mobilize collectively, inside your countries and across GHI countries, to hold governments accountable to young people’s health and well-being.
The performance focus in the GHI is where youth can become important advocates. Several of the health targets in the GHI will require significant investments in young people to achieve them, including a focus on youth sexual and reproductive health, political and programmatic participation, and new kinds of data collection on adolescents. With a new “partnership-based” approach to building sustainable, countryrun public health infrastructures, planning for the use of USG resources rests largely with country governments.
As a young person in a country where GHI currently operates or soon will operate, you have a unique ability to hold GHI accountable to youth, and therefore, to help your government and the U.S. government achieve the goals of improved health outcomes. Just by being on the ground, knowing the culture and political landscape, and knowing what is needed to improve young people’s access to health information and services, you are the best judge of what is needed, and if GHI is working to improve health outcomes for young people. This advocacy toolkit is intended for you to understand the structure of the GHI, and your power to leverage youth interests within it. Tables 1 and 2 offer specific tools for youth advocates to understand their advocacy targets and how they can evaluate their own country’s progress towards improved youth health and participation in decision-making.
Critical first steps to start your GHI accountability campaign
In order to mount a successful advocacy campaign, you will need to mobilize your peers to identify and prioritize your sexual and reproductive health and rights needs. The following steps will help you lay the important groundwork for your campaign.
Country assessment tool
Once you’ve organized with others into a formal group, you need a way to effectively evaluate programs and policies in your country in order to make conclusions about their impact and make recommendations for change. Table 1 is an example of a basic assessment tool that you can modify depending on your particular priorities and country context. The tool can be understood in a series of five steps, all of which require organization and dedicated research activity on the part of youth in-country. Publishing the findings of these evaluations helps young people work to hone their own advocacy activities and to highlight action items for responsible government agencies.
Table 1: Country Assessment Tool
Advocacy entry points and strategic actions for youth
Now that you have assessed your country’s health system and determined the key priority areas you want to focus on, you need to examine advocacy entry points for bringing about the change you seek. As Table 2 illustrates, young people have three principle entry points for advocacy in the GHI: the U.S. Government, the Partner Country Government, and the GHI Team, which is a combination of representatives from both governments. This table is not exhaustive, but offers key government agencies and the policies for which they are responsible, so you know where to begin your advocacy efforts. The GHI Team in each country will change depending on the existing relationship between the USG and your government, however, the model given in the chart offers an idea of the agencies which are most frequently part of GHI Teams.
How to advocate with the United States Government
Even though you do not elect the USG, it still has a prime interest in engaging you in a meaningful way.
How to advocate with your government in the context of the GHI
How your government frames your country’s health challenges and its primary needs has serious impacts on the use of GHI resources.
Table 2: GHI advocacy entry points, including US G, GHI Country Team, and Partner Country Government 
Pulling it all together: goals, objectives, and your GHI Advocacy Campaign 
Once you have identified your priority areas and the key decision-makers and agencies that have influence over those policies, you must decide upon a goal to achieve within each priority area. The goal should be a broad statement of your GHI advocacy effort’s anticipated accomplishments. The goal should also reflect the effort’s longterm vision, be obtainable, and specifically in the case of the GHI, focus on contributing to a single or multiple health outcomes for youth. For example, your goal might be to reduce unintended pregnancy or HIV among young people.
Once a goal is agreed upon, you should next formulate your objectives. Objectives should be tangible and concrete. Your objectives might then include: improving youth access to sex education through public schools; improving youth access to condoms; and improving youth access to HIV/STD screening and treatment. After developing the objectives, advocates must agree upon the best strategies by which to achieve them. Strategies should be realistic, specific, and measurable in charting progress toward the long-range goal. For example, to reach the objective of increasing access to comprehensive sex education, one advocacy strategy might be to publish five op-eds in local newspapers calling attention to the lack of knowledge that young people have about sexual and reproductive health and the impact this has on your communities.
If a number of organizations are working together as a network or a coalition, this process will usually require open discussion and debate as well as negotiation and compromise. While network members might all agree that teen pregnancy is the primary problem that they wish to address, differences in opinion may emerge over how to address the problem. Some members may believe that the network should work to affect policies regarding what young people are taught in school, while others may be in favor of policies that improve the services for youth at local clinics. Although differences of opinion demand time and effort to resolve, they will contribute to a better overall advocacy plan, in which every option has been considered.
Remember, advocacy can sometimes require a long-term commitment. Don’t be discouraged if you don’t immediately succeed in bringing about the change you seek. Incremental change can be just as important in laying the groundwork for further advances. For additional guidance in using media, meeting with policy makers, responding to opposition, and evaluating the results of your campaign, please see:
Glossary of Terms
GHI Strategy: implementation plan that outlines the Core Principles, Goals and Targets, and Standard Implementation Components of the GHI—Issued by the State Department.
GHI Country Strategies: “over-arching framework which outlines the vision for how GHI will utilize U.S. Government health investments by ensuring the integration of GHI Principles into existing and future country programs. [It is] articulated as a multi-year strategy which can be updated annually . . .” (P. 7 of GHI Guidance 2.0)—Issued by GHI Country Teams.
Whole of Government Approach: “characterized by an inclusive process that involves all U.S. Government agencies and offices with expertise in global health activities and assets that can be leveraged to achieve common goals and targets.” (P. 4 of GHI Guidance 2.0)—Referenced throughout GHI documents.
Guidance Documents: clarifying texts used in a variety of USG programs including PEPFAR, GHI, and USAID Health programs to explain how global health law is to be interpreted and understood by implementing partners. Examples include the Guidance on Women, Girls and Gender Equality (issued by the State Department), and the Guidance on MSM (issued by the Office of the Global AIDS Coordinator).
PEPFAR Partnership Frameworks: “a 5-year joint strategic framework for cooperation between the U.S. Government, the partner government, and other partners to combat HIV/AIDS in the host country through service delivery, policy reform, and coordinated financial commitments.”
Written by Brian Ackerman, Janine Kossen, and Mimi Melles
GHI Quick Facts
Established in 1980 as the Center for Population Options, Advocates for Youth champions efforts to help young people make informed and responsible decisions about their reproductive and sexual health. Advocates believes it can best serve the field by boldly advocating for a more positive and realistic approach to adolescent sexual health.
Our Vision: The 3Rs
Advocates for Youth envisions a society that views sexuality as normal and healthy and treats young people as a valuable resource.
Youth have the right to accurate and complete sexual health information, confidential reproductive and sexual health services, and a secure stake in the future.
Youth deserve respect. Valuing young people means involving them in the design, implementation and evaluation of programs and policies that affect their health and well-being.
Society has the responsibility to provide young people with the tools they need to safeguard their sexual health, and young people have the responsibility to protect themselves from too-early childbearing and sexually transmitted infections (STIs), including HIV.
Some related publications from Advocates for Youth
Policy Brief: Youth in the Global Health Initiative
See the complete library of publications at www.advocatesforyouth.org/publications