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Evaluating Health Center and PCA Advocacy, Creating a Legacy for Change

Monday, October 16, 2017   (0 Comments)
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Annette Gardner and Claire Brindis, Department of Social and Behavioral Sciences, Philip R. Lee Institute for Health Policy Studies, UCSF


Annette will be presenting on this issue at the Fall Primary Care Conference


The 2016 election has embroiled the United States in political upheaval, the likes of which have not been seen in recent times. Advocacy is now front and center, with much of it being creative and engaging, but not all of it. Considered a critical means for expanding democracy, this broad swath of advocates are bringing to bear their influence, using traditional strategies and tactics, such as organizing protests and showing up in force at town hall meetings. However, without thoughtful reflection, advocacy strategies are unlikely to result in the policy mobilization and impact that they intend; those who seek greater social justice will be thwarted in their efforts unless they more fully understand what is effective in mobilizing communities and shaping public and political opinion.


Those seeking to bring about policy change need to be prepared to assess the effectiveness of a broad range of advocacy strategies and tactics. As we describe in our new book, Advocacy and Policy Change Evaluation: Theory and Practice (Stanford University Press), this is where evaluation comes in. Coalition building, public awareness campaigns, community organizing, media advocacy, and policymaker education are precisely the kinds of activities that evaluators focus on. Skilled evaluators have long been at work building a new field of evaluation practice, adapting and creating evaluation concepts and methods, and shaping advocate, funder, and evaluator thinking on advocacy and policy change in all its diverse manifestations.



For instance, UCSF evaluators used a battery of instruments to assess California PCA and clinic consortia advocacy capacity gains and federal, state and local policy ‘wins’ secured, such as preserving Federal 330 funding. As part of its commitment to increasing access to high quality and affordable health care for underserved Californians, The California Endowment provided multi-year funding (2001-2010) for the Clinic Consortia Policy and Advocacy Program to support the management, leadership development, policy, and systems integration needs of community clinics. Funding supported specific activities related to policy advocacy, technical assistance, media advocacy, and shared services in order to increase the collective influence of clinics.  In particular, we assessed the progress in developing organizational advocacy capacity, the effectiveness of an array of advocacy tactics, the role of partnerships and advocacy allies, and the impact of clinic policy ‘wins’ on clinics and their target populations.


Our findings on the effectiveness of consortia media advocacy spoke to the difficulties in determining its impacts on policymaker and public opinion. However, consortia were able to secure coverage of their issues in daily newspapers and radio, as well as broker ongoing relationships with the media and establish themselves as credible sources—no small feat (Gardner, Geierstanger, Brindis, McConnel 2010). Additionally, findings on targeting policymakers suggest that health center advocates were also successful in partnering with decision-makers, creating enduring relationships that have significant pay-offs later on, such as inclusion on agency committees or ‘being at the table.’


While evaluation of an advocacy portfolio sounds daunting, it’s not. As part of this advocacy and policy change evaluation, we worked with the PCA and clinic consortia to build their own evaluation capacity, facilitating workshops on outcomes, indicators, and monitoring, such as reporting funding secured through their policy change efforts for a Return on Investment  (ROI) Analysis, tracking and documenting annual clinic policy ‘wins’ at the federal, state and local levels, and tracking contacts with the media and coverage secured.  Health centers can document their interactions with the media and decision-makers and whether their message is getting across and if they are successful in securing decision-maker support for clinic issues.  (Hint—talk to the legislative aids.)


The results of the 2016 elections and subsequent threats for health center 330 and CHIP funding speak to focusing more on strategic learning (and not just accountability) so that advocacy can fulfill its vision more effectively. Using credible evidence to inform advocacy in real-time is as important as assessing initiative effectiveness in an era where policy change (such as the signing of executive orders) is occurring at break-neck speed. Center advocates must now work at the top of their game, will benefit from having a compendium of evaluation strategies and tools to monitor their strategies and tactics though they may still require expertise in designing and implementing a full-scale evaluation.  Community health centers, no newcomers to advocacy, can access some of these resources through their involvement in Advocacy Center of Excellence or ACE. Similarly, we provide a compendium of resources in our book. Now more than ever, health centers and PCAs need to know what is working and what is not.


For more information:

Annette L Gardner, PhD, MPH

Assistant Professor

Department of Social and Behavioral Sciences

Philip R. Lee Institute for Health Policy Studies

University of California, San Francisco

Phone: 415.615.2749

Email: Annette.gardner@ucsf.edu


NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.

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