HRH Policy Advocacy Leaders in Action Interview: Sandra Krause
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.
Sandra Krause has been working in international health for more than 20 years and has been the Director of the Reproductive Health Program at the Women's Refugee Commission for the past thirteen years. She is a registered nurse with a Bachelor's of Science in Nursing and a Master's degree in Public Health.
What is policy advocacy work in the human resources for health field?
In my case, the aim is to obtain favorable policies in support of reproductive health for crisis-affected populations. I’m coming from the world of refugees and humanitarian assistance, so I’m advocating for favorable policies from donors, the government, the United Nations, international nongovernmental organizations (NGOs). We have been very involved in influencing guidelines and policies for health such as integrating reproductive health with HIV/AIDS guidelines, global health cluster guidelines, gender guidelines and the Sphere Minimum Standards in Disaster Response.
Where do you do your policy advocacy work? Is it primarily at the United Nations (UN) in New York or do you travel to the field?
The Reproductive Health Program has been in existence since the early 90s. In the beginning, the Women’s Refugee Commission advocated getting reproductive health on the humanitarian agenda, and we did that by going to the field to hear directly from the displaced population – women, men, and adolescents – about their needs. In 1994, we published a report, "Reproductive Health: Reassessing Priorities" that called attention to the fact that in eight different refugee and internally-displaced settings, reproductive health was not being addressed. It came out just ahead of the International Conference on Population and Development, which was a watershed for explicitly recognizing refugee and internally-displaced persons' rights to reproductive health. After that, the UN agencies responsible for humanitarian assistance started a group called the Interagency Working Group on Reproductive Health in Crises to start to deal with the issue, and we continue to support that effort and advocate together with this group to move the reproductive health agenda forward.
What do you need to do policy advocacy work?
You have to constantly know the problems and gaps. For example, you might get reproductive health on the agenda and then recognize that family planning or adolescent sexual and reproductive health is a major gap in the whole area of reproductive health. You have to focus, and you always need field-based information that supports your efforts.
We have a number of audiences, including the displaced population themselves, and it's really important for them to participate in our advocacy and in our work. Collecting information from them is critical to our work, and it keeps us focused on their needs and the responsibility of humanitarian assistance to be accountable to the people that we are aiming to assist.
What are the challenges in policy advocacy work?
One challenge is that all of the communication materials have to be honed to several different types of audiences. Our audiences include professional humanitarian workers who want very technical communication, the US government with its own language, and the displaced populations who need plain translated language. If we go to the field and do an assessment with a full report, we also develop a much shorter, user-friendly report for busy U.S. government representatives and a report for the beneficiary audience.
You have to stay current in terms of communication methodologies too. Jumping into the world of Facebook and mHealth is a challenge because we do not necessarily have in-house capacity for that. We are recognizing that we to have to build it in and that it is extra work to try to keep up. Having a Facebook page and Twitter is important to getting issues in front of your audiences and getting support, and it requires adequate resources within an organization.
Also, in a lot of humanitarian settings, the security situation often prevents UN agencies and international NGOs from accessing an area, so we are trying to pilot programs on community-based strategies to influence policy. For example, the World Health Organization (WHO) has a standard policy on clinical care for survivors of sexual violence for facility-based care. In compromised settings, facility-based treatment is not always possible, so, with partners in the field, we are piloting community-based care for survivors of sexual violence. The idea is that once we have the evidence to show that a community approach can be successful in making sure that displaced women, and girls and vulnerable groups like those with disabilities have access to care, the WHO would consider changing its policy to include community-based care for survivors of sexual violence.
What are signs of success in policy advocacy work?
Changes in policies and guidelines are one successful sign, but in a new humanitarian emergency, we go out after a few months to assess if the programming that is recommended in existing guidelines is actually available to the population that is displaced. The success is measured by real change on the ground. Sometimes I have to look also at proxy measures, such as the funding that goes directly to reproductive health, and compare it to other sectors to see if it addresses the standards. There is a standard called the Minimum Initial Service Package (MISP) – a priority set of coordinated reproductive health activities that should be in place from the onset of an emergency, and we can break it down to see if the Office of Foreign Disaster Assistance supported funding to implement these reproductive health services and if international organizations submitted proposals for the MISP of reproductive health to secure funding.
In general, what is the attitude of policymakers, donors and officials towards reproductive health issues?
You have to make the case that reproductive health is not a luxury; it is a critical, life-saving need. You have to appeal to their priorities and to make the situation real for them. Women and girls in these settings suffer from high levels of morbidity and life-long trauma if they have been raped and do not receive care or risk death from unsafe abortions.
Would you say that the role of the UN, humanitarian organizations, and internationally-focused groups is pivotal to accomplishing policy advocacy work?
Yes, and I see it changing in the future, at least in my area, because natural disasters are increasing in frequency and intensity. Those aiming to assist people who are affected by crises are going to increasingly have to include development agencies and civil society, not just humanitarian organizations because there will be a big focus on emergency preparedness and disaster risk reduction. The agencies to do this work are not the ones to respond after an emergency, but are the development agencies and civil society organizations that are already there. There is a lot of talk about engaging these groups, but it will require us to change funding policies and the target audiences for policy advocacy. I think the issues of disaster risk reduction and emergency preparedness are going to force sort a merger to the two tracks, so we have been reaching out to more development agencies and community-based organizations to bring the issues of crisis-affected populations to their work.