Social Mobilization, Advocacy and Social Marketing

FRANCISCO S. CRUZ, MD., MPH.HPAD 201 Session 13, Sep 15

References: (1) Rafaelita A. Ong, DrPH Health Promotion Consultant, DOH

(2) Family Health Communication, JHU-CCP, 1994 (3) Dr. Ofelia Valdecanas, UNICEF-PIA, 1990

(4) Dr. Fernando Sison, DHPA, CPH, UPM (5) DSWD’s Pantawid sa Pamilyang Pilipino Program

HPAD 201 Session 13By the end of the session, the

graduate students should be to:

• Define and discuss social mobilization and advocacy including their basic concepts and elements

• Define and discuss social marketing, its concepts and 8 P’s

• Define and discuss demand-side financing and conditional cash transfer scheme

Session Plan 13

3:00 Introduction: Demand Creation

3:15 Social Mobilization and Advocacy

4:00 Social Marketing4:30 Demand-Side

Financing: CCT and DSWD’s 4Ps

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Supply and Demand ► Serves as the foundation for all economic analysis

► Pricing and output decisions are based on the underlying forces of supply and demand

James W. Henderson. Health Economics & Policy. 3rd Edition. 2006.

The Concept of Demand and Supply – there are two forces which interact and determine the state of the economic system.

Q

P Supply Curve

Demand Curve

Equilibrium point

The Law of Demand

“► There is an inverse relationship between the amount of a commodity that a person will purchase and the sacrifice that must be made to obtain it”

► Q&A: When price of a commodity / service changes, what is the effect on quantity demanded?

Factors affecting the patient’s demand for medical care:

► Actual or perceived illness or desire for preventive medicine

► Marital status ► Type of people desiring the commodity ► Income ► Education ► Availability of substitutes ► The price of related commodities ► Time costs

Demand for Health Care Services

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Market Failure►A situation in which a market fails to produce

the socially optimal level of output.

James W. Henderson. Health Economics & Policy. 3rd Edition. 2006.

When does it exist? ► mismatch between what the market supplies and what fully informed, rational consumers of health care would demand.

What will be the health consequence? ► unreasonably high prices for services which are beyond the reach of many consumers.

Market Failure in Health Care

Why does market failure occur?

► Information asymmetry ► Public goods ► Externalities in production and consumption ► Presence of monopoly and monopsony

Types of Government Intervention

Inform, educate and communicate; regulate;

mandate; finance;

provide or deliver; MOBILIZE AND ADVOCATE

DefinitionWhat is Social Mobilization? The Regional Framework for Health Promotion cites

three sets of health promotion action: Education Advocacy Social mobilization

Social mobilization is the engine that can drive the two other elements into motion

It can also sustain involvement in health promotion not as a program but as a social action

It solicits participation of community members in activities and efforts that would benefit them. They develop a sense of ownership making sustainability of the efforts more likely.

What is Social Mobilization? Social mobilization comes handy since the salient

feature of social mobilization programs is an attempt to “go to scale” at an accelerated rate

Social mobilization is said to be effective when target beneficiaries become actors and main stakeholders

Social mobilization is a term used by the United Nations International Children's Emergency Fund (UNICEF) to describe a comprehensive planning approach that emphasizes political coalition building and community action (UNICEF 1993, Wallack 1989)

Main Approaches Political mobilization aims at winning political and

policy commitment for a major goal and the necessary resource allocations to realize that goals.

Government mobilization aims at informing and

enlisting the cooperation and help of service providers and other government organizations that can provide direct and indirect support.

Corporate mobilization aims at securing the support of national and international institutions in promoting appropriate goals either through the contribution of resources or the carrying out of appropriate messages as part of their advertisement or product labeling.

Main Approaches Beneficiary mobilization aims at informing and

motivating program beneficiaries through training programs, establishment of community groups and communication through traditional and mass media.

Community mobilization aims at informing and getting

the support of local political, religious, social and traditional leaders as well as local government agencies, non government organizations (NGOs), women’s groups and cooperatives. The communication methods include training, participation in planning, and coverage of their activities by the mass media.

Social Mobilization aims to achieve the following in order to attain the goals of human development:

Empower communities to act towards satisfaction of their demands and needs

Motivate key decision makers to commit the needed political support in creating and sustaining the structures and services

Change behavior of individuals to facilitate acceptance of

advocated practice4s and technology Commit health providers to improve in terms of quality

and effectiveness of the services they provide.

Concepts and Basic Principles Empowerment Equity Sustainability Integration Cultural sensitivity and gender fairness Participation Collaboration Partnership Quality

Components of Social Mobilization

• ADVOCACY• Community Organizing• Information Education and Communication

(IEC)• Training• Monitoring and Evaluation

Advocacy: systematic approach to persuade a targeted population, audience, gatekeepers, stakeholders or beneficiaries towards a policy, program and person

Kohlberg’s Theory on Moral Stage Development• Pre-conventional stage: advocates to avoid punishment• Conventional stage: advocates for approval• Post-conventional stage: advocates for social justice

Types of Health Advocates• Legal advocate : The health worker (HW) guards the patient’s rights to

competent care, informed consent, and privacy.• Moral–ethical advocate: The HW upholds the patient’s values in decision-

making.• Political advocate : The HW facilitates equal access to health care.• Spiritual advocate: The HW provides access to spiritual support and

reassurance.• Substitutive advocate : The HW protects the interests of patients who

are incapable of speaking for themselves.

Valuable learning points in Social Mobilization and Advocacy

• Be flexible and adjust when needed. • The research component, as action oriented and participatory, cannot be

eliminated. • Mobility and communication are essential to any major field-based project. • People are receptive to dialog and involvement. They are not receptive to

"being told." • Be non-judgmental when discovering and discussing issues. • Give praise freely and show an interest and pride in even the smallest of

impacts. • Train field workers from different sectors, and within sectors, together as

equals. • Where possible, work within existing structures. • Continuous monitoring is essential, at all times, at all levels, by all concerned.• Transparency and accountability must be established from the very beginning

and among all partners.

The most valuable lesson is that social mobilization is an effective strategy for involving communities and creating powerful partnerships for sustainable change.

Social Marketing

• Social Marketing: "differing from other areas of marketing only with respect to the objectives of the marketer and his or her organization. Social marketing seeks to influence social behaviors not to benefit the marketer, but to benefit the target audience and the general society." (Philip Kotler)

• The primary focus is on the consumer--on learning what people want and need rather than trying to persuade them to buy what we happen to be producing.

8 (4+4) P’s of Social Marketing• Product: specific solution to a health problem; tangibles (vaccinations, TB

meds, RH commodities, antibiotics, medical and pre-natal check-ups) to intangibles (healthy heart diet, breastfeeding, tobacco cessation, stress)

• Price: clients must do to obtain products (not always monetary); perceived benefits must be greater than costs; used in positioning of product

• Place: way where the product reaches the clients including information channels; dependent of type of product (RHU, community, malls, schools)

• Promotion: integrated use of advertising, public relations, promotions, media advocacy, personal selling and entertainment vehicles (Enter-educate); need for market research

• Publics: audience segmentation; external (clients, gatekeepers, poicy makers) and internal (DOH, LGU)

• Partnerships: multi-sectoral collaboration • Policy: legal mandate and/or advocacy components• Purse strings: funding requirements (DOH, LGU, NGOs, Global Fund, PPP)

Demand Side Financing, CCT and DSWD’s 4Ps

• Supply side financing versus demand side financing• Demand side financing: Conditional cash transfer and

as safety nets; empowering the poor families• Not a dole-out. Investments in human capital with

the beneficiaries must meet specific conditionalities before they can get the cash assistance. Enhances the role of parents and helps them accomplish their duties and responsibilities to their children.

• Proven successful in developing countries with direct impact on micro-economics, health and education

Pantawid Pamilyang Pilipino Program

• 4Ps is a poverty reduction and social development strategy of the National Government that provides conditional cash grants to extremely poor households to improve their health, nutrition and education particularlyof children aged 0-14.

• 4Ps has dual objectives: Social Assistance- to provide cash assistanceto the poor to alleviate their immediate needs (short term poverty alleviation); and Social Development- to break the intergenerationalpoverty cycle through investments in human capital.

• 4Ps helps to fulfill the country’s commitment 4Ps helps to fulfill the country’s commitment to meet the MDGs, namely: (1) Eradicate Extreme Poverty and Hunger, (2) Achieve Universal Primary Education, (3) Promote Gender Equality (4) Reduce Child Mortality, and (5) Improve MaternalHealth.

Pantawid Pamilyang Pilipino Program

• Eligible beneficiaries are: 1. Residents of the poorest municipalitiesbased on 2003 Small Area Estimates (SAE) of NSCB; 2. Households whose economic condition is equal to or below the provincial poverty threshold;3. Households that have children 0-14 years old and/or have a pregnant woman at the time of assessment; and 4. Households that agree to meet conditions specified in the program.

• 4Ps provides conditional cash grants to beneficiaries to wit: P6,000 a year or P500 per month per household for health and nutrition expenses; and P3000 for one school year or 10 months or P300 /month per child for educational expenses. A maximum of three children per household is allowed.A household with three qualified children receives a subsidy of P1,400/month during the school year or P15,000 annually as long as they comply with the conditionalities.

Pantawid Pamilyang Pilipino Program

• To avail of the cash grants beneficiaries should comply with the following conditions:

1. Pregnant women must avail of pre- and post-natal care and be attended during childbirth by a trained health professional;

2. Parents must attend family development sessions; 3. O-5 year old children must receive regular preventive health check-ups and

vaccines; 4. 3-5 year old children must attend day care or preschool classes at least

85% of the time. 5. 6-14 year old children must enroll in elementary or high school and must

attend at least 85% of the time. 6. 6-14 years old children must receive deworming pills twice a year.