HRH Policy Advocacy Leaders in Action Interview: Mary Beth Powers
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.
Mary Beth Powers has worked in global health for more than 20 years and currently leads Save the Children's newborn and child survival campaign in the USA. The campaign website tells the story of the lifesaving work of frontline health workers.
What is policy advocacy work in the human resources for health (HRH) field?
It centers on the importance of raising the visibility of [HRH] issues. There is a global shortage of health workers, and many health workers may not have the right skills or be in the right place at the right time to prevent or treat illness. It is important that we communicate about the challenges we have in the health workforce to move it up in terms of issue ascendancy in the field of global health and development.
How do you communicate this?
At Save the Children, we attempt to make these unsung heroes visible. The goal of the Good Goes campaign is to help people realize that all around the world there are health workers who are making a big difference. We’re trying to find ways to engage the American public in recognizing the value of health workers, but people all around the world have to realize it. We have Teacher Appreciation Day. Why isn’t there a Health Worker Appreciation Day?
We are attempting to bring greater visibility to the work of health workers, as well as the gap in the number of health workers and in the skills of existing health workers, to encourage policymakers to set targets, write strategies for health workforce strengthening, and then implement those strategies with new funds that are required to upgrade the health workforce.
How are you striving to make people aware and bring about changes that would help healthcare workers?
Some of it is appealing to the public in this country and around the world for people to stand up for health workers, to take notice of what health workers are doing, but it is also really important that we look to Washington. We will be doing some targeted work to educate policymakers about the role of health workers. We will also work with the administration to get partners on the Global Health Initiative to make a more concerted effort and create an integrated platform for training and up-skilling health workers so that they can better save lives around the world.
Would you say that your policy advocacy work is primarily being done in Washington?
The work that I am doing with the Frontline Health Workers Coalition is very focused on how we get change to happen in Washington, but we’ve also had real successes at the United Nations. Last September during the United Nations General Assembly meetings, we did a number of events to raise the visibility of the health workforce crisis globally, and governments from around the world are responding. They are setting targets for how many health workers they can train and contribute to fill the global gap. They are rethinking their policies about what kind of health workers they train and how to better address some of the needs for frontline health workers, those health workers who serve closest to the communities in need.
How is policy advocacy work enacted?
The challenge is that sometimes you can get a policy in place, but it can be difficult to enact it. We have to talk to ministers of health, finance, and education, and the public and private training institutions and civil society organizations. These are not only international civil society organizations like Save the Children, but also local organizations and associations of health workers who can hold their governments accountable to better support existing health workers; fill the gaps; improve the places where health workers are trained; and better retain health workers through support, proper payment and conditions that would make it attractive to stay in the health workforce. Health workers need to talk about what kind of support can help them do their jobs better, what they need to be successful, and what kind of investments they want their governments to make.
Local organizations may not have people whose job focuses on policy advocacy, but it is important to empower local civil society organizations such as association of health workers. [Health workers] see the situation on the ground, in clinics that are understaffed, and in communities with gaps in the provision of basic healthcare. Giving them the chance, sometimes even the training, to be better advocates of the issues is critical.
What are the channels to communicate effectively with policy decision-makers?
Education of policymakers can happen through personal meetings or by involving their constituents. It is also really important that these issues get covered in the media. Telling the stories, doing research that’s publishable as well as interesting enough to encourage the media to cover global health issues in newspapers around the world is an important role that we can all play.
Finally, we need to build coalitions, such as the Frontline Health Workers Coalition which we have been working with IntraHealth International and others to create. Through these coalitions, I think people will see that there are many institutions and organizations committed to advancing the cause [of HRH] and take the need to strengthen the health workforce to policymakers.
What would you say are signs of success in policy advocacy work?
One sign of success is when you find government champions willing to go to other members of the government to bring health workforce issues to their attention. Another important thing in the U.S. political context is getting the voice of corporations or the private sector involved. They also care about the need for a frontline health workforce, both for philanthropic reasons and as a vehicle to deliver products in the field. The engagement of the private sector on this issue of frontline health workers has been fantastic. Pharmaceutical and IT companies are making major investments and training frontline health workers around the world. We need more voices to influence policymakers, and the inclusion of the private sector is a sign of success.
What are indications that a path you are taking isn’t succeeding?
The length of time and the kinds of resistance are good indicators. If you can get people to articulate the reasons they are not supporting the agenda that you’re promoting, the barrier could be addressed. It is possible that you need to change your tactics, are not sharing the right information to move policymakers on the agenda, are talking to the wrong people, or that a key decision-maker has been left out of the process. You need to do a diagnosis of the barriers to success every six months or twelve months if you feel like you are not getting to the kind of policy change that you were seeking.
How have you seen the focus of policy advocacy work evolve?
What I have seen over the last twenty years is the success of many global health advocates for one disease or issue but not a lot of success on holistically looking at how we move ahead on maternal-child health, communicable and non-communicable diseases, etc., all of which depend upon a functioning frontline health workforce. We won’t be able address the world’s health problems disease by disease. In fact, sometimes when funding comes in segmented for only one issue, it is hard for national health planners to put funding to the best use when what people really need is a comprehensive, primary healthcare system with frontline health workers who can provide basic care.
In your work as a policy advocate, do you facilitate the average person's interaction with, for example, a Congress person to get the message across that this is important to people?
Part of my work is empowering citizens around the world to talk to policymakers. Policymakers want to hear from constituents, and I think a lot of Americans don’t know they can do this. Every year, Save the Children has an Advocacy Day. We take more than 200 Americans to Capitol Hill and train them on how to talk to policymakers and staff about critical issues facing children. That may not work in every country around the world, but surprisingly, a lot of countries are quite open to hearing from folks about issues that are on their mind, especially where there is an elected government. It is important that people realize they have a voice.