Supporting non-profit participation in health advocacy during an election year: Lessons-learned from the Connecticut Health Foundation's advocacy grants initiative

Background: Through advocacy, non-profit organizations (NPOs) provide visibility for health issues that might otherwise get excluded from public debate. However, advocacy is a critically underused strategy, especially by NPOs that are small and direct service-focused. Funding advocacy is often considered risky by foundations, but the Connecticut Health Foundation (CHF) recognized its unique position and implemented its first health advocacy grant initiative. Intervention: CHF released a request for proposals challenging NPOs to elevate health on the public agenda during the 2006 election year. Successful grantees were each awarded $25,000 and were required to attend technical assistance sessions for strategic communications, workplan development, advocacy rules for NPOs, and peer-to-peer learning. Outcomes: Nine NPOs were funded. Project topics ranged from medical errors to childhood lead poisoning to employer based health coverage. Activities ranged from candidate forums to get-out-the-vote campaigns to podcasts. Incremental indicators of success included tangibles like increased voter participation in a disenfranchised neighborhood and intangibles like grantee-reported increased comfort participating in advocacy. Eight grantees reported intention to continue advocacy post-grant. Lessons Learned: Most small NPOs do not have year round advocacy strategies. NPOs accustomed to responding to community needs, struggled to shift to a strategic mindset. Grantees tended to focus on policy makers over constituents. Evaluating advocacy calls for a different framework, methods, and indicators. Recommendations: Private, federal, state, and more sophisticated non-profit organizations can all make local NPO advocacy efforts more effective through capacity and skill building. Funders should invest in long-term advocacy capacity building that supports their program priorities.