Policy Bite: Effective advocacy – personal, professional, and political

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Amanda Howe (President) and Viviana Martinez-Bianchi (WONCA WHO Liaison) write:

One of the things that our members tell us they value about WONCA is its ability to advocate at the World Health Organization level. We spend time, energy, and money trying to get your voice heard in the different WHO activities. Our trip in January included regional office linkage, discussions with several different directorate leads (Service Delivery, Human Resources, Ageing and Lifecycle, NCDs…), other ‘non-State actors’ (such as the International Federation of Medical Students Association, the World Medical Association, International Council of Nurses, the World Federation of Public Health Associations, and the Global Coalition for Circulatory Health); and learning about the new programme of work for WHO.

Are we effective advocates on your behalf? Family doctors are often advocating for individual patients so they can get a better outcome; for communities, to reduce health risks and improve services; and to governments and authorities, to implement appropriate changes. Usually, our communication skills teaching is focused mainly on the clinical encounter. This policy bite aims to summarise key skills in effective organizational advocacy – and to invite your help.

There is some evidence about what makes a good advocate:
Clear and simple messages matter
In academic talks, on social media, or in a political meeting. Messages can be tailored to the language and background of the audience, and they need to be in words they can understand. They also need to show what the audience will gain, and what they can do to help – showing a desirable and achievable outcome.

Emotion with evidence
Many effective advocacy campaigns are led by stories and fed with passion. Both experience and evidence of why change is needed will add value. Use data to support your claim. We can all make a claim, but if there is no evidence then – at least at government level – change is unlikely. Of course, a new situation may not yet have local evidence, but a case study from a similar setting can be very useful.

Hear from people who are affected
Patients’ own experiences and stories may be the best advocates for an issue. When parliamentarians and other decision-makers meet the people, they are much more likely to listen and feel compelled to act than if professionals are claiming a need for change. It is also more effective to focus on outcomes and issues than to expect people to agree with our own preferences. As WONCA, everyone expects us to say that family doctors are the solution – this is nothing new to our members, or to our friends at WHO. We have to show why this is the best solution - an essential part of effective health care. “Actions speak louder than words”…

Work in coalition
It can be both efficient and effective to work in partnership – finding shared solutions, gaining strength from working with others, and avoiding division where possible. For example, if an agency is getting multiple representatives working in primary care (doctors, nurses, pharmacists, community health workers), they may find this both time consuming and confusing. A group coming together to explain how a modern primary health care service works may be more convincing. We saw an excellent example of this at WHO itself, where the NCD group had developed a number of documents integrating their work with the vertical programmes on malaria, HIV and TB.

Be seen, be heard, be prepared
It is very difficult to have an impact if your voice is not heard – this is why we try to enable all members to speak for family medicine; why we teach – to influence learners; why we publish – to influence knowledge and share ideas; and why we use different media to try to get messages across.

It is also why we send a delegation to Geneva twice a year – so that WONCA is seen at this level. Each time we go to Geneva, we get more invitations to participate in more WHO activities. Participation increases spheres of influence, and as a result, we have seen significant WHO documents altered by our inputs. We also try to speak in the Assembly itself, as the President did this January. (Link)

Photo: WONCA was represented at the 70th World Health Assembly in 2017 by (l to r) Garth Manning (WONCA CEO), Viviana Martinez-Bianchi (WONCA-WHO Liaison), Amanda Howe (WONCA President), Donald Li (WONCA President-Elect).

Create capacity for advocacy
The final point follows all the above – if you are just one person in one place at one time, the message and its impact will be limited. If you are many, and if the message brings a potential solution to the need of the listeners, then the chance of creating change is much greater.

Next steps

So what is happening at WHO?
There is a new programme of work following the change in Director General. There is a clear shift towards expecting the structures of WHO to implement its key strategies and technical advice, and to see these taken through to action at country level.

There will be a major Declaration and set of supporting documents issued to mark the fortieth anniversary of the Alma Ata Declaration. This is why it is crucial that WONCA at every opportunity gets its voice heard in the next six months: it is why our spoken statement included the key message that “.. in order to help countries to achieve universal health coverage and strengthen PHC, WHO strategies need to promote the training of all members of the healthcare team; in particular, family physicians capable of diagnosing, managing and treating) the majority of presenting health problems. We urge WHO that it is of the utmost importance that meaningful investment in the education of health workers is more clearly specified to guide implementation.

We also request explicit reference to the need to invest in developing and strengthening a workforce of family doctors”. It is also why we shall be producing a briefing paper; attending as many WHO events as we can get invites to; asking our Special interest Groups and Working Parties to review statements in some very specific areas; and asking all our Member Organizations and regional Presidents to put aside time and energy to try to contact their country representatives to WHO – to lobby, to advocate, and to remind them that family medicine matters to the future of the world’s health and healthcare.

We are a diverse membership network, and within this network, we have many messages that are important. But we have no impact if there are no family doctors. We all have to become involved in delivering these messages and advocating for the importance of healthcare systems with Family Medicine at their core, with sufficient numbers of family doctors trained to meet the needs of diverse communities.

WONCA has grown hugely since the last decade, when we spoke to the 2008 WHO report – “Primary Care – Now more than Ever”. We know that each member organisation, and each member, can be an effective advocate for change. You can rehearse your “elevator” speech*! So if you run into your health minister, can you advocate for Family Medicine in 20 seconds? Do you have the two minute follow up ready to go if you are invited to share more information?

Please play your part.

*“elevator talk” = if you run into someone at the elevator you should have a well articulated and planned 20 second idea so that you can impress him or her then you are likely to be given the chance to a longer explanation or an audience to share the rest. Or at least you will leave a lasting impression about your area of advocacy.