From Capital to Clinic: tools to help health advocates navigate policy implementation
PATH's Capital to Clinic initiative examines bottlenecks that prevent policies developed at the national level from being implemented at the point of service delivery. Building upon defined strategic frameworks and practitioner know-how, the initiative has developed a set of tools to help advocates move the policy process from development to implementation and evaluation.
Robust policy is critical to achieving improved health outcomes—but too often, action stops once a policy is developed and adopted. Policies are only as effective as the extent to which they are implemented, and poor policy implementation impedes equitable access to health services.
While there is a documented understanding of the barriers to successful health policy implementation—including lack of evidence-based planning, inadequate political commitment and resources, weak capacity of public institutions, and failure to include frontline workers and other key stakeholders in decision-making processes—strategies to help overcome these barriers through advocacy, especially in settings in low- and middle-income countries, are less documented.
“Often policies are fit for purpose at the time they are developed—but as communities change, we need to be able to adapt and evolve to deliver the intervention and ensure a vibrant health system for all.”— Coceka Nogoduka (South African National AIDS Council)
To provide practical and evidence-based guidance for advocates, the Capital to Clinic initiative, supported by the Bill & Melinda Gates Foundation, was designed to be a consultative process from the start. We convened a technical advisory group in London in late 2019 to shape our main points of focus for the work and decide on parameters for an outcome tool. We then conducted a literature review of policy implementation frameworks and existing tools on the drivers of policy implementation, and in early 2020, we held a participatory workshop at the Prince Mahidol Awards Conference to engage participants in discussion around methods for evaluating implementation of primary health care and universal health coverage policies. Late in 2020, PATH also held two virtual sharing and consultative forums on policy implementation, bringing together civil society, advocates, academia, and policymakers operating at national and sub-national levels across African countries.
As a culmination of these learnings from policy researchers and the literature, PATH developed a set of tools to help advocates work with decision-makers to bring policies from development in the capital to implementation in the clinic. Our flagship tool, "From Capital to Clinic: A resource for effective advocacy for policy implementation," looks across the policy cycle and outlines actions that advocates can take to support the roles of decision-makers, hold them accountable, and act as a liaison between civil society, health providers, subnational stakeholders, and communities.
KEY TAKEAWAYS FOR ADVOCATES:
Hold decision-makers accountable for all their responsibilities and commitments across the policy cycle.
Package and share evidence from those impacted by the policy, and establish feedback loops to inform policymaking.
Engage in budget advocacy throughout the entire cycle to ensure adequate resourcing.
Build a civil society coalition to support community groups, highlight local priorities, and provide feedback.
Advocate for transparency and accountability by making policies publicly available to everyone.
Engage the media to highlight key gaps and successes throughout the cycle.
Resources
TOOL FOR ADVOCATES
Tool for effective advocacy for policy implementation
Designed by advocates, for advocates, this flagship resource outlines actions that civil society advocates can take to support effective policy implementation across every step of the policy process—from agenda setting and policy development to implementation and evaluation. Throughout the tool, advocacy actions are paired with decision-maker responsibilities to help advocates hold government accountable at every part of the policy cycle. (Tool also available in French.)
WHITE PAPER
White paper exploring successful policy implementation
This paper is the academic foundation of the Capital to Clinic initiative. Informed by existing literature on policy implementation science, as well as consultations with policymakers, advocates, academics, and other experts, it seeks to better understand policy implementation by outlining existing frameworks and examining facilitators and barriers to implementation in two case study policies from Ghana and Ethiopia.
CASE STUDY
The story of Capital to Clinic
Want to learn more about how the initiative came to be? This case study outlines the life cycle of Capital to Clinic, from conception through consultations and, ultimately, to the development of a suite of tools. In this case study, we reflect on what we learned along the way.
SUMMARY
Infographic reference guide
This one-page "cheat sheet" is a brief visual summary of the full advocacy tool—a quick, simple pocket guide ready to be posted on cubicle walls, bulletin boards, and social media.