How advocacy can support the implementation of healthcare reform

Advocacy to influence strategies and public policy is an essential part of supporting and advancing healthcare systems in Africa. But with a complex mix of diplomacy, financial capacity and relational capital required to make advocacy effective, how can it be best implemented by those wishing to support governments?

January 11, 2021
Bonface Fundafunda, Paul Bitarabeho and Le Beau Taljaard

The most important thing to understand is that advocacy needs to be intentional. It cannot be an incidental component of a public health initiative or proposal.


Complex relationships exist between and within the different stakeholder groups that have authority and responsibility for the domains that need to be aligned before a vision can be implemented. This means that people within an organisation, although they may understand and agree with a particular model on a personal level, need to assess the institutional stance or concerns around the issue before they are likely to become vocal supporters.

In many instances in Africa, this has led to the need for slow, trust-centred relationship building on an informal level. This could include an in-house champion in a department or organisation being equipped with all the relevant information to create a long-term narrative about the benefits that will allow their institution to begin incorporating some of the new thinking and approaches into their policy decisions.

An internal champion can help enable a key client to reach out to other influential departments that have a bearing on the success of an initiative. This will improve buy-in, support and understanding of how it is in the interest of public health and can support the delivery of public services.

Different organisations and influences need to come together for new approaches to be implemented effectively, meaning that advocacy needs to incorporate continuous, widespread communication about the intention, anticipated benefits and means to apply new public health initiatives. Some of this will be informal, but in several countries, more formalised advocacy and active communication with stakeholders have greater effectiveness.

More formal advocacy includes alignment or involvement with technical working groups as early in the process as possible when a new model is being developed. In addition, finding ways to link proposed models with existing policy will help facilitate greater buy-in from key stakeholders, particularly governments, which are often bound by institutionally set priorities and policies. This will also allow stakeholders to raise some of their concerns upfront, which can be addressed then and there, or after consultation with other relevant parties.

Continuous advocacy throughout the process of developing a product, solution or model means that people’s input will be included along the way, and a collective process will have shaped the result. This will also allow support organisations to keep abreast of changing strategies, and environments. For example, with the arrival of COVID-19 health ministries have shifted their focus to integrated services and decongesting facilities, and when advocates have a seat at the table they can observe and apply these learnings to new approaches from the start.


Advocacy is also not just one-directional. At different points, donors, suppliers and governments, may each need an independent advocate to facilitate below-the-line conversations to enable the advancement of a project or model. This requires the support of an organisation like the Africa Resource Centre, which has omni-directional influence and has cultivated a reputation of being a neutral, trustworthy support to many different stakeholders involved in public health supply chain.

With increased and consistent involvement in advocacy, respect and interaction with different stakeholders increases. It is essential to understand that influence and advocacy rely on trust and good relationships.

For organisations wishing to contribute to positive, effective advocacy, one of the most important components is to establish a comprehensive list of every stakeholder and decision maker that will be influenced by or need to be consulted with in order to implement a new or revised approach. This also allows advocacy groups to present their messaging in a way that will have the greatest relevance for each stakeholder.


The impact of effective advocacy will not be immediately obvious. Slow and indirect outworking of successful advocacy emerges in shifting approaches based on shared ideas over time. This in effect can create a ‘long tail’ for some projects, where there is a long lead time for all the relevant stakeholders to align with the vision. This shifts the focus to be less on speed, and more on long-term efficacy, which means cultivating trust over time.

That can be challenging when a support organisation is restricted by timeframes that depend on external funding criteria, and they need to account for this possibility in their financial planning.

Effective advocacy for a single initiative can take six to 18 months, which represents a serious financial investment. However, if it has been sufficiently planned for, creating space for advocacy to work effectively can have a substantial, positive long-term impact on healthcare systems in Africa.


Bonnie Fundafunda, PhD. is the regional lead, supporting East and Southern Africa countries for ARC. He has over 30 years’ experience in health policy, planning, strategy, operational systems and business development in Africa.

Paul Bitarabeho has over 23 years’ experience in supply chain management in the FMCG industry. He has worked with Coca-Cola in Africa and Asia, Uganda Breweries and Kenya Breweries Ltd, all subsidiaries of Diageo and In Nile Breweries, in supply chain management, Sales and Human Resources at Director Level.

Le Beau Taljaard has over 25 years’ experience delivering growth for clients and his own organizations in the FMCG industry. He gained significant experience and expertise in the Route to Market and Supply Chain with the Smollan Group where he participated in and led new business development, establishing new business units, operational implementation, operational/general management and client interaction.