Advocacy for Health: An Educator’s Guide to incorporating Advocacy into the Health Sciences Curriculum Samantha Khan-Gillmore SMU – 14 September 2017
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 7 • *not exhaus,ve defini,on
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 εσ ρελ τεσ νο νοτ ονλ νλψ τι µ εσ ελατεσ το τεχ ηνιχαλ χο µ πετενχ ετενχε , βυτ βυτ το το α λοσσ σσ οφ οφ το τεχηνι τηε ηι στοριχαλ περ τιϖε , το το τηε τηε τηε ηιστο ερσπ σπεχ εχτι στρουσ διϖορχε διϖορχε οφ οφ χο µ πετενχ ετενχε φρ φρο µ δισα σαστρ χονσχιενχε ” • Ερνεστ Βοψερ , µ εδιχαλ 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
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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 18 • Privilege-oppression works through series of unearned privileges
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 20
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?
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