HRH Policy Advocacy Leaders in Action Interview: Crystal Lander


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.

Crystal Lander
Crystal Lander

Crystal Lander is the Director of Policy and Advocacy at Management Sciences for Health (MSH). She helps to educate members of Congress on MSH’s work in the field and make recommendations for the best way to fund global health and international development.

What is MSH's mission?

Our work is about taking the knowledge that already exists and combining it with local activities on the ground. A good number of our staff are health practitioners, and they came to this work because they experienced broken systems themselves and want to work towards setting up good systems so health care can reach the poorest populations. Our goal is a world where everyone has access to affordable and equal health care.

What is policy advocacy work in the human resources for health (HRH) field?

HRH is mostly a forgotten piece of the puzzle. Many times when you are looking at the bigger picture of health systems and why health is not being delivered, making sure that you have the people and systems in place to support them does not come to mind. Advocacy is educating decision-makers and influential people on what is really needed, why it is not happening, and helping local governments to make it a priority to set up the systems they need to keep and support good health workers.

How do you perform policy advocacy work?

You have to identify those who have the decision-making ability, such as U.S. members of Congress, and help them to understand that HRH is a key piece of the puzzle. You can have great advocates for global health, people who understand maternal health, family planning, and HIV/AIDS, but you have to help them understand the need to set aside resources for the deliverers of those services. You also advocate to organizations involved in global health, such as the United Nations and the World Health Organization, to include HRH as a part of their platforms because they have influence with other donor agencies and countries. At the local level, those who are delivering services have to be able to articulate to elected officials in their countries that if you do not have systems in place to support doctors, nurses and frontline health workers, then the workers are not going to stay.

Is policy advocacy primarily legislative work and action?

A big part of it is legislation because none exists, but legislation is not everything. Great legislation and policies mean nothing if you have no will behind it. If nobody really understands why a law is important, it does not have any effect. You need people to say, "This will make the situation better if you actually implement and support this law."

Who does policy advocacy work?

People who do policy work have a variety of backgrounds. I did economics development and then got a Master’s degree in international public health. Others are technical people who want to influence the cycle of how things are happening, but MSH also trains practitioners to talk about their work because no one tells the story better than service providers and service recipients. They are the ones who say, "This makes an impact on my life, and let me tell you why."

When you speak with legislators that are far removed from developing health systems in third world countries, how can you communicate HRH as an issue that is relevant to them?

Although it may seem far away, it only takes somebody getting sick in a decision-maker’s family to understand a broken system. For better or for worse, the reason why many members of Congress have been more engaged lately is because [dealing with a difficult health system] has made an impact. There is a member of Congress in Washington State who said, "I got involved in maternal health because my wife was hemorrhaging when she was having twins," so the direct impact of a personal connection is really important. We create other opportunities for personal impact, such as having a member of Congress visit a country, bringing people from other countries here, and doing events on Capitol Hill. We have local people talking about their own work in country what could make it more successful. These visits with members of Congress and their staff are really important to give them a picture of what is going on.

Is there an ideal strategy for accomplishing policy advocacy work?

I do not know if there is an ideal, but I know that you cannot have a good strategy that does not include the people who are part of the equation. If you are talking about Haiti, then Haitians need to be included – not just those who are getting services, but those who are in decision-making positions because they may know or see something differently than those on the other end. Consultation at all levels of the health system is needed. I also think that true advocacy requires short and long term strategies and educating donors about both, as well as including donors as a part of the conversation about how to [craft these strategies].

Is there a different approach amongst your policy advocacy audiences?

When you communicate with any decision-maker, [it is important to keep in mind] where they are coming from and how much experience they have. If I am working with a minister of health who is already completely on board, like Dr. Tedros in Ethiopia, getting him to understand the issues or influencing him to make adjustments is easier because we have been working together and he knows he can trust me. However, some previous ministers of health in South Sudan did not see the importance of investing in community health workers in the country, or at least did not consider it a priority. It was more work to convince him of the impact he would see [from investing in community level health workers], so education on the value of it was really needed.

Is there anything else about policy advocacy work in human resources for health that a non-policy advocacy worker should know?

I think that a lot of HRH is as basic and obvious as it is missed. It is important for people to understand what is happening, that those making decisions understand what impact their choices have on people, and how policy-makers can use their resources more effectively [for HRH]. There is still a lot of work to create awareness of what is still needed so that we can even make a bigger impact.

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