The People, The Planet, The Can: emerging lessons from policymakers’ perspective

27 July 2012

My journey up until now, since my last post, has been somewhat slow. Other work commitments and not being able to engage with some prospective interviewees has hampered my progress a little.

That said, there have been some interesting developments since my last meeting with Enrique Mendizabal.

I have had an interview with one policy-maker who is the head of nutrition in a provincial government Department of Health. This person has a scientific research background, has been working as a policy-maker within the public sector for more than a decade, and has championed and been instrumental in instituting a number of policy reforms within their field and works closely with several researchers. They have also experienced working in the same capacity in 2 different provinces, each with their own approach to research uptake, policy implementation, and communication. For this interview, I requested they speak in their personal capacity and from their personal experience rather than on behalf of the department. This, I believe, would yield far more valuable insights than an official statement ’ about the relationship between policy-makers, researchers, communicators, media, and civil society.

What emerged was:

  1. The burden of responsibility for good public health policy rested with them. What was best for society needed to be the watchword and goal for all policy debate and implementation and they were fortunate to have a team of colleagues who were committed to this.
  2. They felt that they had a good relationship with researchers with regard to communication and understanding of research ideas, since they were speaking to peers – fellow scientists. They speak a similar ‘language’ and have a similar structured, detailed approach to work. They were often an integral part of the research process, through their inclusion on advisory committees, facilitating the movement and access of researchers through and to the system and their ability to influence the research agenda in respect of the benefit for the Department of Health and its aims with regard to better policy implementation. Since they (and ergo, their department) are also part of the initial research process, it is much easier to ‘sell’ research into policy. In one province in which they had worked, though, they felt that there was too much expert (by researchers, academics) debate around policy and research.
  3. Political support and commitment is not just helpful but vitally important for effective and timely policy implementation. That said, change does not happen over-night and wisely navigating the political landscape was a key strategy for the championing of specific research ideas that they felt needed to be implemented into policy. Working in a province such as the one in which they operate requires a steely resolve on the part of them and their colleagues, since there are no ‘small issues’ in an area with high levels of poverty and disease that ultimately affect the population as a whole.
  4. On the other hand, the great need to improve the health and decrease the mortality and morbidity of a poverty-stricken population, they believe, has provided an opportunity for innovation and faster implementation of better policy. And where traditional approaches have been less effective or failed, they have had the opportunity to operate with more latitude and flexibility to take calculated risks.
  5. Support from agencies such as the WHO and UNICEF carried great weight and therefore their support was very valuable for political buy-in.
  6. Their relationship with communications agents and the media, though, was a less than satisfactory one. The greatest disconnect, they felt, arose in the area of communicating policy to civil society through the press and other media.
  7. They were inclined to feel that there was a general disinterest from the media (press and broadcast) in public health issues resulting in shoddy, irresponsible reportage and an emphasis on sensational stories, and resistance from publications to give a rebuttal the same coverage. There is also a feeling that, existing problems within the public health sector notwithstanding, there is a general hostility from the press who seem to resist reporting good news stories. They felt that there was a need to cultivate better relationships with the media and find sympathetic allies in this sector, yet this required time which they had precious little of.
  8. They have a long history of engaging or being assigned ineffective communications agents (who had come with glowing references) but who had no real knowledge or understanding of the policy issues and messages that need to be communicated. This has resulted in them (policy makers) having to operate in a capacity in which they are not skilled – as communicators. This person recognised the difference between knowing what needed to be communicated and knowing the mechanism or medium that would be best suited for the message and recognised that many of their own efforts at communication with the public were lacking in creativity.
  9. The policy-maker suggested that perhaps meagre budget allocations for policy communications strategies could be part of the problem, since the more expensive and therefore more skilled communications agencies, in their opinion, would not be interested in taking on a project that could not pay for their services.
  10. The policy-makers are also often reliant on outside funding sources such as PEPFAR (President’s Emergency Plan for AIDS Relief), US CDC (Centre for Disease Control), UNICEF and the WHO for these communication strategies. This can result in the communication of some policy issues being sidelined in favour of what the funding source deems more important or urgent.
  11. The result of a strong and often negative media voice and poor policy communication on the part of government often resulted in a public who received confused messages.

My task from here on will be to further examine the statements made by the policy-maker and whether their perceptions are matched by reality, with regard to the local media and its attitude specifically towards government policy around breastfeeding and also at the current communications media that government has used to promote breastfeeding.

Furthermore, a representative of a major funding partner/agency in a subsequent interview echoed some of the policy-maker’s sentiments with regard to working with researchers and the media, but diverged somewhat on the issue of research and policy-debate.