Advocacy efforts normally aim to realise policy, programmatic or sector-level changes. However for advocacy to lead to meaningful change a number of factors need to align at the right moment in time. Often this is described as the creation of a ‘policy window’. Political theorists argue that there are multiple streams that contribute to policy windows arising. Generally, policy change occurs in response to an agreed ‘problem’. Theorists like John Kingdon suggest that ‘policies’ and ‘problems’ exist as two separate ‘streams’ which are influenced by a range of historical and contextual factors and the systems within which they occur. Running alongside these two streams is third - ‘politics’. In this theoretical context ‘politics’ encompasses advocacy actors who may be pressing governments or the sector to act. The diagram below summarizes some of the factors in each stream, illustrating how these combine in a particular moment to create an opportunity for change.

Image: Saeed Shahabiand Kamran Bagheri Lankarani in Health Sector Reform Following COVID-19 Outbreak: Using Kingdon’s Multiple Streams, 2020

Some people have suggested that the COVID-19 pandemic could be viewed as a large catalyzing ‘problem’ since it has highlighted important health shortfalls and inequities. The pandemic has shone a spotlight on the fact that hand hygiene is critical for interrupting the transmission of COVID-19 as well as a range of diseases. It has also drawn attention to the historically inadequate levels of investment and planning related to hygiene programming, policies, and sustainability. Lastly the pandemic has shown that hygiene promotion and handwashing infrastructure can be rapidly scaled up with increased willingness and buy-in from all actors. The diagram below shows an adapted version of the ‘three streams’ diagram above, which highlights how hygiene related factors may need to align to create a policy window. It illustrates that realising change will require all COVID-19 response actors to actively undertake advocacy work in order to influence policy decision makers.

There are other positive initiatives that are likely to contribute to lasting change. For example in 2020 the WHO and UNICEF set up the Hand Hygiene for All initiative. The initiative is designed to champion hand hygiene at a global level and sets out plans to support countries as they respond to the COVID-19 pandemic, while also developing national hygiene roadmaps to rebuild and reimagine the state of hand hygiene for the future.

Want to learn more about fostering a new generation of effective hygiene initiatives built on the pandemic experience?

Editor's note

Author: Elli Leontsini, Peter Winch and Anika Jain
Reviewers: Tracy Morse, Helen Hamilton, Dan Jones, Sian White, Jenala Chipungu
Last update: 04.01.21

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