10. Advocating for Change

Adapted from: Deane, J., and Parks, W. Advocacy, Communication and Social Mobilization to Fight TB: a 10-Year Framework for Action / ASCM Subgroup at Country Level. World Health Organization and Stop TB Partnership. Geneva: WHO Press, 2006.

Every person with the airborne infectious disease tuberculosis infects, on average, 10 to 15 people every year (WHO). Currently, one third of the world’s population, or two billion people, are infected with TB-causing microbes (WHO). It is a disease of poverty, greatly affects those living with HIV/AIDS, and has caused several African countries to declare it a regional emergency. Nelson Mandela warned, “We cannot fight AIDS unless we do much more to fight TB” (WHO). TB has killed more women than all other causes of maternal mortality combined (Stop TB, Module 4). The treatment for TB is a long course of antibiotics and many fail to take the complete course giving the microbes a chance to thrive and become resistant to first-line treatments.

Global targets to control tuberculosis were developed by The Global Plan to Stop TB, 2006-2015. To help meet the strategic directions of this plan, the Advocacy, Communication and Social Mobilization to Fight TB (ASCM) was established as a working group of the Stop TB Partnership. The goal of the ASCM Working Group (ASCM WG) is to support The Global Plan to Stop TB by mobilizing “political, social and financial resources; to sustain and expand the global movement to eliminate TB; and to foster the development of more effective ACSM programming at country level in support of TB Control” (ASCM 7). ASCM also supports the Millennium Development Goal of halting and beginning “to reverse the incidence of TB by 2015 and to have reduced TB prevalence rates by 50% compared with the year 1990” (ASCM 12).

The ASCM WG works to address four key challenges: case detection and treatment adherence, combating stigma and discrimination, empowering people affected by TB, and mobilizing political commitment and resources for TB (ASCM 12). The ASCM WG has embraced four key terms in their efforts: communication, advocacy, social mobilization, and capacity building. Advocacy, communication, and social mobilization are seen as integral and valued efforts in TB strategies. Communication involves all channels of information in mass media, community media, and interpersonal interaction.ASCM views that for communication practitioners to be effective, “communication should be understood as a two-way process, with ‘participation’ and ‘dialogue’” (ASCM 15). Communication targeted at health workers, employers, families and communities can help reduce TB-related stigma, which is a major barrier for people to seek diagnosis and treatment.

 Advocacy in the ASCM definition “denotes activities designed to place TB control high on the political and development agenda, foster political will, increase financial and other resources on a sustainable basis, and hold authorities accountable to ensure that pledges are fulfilled” (ASCM 16). Advocacy involves policy advocacy aimed at influencing senior politicians, program advocacy aimed at convincing opinion leaders at the local and community levels, and media advocacy to generate government and donor support. “In the global context, advocacy for TB control is to be understood as a broad set of coordinated interventions”, while in “country contexts, advocacy efforts broadly seek to ensure that national governments remain strongly committed to implementation of national TB control/elimination policies” (ASCM 16). The latter may focus on press conferences, meetings between stakeholders, and letter-writing. ASCM emphasizes capacity building in their advocacy efforts because it helps to make the program efforts sustainable. ASCM has numerous models and tools for doing advocacy work with matching indicators. They include the promotion of TB champions within and outside government, the establishment of national partnerships, TB patient activism, use of media, and World TB day promotional materials. Anticipated outcomes of timely and sustained advocacy efforts include 1) governments make TB a high priority and provide quality services, 2) effective monitoring, 3) an increase in the number of TB-free communities, and 4) governments, communities, and households integrate appropriate health values and practices into their culture (ASCM 50).  Funding of such advocacy efforts was determined through in-country consultations, an analysis of proposals submitted to The Global Fund for AIDS, TB, and Malaria, and “extensive experience in other health issues suggesting that an overall 5-15% of total TB control program efforts should be allocated to country-level ACSM activities” (ACSM 84).

ASCM encourages matching tools and problems because “advocacy sets up the enabling environment, but by itself might not change behavior” and it recognizes that campaigns could have unintended consequences or “build the wrong behavior” (Stop TB, Module 5). Advocacy may not necessarily change behavior but it can raise awareness, influence policy, and set the public agenda.  It is recommended to consider specific community opinion leaders who make health decisions because “people make many behavioral choices to comply within their communities and social networks” (Stop TB, Module 5).

Peru and Mexico have seen positive results of ACSM in TB control efforts. In Peru and Mexico, TB was approached as originating in a social, economic and cultural context. In Mexico, appropriate community and local mass media supported communication mechanisms (ACSM 19). Peru used patient-centered mobilization and empowered patients in creating “citizenship awareness of the complexity of TB,” and “brought in the commitment of new actors” (ACSM 20). In both countries, advocacy and community mobilization efforts have been sustained over many years.

RESOURCES:

"2007 Tuberculosis Facts." World Health Organization and Stop TB Partnership. 13 Nov. 2007 

Deane, J., and Parks, W. Advocacy, Communication and Social Mobilization to Fight TB: a 10-Year Framework for Action / ASCM Subgroup At Country Level. World Health Organization and Stop TB Partnership. Geneva: WHO Press, 2006.

"Introduction to Advocacy Communication and Social Mobilization Workshop." Module 4 and 5. Stop TB Partnership. Sept. 2005. 15 Nov. 2007

(Based on a report of a policy advocacy campaign for child passenger safety with the State of Kansas legislature in the early 1980's; as reported by Valorie Carson, KU Center for Community Health and Development​. For more detailed information see the following citation: Fawcett, S.B., Seekins, T., & Jason, L.A. (1987). Policy research and child passenger safety legislation: A case study and experimental evaluation. Journal of Social Issues, 43, 133-148.)

BACKGROUND AND CONTEXT:

In the winter of 1980-1981, a Kansas state representative, with the support of the Kansas Medical Society and Kansas Women for Highway Safety proposed the Kansas Child Passenger Safety Act. A group formed to advocate for the passage of this bill aimed at improving safety of children riding in cars and other vehicles. The campaign was started in response to data collected indicating that many children were being injured when riding in motor vehicles and that child passenger safety devices were not being used. Similar bills had been passed in the states of Tennessee and Rhode Island, (USA).

GOALS OF THE CAMPAIGN:

The mission of the campaign was to prevent children from being injured while traveling in motor vehicles. The specific goal of the legislative advocacy campaign was to help pass a state law that would require all children under the age of 5 years in the state of Kansas to use a safety seat while traveling in motor vehicles and for a fine to be imposed on parents or guardians found driving with children not riding in protective devices, such as an infant carrier or car seat. Specific changes sought included seeking the Senate Transportation Committee's approval for the bill and subsequently the state legislature.

TARGETS AND AGENTS OF CHANGE:

Concern about the passage of a child passenger safety bill led the advocacy group to engage several agents of change. Members of the Senate Transportation Committee were seen as the most immediate targets of change for passage of the bill, with the full legislature following. Several agents of change were enlisted to address concerns about public support and perceived need for such a bill and to illustrate the physical injuries that can result from motor vehicle accidents in which children passengers are unrestrained.

STRATEGIES AND TACTICS OF LEGISLATIVE ADVOCACY:

Researchers from the University of Kansas collected data regarding: (1) whether the issue was sufficiently important to merit consideration by the legislature, and (2) whether constituents would support any regulation in an area usually reserved to parental discretion. Surveys and behavioral observations (to measure the prevalence of children under the age of five years in passenger protective seats) were completed in three Kansas communities to provide data to the legislature of their constituents support for such a measure. A pediatric psychologist presented a film about depicting physical injuries resulting from unrestrained child passengers and the president of the Kansas chapter of pediatricians spoke on national efforts for child passenger safety. In addition, a pediatrician spoke of treating several children who had been injured. The afore mentioned data was presented in public testimony to the House Committee on Public Health and Welfare as an argument for the bill's passage.

RESOURCES AND ASSETS USED:

Resources used included the time and talent of University of Kansas researchers and the conviction of Kansas health care providers and other experts in child passenger safety. A grassroots advocacy group, the Kansas Women for Highway Safety, provided a statewide presence. The campaign was effectively orchestrated by a lobbyist for the Kansas Medical Society.

ALLIES AND OPPOSITION:

Allies in the campaign included the Kansas Medical Society (especially pediatricians and family practitioners), a grassroots advocacy group called the Kansas Women for Highway Safety, and a freshman legislator who had been a nurse. A lobbyist from the Kansas Medical Society helped to draft the bill based on the Tennessee and Rhode Island legislation for child passenger safety. The Kansas Women for Highway Safety had had prior experience supporting legislative attempts to prevent injury and death due to highway accidents. While the freshman legislator knew that many similar bills were being introduced in other states, the committee's vote for consideration of the bill was close and she was concerned about its passage.
Anticipated opponents of the bill included car dealers and owners of station wagons. Unanticipated opponents that emerged after the bill was proposed were conservative forces and parent's rights groups, who felt the proposed bill put an undue burden on parents and imposed on the freedom of parents to care for their children as they best saw fit. Opponents sought to block the policy change, based on the argument that it would be too expensive to implement and enforce and that it infringed on individuals' rights, creating only more government interference into people's lives. They also argued that it unfairly burdened poor families and those with many children. The advocacy group reframed the debate away from one of the freedom of parents to one of the rights of children to be safe and healthy.
Subtle intimidation was later applied by an unidentified legislator opposed to the bill who charged the researchers with research bias and political involvement through the university's lobbyist in the state legislature. Although the researcher responded to the charges and no action was taken by the University's administrators, it was clear that researchers whose results were used to support policy advocacy could be subject to pressure from political groups.

RESULT AND EVALUATION OF SUCCESS:

In the end, the bill was amended in several ways in order to increase the likelihood of passage through the legislature. The original requirement that all children under the age of 12 be required to use child passenger safety devices was changed to children 5 years and younger. In addition, the penalty for not having one's child in a protective seat or carrier was eliminated, significantly reducing the incentive for parents and guardians to comply with the bill but also reducing the burden of enforcement and problems with the inability of poor families to afford protective devices. The bill received support of the chairman of the Transportation Committee along with several prominent members of the Senate and was passed in March of 1981. It went into effect January 1st, 1982. After an unsuccessful attempt to repeal the law, a stronger bill was passed in a subsequent legislative session.
Subsequent research suggested that the effects of the Kansas bill on the actual use of child passenger safety devices were weak. Although increased use was noted during the policy debate, the relatively weak Kansas bill had limited effect. However, the effect of the passage of a stronger bill in Illinois on the use of child passenger safety devices suggests how effective policy change can be. In Illinois, infant use of appropriate restraints increased from 49 to 79% and in children ages 1-4 years, use increased from 13 -42% after the Illinois Child Passenger Safety Law went into effect.

BACKGROUND 

The Missouri Community Advocacy Network (MoCAN) and a team of AmeriCorps VISTA Volunteers (Volunteers in Service to America) provide education and training on the importance of community inclusion for individuals with developmental disabilities. These teams provide education at 11 regional sites to the general public, service providers, and people with developmental disabilities and their supporters. The overall project goal is to empower individuals with disabilities to lead the way toward a better informed, more diverse, and inclusive society.

RESEARCH THE ISSUE BY GATHERING BACKGROUND AND LOCAL INFORMATION 

The MoCAN project addresses three main issues that affect people with disabilities:

• Lack of public awareness about the ability of individuals with developmental disabilities to be productive members of society
• Lack of understanding among service providers about how to encourage choice among individuals with disabilities
• Inability of some individuals with disabilities to advocate for themselves and make self-directed choices.

These three issues are usually well supported by people within the disability community and by the general public once they have an understanding of the importance of the issue. While addressing these issues in the community, MoCAN sometimes battles long-held ideas, myths, a lack of understanding, negative stereotypes, and the desire to “take care of” people with disabilities. There isn’t direct opposition to specific issues, just a lack of awareness that these issues even exist.

Those directly affected by these often inter-related issues include people with disabilities, family members, and service providers. Factors that contribute to the lack of awareness and understanding can include personal characteristics, past experiences, incorrect information, or a lack of knowledge. The negative consequences for people with disabilities can be significant if they are not given the same opportunities to pursue social, recreational, employment or other interests as other members of society. Over the past several years, local groups have been working together to promote community inclusion for people with developmental disabilities.

STATE THE BROAD GOALS OF THE ADVOCACY CAMPAIGN. 

MoCAN’s main goal is to make Missouri communities more inclusive of people with developmental disabilities.

The main objectives of the advocacy campaign include the following:

• Increase public awareness about disability issues and the desires and supports needed for individuals to lead meaningful lives in the community
• Increase ability of service providers to support and encourage self-determination among individuals with disabilities
• Increase ability of individuals with disabilities to advocate for themselves and understand self-determination.

STATE THE ADVOCACY TACTICS TO BE USED, INCLUDING THESE BROADER STRATEGIES. 

Education and encouragement

Volunteers and others involved in the project will receive extensive training and education throughout the project. There will be opportunity for encouragement and feedback at various meetings and events during the project period. The regional centers supported by the Missouri Department of Mental Health –Division of MR/DD provide day-to-day support and encouragement to VISTA.

Direct action campaign

The direct action campaign will consist of the education and training events provided by the AmeriCorps VISTA volunteers, and team members. These events will include presentations to community groups such as schools, churches, business, and other community organizations to raise awareness about disabilities. Training events for service providers and people with developmental disabilities also are part of the direct action campaign.

Media advocacy

Media advocacy will be used to promote the project, especially the link to the AmeriCorps VISTA program whenever possible. Personal stories are being promoted in print as the best use of media advocacy.

IDENTIFY RESOURCES AND ASSETS TO BE USED 

The AmeriCorps Volunteers in Service to America (VISTA) program provides primary funding to the project, technical assistance, and training for VISTA and supervisors. The program uses a total of 54 VISTA volunteers in 11 regional centers. In each center, teams consisting of VISTA volunteers, family members, and individuals with disabilities provide community training. The following partner organizations provide additional funding and support:

• The UMKC Institute for Human Development provides administrative support and statewide coordination of the MoCAN project.
• The Missouri Department of Mental Health supports the 11 regional centers that serve as the framework for the project. These regional centers provide mentorship, support local advisory teams, and provide day-to-day support and guidance to MoCAN VISTA.
• The Missouri Planning Council for Developmental Disabilities provides transportation funding for presentations to educate the community and other activities of the VISTA.

IDENTIFY POTENCIAL ALLIES 

The previously listed partner organizations ally for the project. Each organization brings an asset that contributes to project success. Additional allies are members of the local advisory team, which could include regional council members, parents, policy partners, resource specialists, family members, local chamber of commerce members, or the special education director. Other potential allies include disability organizations, parent support groups, school systems, recreation departments, therapists and various health care providers, or additional community service organizations.

IDENTIFY AND COUNTERACT OPPOSITION 

The project could not identify any apparent opposition to the advocacy effort. Community awareness trainings are purposely presented in a positive light to counteract personal internal opposition that might arise. Information and positive examples of inclusion counteract opposition relating to personal attitude and stereotypes.

DESCRIBE THE EVALUATION OF THE ADVOCAY CAMPAIGN 

Initial measures of success were the number of presentations and trainings conducted and their attendance counts. Another measure of success could be the number of people who are aware of the campaign’s message. The population-level indicator of success for community inclusion would be to what extent individuals with disabilities have been more included in their communities.

DEVELOP AN ACTION PLAN FOR IMPLEMENTATION OF THE ADVOCACY EFFORT

The primary action of the advocacy effort is education and training. It is the function of the team, which is made up of an AmeriCorps VISTA, a person with a disability, and a family member of a person with a disability, to make presentations to community groups. Teams also provide training to service providers and individuals with developmental disabilities. VISTA also works to support individuals with developmental disabilities by providing individualized one-on-one education and training. Local advisory teams at each of the 11 sites help assign activities to VISTA and discuss future presentations. MoCAN mentors also support VISTA to reach their goals and provide whatever support is needed. Grant funds and partner organizations provide the foundation to under gird all activities.

“Stoplights Don’t Stop Us!” tells the story of how people with disabilities in Emporia, Kansas, living in a high-rise apartment complex near a dangerous intersection, came together as allies to advocate for change in their community. The changes they achieved enhanced their ability to more fully and safely participate in the community. (The video is also available with audio description.) To learn more about this process for making change to support independent living for all, visit the free publication: Your Action Planning Guide for Promoting Full Community Participation Among People with Disabilities: A Resource for Independent Living Centers and Other Community-based Initiatives.

"Say YES for the Children": India  

Contributed by: Anne Nzuki

Advocating for Protection and Improvement of the lives of Children

BACKGROUND:

The “Say YES for the children” campaign was launched on April 16th 2001 in an effort to rally people behind 10 principles (imperatives) that seek to improve and protect the lives of children. The 10 principles are:

• Leave no child out
• Put children first
• Care for every child
• Fight HIV/AIDS
• Stop harming and exploiting children
• Listen to children
• Educate every child
• Protect children from war
• Protect the Earth for children
• Fight poverty; Invest in children

This campaign was launched by the Global Movement for Children (GMC) which was created by the United Nations Children’s Fund (UNICEF).

More than 94 million people from 194 countries signed up for the campaign. This example focuses on how this campaign was implemented in India.

Research the issue by gathering background and local information

a) Conduct a study of the issue:

• Studies documented by UNICEF-India show that violations of children’s rights occur frequently, and legal protection of children and their rights is minimal. According to the 2001 Census, 12.6 million children engaged in hazardous occupations; and 60% of girls dropped out of school before completing their five years of primary education. Additionally, child sex trafficking was running rampant, evidenced by the fact that over 40% of female sex workers had entered into prostitution before they were 18 years old.

b) Gather data on public opinion:

• The top three priorities of the campaign as identified by Indians in several communities were: “Education for every child;” “Care for every child;” and “Leave no child out.”

c) Conduct research to influence policy

• This campaign had the backing of UNICEF and GMC and provided expert testimony on the level of the problem and potential solutions.

State the advocacy tactics to be used

a) Education and Encouragement

• Reframe the debate—UNICEF-India adapted the slogan from “Say YES for children”, which they were afraid might be interpreted as an encouragement to have more children, to a question: "If someone asked you ‘are children important?’ what would you say?"

b) Direct action campaign:

• Lobby decision makers and influential people in society— UNICEF-India initiated new partnerships with civil society organizations, celebrities and politicians to help bring attention to the issue, and gain influence.

c) Use media advocacy

• Use advertising: Popular television channels, from MTV to the state-run Doordarshan television network, have run free spots publicizing the GMC and the campaign.
• Use cyber campaign: Cyber partnerships were developed with mainstream internet providers and popular websites such as Mantra Online to target wealthier children and professionals.

Identify and counteract opposition:

a) Forms of opposition tactics used:

• Discredit— Many Indians thought of foreign organizations as colonial agents and thought that the campaign was an attempt to impose a perceived Western paradigm of child rights on a culture that prides itself on respect for elders.

b) Solutions to opposition tactics:

• UNICEF drew on India’s long history of activism and emphasized rhetoric that children are the future, reframing the issue so that it was something that everyone would agree with, rather than making people feel like an ideology was being forced upon them.

Develop an action plan for implementation of the advocacy effort

The Education Ministry and a large youth union teamed up on “Say Yes for the Children” to distribute promotional material to children and young people, while the Tara Punjabi channel helped to collect 60,000 pledge forms. All throughout India, people at all levels, from Chief Ministers to local celebrities, pledged and supported the campaign, while collaborative efforts to distribute and collect pledge forms have been made by NGOs, youth clubs and others.
As a result, throughout India, Parliamentarians joined local politicians, national celebrities, civic leaders and sports stars to mobilize support for children. Momentum also picked up following the creation of a National Commission for Children.

Even the Prime Minister, Atal Behari Vajpayee, joined in during an Independence Day speech on August 15, 2001, in which he referred to children as "the most precious wealth of our nation.” The Prime Minister recalled having attended the 1990 World Summit on Children and committed the Indian government to participating fully at the UN Special Session on Children back in May 2002.

RESOURCES:

• The Advocacy Project: Background on Children in India
• UNICEF “Say YES for the Children” Campaign
• Global Movement for Children
• United Nations Special Session on Children

Contributed by: Alexandra Ataya

(Based on a project titled “Supporting tobacco control research and dissemination” implemented by the American University of Beirut with the collaboration of various NGOs and funded by International Development Research Centre. For more detailed information please visit the AUB-Tobacco Control Research Group website.)

BACKGROUND AND CONTEXT: 

As reported in the 2010 paper, The economics of tobacco in Lebanon: an estimation of the social costs of tobacco consumption, produced as part of the American University of Beruit Tobacco Control Research Group, “Lebanon has high smoking rates for both cigarettes and waterpipes, especially among the youth aged 13-15. According to the most recent figures (Sibai and Hwalla, 2010; Saade, 2005), approximately 42.9% of male adults and 27.5% of female adults are cigarette smokers. The prevalence rates are 14.8% and 6.7% for male and female youth respectively. Waterpipe smoking prevalence in youth was even more staggering than that of cigarettes, with 64.5% of males and 54.6% of females smoking on a regular basis. Lebanese women have the highest female smoking rate in the region. An alarming 78.9% of children in Lebanon are exposed to smoke at home, and 74.9% are exposed to it outside the home. In 2007 approximately 2,701 deaths were due to smoking-related diseases, leading to an indirect cost of $64.6 million. … Experts estimate that in Lebanon 150,000 children and 350,000 adults alive today will die prematurely because of smoking or second-hand smoke unless tobacco control measures are improved.”

Lebanon ratified the Framework Convention on Tobacco Control (FCTC) in 2005, but the implementation was past due, as Lebanon still had one of the weakest tobacco control policies in the Middle East region in 2010. In January 2010 the Lebanese Parliamentary Committee of Administration and Justice started discussing the tobacco control law that was dormant since 2003-2004. In February 2010, in collaboration with two civic non-governmental organizations, Tobacco Free Initiative-Lebanon and INDYACT, the American University of Beirut-Tobacco Control Research Group (AUB-TCRG) conducted a press conference in which they issued a position statement titled: “Advocating for a strong tobacco control law in Lebanon”. The objective of the conference was to announce through the media to the public and policymakers that the law under discussion was currently not in line with FCTC and with best research evidence. The position statement covered all aspects of the law that needed amendment and provided the scientific evidence to back it up.

GOALS OF THE CAMPAIGN:

The Mission of the AUB-TCRG is to promote public health by producing and disseminating evidence-based tobacco control research.

The specific objectives were:

At the national level:

• Generate evidence-based data in multiple fields related to tobacco control and contribute to the knowledge base
• Disseminate research findings in a user-friendly way to the public
• Transfer evidence of best practices in tobacco control legislation to policy and decision makers
• Build the capacity of civil society to implement and evaluate interventions to promote tobacco control
• Advocate for the implementation of strong tobacco control policies in Lebanon

At the regional level:

• Share research findings and successes in tobacco control across countries
• Facilitate networking and communication among tobacco control researchers and civil society in the region
• Support research collaborations

TARGETS AND AGENTS OF CHANGE:

The advocacy group engaged several agents of change in working to promote the adoption of a tobacco control policy. Members of the Lebanese Parliament were seen as the most immediate targets of change for the adoption of the policy. Following the press conference, AUB-TCRG members, with the assistance of two local NGOs, met with over 35 Lebanese Parliamentarians from different political parties to advocate and seek support for a strong, comprehensive tobacco control policy. Later, a reception designed to bring together policy makers was attended by 22 members of Parliament, who all expressed their support for the implementation of a strong tobacco control law in Lebanon. In addition, local media, NGOs and civil society were mobilized to advocate for a stronger law.

STRATEGIES AND TACTICS OF LEGISLATIVE ADVOCACY:

Advocates pushed for a law that is in line with the FCTC articles, which highlighted three points:

• Total ban of smoking in indoor public places (with no exemptions)
• Comprehensive advertising bans, including sponsorship
• Large pictorial health warnings

AUB-TCRG coordinated with partners to develop a petition which called for a strong evidence-based tobacco control law. The petition was circulated to organizations and individuals through email and advertised through Facebook pages. To date, the petition has been signed by over 50 organizations, 15 syndicates and public institutions, and 30 private companies, as well as Heads of Parliamentary blocs and a number of individual Parliamentarians. The petition was covered in major local newsletters and websites.

The three main targets of advocacy by the AUB-TCRG were policy makers, media, and non-governmental organizations (local and international).

Research evidence was produced by the AUB- Tobacco control research group, and dissemination efforts included policy briefs, fact sheets, newsletters, posters, social media, and the development of a group website.  Advocacy efforts entailed press conferences, position statements, lectures and seminars, meeting up and lobbying with parliamentarians, petitioning, intensive media advocacy (including articles in local newspapers, magazines, press releases, interviews on TV shows, radio spots, etc.), and having a team run in the annual Beirut Marathon under the theme “Run for Tobacco Free Lebanon.” AUB-TCRG also collaborated with NGOs from the civil society for direct advocacy action and mobilized, supported, and provided knowledge to the civil society.

RESOURCES AND ASSETS USED:

Resources used included the results of research projects conducted by the American University of Beirut faculty.

ALLIES AND OPPOSITION:

The major advocates of a tobacco control policy included: AUB-TCRG, the Lebanese Ministry of Health and the Ministry of Social Affairs, NGOs/Civil Society such as INDYACT and TFI, the Lebanese Coalition on Tobacco Control, other academic institutions, social networks such as Facebook groups, and 20 NGOs who were part of the Lebanese National Tobacco Control Coalition (LNTCC). The main benefit of working and cooperating with NGOs is that they have a direct connection to the public and can reach the different areas of Lebanon. All these advocates were supportive of the AUB-TCRG efforts and played an important role in communicating the message in different parts of the country.

The groups opposing the adoption of the policy included: the multinational tobacco industry and Regie, the National Monopoly in Lebanon (such a policy could be damaging to their tobacco sales in a country where the demand is high), the hospitality sector, some farmers syndicates, and advertising agencies that rely on tobacco company funds.

The groups that had a variety of opinions included policy-makers, the media, and the hospitality sector.  Some parliamentarians argued that most countries implemented such laws gradually and they were afraid that a strict law would result in the loss of business for waterpipe cafés as well as the loss of subsidy for tobacco farmers.  They were also implicitly worried about losing popularity among their constituency if they were supportive of tobacco control policy.

To contend with the opposition, AUB-TCRG used research findings from previous surveys about positions on FCTC articles which revealed that the Lebanese overall were supportive of tobacco control policy. The point that a large number of Lebanese people are in fact non-smokers was emphasized as well.  Mostly, the arguments that were brought up by opposing parliamentarians were similar to those perpetuated by the tobacco industry in various countries in the world. All arguments against a tobacco control policy were countered with multiple materials containing research findings and local statistics to clarify the gravity of the tobacco problem in Lebanon and the desire of the people to improve the situation.

RESULTS AND EVALUATION OF SUCCESS:

One way that AUB-TCRG conducted evaluation was through media monitoring – collecting and analyzing tobacco related news on a daily basis, which provided immediate evidence of the effects of the initiative.

On the media level, there was a positive shift towards supporting the tobacco control movement. The daily monitoring of local newspapers revealed a high coverage of tobacco related news/articles (this is a change from previous years, although this has not yet been quantified systematically). Additionally, many articles were supportive of tobacco control policies and criticized the tobacco industry, its misleading health messages, and its manipulation of the Lebanese government officials since the FCTC was ratified in 2005.

These changing opinions in the media were reflected in January 2011 when one of the top five TV stations in Lebanon (LBC) shifted its position from conservative and resistant to airing news about tobacco control policies, to banning all kind of tobacco advertising on its screen.

One of the main roles of AUB-TCRG was capacity building of NGOs, by providing them with all the needed support in their advocacy activities (providing them with tobacco control related materials and references, research findings, some logistics, and advice). AUB-TCRG is often the first reference contacted by NGOs and the public when it comes to certain tobacco related issues and activities due to the quality of the research they conduct and their efforts at disseminating the results of this research. As public awareness of the tobacco control policies increased, the group received numerous requests to go on TV shows and do interviews with the media.

The increased awareness of tobacco control policies in Lebanon also motivated some organizations to announce themselves as a smoke-free closed area, such as some restaurants (listed on the website of the National Tobacco Control Program), a few municipalities (Municipality of Zouk Mikayel, Sarafund and Saida, and Beirut as of February 2011), two ministries (Ministry of Social affairs and the Ministry of Public Health), and three educational universities (Hagazian University, Al-Jinan University, and the Lebanese American University).

The increased media attention to the issue of tobacco control:

• Made the public more aware of the ill effects of not only smoking but also exposure to second hand smoke
• Informed the public of the unethical tactics of the tobacco industry
• Increased the public’s knowledge of the advocacy efforts  and activities conducted by different civil society groups
• Kept the public updated on the progress of the tobacco control policy draft during the parliamentarians’ committees’ discussions.

As part of the global and regional trend of adopting a smoke-free policy in restaurants, cafes, pubs and clubs, some of the Lebanese hospitality businesses decided to introduce in their establishments smoke free areas or days or even go totally smoke free. This was intensified during the last few months, obviously as a result of the actions of the tobacco control advocates whose activities were advertised in the media.

The AUB Tobacco Control Research Group’s (AUB-TCRG) joint efforts with civil society succeeded in pushing the Lebanese Parliament to adopt the first comprehensive Tobacco Control Policy in Lebanon’s history on August 17, 2011.

RESOURCES:

• Chaaban, J, Naamani, N, & Salti, N. (2010). The economics of tobacco in Lebanon: an estimation of the social costs of tobacco consumption. Paper produced as part of the AUB Tobacco Control Research Group and sponsored by the Issam Fares Institute for Public Policy and International Affairs at AUB.
• AUB-Tobacco Control Research Group

Contributed by: Anne Nzuki

Adapted from Picha Mtaani.

BACKGROUND:

Picha Mtaani, Swahili for ‘street exhibition,’ is a youth-led peace initiative that seeks to create space for young people to reconcile and become agents of reconciliation in their respective communities.

Nearly three years after Kenya’s worst election violence, which left 1,500 dead and hundreds of thousands internally displaced, Kenya is a nation in search of its identity. Picha Mtaani aims at providing a platform for national reflection and building local reconstruction consensus through photo exhibitions and conversation. This project aims at organizing target communities to play their part in the reconciliation and reconstruction process.

BROAD GOALS AND SPECIFIC OBJECTIVES FOR THE ADVOCACY EFFORT:

The Picha Mtaani national peace-building initiative and exhibition tour has visited ten towns most affected by the election violence, including Nairobi, Nakuru, Eldoret, Kericho, and Kisumu. This initiative has enjoyed tremendous support from the Kenyan public, as illustrated by the participation of over 700,000 young people, the submission of over 30,000 completed questionnaires, and the subsequent signing of over 61,000 peace pledges in the exhibitions series throughout the country. Additionally, videos of the exhibition have been used as a model in 10 African countries by the Africa Youth Alliance of YMCA.
Most recently, October of 2011 marked the launch of Heal the Nation, the documentary film chronicling Picha Mtaani’s journey across the country.  Through this independently produced film, Picha Mtaani intends to bring this experience to an even greater audience.  The film is embedded below and also available on YouTube. You can also view pictures from Picha Mtaani on their Flickr page.

For more updates on Picha Mtaani and future plans, see their newsletter.

ADVOCACY STRATEGIES TO BE USED:

Picha Mtaani plans to reach out to at least two million additional young persons in Kenya.  They are working in 210 constituencies, mobilizing young Kenyans into the Kenya Ni Kwetu (Kenya is Our Home) movement.

Next, Picha Mtaani is launching a creative hub social enterprise, which opens its doors in December. PAWA 254 will be an innovative, new, collaborative office for visual creatives in Kenya. PAWA 254 derives its name from a combination of “power” in Swahili and the Kenya country code, a symbol of national unity. This new workspace – a community facility and studio – will bring together established and aspiring young photographers, cartoonists, animators, video & filmmakers, as well as entrepreneurs and activists, to work, learn, and share in an environment that inspires creativity and endeavors to bring about social change.

Picha Mtaani believe that  “together we can forgive, make peace, heal, and move forward — together we can, pamoja tunaweza.  And we must, because Kenya Ni Kwetu.”

Resources, people, and assets to be used in the advocacy effort:

The partners of Picha Mtaani include:

Contributed by: Ithar Hassaballa

 Picture of a displaced girl, 12, raped when fetching firewood. (Sudan)

BACKGROUND AND CONTEXT:

Generally, the issue of sexual violence in Africa is difficult to overcome because of the social stigma that comes with it. The community will more than likely be quick to judge a girl for ‘engaging in sexual behavior at such a young age’ even if it was sexual violence. Because young women are not made comfortable to speak openly about their experiences with sexual violence, many keep it a secret.

There are essential facts that are related to the issue of sexual violence. Girls and young women are the main victims of this issue. Both social factors and economic factors contribute to the problem. For instance, the social stigma can lead to a lot of shame felt by the girls. Because of poverty, some girls can even be dragged into prostitution. Addressing this issue also has political and cultural barriers. Because of the poverty, employment, and health issues in many African countries, sexual violence is not seen as a high-priority concern that needs to be addressed by politicians. The interesting thing is that issues of poverty and unemployment can lead to sexual abuse and violence. Sexual abuse can also lead to many health problems. “Sexual violence against girls is a global human rights injustice of vast proportions with severe health and social consequences.” (CDC 2011)

In 2002, the World Health Organization estimated that 150 million girls under the age of 18 had experienced some form of sexual violence. Studies also indicate that as many as six out of ten sexual assaults are committed against girls ages 15 and younger. As shocking as these numbers seem, they are likely underestimates because most cases of sexual violence are never reported to authorities due to fear, stigma, and discrimination. Millions of girls are also exploited in prostitution and pornography every year, often lured or forced into these situations through false promises and limited knowledge about the risks.

The consequences of this injustice are profound, with immense health and emotional effects on  individuals, as well as broader social and economic impacts. Girls who are victims of sexual violence are three times more likely to have an unwanted pregnancy, and girls under age 15 who are pregnant are five times more likely to die in childbirth than women ages 20 to 24. Girls who are victims of sexual violence are also at increased biological risk of contracting HIV/AIDS and other sexually transmitted diseases. Even if a girl is not infected with HIV directly following an act of sexual violence, research indicates that she becomes more likely to contract infectious and chronic diseases afterwards. This is because sexual violence alters the life path of many girls, leading to depression, substance abuse and high-risk behaviors.

BROAD GOALS AND SPECIFIC OBJECTIVES:

The Together for Girls partnership includes UNICEF, UNAIDS, UNFPA, UN Women, the US President’s Emergency Plan for AIDS Relief (PEPFAR), the US Department of State’s Office Global Women’s Issues, the US Centers for Disease Control and Prevention, and the CDC Foundation.

Together for Girls has employed advocacy tactics to combat sexual violence. Working with national governments and civil society, the Together for Girls partnership is taking practical and effective steps to tackle sexual violence against girls. There are broad goals and specific objectives for the advocacy effort: the broad goal is to end sexual violence against girls, and to accomplish this, they worked towards specific objectives such as establishing child-friendly courts and integrating Domestic Violence and Sexual Offenses units into 75% of police stations in the country.

Partnership efforts focus on three pillars:

• Data: Conducting national surveys and collecting data to document the magnitude and impact of sexual violence against girls to inform government leaders, civil society, and donors.
• Action: Supporting a plan of action at the country level with interventions tailored to address sexual violence. These range from national policy-level dialogue and legal reform to improved services and community-based approaches.
• Awareness: Launching communications and public awareness campaigns to draw attention to the problem and motivate changes in societal and gender norms and behaviors.

IDENTIFYING RESOURCES AND ASSETS TO BE USED IN THE ADVOCACY EFFORT:

• Women and girls who have experienced sexual violence, and those affected or potentially affected by sexual violence
• CDC’s national collection of data on the prevalence of sexual violence
• The Together for Girls initiative
• Other international agencies
• Government
• Police
• Other key stakeholders

RESULTS AND EVALUATION OF SUCCESS:

Experience in Swaziland demonstrates how this approach can make a difference. Swaziland collected accurate national data on the scale and causes of sexual violence. This research indicated that one-third of girls experienced sexual violence. This alarming finding provided a catalyst for coordinated actions by allies like the government, civil society, international agencies and other key stakeholders. This included a national education campaign for the general public to raise awareness around the issue of sexual violence and how to prevent it, strengthening the capacity of police to respond to sexual violence through training and establishing specialized units to investigate such offenses against children, and the establishment of a child-friendly court with safe spaces for children’s testimony and strengthened legal systems.

Together, we can build societies where all girls are safe and valued. The result will be a more hopeful world for girls – and for us all.

To learn more, read this booklet about Together for Girls, their mission, and their work.