Presentation
Health Education and Advocacy
Experiences from Jordan
Amman
January 12, 2016
This document is confidential and is intended solely for the use and
information of the presenter.
1
Outline
 Health Education
 The Jordan Breast Cancer Program
 Health Advocacy
 The Health Care accreditation Council
 Interlinkages and Impact
2
Outline
 Health Education
 The Jordan Breast Cancer Program
 Health Advocacy
 The Health Care accreditation Council
 Interlinkages and Impact
3
A few Definitions in the world of Health Education
Health Education
Health education is a social science
that draws from the biological,
environmental, psychological,
physical and medical sciences to
promote health and prevent disease,
disability and premature death
through education-driven voluntary
behavior change activities
Health education is defined by the
Jordan Ministry of Health as "any
combination of learning experiences
designed to pre-dispose, enable, and
reinforce voluntary adoption of
behavior conducive to health".
Health education aims to increase
knowledge and awareness and is an
important component of health
promotion.
Information, education and
communication
Information, Education and
Communication (IEC) in health
programs is an important tool that
aims to increase awareness, change
attitudes and bring about a change in
specific behaviors.
IEC means sharing information and
ideas in a way that is culturally
sensitive and acceptable to the
community, using appropriate
channels, messages and methods.
It is therefore broader than
developing health education
materials, because it includes the
process of communication and
building social networks for
communicating information.
IEC interventions involve the active
participation of the target audience
and adopt channels, methods and
techniques that are familiar to their
world view.
Health Promotion
Health promotion aims to help people
to live healthy lives. It involves
increasing people’s knowledge and
awareness, enabling them to take
action to improve their health, and
ensuring that their circumstances
allow them to make healthy choices.
Health promotion includes:
•Health education
•Developing personal skills
•Strengthening community action
•Reorienting health services
•Building healthy public policy
•Creating supportive environments
4
Health education takes on the lead to change a certain behavior in
a strategic, systematic and targeted manner
Motivating
people

Supported by the latest
knowledge from research
(medicine, sociology,
psychology).

A systematic, comprehensive and
consistent activity.

Adapted to age, gender,
education and particular health,
mental or social problems of an
individual or community (school,
entreprise, city).

Encourages personal investment
of an individual.

Respects environment of an
individual.
Informing
people
Guiding into
action
5
Health education occurs in different settings for many purposes;
however, the process of what health educators do is the same
Setting
Primary Mission
Who is Served?
What kind of Services
School
Education
Children/
adolescents
• Unintentional injuries, Child abuse and neglect,
Substance abuse, personal health and hygiene
Worksite
Produce goods and
services; Make a profit (if
applicable)
Consumers of
products and
services
•
•
•
•
•
Hospitals
Treat illness and trauma
Patients
• In the hospital, direct patient education is part of
ongoing patient care and is typically delivered by
nurses and physicians
• Group health education on such topics as diabetes
and prenatal care are also provided
Community primary
care setting
Prevent, detect, and treat
illness and trauma
Patients
• Family planning
Physical activity and fitness
Nutrition and weight control
Stress reduction
Worker safety and health
Blood pressure and/or cholesterol education and
control
• Alcohol, smoking and drugs
• Nutrition
• Breast feeding
Health Department
Voluntary health
agencies
Chronic and infectious
disease prevention /
control
Public
Prevention and control
targeted disease/condition
Public
• Non communicable diseases
• School health
• Mental health
• Supportive of the last two examples
6
Health educator focus on the stages of change that a community
or individual will go through
7
Health education is part of an overall health promotion process
that is trying to impact individual or community behavioral change
III
Design and
implement
service
provision
Services
I
II
Define and
Understand
the health
problem
Assess the
barriers
IV
Enabling
environment
Evaluate and
assess impact
III
Knowledge
attitude
Design and
implement
Health
education
plan
V
Back to the drawing board
Remarks
Approaches in Public Health
 Regulatory approach
 Service approach
 Educational approach
8
Follow all the steps to design and implement a successful health
education plan
Establish the
program
Involve key
stakeholders
Identify target
audiences
Conduct a
formative
assessment
Segment target
audiences
Define behavioral
change
objectives
Pretest all tools
Monitor and
evaluate
Develop
communication
tools and
activities
Design the
strategy, plan and
evaluation of the
program
Implement
9
The communication / education plan is not only about the media
channels that are used
Communicator
Knowledgeable, effective, responsive, trained, trustworthy, influencer
Message
Target specific, age, culture, sensitive, comprehensible, action oriented, designed
properly
Audience
Defined, understood, receptive, reachable, influenced by
Channels
Accessible, trustworthy, combination,
10
Modes of communication can be grouped into three categories
Mass
Group
Individual
 T.V
 Lectures
 Individual and family sessions
 Radio
 Film and charts
 Door to door outreach
 Press
 Group discussion
 Clinic based education
 Films
 Panel discussion
 Health magazine
 Symposium
 Posters
 Workshop
 Health exhibition
11
All of which should be identified and measurable from the
beginning
12
Outline
 Health Education
 The Jordan Breast Cancer Program
 Health Advocacy
 The Health Care accreditation Council
 Interlinkages and Impact
13
First we define the problem
III
Design and
implement
service
provision
Services
I
II
Define and
Understand
the health
problem
Assess the
barriers
IV
Enabling
environment
Evaluate and
assess impact
III
Knowledge
attitude
Design and
implement
Health
education
plan
V
Back to the drawing board
14
Breast cancer is the most common cancer among females and
continues to grow on a yearly basis
Ten Most Common Cancers
Among Jordanian Females
JNCR 1996-2006
New Cases of Breast Cancer
JNCR 1996-2007
817
646
554
Number of Cases
Cumulative Number of Cases
6018
1710
1228
954
925
953
674
744
t
l
ri
d
n
ry
ia
ta
as
NS
te
oi
ki
c
r
e
m
va
C
U
S
r
e
y
.
e
r
O
&
B
s
k
.M
lo
Th
in
eu
pu
o
N
a
r
r
L
C
B
Co
Primary Site
629
448
ASR
45.6
ASR
39.2
ASR
29.4
525
1996
L
h
H.
ac
N.
om
St
ASR
35.2
2000
2004
2007
35.3%
36.2%
years
% from
all
cases
28.5%
32.7%
15
Jordanian females are inflicted with the disease at a young age
when they are at the peak of their productivity
Distribution of Breast Cancer Cases by Age Group
JNCR 2005
Average Age Specific Incidence Rate (ASIR)
Per 100,000 Females 1996-2006
JNCR
7%
10
8.
3
92
.5
90
.4
88
.4
80
60
40
1.
1
0.
09
5.
9
20
2%
13
2.
4
57%
9
15%
100
54
.2
18%
120
23
.4
Number of Cases
Percentage of
Breast Cancer Cases
140
13
1.
8
26%
4
160
14
1.
3
16
5.
3
180
31%
Age
*Median age in developed countries = 65 years
75
+
4
70
-7
9
4
65
-6
60
-6
55
-5
50
-5
9
45
-4
9
4
40
-4
35
-3
4
9
70+
30
-3
60 - 69
25
-2
50 - 59
4
40 – 49
20
-2
30 - 39
<2
20 – 29
0
0
Years
Ave Crude Incidence Rate
= 22.8/100,000
16
At the onset of JBCP, Breast Cancer used to be detected at late
stages when the survival rate and treatment success are not
promising
Stages of Breast Cancer in Jordan
based on KHCC Experience b4 JBCP
Direct Correlation of Survival to Stage of Detection
120%
Stage 0,
0.50%
Stage 1
6.70%
100%
100%
98%
Stage IV,
12.90%
Stage II,
23.70%
Stage III,
56.20%
Percent of Survival
88%
76%
80%
60%
46%
49%
40%
16%
20%
0%
0
I
II a
II b
III a
III b
IV
Stage of disease at Detection
5 years relative rate of survival
N=550
17
Then we look at barriers
III
Design and
implement
service
provision
Services
I
II
Define and
Understand
the health
problem
Assess the
barriers
IV
Enabling
environment
Evaluate and
assess impact
III
Knowledge
attitude
Design and
implement
Health
education
plan
V
Back to the drawing board
18
Awareness and services on breast cancer early detection and
screening were limited, diagnosis focused and not
institutionalized
Capacity Building
Mammography Services
 Lack of female technicians trained in
mammography and recruited to serve the facilities
 Lack of availability and accessibility to screening
services
 Absence of training facilities (other than KHCC) in
Jordan to accommodate for training of technicians
and radiologists
 Unequal distribution of services across the
Kingdom
 Incomprehensive academic curricula that do not
mandate mammography as a required course for
technicians
 No asymptomatic screening policy; only referred
symptomatic patients accepted
 Cumbersome regulations to screening
 Training manuals have not yet been implemented
Quality Assurance
Public Awareness
 Lack of protocols and standard operating policies
and procedures (SOPs) to run the units
 No certification program to set the standards for
the mammography units
 Negative attitudes towards subject of breast cancer
(many females prefer not to know) added to cultural
barriers & social taboos that extend beyond the
female herself leading to fears of being ostracized
by husband, family, or society
 No monitoring and evaluation of performance of
health providers regarding guidelines for breast
screening
 Need for more individualized and one-on-one
activities in order to change behavior that require
large outreach efforts
 Lack of awareness, buy-in & action of keyinformant & service providers supporting screening
19
Then we design the program
III
Design and
implement
service
provision
Services
I
II
Define and
Understand
the health
problem
Assess the
barriers
IV
Enabling
environment
Evaluate and
assess impact
III
Knowledge
attitude
Design and
implement
Health
education
plan
V
Back to the drawing board
20
Thus the Jordan Breast Cancer Program was set up in early 2007
to down stage the disease and decrease morbidity and mortality
 To reduce morbidity and
mortality from Breast Cancer
by early detection and
screening;
 To shift the current state of
diagnosis of Breast Cancer
from its late stages (III- IV), to
diagnosing Breast Cancer at its
earliest stages (0-II) where the
disease is most curable,
survival rates are highest, and
treatment costs are lowest;
Program Objectives
Program Goals
 To improve availability and accessibility of screening
services across Jordan, especially to those with low
income and those residing in remote areas with little
access to healthcare services;
 To increase the knowledge of the public on the benefits
of breast cancer prevention and to change the attitude and
behavior of the target population to seek early detection
services;
 To establish national unified protocols and guidelines
that cover all processes of a comprehensive early
detection and screening program. These guidelines will
include best practice and quality assurance guidelines on
training, medical equipment, diagnosis, and referral
systems;
 To improve healthcare personnel education and
training; and
 To evaluate the impact of the program by collecting
data for surveillance and epidemiological analysis to
record and measure success of early detection.
21
We look closely at the health education part
III
Design and
implement
service
provision
Services
I
II
Define and
Understand
the health
problem
Assess the
barriers
IV
Enabling
environment
Evaluate and
assess impact
III
Knowledge
attitude
Design and
implement
Health
education
plan
V
Back to the drawing board
22
JBCP designed core strategic areas to work on and developed an
action plan with prioritized activities
Accessibility,
Availability and
Usability
Developing
Human
Resources
 Targeted Awareness Activities
 March Campaign
Strategy and Data
Campaigns October
 Development of Information &
Communication Toolkits
 JBCP Hotline promotion
Quality
Assurance
Public Awareness
and
Health Education
23
The Jordan Breast Cancer Program follow a very rigorous and
scientific approach in designing their educational campaign
Step One: Research
Step Two: Planning Phase
2.1: Setting A Goal
2.2: Identify Target Group
• Who / where are they (demographics)?
• How do they obtain daily information?
• Who are their role models?
• What are their current perceptions, knowledge,
needs, wants, preferences, and behavior in relation
to the issue addressed by the campaign?
• What prevents them adopting the alternative
behavior promoted by the campaign?
• What would motivate them to adopt the promoted
behavior?
•
•
•
•
A good message gives a reason.
A good message is understandable.
A good message is, convincing.
A good message is acceptable.
2.4: Developing the Campaign Action Plan
Step Three: Implementation phase
Step Four: Follow up…Monitoring
Step Five: Reporting and Evaluation
5.1: October Campaign report
5.2: National Survey to assess the campaign
2.3: Developing the Campaign Message /Slogan and
Design
• A good message is simple and clear.
• A good message is true and credible.
24
The health education plan includes several channels of
communication for awareness and targeted goals
Mass Awareness
• Audiovisual activities (TV, Radio,
• Printed media (newspapers, magazines)
• Outdoor branding (bridges, wall units, billboards,
mupies, lamp-posts)
• Social media and E-Media (FB, Twitter, instagram,
Websites)
Outreach
• IEC Material distribution (flyers, shower cards,
booklets, bookmarks, bank inserts)
• Lectures
• Road-shows. ( malls, schools, health centers,
universities)
• Open days. (auditioning performances)
Screening
• Free CBE
• Discounted mammogram for all women
• Free mammograms for underprivileged women
25
Provision of services is coupled with raising awareness among
the public and driving the demand towards early detection
Outreach
# of Beneficiaries
Clinical Breast Exam
31,813
20,067
12,133
2006
2007
2008
Women
Year
Mammograms
1,788
2,030
431
2006
2007
Year
MoH
JBCP
Total
Lectures
1,445
162
1,607
Attendance
13,414
5,985 19,399
SBE’s train
9,392
5,985 15,377
2008
26
Then we monitor and evaluate before going back to the drawing
board
III
Design and
implement
service
provision
Services
I
II
Define and
Understand
the health
problem
Assess the
barriers
IV
Enabling
environment
Evaluate and
assess impact
III
Knowledge
attitude
Design and
implement
Health
education
plan
V
Back to the drawing board
27
In less than two year’s experience, preliminary indications from
KHCC data already show a shift in staging of the disease
Stages of Breast Cancer in Jordan
based on KHCC Experience before program
Stage 0,
0.50%
Stage 1
6.70%
Stages of Breast Cancer in Jordan
based on KHCC Experience after program
Stage 0
4.79%
Stage I,
8.90%
Stage IV,
12.90%
Stage IV,
17.35%
Stage II,
23.70%
Stage II,
41.32%
Stage III,
24.20%
Stage III,
56.20%
3.42% unknown
N=550
N=438
28
Year after year the message matures and changes to build on the
successes of the year before and address the challenges that are
still faced (1)
2006
Early detection saves lives
2009
At 40 we screen
2007
Female: a mammogram helps you
2010
We screened…did you?
2008
Detection means safety
2011
Encourage her to screen
29
Year after year the message matures and changes to build on the
successes of the year before and address the challenges that are
still faced (2)
2012: promise to Screen
2013: Screen we are all with you
2015: stay in my life
2014: Lets go, your health is more important
30
Outline
 Health Education
 The Jordan Breast Cancer Program
 Health Advocacy
 The Health Care accreditation Council
 Interlinkages and Impact
31
Advocacy is to promote or reinforce a change in policy, program
or legislation rather than providing support directly to clients or
users of services, advocacy aims at winning support from others.
III
Design and
implement
service
provision
Services
I
II
Define and
Understand
the health
problem
Assess the
barriers
IV
Enabling
environment
Evaluate and
assess impact
III
Knowledge
attitude
Design and
implement
Health
education
plan
V
Back to the drawing board
32
In many ways, advocacy, like any other program, follows a series
of steps to arrive at the intended goal
Process
 Identify the need or the problem
Pitfalls
 Gather data to document the need or problem
 Failing to effectively communicate needs to
healthcare providers
 Identify decision-makers
 Taking an “all or nothing” approach
 Gather support
 Not being willing to try a service or program
 Develop recommendations to address the need or
problem
 Focusing on unproductive approaches in the
healthcare process
 Make the case
 Not documenting everything
Areas of Advocacy
Stakeholders
 Leadership development
 Beneficiaries
 Coalition building
 Decision makers
 Networking
 Allies and partners
 Political Lobbying
 Resistant groups (Adversaries)
 Promoting legislative change
 Briefing media
 Counteracting opposition
33
Advocacy has specific techniques and tactics
Advocacy
techniques and
tactics
Audience/Stakeholder Category
Beneficiaries
Partners
Adversaries
Decisionmakers
Sensitization
Mobilization
Dialoguing
Debating
Negotiating
Lobbying
Petitioning
Pressuring
34
Advocacy in health care is critical at the policy level and for
sustainability purposes
Health is a political issue
Why
How
 Individual & institutional health actions have
spillover effects
 Measure public priorities/opinions:
 Citizens expect government to satisfy physical,
economic & psychological needs
 Find priorities of legislators:
 Protecting public health involves moral judgments
that acquire legitimacy thru political debate
 Healthy population is vital to economic growth &
social order
 Measure media coverage:
 Categorize the salience of issue:
 Identify key political decision makers
•
Which organization?
•
Who?
•
When and how?
When
 Documentation of scientifically & socially credible
threat
 Agreement on who or what is responsible for the
problem
 Social views about affected populations
Who
 Individual
 Professional
 Interest group
 Lobbyers
 Academia
 community
35
Outline
 Health Education
 The Jordan Breast Cancer Program
 Health Advocacy
 The Health Care Accreditation Council
 Interlinkages and Impact
36
Although Jordan fairs well on many health indicators, the in depth
reality of services in Jordan was challenging
Weaknesses
 No data related to patient
safety
 No P&Ps &/or clinical
guidelines
 Reporting culture
 Lack of enforcement of
Regulations and Safety
regulations
 No medical liability law
 Lack of continuous
credentialing and
privileging system tied to
continuous education
 Impact of crisis in the
region and load on the
healthcare system.
37
So the Health Care Accreditation Council (HCAC) was established
in an effort to address some of the challenges
PHCs accredited
Surveyor
training started
Donor support
for government
of Jordan on
accreditation
Piloting in
Hospitals
Diabetes
Standards
&
Cardiac
Standards
Launched
ISQua accredits
HCAC
ISQua accredits
the hospital
accreditation
standards
First group of
accredited
hospitals
Strategic plan
MOH
ISQua
Reaccredits
HCAC
1st Change Day
2006
2004
2003
12 members
form a
National
Accreditation
Committee
was approved
2005
2008
2007
2010
2009
1st edition
Primary Health
Care Standards
First draft of
Jordanian
Hospital
standards was
published
Establishment
of HCAC
NQSGs
launched
ISQua accredits
Surveyor
Certification
Course
2014
2012
2011
Centers of
Excellence First
Edition
Breast imaging
Units Standards
Medical
Transport
Standards
2013
Official
partnership
with
Ministry
and
stakeholder
2015
Mandatory
accreditation
law drafted
Change Day
2015
3rd Quality
Conference
38
Through the provision of two types of services
Standards Development
Surveyor Development
Accreditor
Accreditation
Surveys and
Standards
Development
Department
Functions
Firewall
Mock Surveys
Consulting for Quality
Preparedness
Enabler
Training and Certified Courses
Education and
Consultation
Department
Consultant Development
39
So today, HCAC is not just an accreditation body, it is a nonprofit
institution with the aim to raise the quality of health services
Mission
Objectives
Stakeholders
Components
Accreditation
Consultation
Capacity Building
Quality services
Institutions
Health Professionals
Patients & Families
Supportive environment
Research
Decision Makers
Continuous Quality
Improvement and
Patient Safety
40
…works on different levels to support quality improvement and
patient safety…
Awareness
Education
Research
Courses
• Healthcare Certified Quality Practitioner
• Healthcare Certified Clinical Risk Manager
• Healthcare Certified Executive Leadership
• Healthcare
Certified Infection
Preventionist
41
…and runs National Quality and Safety Goals every other year
Remarks
Goals
2010
 Ensure compliance with hand hygiene
best practice
 All Medical Record Entries must be
Timed, Dated, and Signed
2011
 Clear and Interactive Communication
During "Hand Over“
 Improve the Safety of Multiple Dose Vials
(MDV) Use
 Safe Management of Central Lines to
Minimize Infection and complications.
2012
 Identify Patient Correctly
 Improve Safety of High Alert Medication
 Ensure Correct-Site, Correct-Procedure,
Correct-Patient
 Patient fall
 Appropriate use of prophylactic antibiotics
in surgery
 Reduce the risk of catheter associated
urinary tract infections
2013
2009
Year
 Improve Pain Management
 Medication Reconciliation
 Zero Tolerance for Workplace Violence
 It is part of HCAC’s CSR
 Goals are developed in a consultative manner
 Goals are selected based on the:
 Potential of happening
 Potential impact
 Applicability to all sectors
 Applicability to all types of people
 Uniquely Jordanian
 Solutions are possible
 Goals must be:
 Valid
 Reliable
 Clear
 Realistic
 Measurable.
 Institutions apply voluntarily and have to demonstrate:
 written and implemented evidence based policy/guidelines
 In-service training for relevant staff
 Documented evidence of implementation
 Monitoring of the compliance
 With positive results
 Certification is awarded for one year
42
The accreditation initiative has had several impacts at the macro
and micro levels in Jordan
Macro
 Develop the expertise of
quality and patient safety 
8 Certified
Consultants
35 Certified Quality
professionals
27 Certified Infection 
Control professionals
14 Certified Risk
Management
26 Leadership &

Management
 Instill at the institutional 
level progress, change
and improvement
17 hospitals
accredited – four in

the pipeline
90 PHC accredited –
27 in the pipeline
 Have a body to advocate,
focus and push the
agenda (become a line
Institutional
item in the MOH Budget)
Raise level of awareness
of the importance of the
subject matter & develop
services to ensure buy in
Address needs of the
country & region and
respond to emerging
issues
Improve health care
quality through standards
Stimulate the
management of health
services to focus on
quality and patient safety
Improve professional’s
understanding and skills
on quality improvement
strategies and "best
practices"
Radiation Safety
 Increased the
professionalism of
care providers
 Increased sense of
responsibility
towards the clients
 Improved
communication
and cooperation
with client/ families
 Improved the level
of medical services
provided to clients
 Enhanced the
confidence in the
care
 Minimized/prevente
d incidents caused
by the health care
process
Medication
management
Overall Safety
Infection
Control
Medical Record
Patient and
Employee
Satisfaction
Housekeeping
Management
and
Leadership
Committee
Medical
Record
Committee
Infection
Control (IC) &
Environmental
Safety
Committee
Quality
Improvement
& Client Safety
Committee
Continuity
43
The evidence of the impact of HCAC accreditation is being
generated but still needs more years of implementation
44
Accordingly the government has taken many strides to
institutionalize accreditation
Ministry of Health
Establishment of Central Accreditation
Steering Committee Headed by
General Secretary
Support quality management
directorate with staff and other
resources
Assign quality coordinator in all
health directorate
Establishment of medical record
committee
Quality and accreditation on MoH
strategic plan for 2014 – 2017
Recent Steps
 His Majesty King Abdullah II bin Al Hussein initiative for
at least one accredited hospital in each governorate
 New private hospitals law indicates accreditation to be
accomplished within 5 years from publishing
 Accreditation targets identified and specific in Ministry
of Health strategic plan 2014-2017
 Jordan 2025 indicates accreditation as a requirements
for hospitals
 In response to a directive of His Majesty, the Prime
Minister commissioned the Ministry of Health to draft a
law for mandatory accreditation for all health sector in
Jordan
 Senate has requested accreditation of institutions to
follow medical liability law
45
Health workers have a very positive view of the role of
accreditation on improving the work of health centers
"The accreditation had a positive effect on my health center"
Strongly
Disagree,
0.3%
Strongly
Agree,
54.0%
“The following department or service
was mostly effected”
Disagree,
0.3%
Agree,
45.4%
Mean Scores for 1st & 2nd Collaboratives
Patient Satisfaction Surveys
Courtesy of Health Systems Strengthening Project II implemented by Abt Associates and funded by USAID
46
Upward trends in several areas in accredited vs. non-accredited
PHCs have been noted
CYP Increase: 3rd Collaborative HCs
2500
2000
1500
1000
500
0
qtr
1/2013
qtr
2/2013
qtr
3/2013
qtr
4/2013
qtr
1/2014
Courtesy of Health Systems Strengthening Project II implemented by Abt Associates and funded by USAID
47
Sometimes pictures are worth a thousand words (before)
48
Sometimes pictures are worth a thousand words (after)
Look alike
medication
Sound alike
medication
49
So how did health care quality and patient safety become a
political issue through the advocacy steps?
Health is a political issue
Why
How
 Individual & institutional health actions have
spillover effects
 Measure public priorities/opinions
 Citizens expect government to satisfy physical,
economic & psychological needs
 Find priorities of legislators
 Protecting public health involves moral judgments
that acquire legitimacy thru political debate
 Healthy population is vital to economic growth &
social order
 Measure media coverage
 Categorize the salience of issue
 Identify key political decision makers
•
Which organization?
•
Who?
•
When and how?
When
 Documentation of scientifically & socially credible
threat
 Agreement on who or what is responsible for the
problem
 Social views about affected populations
Who
 Individual
 Professional
 Interest group
 Lobbyers
 Academia
 community
50
Outline
 Health Education
 The Jordan Breast Cancer Program
 Health Advocacy
 The Health Care accreditation Council
 Interlinkages and Impact comparison
51
Health education and health Advocacy are similar yet different in
many ways however always aiming at improved health
Advocacy Goal:
Actively
supporting a
cause,
and trying to
get others
to support it
as well
Process Similarities
. Identify,
segment audiences
. Undertake research to
clarify issues
. Develop
strategies & messages
. Monitor and
evaluate
Health Education Goal:
Change attitudes,
Beliefs, values and
Behavior of
individuals
or group of
individuals
Although there is a good deal of overlap between health education and advocacy, advocacy activities tend to be
more deliberately persuasive and campaign oriented.
52
Comparing the JBCP and the HCAC programs
Advocacy
Health education
aims to gain wider support ensuring
educates individuals and the community
about the existence and benefits of
JBCP
regular screening for women for the early
detection of breast cancer
Importance of early detection through
regular exams and successful treatment
HCAC
Improving patient safety and quality in
health care
Patient rights, patient safety tools,
53
whether it is a health education issue or an advocacy issue, the
systematic targeted approach is the same
Understanding
situation
and needs
Acquiring
skills
Implement
-ing
behavioral
change
Requiring
change
Doing it
over and
over
Doing it
willingly –
embedding
behavioral
change in
day to day
life
54
JBCP is a bottom up participatory approach to inducing change in
a the health of a population
JBCP
5
4
3
2
1
Public
Awareness
Capacity
Building
Development of
Services
legislation
Stable
Funding
HCAC
5
4
3
2
1
Public
Awareness
Stable
funding
Awareness and Education
Legislation
Capacity
Building
Service
provision
Advocacy
55
However, many education and advocacy efforts in health in the
region are not institutionalized
What's working?
 Many national programs driven by government or
NGO that have positive impact on health
Challenges
 Continuity vague
 Not legislated
 Diabetes
 Funding dependent
 Healthy lifestyles
 Not coordinated
 Family planning
 Working in silos
 Vaccination
 Advocacy is not well used as a science for change
 Road accident
 Politics / policy are government driven
 Several advocacy efforts working such as quality
and patent safety, family protection and safety,
women rights
 Lack of data
 Academia not involved in overall design of policy
 Drivers include NGOs, donor organizations and to
a lesser extent government
 Good capacity for health promotion
56
Therefore a more concerted effort will be more cost effective and
impactful for the success of advocacy and health education
Maturity
Consolidation
Expansion
Experience/
Experiential
Awareness
Pre-existing
phases
57