Advocating in a ‘new normal’

The pandemic is transforming the world around us—shifting priorities, repurposing resources, accelerating policy development, and more. In this new environment, tried and tested advocacy tactics like face-to-face interactions, ad hoc hallway conversations, and informal teas are no longer viable options. Here are six lessons we've learned adapting to the “new normal.”

Since the onset of the pandemic, policies have been developed and implemented with unprecedented speed—often taxing already overstretched governments. When we identify gaps in policy or service provision, instead of first loudly calling on the government to take action, we have seen success rolling up our sleeves and offering to take specific action on policy development or dissemination ourselves, with partners, or established technical working group. When our offers of help are not taken up expeditiously or we lack the resources to support, we can turn to the media for reinforcement.

Our work toward creating equitable health systems for all does not cease because of a pandemic. While we respond to the urgency of the moment, we must continue to maintain a long-term vision in our advocacy strategies. We must find effective ways of balancing efforts to focus on both short-term needs for COVID-19 response and longer-term health system improvements. As governments rapidly build health system architectures to respond to the needs of today, there is a special opportunity to reimagine primary health care (PHC) in alignment with political commitments to placing PHC at the foundation of universal health coverage.

While advocating for specific health interventions—such as the scale-up of medical oxygen and related technologies to treat COVID-19—we should also consider the ongoing need for medical oxygen for the treatment of childhood pneumonia. We have also found success in highlighting the indirect impacts of COVID-19 and the disruption of essential health services on vulnerable populations, issues that must remain on the policy agenda during and after the pandemic.

Advocates must set aside institutional egos and ask ourselves: Who is the most important messenger? Who has the most influence to make this happen? Who do we need to hear from most? The answer to these questions is not always us.

We must understand when our involvement can move things forward and when progress can be made without us. We must also know when to cede our place at the table in order to make space for marginalized voices.

Working in coalition can be essential, but also labor intensive and may slow things down. We must think critically about our existing partnerships and be deliberate in the new relationships we form. We have stepped up collaborative partnerships from the grassroots to regional levels. These partnerships elevate fundamental health systems issues including primary health care, universal health coverage, and health research and development through joint actions and virtual dialogues. We have also stepped back where we knew our voice or expertise was not needed.

Given the increasingly virtual nature of our work, we must put more time and effort into the development of creative assets that can promote our advocacy agenda virtually. Thinking creatively about how to leverage new and existing communication tools have been increasingly useful for communicating with policymakers, expanding interface with communities, and combating the spread of misinformation.

However, we cannot ignore the risk that virtual tools will exclude and marginalize community voices due to limitations in access to technology. We have found that virtual engagements are useful with national-level policymakers but not as effective at the sub-national—level. As a result, critical community voices are being lost.

We have found success in addressing this issue through improving the capacity of sub-national level advocates for virtual engagement. Their voices can be surfaced to national-level committees to influence decisions that respond to the expressed needs of communities. We have also worked with government agencies and local partners to co-create inclusive communication tools that are responsive to community groups across the digital divide—from using local radio, television, and public address systems, to hosting weekly #AskTheDG Twitter discussions and publishing op-eds and calls to action over social media.

We find ourselves increasingly sitting at the table with governments, jointly coming up with plans and supporting implementation of the same. This collaborative effort tests our traditional approaches for holding decision-makers accountable and calls for a rethink of our approach to accountability.

In response, our new accountability strategy provides platforms for decision-makers to share their policy plans and priorities related to the pandemic. Through virtual forums, we have engaged ministry of health officials on topical issues ranging from commitment to immunization to pivoting health systems and ensuring continuity of essential health services. These forums provide opportunities for advocacy and accountability tracking by health advocates at various levels.

While we adapt our advocacy approaches to the ongoing pandemic, we cannot ignore that we too are part of communities living in crisis. Our lives have been altered by curfews, stay at home orders, children out of school, family members in need of care, and significant emotional stress. To be the best advocates we can be, we must also take care of ourselves

Today, more than ever, we are challenged by the pressing matters of the pandemic while also maintaining focus on closing the equity gaps in access to health services. As advocates pivot their work to adjust to today’s rapidly evolving public health landscape, no one organization has all the answers. We do, however, want to get the conversation started.