HRH Policy Advocacy Leaders in Action Interview: Andrew Barrer
An interview series with HRH champions in developing countries produced by the HRH Global Resource Center. This part of the series focuses on HRH leaders in policy advocacy.
Andrew Barrer is the External Affairs Advisor for the Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), a program of Seattle Children which focuses attention on the need for scientific research around prematurity and stillbirth both in the U.S. and globally.
What is policy and advocacy work in the human resources for health field?
There is a need to educate policymakers and decision-makers about the importance of having a health workforce in developing countries who can implement health programs. As we develop new technologies and interventions, we need the people to carry them out. For example, we require people to administer the new vaccines that have been introduced over the last ten to twenty years. It takes health workers to go door-to-door to assess families and educate them about the importance of attending a vaccine program, so it is not just the development of the vaccine – it is the implementation of that technology. Our job [as policy advocates is] to educate decision-makers on the need to include the human resource issue in our development aid and in our country-by-country planning for global health. Part of the GAPPS view on human resources in global health, also includes the need to train new researchers and to have research capabilities in developing countries.
How do you educate policymakers? How do you perform policy advocacy?
We develop policy briefs and fact sheets that translate the technical aspects into very simple and direct communication so that the listener absorbs the information. It is not just disseminating documents; it is making sure that people understand what the policies are. Our role at GAPPS is to advocate for the need for scientific research around the prevention of prematurity and stillbirth. In coming months, research will be released that shows the number one cause of newborn deaths is complications from premature birth, so we advocate for the need for additional scientific research to come up with both causes and new solutions.
Is the purpose of policy advocacy work to affect a change?
We want to see that there is a change or make sure that a promise is delivered. For instance, under the PEPFAR reauthorization, fifteen percent of the budget is supposed to go towards health system strengthening, and there is a commitment from the U.S. government to ensure a strong health workforce. Within the legislation there is a stipulation to train more than 100,000 new health workers. We try to get measureable outcomes from that health workforce promise, so we may meet with policymakers to define how we measure health workers and additions to that number. A lot of advocacy work is developing communications, strategies, and outcome measurements to see that promises are fulfilled.
What are challenges to doing policy advocacy work?
The biggest challenge is that there are a lot of new ideas and coalitions, and the space that you are trying to communicate in is getting very crowded. Ten or fifteen years ago in global health, there were a few objectives, but now we have many new solutions such as a malaria vaccine, new treatments for neglected tropical diseases, new technologies that can lead to better scientific research and so many more. Each of these issues has an advocacy program. Each disease and condition has an advocacy program and a coalition of groups promoting ideas and solutions. There is so much information, but your audience has not changed that much. It is still the same person in a Congressional office who is assigned to health, who usually has other portfolios, is now hearing about fifty issues instead of five.
The second biggest challenge is the economy. With limited resources being allocated to global health, resources are dwindling; but new ideas and new technologies are growing. There is a basic conflict between implementing new solutions that cost money and an environment where money is more limited.
What are the best communication channels for dealing with decision-makers?
I think in person meetings and very simple, straightforward fact sheets are probably the best channels. If someone who handles a hundred different topics needs to understand the pneumonia vaccine, they should be able to pull up one to two pages and understand what the issue is, what needs to be done, and why. Your audience needs simple resources that they can grasp easily. I think, generally, for the high-level policymakers/decision-makers, it is not about events. Events are best for getting your colleagues to agree with you, to stir up enthusiasm, and to educate the public health community that an issue is important. The most important thing is the personal connection you can make with the individual you are trying to persuade or enlist to your cause.
What are the signs of success in policy advocacy work? What might be an indication that you need to change your approach?
Signs of success would be when government makes a change in policy, when you see increased resources, or have key decision-makers talking about our issue. One of the things that the Coalition for Child Survival did on the Hill was try to get members of Congress to talk about newborn and child health whenever they talked about global health. We provided them with examples, and many members of Congress used our fact sheet to provide basic facts on the issues and used the term "child survival." Even without a change, we saw this as a success. Between 2006 and 2010 we saw a renewed enthusiasm for child survival and increased funding for programs through USAID.
I think a setback is when important decision-makers on the Hill start talking about global health and foreign assistance as not being important. When we see the decision-makers and people in power are not supportive of funding global health, or we have someone who is a supporter that does not follow through with their promises, that is a stumbling block. Enthusiasm and policy agreement is one thing, but action is what we need.
Are there any lessons that you have learned about policy advocacy work during your time at GAPPS?
I have learned that you need to put the information in simple, straightforward terms. Highly technical information does not resonate with the people making decisions; they want to see the basic facts. You cannot send someone on Capitol Hill a ten-page brief because they are not going to read it. It is also important to have good examples to give people hope. If the problem is overwhelming, decision-makers may feel there is nothing they can do to make it better. You need to show them an example of how things are working. They need to see that success is possible and realistic. Five years ago people didn’t talk about premature birth but now we hear the term being used. We also have communicated to many people that premature birth is rapidly becoming the number one killer of newborns. Now we have to educate people that we don’t yet have all the solutions needed and that we need more research to fill that solution gap. Scale-up of current interventions is important, but we need more interventions that can be proven to work.