Advocating for change

Bringing about change through advocacy is hard - where do you start?

To keep it simple, I’ve written a blog on the questions you need to be able to answer before setting out trying to deliver change:

1. Do you understand the problem?

2. Is now a good time?

3. Are you a pragmatic optimist?

4. Is this an inside/outside job?

5. Who is with you?

It’s not a technical playbook, so read on if you want some jargon free thoughts on advocacy.

1. Do you understand the problem? – “of course”, you say, “what a silly question”. What I mean though, is have you put in the time to really get to grips with why things are the way they are? Do you know what is keeping things this way? Have you found enough evidence to support your observations? Has somebody tried to tackle this problem before, and what happened? And secondly (and in my experience just as importantly), can you explain the problem in a way that someone who isn’t in your organisation or area of expertise can easily understand? This is essential if you want to stop mission creep further down the line as people join you in the effort to bring change and try to add further complexity to the description of the problem.

2. Is now a good time? – perhaps the hardest question to answer is whether the timing is right to push for change. On the one hand, when it comes to issues of poverty, injustice and inequity, the time is always ‘now’. But on the other hand, if you’re trying to change big things that are deeply ingrained like the way a system operates, or how stakeholders interact with each other, then you may only have one good shot every decade or so. I’m not saying that ongoing advocacy and campaigning isn’t effective, or is mutually exclusive with big generational pushes – it’s just that the best windows to act don’t come around often when you’re trying to land significant change. Political, financial, social, technological, legal and environmental factors should all play into an assessment of whether the time is right to go for it, and so too should your sense of the mood music within your sector, network, profession. Are you detecting some subtle or more obvious shifts in appetite or attitude towards the problem you have identified? This is a part of the art of advocacy – using your senses alongside the hard data.

3. Are you a pragmatic optimist? – I don’t think change is driven by traditionalists (in their minds too much at stake) or optimists (too easily disappointed by the harsh reality of invested interests), but in my experience is often catalysed and led by pragmatic optimists: people who understand that change is really hard to bring about, that there will be people opposed to the change, but who believe that the effort is worth it when the window of opportunity presents itself. If you’re not a pragmatic optimist don’t worry, you’ll know people in your network who are. Bring them in to what you’re working on.

4. Is this an inside/outside job? – an analysis of the key individuals and organisations that you think you will need to reach with your advocacy is important here, alongside some insights about what levers are available to influence those parties. You won’t know if those levers are real or effective at bringing the change you want to see until you start the advocacy effort. And with feedback along the way you can tweak your tactics. But what’s really important here is to try and discern whether those levers are activated from inside or outside the ’system’, or both. This is key to know, because it will inform who should be doing the advocacy, and what kind of advocacy – e.g. behind the scenes diplomacy is inside, and public campaigning is outside. And you might sometimes be doing both, but the people doing them will be different.

5. Who is with you? – anything meaningful I’ve achieved in my career has been with others. Sometimes a handful of others, and other times with dozens directly and hundreds indirectly. When you’ve found the pragmatic optimists and you think you know what kind of job this advocacy calls for, then it’s time to build the team. Building coalitions for advocacy efforts is very often a critical success factor – more likely to effect whether you can deliver real change than the quality of your initial problem statement and stakeholder mapping. Because people and groups with similar motivations will also have diverse skills, resources and networks which will help you to be more resilient and agile as your advocacy efforts hit the real-world environment. There will be times – many probably – when you’re not your own best advocate, so establishing a group with common interests and motivations but diverse characteristics will enable you to deploy the right voice for the right audience.

Advocacy is an art not a science. Its not easy - but if you start by answering these questions you’ll have a good foundation.

Global Health - Where Are We?

I’ve been thinking recently about where we are in global health. Since the pandemic ended, it has been back to business for most. But so much has changed in the past few years that I wonder if we know where we are.

Why does it matter? Afterall, most of us know the destination we’re aiming for. We’re (hopefully) working to some defined organisational goals, and are measuring progress from time to time.

It matters because our work isn’t achieved in a vacuum, and our strategies don’t succeed or fail based solely on whether they are ‘good’ or are ‘implemented well’. Everything we do exists in a wider environment. It sits within the framework of a world that is always changing - sometimes imperceptibly, and sometimes quite visibly.

So from time to time, it’s important to look around and see what is happening in the world, and try to relate those observations to the work you’re doing – you might call it ‘understanding the times’.

Working out where we are is hard: especially in global health, where politics, economics, society, technology and the environment interact to create a complex and complicated reality.

A useful starting place can be to look at the ‘big picture’. What trends can we observe? What signals are we picking up? And then each of us will want to drill down in more detail in the specific areas we’re working on.

To get you started, here are four themes that keep coming up in conversations I’ve had with people across the global health community. How might you internalise these in your organisation’s plans for the future?:

• Health needs have shifted – this much is obvious. Over the next decade, significant changes to health ‘priorities’ at national, regional and global levels will take place. The re-ordering of priorities will require adjustments in the distribution of financing among these priorities, and ongoing dialogue between stakeholders at all levels so there is a shared understanding of where, together, they can have the greatest health impact. The question of which priorities are best tackled (and paid for) at the country level, coordinated through the regions, or led at the global level is going to be critical.

• Money is tight – traditional sources of financing for health cannot meet the growing cost of delivering health. Many in the sector are starting to acknowledge that we’ve probably passed the point of peak donor financing. Ensuring that the available funding has the greatest impact will need new approaches to resource distribution, but equally important will be efforts to identify new sources of financing. In the end, for many health priorities, our goal should be domestic financing. But this takes time and may need some radical thinking to speed up this financing transition.

• New approaches are needed – take the case of antibiotics. The decline in investment for developing new antibiotics is well documented. Life science companies have understandably moved their R&D assets into other therapeutic classes where the return on investment looks more promising. At the same time, we’ve seen through the pandemic what it can look like when the world relies on too few suppliers of a scarce product. Creating new business models to incentivise R&D for critical diseases is something that needs to a lot more attention and energy. , We are a long way from the sort of healthy, sustainable business models that are required to reinvigorate some fields of R&D, but credit goes to those who have been calling for this for a long time, and are trying some innovative pilots.

• Stronger regional institutions – are emerging. This is excellent and will accelerate the process of global institutions reimagining their relationships with regional and national stakeholders. It will give countries a stronger voice as well as the collective capacities and capabilities to determine their own approaches and positions on issues that are globally significant.

These are just four macro observations that came to mind: I’m sure you can think of plenty of others, like the emergence of promising new technologies, or the inequity that remains in access to healthcare around the world.

I’m interested to hear what you think about where we are in global health.

There’s a lot of change taking place. Do you think we’ve reached an inflection point in global health? Or is it more akin to a slow metamorphosis of the sector?

In a future blog I’ll offer some thoughts about how to respond to the changing winds in global health.