Advocacy for Health: An Educators Guide to incorporating Advocacy - - PowerPoint PPT Presentation

Samantha Khan-Gillmore SMU – 14 September 2017

Advocacy for Health: An Educator’s Guide to incorporating Advocacy into the Health Sciences Curriculum

Where does RHAP work?

Rural CommuniEes

Who is the future of health?

Background to the manual

• Health system challenges
• Inequi2es and inequali2es remain in the health system
• All of this impacts on pa2ent care and pa2ent health
• While health care workers have clinical knowledge, they don’t

all necessarily have the tools to deal with health system challenges which includes specific key principles and strategies outlined in the manual

• Current status quo of producing clinically skilled HCW’s but

who lack the confidence and skill to conduct health advocacy is no longer sufficient to meet the demands of an ailing health sector

Advocacy is *

• An acEve promo2on of a cause or principle involving ac2on to

change policies, prac2ces, make broader impact, reform ins2tu2ons, alter power rela2ons and change aDtudes/behaviors-about agency

• Cognisant of context- poli2cal-economic , power, privilege,

cons2tu2on, violence, poli2cs legi2mated through law and administered through the bureaucracy

• Beyond ethics, pa2ent-centered, primary care, public health—

because all need advocacy to succeed

• No one size fits all & at all levels
• *not exhaus,ve defini,on

7

Why focus on advocacy now?

• The current demand is such that students need to

know how to advocate for what they want, what they should have and what they need.

• Students are increasingly valuing their voice and

space to speak out against social injus2ce

8

Why focus on advocacy now?

• Current context demands reform strategies and

cri2cal thinking

• Health educa2on reform is impera2ve and cri2cal
• Our experience at RHAP provides evidence that

frontline health professionals are reques2ng advocacy training on a daily basis to deal with current challenges

• “Τηε χρισι

σισ οφ οφ ουρ ουρ τι τιµεσ εσ ρελ ελατεσ τεσ νο νοτ ονλ νλψ το το τεχ τεχηνι ηνιχαλ χοµπετενχ ετενχε, βυτ βυτ το το α λοσσ σσ οφ οφ τηε τηε ηι ηιστο στοριχαλ περ ερσπ σπεχ εχτι τιϖε, το το τηε τηε δισα σαστρ στρουσ διϖορχε διϖορχε οφ οφ χοµπετενχ ετενχε φρ φροµ χονσχιενχε”

• Ερνεστ Βοψερ, µεδιχαλ

εδυχατορ

Context of the SituaEon

Universi2es who are seeking to create health professionals who able to impact on the health outcomes of pa2ents and communi2es can: 1. Innovate by valuing and ensuring the teaching, learning and prac2cing of advocacy against social injus2ce as a therapeu2c tool 2. Realise the HPCSA/CANMEDS/AFRIMEDS Health advocate competencies 3. Bridge the gap between professionals and Quality

Who is the manual for –target audience?

• Although health advocacy is recognised as a key component in

health sciences educa2on, it is not explicitly taught.

• Challenges in teaching advocacy: how to teach it? Where?

What tools? How to assess it?

• Manual was wri]en for educators mo2vated to and

interested in integra2ng advocacy in the health sciences curriculum

• Teaching advocacy cannot be a stand alone module – it needs

to be integrated across the curriculum to assess it’s value and enhance the goal of people-centred approach

15

Few comments aRer a review at UKZN on Advocacy in 2015

• ‘’We are not all ac2vists but now I feel like I could be”
• “Yes this should be in our curriculum because it is not—problem is

they not winning our hearts at the moment”

• “Our courses are not open to cri2que while we doing them”
• “Exposure is not enough-we need to do it”
• “I’m not capacitated to teach this”
• “ Transforma2on is wanted by all of us for many years but we have

not changed as much as we should have”

What did the students say?

• We do not see our role as one of facilita2ng pa2ents and

communi2es to advocate for themselves

• We do not advocate for ourselveselves as HCPs
• We do not advocate on behalf of their pa2ents and

communi2es

• We do not have role models (from the academic staff)
• Are “beholden” to staff and faculty to behave in a certain

manner – the hidden curriculum emerges here

Current context

• RhodesmustFall/#FeefmustFall/#AfrikaansmustFall/#TsongamustRise-

groundswell of ac2vism that showed the need for deeper reflec2on and quicker progression from rhetoric to realising change

• Right to health is under threat (poli2cal environment, corrup2on,

lack of good governance, budge2ng constraints, etc)

• HCP’s are first hand witnesses (frontline workers) and many are part of

a proud tradi2on of rights’ based ac2vism– however, they now need confidence and tools: responsibility of the university to impart this

• Social capital – working together, networking, collabora2ng, etc
• Privilege-oppression works through series of unearned privileges

18

Why is advocacy so important in the health sciences?

• Students need to learn how to advocate for their pa2ents – in

and outside of the clinical environment

• Development of knowledge, skills and aDtude (KSA

framework) around advocacy is important for future health advocates

• Nurture students value and willingness to serve where the

need lies and allow them to be able to address health care challenges effec2vely and confidently, without fear of reprisal.

• And also to nurture social responsibility and social

accountability

Context of health educaEon reform

• Need to support the evolu2on of curriculum development
• Looking for the ‘hidden curriculum’ and circumven2ng it for a

more progressive approach

• Transforma2on agenda is important at all levels at the

university

• Who are our students and where do they come from?
• The urgent need to be ‘relevant’ has never been more cri2cal
• Decisive trac2on on social accountability, transforma2ve

learning, PHC, community based educa2on is in dire need

• Students need to recognise and know Champions who

advocate for advocacy

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Core Advocacy Competencies of HCP

• Respond to individual pa2ent/client health needs and related

issues as part of holis2c health care

• Respond to the health needs of the communi2es that they

serve

• Respond to the pa2ents’ health needs by advoca2ng with the

pa2ent within and beyond the clinical environment

Frameworks for health educaEon reform

Socially accountability- (The Lancet`)

• ‘ac2ve in broader advocacy and

health-related reform”

• ‘societal needs” e.g. failing health

system and unrealised rights

• competencies of problem-solving and

advocacy

Frameworks for health educaEon reform

Purpose of transformaEve learning (The Lancet) 3 shiRs:

• from fact memorisa2on to criEcal reasoning
• to achieving core competencies for effecEve

teamwork in health systems

• from non-cri2cal adop2on of educa2onal

models to creaEve adaptaEon of global resources to address local prioriEes

How does the manual link with transformaEve learning?

• Students are able to change the way they interpret the world

and their experiences

• Development of a social and poli2cal consciousness
• Inspiring a social jus2ce framework for health eg. Equality,

equity, access, etc and not merely looking through a clinical lens

• Endorsing a direct link between human rights and pa2ents

rights

When does the learning begin?

• Begin cri2cal thinking pedagogy early in the curriculum [from first

year]

• Begin to ask the tough ques2ons early on:

I. Who is invested in the public interest?

• II. Whose interests are served/violated?
• III. Is this the best way to deliver service?
• IV. How do you change things?
• V. Reflect on assump2ons, biases, values, deconstruct privilege and

class in society. – are these biases following you into the lecture room?? I. Reflect on the global dynamics and how they relate to the local

Beginning the learning…..

• Classroom hours ( large and small groups) and

experien2al learning including topics of social jus2ce integrated closely into other subjects

• Open to innova2ve evalua2on instruments—self

reflec2on pieces for publica2on, presenta2ons to peers and communi2es, actual work toward redress social condi2ons (not just recommenda2ons from a project)

CriEcal elements to include with Advocacy in Teaching and Learning

• What is advocacy? [Broad, mainstream,

specific defini2on]

• In what context is it taught in the various

facul2es?

• What content related to advocacy is

taught? Human rights? Social jus2ce? Pa2ent rights ac2vism?

• What scope and landscape is included?

Urban, peri-urban, rural, class, privilege?

CriEcal elements to include with Advocacy in Teaching and Learning

• How do you assess advocacy skills? [prac2cally,

research, MCQ’s, community outreach projects?]

• How and by whom is your curriculum &

assessments validated?

• What kind of culture and values does the

university embrace when faced with students speaking out and advoca2ng for their rights?

• Cri2cal reflec2on and thinking should be the

pillar of the ins2tu2on

• How do you and students value, learn and apply

these tools and strategies?

AddiEonal Elements

• 1. Communica2on skills eg. Media training,

developing a campaign

• 2. Teach strategic thinking explicitly – how to

develop strategies and alterna2ve strategies

• 3. How to mobilise, network and work in

solidarity with others

• 4. Valida2on by communi2es directly affected

themselves

• 5. Understanding power rela2ons and how

produc2ve it can be for pa2ent advocacy

A curriculum that values social jusEce and advocacy as a skill

• Situa2onal analysis
• ‘Commitment”/Champions by seniors and new cri2cal

thinking voices emerging

• Simultaneous reform of the curriculum and its ins2tu2onal

context

• Involve and embed students from the start to form

collabora2on between the sciences and other facul2es. Problem - Health sciences only talk to each other. (SMU is different here)

• Assess targeted students needs: A process by which

curriculum developers iden2fy the differences between the ideal and the actual characteris2cs of the targeted learner group and between the ideal and actual characteris2cs of their environment

Advocacy Manual Curriculum Goals

• Become familiar with the legal and policy frameworks for

human rights and social jus2ce in a health context

• Become familiar with the rights, du2es and responsibili2es of

a health care worker

• Be able to define advocacy, and to discuss the scope and

principles of health advocacy, either broadly or in a par2cular context

What makes the manual different?

• From once-off lectures on medical ethics, social jus2ce, public

health….?

• It takes a broader approach: it seeks to integrate advocacy

interven2ons across the student life rather than in pockets. This can be done through:

• Clinical rota2ons
• Prac2cals
• Elec2ves
• Using clinical examples as an opportunity for advocacy

teaching in lectures

• Community engagement provides a plaporm to engage with

society and it’s needs in a specific context

• “The teacher is of course an arEst, but

being an arEst does not mean that he or she can make the profile, can shape the

• students. What the educator does in

teaching is to make it possible for the students to become themselves”

• Paulo Freire

OpportuniEes for teaching advocacy

• Common situaEons to avoid and/or remedy to which the

faculty and learner can refer are:

• Pa2ent care is compromised due to a lack of equipment/staff/

drug/poor response 2me by emergency medical care

• A pa2ent interrupts treatment due to a drug shortage
• A pa2ent is unable to go to theatre due to a porter’s strike or

no electricity

• Some doctors abuse of the remunera2on of work done
• utside of the public sector

OpportuniEes for teaching advocacy

• Common situaEons to avoid and/or remedy to which the

faculty and learner can refer are:

• Medica2on is prescribed or dispensed incorrectly, which can

include the incorrect dose, site, frequency, dura2on or medica2on itself

• Poor communica2on between health care worker and pa2ent

leading to failure and/or delay in diagnosis

• The aDtude of staff is poor
• Procedural errors – eg. Wrong pa2ent taken to theatre

Examples of Health advocacy learnings and discussions with students

• 1.

Lectures on obstetric emergencies are a good

• pportunity to include a discussion on access to health

care services and emergency obstetric transport

• 2.

Discussions about the management of disabili2es present an opportunity to discuss access to rehabilita2on services in rural areas, the shortage of allied health workers, and necessary equipment eg. wheelchairs

• 3.

The late presenta2on of children with hearing loss can be an opportunity to discuss the health system factors that result in a reduced demand for health care

Examples of Health advocacy learnings and discussions with students

• 4.

Students can reflect on the health system errors that have led to an adverse event in a clinic or a hospital – a maternal death, a s2llbirth and the death of a child under five years of age

• 5.

Rehabilita2on follow-ups and con2nuity of care of rehab pa2ents is oqen in dispute in a hospital seDng – lessons for pa2ent centred treatment

ExperienEal Learning Case study

• Consider the following student experience:
• A student is observing a clinical consulta2on with a senior

health professional. As an elderly pa2ent enters the room, the health professional answers a personal telephone call on her cellphone and con2nues to talk on the phone for a further 15minutes while the pa2ent pa2ently waits.

• What would you say to the student?

ReflecEon as a learning tool

• Encourages students to think about what they have seen and

what they may do differently in the future

• 1.

The experience – what has happened, what was done or not done

• 2.

The learning – what has significance for doing or changing things in the future (what was learnt about the problem and about myself)

• 3.

The evidence – how the learning is being applied in a par2cular context (how will the same or similar situa2on be addressed next 2me)

• 4.

Learning needs – where would it be appropriate to go next? (What I would like to have done but couldn’t or didn’t)

An example of the need for Advocacy Teaching

• A medical student at a Rural Health Club debate on advocacy

in 2016 expressed outrage and disempowerment that she had felt during an obstetrics rota2on during which she couldn’t even offer clean sheets to a mother who had given birth the day before. Yet, there was no place she felt she could go to rec2fy the situa2on.

• This type of outrage needs to be channelled into posi2ve,

construc2ve ac2on before it dwindles and is replaced by an acceptance of the status quo.

So you’re thinking…..but I’m too busy!!

Challenges of teaching advocacy

• Teaching staff will raise criEcal quesEons that need to be

addressed:

• A)

Why should advocacy be integrated when there is no space to do so?

• B)

Why is the topic of advocacy more important than the current topics in our course?

• C)

We may not be advocacy content experts, so how will the ownership of the course be affected?

• D)

What will be cut from the curriculum to include advocacy?

• ALL Relevant and URGENT ques2ons that need to be

addressed through the commitment of process of change

Teaching advocacy….

q Iden2fy good role models and lecturers who can talk from experience q Use guest speakers from health advocacy groups q Use prac2cing clinicians q Build networks with key organisa2ons in the field of advocacy. q Work with community agencies that can help highlight issues in the community that informs advocacy needs q Be explicit in what you want students to learn and have a ra2onale for why you are teaching advocacy to them q Create clear links between what students already learn and the knowledge, skills and aDtudes essen2al to be a health advocate q Create opportuni2es for dialogue and discuss

“I never teach my pupils. I only provide the condiEons in which they can learn” Albert Einstein

For more information

For more informaEon: Rural Health Advocacy Project Samantha Khan-Gillmore Email: samantha@rhap.org.za or info@rhap.org.za Tel: 010 601 7427 Follow us on: Twi]er: @RHAPnews Facebook page: Rural Health Advocacy Project