Published On: Fri, Aug 8th, 2014

Leadership and advocacy in effective health care delivery

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 Leadership skill is what every ambitious professional aspire to acquire. Thus, this column affords you the privilege of learning about leadership and how to obtain the expertise.

 For in-depth understanding of this topic, there is a need to define the key concepts.

  •  Leadership: Leadership is a process by which a person influences others to accomplish an objective and directs the organisation in a way that makes it more cohesive and coherent. It is also defined as a process whereby an individual influences a group of individuals to achieve a common goal.
  •  Advocacy: Advocacy is the deliberate process, based on demonstrated evidence, to directly and indirectly influence decision-makers, stakeholders and relevant audiences to support and implement actions that contribute to effective changes to corporate policies, practices and processes.Advocacy involves delivering evidence-based recommendations as a means of seeking change in governance, attitudes, power, social relations and institutional functions


  • Health Care: Health careis the diagnosis,treatment, and prevention of disease, illness and impairment in human beings. Health care is delivered by practitioners in medicine, nursing, pharmacy, physiotherapists and other allied practitioners.

Comparing and combining the elements in these keywords, leadership and advocacy in effective health care delivery can therefore be considered as”a mechanism for influencing a group of individuals, with the overall goal of enhancing healthcare delivery. It seeks changes in governance, attitudes, power, social relations and institutional functions through evidence based processes in the health care industry.”

Areas where leadership is needed to champion advocacy efforts in health care delivery could include:

*    Influencing improvements in the health of the population.

*    Inspiring confidence in the health care system.

*    Empowering the workforce to deliver quality care.

*    Increasing indigenous health care research and development.

*    Rewarding and recognising individual contributions.

*    Fostering capacity development and continuous education.

*    Developing greater institutional capacities.

Keys to effective leadership

The two most important keys to effective leadership are trustworthiness andability to communicate a vision. The leadermust be believable–considering his character and qualifications. The followers should be able to see in him the capacity and commitment to deliver a particular set of expectations. He should also be able to clearly communicate the vision of a desired end. This ability to communicate is, perhaps, the chief of a leader’s functions.

Principles of leadership

  • Know yourself and seek self-improvement:A leader must have self-awareness.Adequate knowledge of your strengths and weaknesses is essential; a leader needs to know where best to make his contributions, and where to seek improvement and help.
  • Technicalproficiency: As a leader, you must be a master of your job and a good manager of your employees’ tasks.
  • Make sound and timely decisions: Use good problem-solving, decision-making, and planning tools.
  • Set the example: Be a good role model for your employees. They must not only hear what they are expected to do, but also see them done by you.
  • Know your people and look out for their well-being:Understand the diversity of human nature and the importance of sincerely caring for your workers.
  • Keep your workers informed:Know how to communicate with not only the followers but also seniors and other key people.
  • Develop a sense of responsibility in your workers:Help to develop good character traits that will help them carry out their professional responsibilities.
  • Train as a team:Ensure that tasks are understood, supervised and accomplished. Communication is the key to this responsibility.
  • Use the full capabilities of your organisation: By developing a team spirit, you will be able to employ your organisation, department, section, etc. to its fullest capabilities.

Leadership and advocacy

Advocacy, as hinted earlier, is a useful platform by which leaders utilise demonstrated evidence to influence and seek for change in governance, attitudes, power, social relations, policies and institutional functions. Leaders have the necessary ingredients for achieving advocacy for effective health care delivery.

The two basic foundations for an effective advocacy effort arecredibility and skills.


  1. Credibility: As an advocate, it is crucial that the governments, institutions and communities we work with trust us and value what we have to say. Expertise and trusting relationships, complemented by strong research and analysis, form the cornerstones of credibility.Are you known and respected by decision-makers?Are you perceived as objective and trustworthy, or politically partisan?Are you fully compliant with ethical standards of engagement with partners?


  1. Skills: Advocacy is a skill that combines knowledge, good judgement and creativeproblem solving. Building skills for advocacy requires organisational commitment to training, capacity-building and promoting staff ability to engage with a wide range of people, both within the office and outside of it.Does the office have staff with strong core advocacy skills for analysis, research and communication? If not, can it draw on such people from partners or other arms of the organisation?Do staff members have adequate technical knowledge to develop an advocacy strategy and implement it?


Other foundations include:

  1. Intra-sectorial coordination and leadership:Is there a strong degree of coordination and communication across sectors to work together on a coordinated advocacy strategy? Is there strong leadership for advocacy?Does everyone in the team understand their advocacy roles and responsibilities?Are mechanisms in place for all to be aware of advocacy priorities and messages?


  1. Capacity to generate and communicate evidence: Evidence for advocacy provides credibility and authority to the organisation, allowing us to convince decision-makers to support an issue. Data collection, research, analysis, organisation and management provide the basis for solid evidence. This evidence, however, must also be interpreted and then communicated at the correct time, to the relevant audiences, and in the appropriate manner. The evidence needs to highlight the issue, the causes of the issue and the solutions to the issue. Being transparent about methodology, and not overstating findings, adds to credibility and helps the advocate gain advantages in public argument.


  1. Ability to assess risks: There are risks in both undertaking and not undertaking advocacy. Is careful consideration given to the long-term and short-term risks and gains? Are staff members willing, encouraged and supported in taking calculated risks in advocacy?Does the office have effective processes for risk mitigation and risk management?Has a vulnerability and capacity analysis been conducted?


  1. Long-term partnership and networks: The ability to build relationships – personal, public and institutional – is very important for effective advocacy. Good relationships allow organisations to reach target audiences or overcome gaps by connecting with influential ‘secondary’audiences, as well as generating mass support for the causes and issues that advance effective health care. Building such relationships requires understanding the dynamics of power and having the capacity to engage audiences through multiple platforms and forums. As relationship is nurtured, people will respond and provide support for you –butyou must also be prepared to respond in a timely and diligent way. Reciprocity and responsibility strengthen, build and sustain partnerships. How strong is your engagement with domestic NGOs, think tanks and universities to generate evidence? How strong is your engagement with the private sector? How strong is your engagement with the government, including relevant ministries(MoH,Finance etc.) and agencies?Is your establishment a member of any coalitions, alliances or networks? If so, does it engage in a leading role on issues that affect health care?

Sufficient resources: Advocacy is resource-intensive. It requires investments of funds, personnel, timeand materials, over an extended period of time. Are there adequate resources for advocacy?Resource availability often changes the shape of an advocacy strategy and how it is planned. Therefore, it is essential to know the likelihood of what resources will be available for an advocacy issue from the outset.

Leadership and advocacy in Nigeria: A case study

Despite recently observed progress in population health, there remains an urgent need to do more to improve health outcomes, otherwise Nigeria will be unable to attain the health related MDGs.As a result of the private sector’s potential to expand the access to health services, improve quality of care and complement the public sector’s efforts in addressing health system challenges in the country, corporate leaders in Nigeria formally endorsed the activation of the Private Sector Health Alliance of Nigeria (PHN) to mobilise the broader business and corporate community, as well as the private health sector, towards a multi-sectorial coalition focused on improving health outcomes.

 The PHN initiative

The PHN is championed by notables like Alhaji Dangote,Jim Ovia andDr Ali Pate(former minister of state for health). The mission is”to save at least one million lives by focusing on innovation; strategic partnerships; advocacy and impact investments.”

The initiative leverages the collective capabilities and resources of the private sector to address the leading causes of mortality (this emphasises cross-border collaborations) and also harnessesinnovation and technology (from the private sector) to leapfrog constraints and increase access to care (this emphasises use of evidence based interventions).



Moderate improvement in some health indices (NDHS 2013).

 Self-test activity

From your understanding of the subject matter,analysethe case study and highlight the following:

  1. Which principles of leadership are involved?
  2. What were/are the critical elements for success or failure in such interventions aimed at achieving effective health care delivery?
  3. Can you develop similar project interventions?


Leadership and advocacy can provide optimal health care delivery through visionary and innovative concepts. There are several opportunities available for us to contribute toimproved quality of health care in Nigeria. To do so effectively requires developing effective leadership and advocacy skills; achieving and maintaining credibility; building the necessary partnerships; mustering sufficient resources; and being able to communicate compelling evidence to the appropriate channels.

By Pharm Agboola Oguntonade

 Agboola Oguntonade holds a Master of Science degree in Clinical Pharmacy. He has worked as Social Mobilisation Consultant with the UNICEF, USAID Community Participation for Action in the Social Sector Project (COMPASS) and as National Facilitator with the WHO on the Polio Eradication Initiative. He currently consults for the MALARIA CONSORTIUM on the Support to National Malaria Programme (SuNMaP) and also the pioneer lead Pharmacist at the Kesington Adebutu Foundation Maternity, University of Lagos.



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Leadership and advocacy in effective health care delivery