Department of Community Medicine, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria.
Department of Community Medicine, University of Nigeria Teaching Hospital Enugu, Enugu, Nigeria.
BMC Health Serv Res. 2020 Sep 18;20(1):884. doi: 10.1186/s12913-020-05734-0.
The Nigerian government introduced and implemented a health programme to improve maternal and child health (MCH) called Subsidy Reinvestment and Empowerment programme for MCH (SURE-P/MCH). It ran from 2012 and ended abruptly in 2015 and was followed by increased advocacy for sustaining the MCH (antenatal, delivery, postnatal and immunization) services as a policy priority. Advocacy is important in allowing social voice, facilitating prioritization, and bringing different forces/actors together. Therefore, the study set out to understand how advocacy works - through understanding what effective advocacy implementation processes comprise and what mechanisms are triggered by which contexts to produce the intended outcomes.
The study used a Realist Evaluation design through a mixed quantitative and qualitative methods case study approach. The programme theory (PT) was developed from three substantive social theories (power politics, media influence communication theory, and the three-streams theory of agenda-setting), data and programme design documentation, and subsequently tested. We report information from 22 key informant interviews including national and State policy and law makers, policy implementers, CSOs, Development partners, NGOs, health professional groups, and media practitioners and review of relevant documents on advocacy events post-SURE-P.
Key advocacy organizations and individuals including health professional groups, the media, civil society organizations, powerful individuals, and policymakers were involved in advocacy activities. The nature of their engagement included organizing workshops, symposiums, town hall meetings, individual meetings, press conferences, demonstrations, and engagements with media. Effective advocacy mechanism involved alliance brokering to increase influence, the media supporting and engaging in advocacy, and the use of champions, influencers, and spouses (Leadership and Elite Gendered Power Dynamics). The key contextual influences which determined the effectiveness of advocacy measures for MCH included the political cycle, availability of evidence on the issue, networking with powerful and interested champions, and alliance building in advocacy. All these enhanced the entrenchment of MCH on the political and financial agenda at the State and Federal levels.
Our result suggest that advocacy can be a useful tool to bring together different forces by allowing expression of voices and ensuring accountability of different actors including policymakers. In the context of poor health outcomes, interest from policymakers and politicians in MCH, combined with advocacy from key policy actors armed with evidence, can improve prioritization and sustained implementation of MCH services.
尼日利亚政府推出并实施了一项改善母婴健康（MCH）的卫生计划，称为母婴健康补贴再投资和赋权计划（SURE-P/MCH）。该计划于 2012 年启动，2015 年突然结束，随后加强了维持 MCH（产前、分娩、产后和免疫）服务的宣传，作为政策重点。宣传工作对于允许社会发声、促进优先事项的确定以及将不同的力量/行动者聚集在一起非常重要。因此，该研究旨在通过了解有效的宣传实施过程包括哪些内容以及哪些机制在哪些情况下触发以产生预期结果，来了解宣传工作是如何进行的。
该研究采用了真实评估设计，通过混合定量和定性方法进行案例研究。该计划理论（PT）是从三个实质性社会理论（权力政治、媒体影响传播理论和议程设置的三流理论）、数据和计划设计文件中发展而来的，随后进行了测试。我们报告了来自 22 名关键知情者访谈的信息，包括国家和州政策和法律制定者、政策执行者、民间社会组织、发展伙伴、非政府组织、卫生专业团体以及关于 SURE-P 后宣传活动的相关文件的审查。
关键的宣传组织和个人，包括卫生专业团体、媒体、民间社会组织、有影响力的个人和政策制定者，都参与了宣传活动。他们的参与性质包括组织研讨会、专题讨论会、市政厅会议、个人会议、新闻发布会、示威活动以及与媒体的接触。有效的宣传机制包括联盟代理以增加影响力、媒体支持和参与宣传以及利用拥护者、影响者和配偶（领导和精英性别权力动态）。决定 MCH 宣传措施有效性的关键背景影响因素包括政治周期、问题上的证据可用性、与有影响力和感兴趣的拥护者建立网络以及在宣传中建立联盟。所有这些都加强了 MCH 在州和联邦层面的政治和财务议程上的地位。
我们的结果表明，宣传可以作为一种有用的工具，通过允许不同的声音表达并确保不同行为者（包括政策制定者）的问责制，将不同的力量聚集在一起。在健康结果不佳的情况下，政策制定者和政治家对 MCH 的兴趣，加上有证据武装的关键政策行为者的宣传，可以提高 MCH 服务的优先排序和持续实施。
