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. ^[1] 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. ^[2]

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. ^[3] 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.

1. Organize with others into a formal group that can represent a diversity of interests and effectively launch a research and advocacy campaign.
   
   
2. Study your own health system.
   
   
   • Identify what services and information young people currently lack, and what programs must be offered to improve youth sexual and reproductive health and rights. Use Table 1 to help assess your country’s strengths and weaknesses.
     
     
   • Identify the current relationships  between your government and the USG (for example, is the USG active in family planning, HIV/ AIDS, malaria, or all three, in your country?). What U.S. global health programs are active there (PEPFAR? PMI? FtF?). Every GHI country is unique in its own health challenges and its relationship with the USG and your successful advocacy will depend on your knowledge of your country context. To see what health programs the USG offers in your country see:
     
     http://www.usaid.gov/our_work/global_health/home/Countries/index.html
     
     
3. Identify weak youth policies in existing U.S. global health policy documents for your country. As noted above, each country has a unique mix of GHI interventions, ranging from one country with a family planning program, to another with HIV/AIDS, Malaria, Tuberculosis, and malnutrition programs along with extra technical support if it is a GHI Plus country. Each of these unique programs has their own policies, operational plans, guidance and strategies, all of which remain in place in the GHI, but will be coordinated by the GHI Country Strategy. ^[4] Your job is to find out what these documents say (and don’t say) about young people to identify strengths and weaknesses for youth health and rights, and make recommendations both for those documents (such as the PEPFAR Partnership Frameworks) and for your overall GHI Country Strategy. For a quick review of youth policy within the first round of 8 GHI Plus Country Strategies, see Table 2 in the policy brief available here:
   
   http://www.advocatesforyouth.org/publications/1831-youth-in-the-global-health-initiative
   
   
4. Document your stories, and those of your peers, in accessing critical sexual and reproductive health information and services in your country, to illustrate programs that work and those that do not.
   
   
5. Identify organizations that partner with the GHI to implement youth health programming, and create plans to work with them to help you leverage your advocacy, to use their influence to open doors for you.
   
   
6. Communicate recommended changes to appropriate decision-makers. Using your knowledge of your country’s health system structure, and your own conclusions about how to improve it, communicate your findings to appropriate decision-makers by using effective advocacy techniques (particularly your stories), and leveraging relationships with partner organizations.

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.

Steps:

1. Identify policies and programs that impact young people in your country. Use the blank row at the end to add additional policy and program areas that are relevant to your specific country context. (Column 1)
   
   
2. Identify the agencies responsible for designing those policies and implementing those programs. (Column 2)
   
   
3. Identify the status of policy design and program implementation by those agencies. (Column 3)
   
   
4. Note any items of interest on how to advance your advocacy efforts. This could include: a) effectiveness of implemented programs and policies, b) accessibility of services/programs implemented for young people, c) ability of young people to benefit from policies in place, d) existing exemplary programs and policies, e) major setbacks, f) future meetings coming up to influence change, g) pending legislation or policies, h) next steps, etc. (Column 4)
   
   
5. Select 1-3 areas as priority areas within your general advocacy work and rank them accordingly (1, 2, 3, etc.). Factors 5. to consider in priority ranking may include: a) the level of progress needed to bring about sufficient change (can advocacy meaningfully impact the policy/priority?), b) areas you feel are most important for you to focus on, c) the availability of resources you have to influence change, d) time commitment involved to bring about change, e) existence of political will in-country, f) level of public support in-country, etc. These are just some factors you might want to consider as you prioritize which areas you can realistically tackle.

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.

1. Demand meetings for your youth organization with U.S. Ambassadors, USAID Mission Directors, Peace Corps Volunteers, and other representatives of U.S. agencies in your country. During these meetings, offer examples of best practices in-country for implementing programs and policy change, and highlight policies and programs that do not work for young people. Use your stories to illustrate your claims.
   
   
2. Demand youth representation on your country’s GHI team.
   
   
3. Demand USG funding for youth advocacy in your country and USG pressure on your government to ease any restrictions on citizen organization and expression.
   
   
4. Develop petition and letter writing campaigns to share your stories about access to youthfriendly health services and education with the Executive Director of the GHI, the U.S. Global AIDS Coordinator, USAID, the Office of Global Women’s Issues, the Centers for Disease Control, and members of the U.S. Congress.

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.

1. Demand formalized conduit s for youth representation in your Ministry of Health. The Ministry of Health is generally the most important advocacy pressure point between your government and the GHI. Young people must demand representation within MoH evaluation and planning initiatives and demand improved policies for young people’s sexual and reproductive health and rights. You should not stop at the Ministry of Health, however. Demand participation across the government decision-making bodies whose policies affect your health and rights (Ministries, Parliament, technical and policy committees, working groups, advisory boards, etc.).
   
   
2. Demand youth representation on all GHI teams that determine partnerships between your government and the USG. Young people, crucial to the sustainable success of GHI health programs, should advocate for youth-friendly services, comprehensive sexuality and health education, youth indicators, disaggregated data, and health workforce training as participants on GHI Teams.
   
   
3. Publish “shadow reports” (supplements or alternatives to published government reports) of information regarding the truth about youth access to sexual and reproductive health information and services. This helps advocacy networks inside and outside your country to learn your needs and leverage more pressure.

Table 2: GHI advocacy entry points, including US G, GHI Country Team, and Partner Country Government ^[5]

Pulling it all together: goals, objectives, and your GHI Advocacy Campaign ^[6]

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.

Next Steps:

Once you develop your GHI Advocacy Campaign plan, it is time to consider what comes next. Here are some questions for you to think over as you set your plan into motion:

1. How will you get started? Even with a plan of priorities, entry points, goals, and objectives, there is the difficulty of the crucial first step— collecting a team of committed colleagues, and delegating responsibility for each task to ensure you are moving forward collectively.
   
   
2. What obstacles do you anticipate? In many countries, the political climate does not permit public criticism of government policies; In others, expression may be liberated but resources for youth advocacy may be limited at best . You should take a moment to identify obstacles you may encounter in your work to achieve your objectives and goals given your particular country context.
   
   
3. What organizations and key leaders are available to help you overcome challenges? Even if your list of obstacles is a long one, there are resources to help you. If the Ministry of Health is extremely unfriendly to youth, then perhaps trying to get a meeting with the U.S. Ambassador can offer an opportunity for you to explain your advocacy objectives, and to encourage the U.S. government to pressure your Ministry of Health to take action. Because the GHI is more complex than a simple transfer of funds, but a real managerial relationship between the USG and your government, both sides have vested interests in achieving health outcomes. As such, in-country and international non-governmental organizations should also be considered as partners in your advocacy. When approaching any individual or institution for assistance, be sure that you know first what you need, and second, what they might be able to offer, to help facilitate an exchange of resources.

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:

• “Advocating for Adolescent Reproductive Health in Sub-Saharan Africa” from Advocates for Youth, available at: http://www.advocatesforyouth.org/storage/advfy/documents/advocating.pdf
  
  
• “Advocacy Toolkit: A toolkit to equip young people with the skills to become powerful advocates for Youth Sexual Reproductive Health and Rights (YSRH&R)” from Advocates for Action and Student Partnerships Worldwide (SPW), available at: http://www.restlessdevelopment.org/file/final-toolkit-pdf
  
  
• "A Youth Activist ’s Guide to Sexual and Reproductive Rights” from the Youth Coalition, available at: http://www.youthcoalition.org/html/index.php?id_art=223&id_cat=7

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

Advocates for Youth © June 2011

GHI Quick Facts

1. GHI is an umbrella initiative that unites final targets, core planning principles, and implementation components for more than 80% of USG health programs.
   
   
2. Includes PEPFAR, PMI, FtF, TB, MNCH, and FP/RH, among other programs.
   
   
3. GHI shifts U.S. global health programs from “input” based to “outcome” based.
   
   
4. GHI applies to all 82 countries where the USG offers health development assistance.
   
   
5. In 2011, the GHI chose eight Plus countries which will serve as “Learning Laboratories”: Bangladesh, Ethiopia, Guatemala, Kenya, Malawi, Mali, Nepal, and Rwanda.
   
   
6. All GHI countries will eventually develop a country strategy coordinating U.S. government interventions with country government goals.

References

1. “U.S. Funding for the Global Health Initiative (GHI): The President’s FY 2012 Budget Request.” Kaiser Family Foundation (KFF) U.S. Global Health Policy Fact Sheets, Washington, 2011, p. 3. http://www.kff.org/globalhealth/8160.cfm Accessed on 15 May 2011.
   
   
2. For a full list of all 82 countries that receive bilateral global health assistance from the U.S. government, see http://www.usaid.gov/our_work/global_health/home/Countries/index.html
   
   
3. Eichler, Rena; Levine, Ruth “Performance Incentives for Global Health: Potential and Pitfalls.” Center for Global Development, Washington, 2009, pp. 11-22. http://www.cgdev.org/content/publications/detail/1422178 Accessed on 15 May 2011.
   
   
4. “Guidance for Global Health Initiative Country Strategies: GHI Guidance 2.0.” United States Government, Washington, 2011, p. 7. http://www.ghi.gov/resources/guidance/164904.htm Accessed on 3 June 2011.
   
   
5. “The United States Government Global Health Initiative Strategy Document.” The U.S. Department of State, Washington, 2011, GHI Plus Country Strategy Documents GHI Team review.
   
   
6. This section is an excerpt from a more comprehensive advocacy toolkit published in 1998 by Advocates for Youth. The excerpt has been adapted to focus on goals and objectives in the context of advocacy on the GHI. Shannon, Adam, “Advocating for Adolescent Reproductive Health in Sub-Saharan Africa.” Advocates for Youth, Washington, 1998, pp. 5-11. http://www.advocatesforyouth.org/storage/advfy/documents/advocating.pdf Accessed on 15 May 2011.

Mission

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.

The core values of Rights. Respect. Responsibility.® (3Rs) animate this vision:

RIGHTS:

Youth have the right to accurate and complete sexual health information, confidential reproductive and sexual health services, and a secure stake in the future.

RESPECT:

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.

RESPONSIBILITY:

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

Policy Brief: Affirming the Rights of Young People The

Facts: Youth and the Global HIV/AIDS Pandemic

See the complete library of publications at www.advocatesforyouth.org/publications