Advocacy refers to the efforts of an individual or group to effectively communicate, convey, negotiate or assert the interests, desires, needs and rights of an initiative, policy, programme, or even an individual or a group. It is different from information, education and communication (IEC) and community mobilization.

Advocacy can also be defined as pleading for defending or recommending an idea before other people, with a view to promoting its acceptability. It can include many activities that a person or organization undertakes including media campaigns, public speaking, commissioning and publishing research or poll. A similar term is Lobbying - (often by lobby groups) which is a form of advocacy where a direct approach is made to Administrators on an issue which plays a significant role in modern hospitals/ health care workers.

Advocacy is needed at various levels in an organization/ hospital/ medical institutes. It has to be conducted for policy makers, Decision makers, teachers/ educator. Advocacy activities may be of different types. It may be in the form of person-to-person, meeting, workshop situation, or through communications and media.

In this article we will focus on advocacy as a significant tool to attain the objectives of HCWs safety issues. In a way, advocacy does not appear to be anything completely unknown. Individuals, groups and organizations have been conducting such activities in varied ways since long. But it is necessary for Facilitators and trainers to appreciate its contextual meaning and significance and also to develop skills for organizing advocacy programmes at different levels and for different target groups. This can be done by conducting the following activities.

It is very important to note that participants may have different ideas about what advocacy is and why should we do it. Quite often confusion prevails between advocacy, information, education and communication (IEC) and community mobilization. Moreover, there is no universally agreed definition of advocacy and it is not necessary for everyone to agree on one definition.

By definition a person who speaks up for and defends the idea or programmed or new Endeavour is known as an advocate.

A good advocate must have the following abilities:
Adequate knowledge of the relevant issues concerning Health care workers (HCW) safety.

1. He/she should have a conceptual framework of skills and a plan to advocacy or to implement is well prepared and organized.
2. Knowledge about the concerned health system and the socio-cultural setting.
3. Understand the profile of the target group and think about what the target group wants and what they will like to say on various issues related to their own safety.
4. Establish rapport comfortably and maintain it throughout
5. Actively listen to what others say; Ask questions not to embarrass the target group but to generate their interest in the discussion.
6. Communicate clearly and with confidence; should be assertive but respectful and never be aggressive.
7. Organization process and the skills to plan and conduct advocacy sessions.

The purpose of advocacy is to empower the health care workers with advocacy and lobbying skills in order to advocate for health and health related issues. It also includes the following:

1. Meaning of lobbying and advocacy and how to identify advocacy issues.
2. Building constituency for support and mobilization.
3. Networking and coalition with other similar organizations.
4. Identifying advocates for a particular issue.
5. Designing and pre-testing messages for identified target groups before going public.
6. Using materials to lobby and support the campaign i.e. flyers, pamphlets, booklets, position papers, fact sheets etc.
7. Use of media in advocacy and lobbying.
8. How to reach and lobby the policy makers i.e. Administrators/ hospital Medical Superintendents, Dean of Medical colleges,
9. Building consensus and dealing with divergent views (addressing / countering the opposition).
10. Fundraising for advocacy.

Value of advocacy

For the patient: In addition to solving problems that contribute to psychological distress, advocacy helps to give clients a measure of autonomy and dignity. By participating in the processes that affect their lives - making treatment decisions, negotiating with clinicians, setting house rules in their residence or controlling their finances - clients grow in their independence, self esteem and ability to work with others.

For the Health Professional: Having an Advocate work with a client means "an extra pair of hands" to resolve a client's problems. Because he/she is external to the system, an Advocate can also help to improve communication, diffuse tensions and resolve conflicts when disagreements have arisen between a advocacy group and a service provider.

For l health facilities - Because of their access and perspective, Advocates help to identify systemic problems that are hidden, even from those working in the system. By participating in the development of policies and practices, Advocates help prevent future abuse and neglect. By articulating their clients' concerns,

For the community - Advocating for the rights and interests of their clients, helps increase public awareness and eliminates stigma. Advocates also can help generate public support for financial, Guiding principles for Advocacy-

 Asking questions is another way of showing respect for the ideas and suggestions of others, and your openness to working as a team. If you do not understand something, ask questions until you do understand.^1,2

 Sometimes people in a conversation do not always hear what the other person is saying because they are arguing with the other person in their head .When you are upset or thinking about something else (like what you want to say next), you may not really be listening .Active listening means staying calm and quiet, and focusing on what the other person is saying. Repeat the main points back to the other person, so that they know that you have been listening and understand what they are saying. A good active listener will also take notes while they are listening to other people at a meeting or during a telephone call.
Always have a pen and paper when you are speaking with target audience. Write down any important information, and include the name/s of the people at a meeting, or the person you are speaking with on the phone. Also include the date and time of the conversation. Write down any actions that you have agreed to take, as well as any actions that the other people have agreed to take.

 It is important to notice if your own feelings are getting in the way of expressing yourself clearly and in an appropriate way. It is hard to be respectful, when you are full of emotion.

 Know the purpose of your call or meeting and stay on that purpose until it has been achieved.

 Effective advocates are assertive advocates. Assertiveness can be defined as the direct, honest, comfortable and appropriate expression of feelings, opinions and beliefs through which one stands up for his/her own rights - without violating the rights of others.

Assertiveness is

1. Expressing your needs clearly and directly
2. Expressing your ideas without feeling guilty or intimidated
3. Sticking up for what you believe in
4. Knowing what your concerns are and how to prompt the target audience to accept those
5. Exhibiting self-confidence when communicating
6. Self-reliance and independence
7. Persisting until you get what you need and want

Assertiveness is not

1. Relinquishing your right and responsibility to advocate
2. Beating around the bush before stating your needs
3. Feeling too guilty or afraid to express your needs
4. Agreeing with others when you would rather not
5. Leaving decisions to others because "they know best"
6. Reliance and dependence on others, giving into defeat
7. Giving up when you run into "red tape”
8. Making assumptions and decisions before you obtain all the facts

1. Be specific when introducing a complaint.
2. Focus on one issue at a time.
3. Don't just complain. Overloading another person with grievances can make her/him feel hopeless, and suggests that either you have been hoarding complaints, or you have not thought carefully about what really troubles you.
4. Do not focus on past grievances. Focusing on problems that happened in the past can interfere with what you are trying to accomplish right now. Complaints, or grievances should be brought up at the earliest possible time, or the other person has the right to suspect that they have been carefully saved as weapons.
5. Take time to think before you speak. Do not feel that you must rush to say something or to sign something.
6. Do not consider counter-demands until your original demands are clearly understood, and there has been a clear response to them.
7. Consider compromise. Look for solutions that meet the concerns of all members of your child’s education team.
8. Don't assume that you know what another person is thinking until you have heard what that person has to say.
9. Do not assume that you know how another person will react, or what they will accept or reject.
10. Avoid correcting another person's statement about his/her own feelings, or telling another person how s/he should feel.
11. Repeat major points of a discussion to make sure that there is agreement, and to re assure the other person that you understand what has been discussed.
12. Avoid sarcasm and labels and name-calling. Do not be intolerant. Be open to the feelings of other people. Try not to say things that you will regret later, and never make racist or sexist remarks that will offend others and violate their rights.

Advocacy can take many different forms - for example, it can be written, spoken, sung or acted. It can also vary in the time it takes, from one hour to more than several years. We can do advocacy work on our own or with others.

Some of the most powerful advocacy methods are led by the people affected by the problem or issue, or directly involve them.

Sometimes advocacy work is forced on us - the problem or issue is already there, and we use advocacy to reduce the problem. This is reactive advocacy. At other times it is possible to plan for the future, to ‘set the agenda’ and use advocacy to create a positive environment or prevent a problem before it happens. This is proactive advocacy.

Although there are multiple levels of advocacy work, for the sake of simplicity we can identify three key ‘levels’ of advocacy.

1. Local
2. State
3. National
4. International (more than one country)
5. Working together in coalitions can be strength at every level, but becomes particularly important as you move from local to national to international level and face greater bureaucracy and power.

None.

The author declares no conflict of interest.

1. National council of education research and training
2. www.campha.org