Evidence-Based Advocacy

Workshop on Evidence-Based Advocacy to Improve MNCHN

26-28 Aug 08

Agra

Interdependence of Evidence, Policy Analysis and Advocacy

Identification of Impediments to Program

Implementation

Share Best Practices and Knowledge from Other States

and Countries

Program Changes are Needed

Policy Changes are Needed

Best Practices Exist?

Evidence

Exists?

Advocate for Evidence-Based Changes in Policy and Resource Allocation

Conduct New Research

Yes

No

Analyze Existing Data

Advocate for Changes in Program Strategy and

Implementation

Provide Technical Assistance to Improve Programs

Yes

No

Research and data by themselves do not change policy — advocacy and leadership do

Researchers help by providing credible analysis and data that advocates and policy leaders use

• Agenda Setting

– First step is to get issue on policy agenda

– Getting policy-makers and leaders to pay serious attention to issue

– Help make case and make it credible

• “No Data, No Problem?!”

– Data and research help make health problems visible to public and policy makers

– Absence of data keeps issue invisible or seen as “unworthy” of public policy

Data and research in policy process

• Translational research helps answer important policy and political questions

– How big a health problem is it? — how many people it affects

– How severe a problem is it? — its health effects, social consequences, and economic costs

– Who is most affected? — characteristics of groups at greater risk

– What causes or contributes to problem? — factors that contribute to problem or increase risk

• Individual characteristics?

• Individual behavior or actions?

• Institutions or systems or policies?

– Frame issue to emphasize important policy perspectives and values

Data and research in policy process

Data and research in policy process

• Specifying policy alternatives

– Provide evidence about relative effectiveness of different policy options

• Research, data and publications that

– Discuss explicit policy implications

– Show extent that policy options address problem

– Show extent that they are feasible

Using data effectively! Choose data

• ...Relevant to policy/decision-maker• ... from a credible source and definitive• …and present it according to different audience

needs• …make sure it reach target audiences from

multiple sources• ...in which the “findings” are clear to policy makers

Choosing Data for Maternal Health Advocacy:

Choose data to show:

…Severity and trends

...Gains made through SBAs and EmOC (What works) and what does not work (ANC alone)

...Why maternal health matters

….Spin-offs/additional benefits

...What will happen without action

Use of evidence for influencing policies:

Some examples

UHRC-

Bringing information and evidence to describe challenge of urban health and its importance before policy makers and key stakeholders

Data on numbers of urban poor and the rate at which this segment was growing was collated from Census and other sources

NFHS-II data was reanalyzed to show that the health condition of the urban poor is comparable and worse at times than the rural population

City level primary research on health condition of the urban poor was carried out in select cities

Outcome:• Evidence helped acknowledgment of the issue by Govt and other

stakeholders

• Urban Health scenario reports for select states prepared, widely circulated among Government departments, state governments and key stakeholders for information, awareness to facilitate program planning and implementation

Bringing Evidence about Population Growth Trends

2 – 3 – 4 - 5 All India Urban areas Large cities Slums

13

Bringing Evidence Regarding Sharp Health Disparities in Urban Areas

101.3

63.1

103.7

6647

73.3

39.131.7

46.7

0

20

40

60

80

100

120

140

160

Under 5 mortality Infant Mortality Neonatal mortality

Low SLI Urban Average Rural average

Source: NFHS 2, 1998-99 reanalysis EHP USAID Urban Health Program, India

Safe Motherhood – WRAI example

• Started with NFHS-2 which indicated an increase in MMR• Used MMR and other maternal health data from NFHS-2 to

present facts to media and GOI on maternal health:– numbers of mothers affected/dying daily, – number of newborns who die when their mother dies– Low incidence of deliveries by health personnel– The three delays

• Identified global/regional evidence-based practices – midwifery life saving skills/skilled birth attendance

• Did a policy analysis to compare India’s policies related midwifery lifesaving skills/skilled birth attendance

• Identified gaps in policies• Advocated for change

No one right place/way to start the process

• Evidence can be global or local• Many places to start but should be backed by

evidence: – policy analysis – data findings– problem/barrier identified at the individual, family,

community, district or national level

• But advocacy issues and recommendations should be evidence-based and not just opinion