Funding Health Advocacy in Turbulent Times: Three Practices to Adopt

Introduction

Effective health advocacy is not an easy endeavor, but when executed correctly, the results can be game-changing. Health advocates, whether operating through organizations, coalitions, campaigns, or movements, are accustomed to spending long periods of time with no outwardly visible activity or tangible progress, followed by an immediate sense of urgency and action to seize a window of opportunity. In many ways COVID-19 was one of those windows with phrases like “health disparities” becoming crystal clear to many.

TCC Group, a consulting firm dedicated to collaborating with foundations, nonprofits, and companies to solve complex social problems, has deep experience supporting advocacy efforts for funders focused on health and other issues, including working with advocates to build their advocacy strategies and capacity, advocacy evaluation, and research related to more effective advocacy practices.

In the last few years, we’ve found our advocacy evaluations are becoming even more complex. Change is happening in less predictable ways and many dynamics, including an emphasis on power, racial justice, equity, and values-led work, are changing how advocates are working. This is certainly true in the field of health advocacy as health equity has increasingly become the framework many advocates use, and more and more issues move from a nonpartisan to a partisan arena.

In 2021, we conducted three research projects for three different clients with the goal of helping funders and advocates better understand ways to improve and sustain effectiveness.  The research confirmed the complexity of the changes and affirmed that there is no magical solution – while also uncovering practical ways that funders can be better partners to advocacy organizations.

Each project was grounded by a main question:

1. How can funders most effectively support advocacy coalitions?
2. How can funders most effectively support grassroots advocacy organizations?
3. How can funders help support policy durability to ensure policies can last over time?

In this blog we’re sharing some key takeaways from the research for health funders; we encourage those interested to also read the full reports.

Effective Support of Advocacy Coalitions

Key Takeaway

For many, the default assumption is that alignment on policy goals matters most to an effective coalition.  Our research found this was not the case. Rather, coalitions that spend more time and effort up front to ensure they have clear alignment on values were likely to be more adaptive, effective, and sustained.  By having formal practices in place to move through conflict and with clarity on the reason for the policy fight defined in advance, it is more likely that the coalitions would stay banded together and have the much-needed trust already in place when a window of opportunity opens.

One practice to try

Funders supporting coalitions should ensure that there is values-alignment firmly in place. Rather than dictating what the values are, funders can assess how transparent the coalitions are about their guiding values and how they use values to navigate differences. One coalition we’ve seen do this especially well has new members sign a statement of values and conflict resolution, which is then reiterated at each major decision-making meeting. While members do not always agree, they are committed to the process.  If a coalition does not have clarity on their values alignment, funders can support the deep work that it takes to build such alignment.  It may not be the flashiest thing to fund, but its impact is foundational and can lead to longer-term sustainability.

Effective Support of Grassroots Advocacy Organizations

Key Takeaway

Advocacy campaigns like to have grassroots organizations on board because they show a level of support and are assumed to imply “sign-off” from communities that could be affected by policy changes.  However, the campaigns often have governance structures that prevent grassroots organizations from having meaningful input into strategies and goals, leading these organizations to feel they are at the table in a nominal way, and are generally not fully resourced to participate. This is often because they have less capacity (e.g., staff time), and sometimes because campaigns are dominated by grasstops and traditional advocacy voices. Funders are sometimes complicit in allowing this to happen by assuming that the larger organizations have effectively engaged grassroots organizations and/or are supporting the work through the larger organizations.

One practice to try

Provide resources directly to grassroots advocacy organizations so that they can participate fully in the campaign work.  This includes funding all the time they need to engage in meetings fully, but also time that is often less accounted for such as time for networking, building relationships, and follow-up on requests.  Funders can also help build the credibility and reputation of grassroots advocates on a certain issue by funding them to foundational campaign work such as participatory action research to better understand the community’s viewpoint on policy issues.

Effective Support towards Policy Durability

Key Takeaway

Advocacy funders sometimes view a policy win as the first and most important step.  Our research found that policy that is sustained long enough to have a positive effect (durable policy) requires work before, during, and after the traditional active policy advocacy window.  For example, after the policy change in Philadelphia’s home rule charter that required efforts to establish a medical home for all Philadelphians, it took years before it had a clear plan in place.  One of the most crucial advocacy transitions happens between policy passage and the switch to implementation, but foundations often show less interest in supporting this period.  However, advocates find these years of funding essential to enacting a sustained and robust policy that is not watered down or reversed.

One practice to try

Fund post-implementation support to give advocates resources they need to prove the effectiveness of a passed policy. This can include funding advocates to engage in “watchdog” activities where they can track and report on how the policy is being implemented or supporting research reports that show how the policy is achieving the desired health benefit.

Conclusion

Health advocacy funders have adapted their work over the last few years to respond to emerging trends, including a more polarized landscape and a greater emphasis on values like health equity. The research discussed in this post can increase the precision of support offered by advocacy funders, whether they be supporting coalitions, engaging grassroots advocates, or seeking to ensure that the policies they help support have the durability for success. If you have insights or comments about the contents of this blog, we’d love to hear from you!

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