HRH Policy Advocacy Leaders in Action Interview: Betsy McCallon
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.
Betsy McCallon has been with the White Ribbon Alliance for seven years. She serves as the Deputy Executive Director where she oversees strategy and program development, staffing, and grants management.
What is policy and advocacy work?
I would define it as ensuring that the right policies, the needed resources, and the implementation of those policies are in place. Advocacy work includes advocating for needed policies, but it goes beyond that to ensure that the resources are there and that the policies are actually being implemented.
What does policy advocacy work entail?
It entails being really clear on the strategy - what is the change that we think needs to happen and who has the power to make that change happen, and then developing a series of strategies and tactics around this. You need an evidence base to show what you are proposing will work, which often involves taking the evidence and developing it into clear messages and sometimes into specific products. It involves individual one-on-one meetings to educate targets. It means convening a wider base of stakeholders for consensus and push from various directions. It also means trying to more broadly influence public and leader opinions by working with the media, so it takes a variety of tactics depending on who specifically has the power to make the particular change you are pushing to happen.
What are examples of these key decision-makers?
For example, with the Frontline Health Workers Coalition, our target is to push the U.S. government to have a clear strategy on the health workforce that cuts across various development initiatives including the Global Health Initiative and PEPFAR, etc. Other times, the target may be Congress when it comes to appropriations. I also support the work of advocates in high burden countries [advocating for solutions to] maternal and child mortality. Depending on the specific change, the decision-makers could be Parliament o the heads of state; or if it pushing for more policy-specific guidelines or strategies, it may be more at the ministerial level – within the Ministry of Health itself or with other key ministries such as the Ministry of Planning or the Ministry of Finance.
Do you do policy advocacy work both on a national and an international scale?
I work on a national scale in countries like the U.S. and in high maternal mortality countries. There is also a role for international advocacy to collectively influence decision-makers, primarily heads of state, through moments like the G8 summit or the United Nations General Assembly. For example, we worked on the establishment of the Every Woman, Every Child initiative, led by the Secretary General of the United Nations, which has a national advocacy component to push for specific commitments from individual countries, and an international component in how all of that fits together in a framework with an accountability mechanism for those commitments on the global stage.
Why is it necessary to do policy advocacy work?
I think at the core, it is the only way we are going to see sustainable change in most of the countries where we work. There are investments being made in very successful programs that are delivering results and saving lives, but these programs require a continuous flow of resources until decision-makers within countries are compelled to make it their responsibility to deliver health care to their citizens. In high burden countries, it is important to move away from being a dependent state with often uncoordinated investments from outside.
For of the U.S. or other donor countries, the benefits of supporting and investing in programs that work abroad are immense. It is a continuous process, especially in [the U.S.] system where there is a lot of turnover within Congress, of educating and showing people that these investments work, that they save lives, and that there is also a benefit to the country investing in the programs.
What are the challenges in policy advocacy work?
A major challenge of it is dealing with competing priorities. When you have issues, particularly around maternal and child health, it is not that officials are not interested. It is just difficult trying to decide where the problem ranks when trying to prioritize and stretch a budget. One issue in health systems is things can get quite siloed. For example, if there are a lot of resources going to one disease, you start to lose some of the broader focus on the system issues.
Often, there is still a lack of true understanding by national policymakers on what is really happening at the village level and the realities facing women and children. Many policymakers who utilize maternal health care themselves, or have wives or relatives that do so, are delivering babies outside of the country or in a private health care facility, so they are not fully aware of the real maternal health care situation in the country.
What are lessons that you have learned during your time doing policy advocacy work?
One of the biggest lessons that I have learned is to be as specific as possible. Advocates see so many things that need to change and so many things that are important, so being able to prioritize and focus can be a challenge. We see advocacy initiatives that are asking for twenty different things, and that makes it confusing to carry out any kind of strategy or to define success. I think this is something that is often a struggle for advocates -- of the hundred things [that need to be addressed], what is the one that gets our focus now? We have to be as specific as possible; and once we see success, we can move on from there to the next issue.
How do you choose your focus issues?
It is part of the process of working in a coalition. One of the things I encourage groups coming up with their advocacy strategy to do is to prioritize what they think will have the biggest impact, and make sure what they take on together is something that could not be done by one group on their own. It is a process of ranking, prioritizing, and debating to determine what will have impact and what is feasible within the political sphere.