Howto Partner with Governments with Phyllis Heydt and Claire Qureshi

Featuring Phyllis Heydt and Claire Qureshi

English: [00:00:01] We can't fix the world alone. But collaborating isn't easy. And systems are allergic to change. So how do we do it without losing our damn minds? [00:00:10][9.4]

Jeff: [00:00:11] That's what we're here to find out. [00:00:12][0.9]

English: [00:00:14] I'm English Sall. [00:00:15][0.6]

Jeff: [00:00:16] I'm Jeff Walker. Welcome to System Catalysts, the podcast that cracks the code for making the world a better place. [00:00:22][6.0]

English: [00:00:28] Hey, Jeff. [00:00:29][0.2]

Jeff: [00:00:29] English. [00:00:29][0.0]

English: [00:00:30] So, Jeff, I was thinking about it the other day. Do you remember how we met? [00:00:34][3.5]

Jeff: [00:00:35] Of course we were in North Carolina, and Claire Qureshi introduced us and said that we ought to get together because we were all working on community health workers, and so why wouldn't we do it together? So we created our collaboration that lasted more than ten years. [00:00:53][18.7]

English: [00:00:54] We did, we did. I hope we get to have another one of those dinner soon. Let's put that on the on the goal list for 2024. [00:01:00][5.7]

Jeff: [00:01:01] And there we go. [00:01:01][0.3]

English: [00:01:02] You know, it's funny because I just talked with Phyllis Heydt and Claire Qureshi yesterday and, you know, those are two former directors of CHAP, Community Health Acceleration Partnership, and focusing on Africa. And it was a wonderful conversation. [00:01:18][16.3]

Jeff: [00:01:19] Well, you know, I love those two. They're people that I think we all grew up with in the system, changed world and brought the idea of community health workers across Africa is one of the core, you know, health care foundations. And the way they did that was amazing. [00:01:35][15.9]

English: [00:01:36] Absolutely. I think what you're going to hear in this episode is really just, you know, Phyllis and Claire really took the time to understand what the issue was and what solutions were possible and what solutions have been tried and, and didn't really work. And, you know, they tell us how they connected with organizations to study the problem and really identify what needed to be done to improve health systems. Also, I think you're going to hear that you really have to play the long game. You know, they share their struggles about raising money and just how much patients they really had to have to not only get the funds and resources in place, but get the buy in of the community and the larger ecosystem of community health. And then I think also the importance of working with governments. You know, we talk about how important it is to work with governments, and they really give us some tips and ideas on how to do that better. [00:02:32][55.9]

Jeff: [00:02:33] One of the thing I love is, you know, once a system catalyst, always a system catalyst. So they're now not only working on community health, which Phyllis is the The Africa Frontline First initiative, which is $1 billion initiative, which is huge. And she set up the Missing Billion initiative, which is focused on those with disabilities. And that's rolling. And then Claire is focused on pandemic preparedness and biosecurity. So you can't stop them there. Keep going. And, I can't wait to see what else they're going to do. [00:03:04][30.9]

English: [00:03:05] They really are amazing. Yeah, it's it's been fun to work with them and then just follow them throughout the amazing things that they're doing. But, yeah, let's get into it. Here is my interview with Phyllis and Claire. I think I was 22 when I started working with you. I was a baby. That was the most thoughtful and adaptable and flexible and lovely learning environment that I ever got to be a part of, and instilled in me a passion that you all have for kind of change the world a little bit, and doing it with people that you love. [00:03:42][37.0]

Claire: [00:03:42] Yeah. You know, and I think all of us who are really young, we want to change some big thing. And I guess, you know, I just turned 40 last spring and I realized that you just have to have this long term perspective and also be very happy, even if you can't know what your impact is. But knowing that you're pushing in a direction you thought mattered and that something good will have to come of it. At least that's how I think about it, because it feels intractable sometimes, and you can really easily just want to give up and go home. But I think changing your mindset to know that at least if I leave in a direction I'm going and I can feel some impact and I get the chance to work with incredible people like English Sall, who believe in the work and who I learn a ton from. That's worth it. What else can you ask for, really? So I paint back, right back to English. It was, you know, that you and Jeff and Austin were so involved in not just kind of writing checks or anything else. That's that was huge. I didn't even know what a Systems Catalyst was until you guys made up that term. [00:04:42][59.3]

English: [00:04:43] And I have to credit Austin and Jeff to that one. I don't think I knew what it was either. So tell me a little bit why community health? Why did you and Phyllis especially start thinking about that? [00:04:56][12.8]

Phyllis: [00:04:57] When I was about 18, I took a trip with my dad around the world, and one of the places that we stopped was Nepal, and he'd been in the Foreign Service and loved to travel, and was very intent on making sure I understood the world a little bit. And when we were in Pokhara, Nepal, which is up in the mountains, I got really, really sick some GI thing, and we ended up going back to Kathmandu and at the Radisson, of course, they have a doctor who's Western trained, and I get the good shot that stops the endless vomiting and, you know, rehydrate me, etc. and as we were walking back to Pokhara from where we've been sort of camping and hiking, and as we were transiting back to Kathmandu, I was struck by this. Wow, I can get access to care because my father, the Western businessman, can make that happen. But for the vast majority of people that we were there with, and among that was just a pipe dream, right? And there was no access in that way to just basic life saving interventions in that same. And I think for me, at the time, it was the first time I'd really seen that, and I continued to be interested from that moment on, sort of that question of access and equity and also just what could I do with tools, technologies, workforces to get access to care? [00:06:09][72.0]

English: [00:06:12] She got the care she needed because she had the means. But think about the people in those remote areas she visited. No chance they could afford it. Turns out about half of the world is in the same boat with no access to health services. Crazy, right? That's where community health workers step in. I asked Phyllis to break it down for us. [00:06:35][22.2]

Phyllis: [00:06:36] For the most part, community health workers are deployed in areas that are labeled hard to reach in health care systems. She at least in Africa. And that means they are a number of kilometers away from their next health care facility. So you can imagine in the absence of, you know, everyone having a car and everyone having a mode of transport, if you are living somewhere where you are quite far away from a health care facility, you really don't have immediate access to a health care system when you need it. If you are a mom and you have to really, you know, overcome such a distance to find help for your sick child, that's injustice. That's health inequity. And that drives the high burden of disease and mortality that people have. So, you know, it is a really important distinction between having access to a health care system and not having health care access. And that's what community health workers can really provide. [00:07:43][66.6]

English: [00:07:44] What is community health in your mind like? How would you define it, and has it changed at all? [00:07:50][5.7]

Phyllis: [00:07:51] Yeah, it has changed a lot for me. Community health centers around a community health worker that's part of a formal health care system, and that is delivering very important services in the community. And very importantly, and that was a big part, right. English of what we worked on is a health care system needs to have the ability to finance appropriate compensation for the work that community health workers are doing. So that means that they will either get an appropriate stipend or they are on payroll. But that's a very important part of community health worker programs approaches. And when I think of community health workers and the work we did and where still some of the biggest issues lies, it's often where's the pay for community health workers so that they can really be a professionalized and professional cadre of a health care system? [00:08:51][60.5]

English: [00:08:52] Absolutely. I mean, this was one of the big elements of so much of what we did and the sort of stewardship and creation of the financing alliance, even a lot of the kind of important components that we implemented with AMP. And then she I mean, talk a little bit, Phyllis, about the evolution of sort of these entities that we stewarded under chap and what the various goals were, kind of through those entities. [00:09:21][29.1]

Phyllis: [00:09:23] Yeah, over time. And I think that's an important part of system change approaches, is that clan. I was very much trying to understand what the underlying bottlenecks, the root causes of the failures of scaling community health workers were. And we came to understand that the fact that many community health workers are not compensated, that that was a key issue in their ability to scale community health workers on the continent. The ability of a health care system to manage a very large workforce was another one of those. So the management and leadership capacity was another underlying bottleneck that we became really interested in. And so both on the financing side and on the management leadership side, we took initiatives to form organizations that were purely focused on working on this particular issue in support of government. It was about changing a system so it would, in the long run, really allow for the deployment of the 2 million community health workers that the EU and all the partners have signed up to. So, yeah, I think at the beginning we were pretty clueless about how to do that in the absence of, you know, real resources and assets to play with. And so, yeah, we spent a lot of time, I think, trying to understand really what are the issues, who are the key partners that are working on this already. There's also a lot of the institutions that have been really carrying this field before that for a long time, like Unicef, I save the children and they still to to the state. So we work, we spend a lot of time with them. We spend a lot of time with those in the field to understand their situations and started building relationships. And then in order to sort of see and formulate our thoughts about, you know, what really were the biggest obstacles and what could be done about that and what we were offering to do and to contribute to that. [00:11:37][134.3]

English: [00:11:41] I just want to take a moment to call out an important lesson here. When you're trying to solve an issue, whatever it might be, your first step should be to spend time with the people who are already looking into it. That way, you can avoid the mistakes that they already made. Or maybe they found great solutions, but they're still missing part of the puzzle. Then you can actually step in and be of help. [00:12:06][25.6]

Phyllis: [00:12:08] I think because we were, you know, investing in building relationships, we were investing in understanding the problem. By the time we put forward ideas and suggestions, we at least had open ears and then think we're diverse. Both Claire and I are also really big doers. And so we put forward a lot of sweat equity and a lot of hard work in shaping new ideas and showcasing what we meant by some of the things that we were amazing, what could be done about it, bringing people together, investing and doing things in a joined up way. And so I think over time, we found a little bit arrogance in how we could really be catalytic and add value. And I think one thing also to understand about system changes, that it really takes time. You have to be incredibly persistent. And when we started in 2012, like really my feeling was like, oh boy, these are the systems side issue to the overall global health priorities and in discourse. And today it's, you know, one of the most important topics. Just last week at the Reaching the Last Mile forum at Club in Dubai, one of the biggest announcements was with President Sirleaf and many of our organizations and the big institutions like Pepsi and USAID was and community health workers. And that hardly isn't a foundation today in health care that isn't involved in community health work and, and community health workers. And so that's, you know, such a different picture. And then where we started in ten years. So I hope to believe we had a role in catalyzing and helping to catalyze and being part of catalyzing a but this movement that exists today. [00:14:01][112.9]

English: [00:14:05] Phyllis and Claire. [00:14:06][0.5]

[00:14:06] Contributed to this sea change by launching several organizations that brought together key players in the community health system. They work directly with ministries of health, improved community health guidelines, funding and policy. But finding the money to do such a thing was extremely difficult at times. Despite the evidence that community health is a great investment. [00:14:30][23.6]

Claire: [00:14:32] We know there's a 10 to 1 return on investment. [00:14:34][1.6]

English: [00:14:34] That's Claire again. [00:14:35][0.7]

Claire: [00:14:36] So every dollar that spent on community health, to build that infrastructure, to make those systems more resilient has a $10 return in terms of prevention of disease, prevention of pandemics and epidemics, and increase in the economy's ability to grow. So if you think about places that have been decimated by various infectious diseases, you can see that both in health cost and economic cost, it's very real. So 10 to 1. But actually getting people to invest in community health on that level. So whether it's ministries of health around the world, global partners, right. The Global Fund, Gates Foundation, Gavi, all the big donors, the world Bank, getting donors to help close that financing gap. We estimates 4 billion required is tremendously hard. Now in the ten years that we worked we saw, you know, financing go from pretty minuscule to I think 100 million or so is, I think, a run rate investment I've seen. And that's transformative. But there's so much more to spend and to sort of have access to. So getting political leaders to pay attention is really just tremendously hard. And to close that financing gap. [00:15:46][69.4]

English: [00:15:47] Does it get exhausting making the argument over and over and over again? And have you ever thought, like, maybe I just need to try, like, maybe I just need to stop? Maybe I need to do it on the beach with my kids. [00:15:57][10.6]

Claire: [00:15:58] I guess, you know, I have tried various versions of that and I've worked in other contexts. I work for companies where we've, you know, I was involved in Novavax trying to get their vaccine launched. And what I found is, yes, we all face the risk of burnout. And I think recognizing that in yourself and saying, gosh, I just need to stop hitting my head against this wall for a while. But I think, you know, someone the other day I was at a Unga event said, you know, the only option is to stay positive rate is to stay optimistic because if you get sick cynical, you might as well just just totally give up. And I don't believe in that. So, you know, I think it is exhausting. You know, it's funny, I was reading a parenting book and gosh, I know we have similar age kids, so they've often been sharing. But then, you know, parents must really play the long game, right? And we know that there will be. We see it every day. But sitting with your child while they're struggling with their math homework or reminding them again and again and again to pick up their laundry, there's no immediate reward for that, for sure. And you just hope and pray that ten years from now, 20 years from now, they're better humans and that they'll remember these little lessons and pass them on their kids and just use them to be less selfish in general. And it makes, you know, the world a little bit better. But I think you need a little bit of that spirit when you're stepping into these big systems, challenges, whatever they are, and to just be okay with that long game mentality. [00:17:15][77.9]

English: [00:17:17] As you started out on this journey, is there any is there any like piece of advice or any wisdom that you sort of wish you knew in going through that very sort of detailed day to day process of trying to leverage those dollars? [00:17:31][13.9]

Phyllis: [00:17:32] You know, governments are at the center of this of this work. [00:17:35][2.9]

English: [00:17:36] That's Phyllis again. [00:17:37][0.8]

Phyllis: [00:17:38] And that also relates to financing and thinking about institutional financing, institutional donors and funders. At the end of the day, fund should fund really what governments set as priorities. And, yeah, to invest in relationships and to invest in understanding the complexities and the processes of institutional donors and not to shy away from it. That's where I think this whole being able to do big Sky thinking, but also being willing to go into the nitty gritty. It's an example where it becomes relevant. You have to understand some of the very detailed criteria for funding and processes and mechanisms in order to see opportunities that you can then also put forward to everyone involved. And that makes sense. And that just requires you to spend the time to get into the details of things. So yeah, I would say, you know, go in with knowing it will take time, really respect and put governments at the center of this work, build relationships and do your homework. [00:18:41][63.5]

English: [00:18:42] Awesome. Do you have any advice for people who are wanting to start an initiative or work with an initiative on working with governments? [00:18:52][10.1]

Phyllis: [00:18:54] I would say often engaging with governments can be an afterthought to work that out. Organizations are planning to implement and are implementing, and I think that's the wrong approach. You have to co-design and make governments to co-owners of any work that an external organization is doing in health care. You know, you can't expect governments to at some point be your what people label, call the exit strategy to at some point just paying for the services when they haven't been involved, they haven't owned, they haven't shaped the solutions that have been implemented in their countries. And so first of all, you have to make them part of the co-design process from the very start. Government engagement. It takes time. And you have to know that in decision making takes time. When it happens, it can have this systemic change potential and impact. And so it is really worthwhile to go down that path and be patient. But you have to know it takes time. And then I think it's also really important to be always aware that governments are led by politicians, and to political arguments and criteria for decision making are important considerations. And, you know, if you're trying to influence a government decision, it's important to build your argument with that in mind. So I would say do the work together with them. Be aware it takes time and think about political arguments alongside the technical pitch are some of the things that we've learned and that I've seen are important. [00:20:36][102.2]

English: [00:20:37] Absolutely. That's that's great advice. And I've I've been lucky enough to see that and feel that in action, especially with with the work that we've done with Chad. Those were entity is really about working alongside governments to try and create the space for efforts in community health to be funded, to be prioritized, to be in really building alongside with the governments through those programs. [00:21:03][26.0]

Phyllis: [00:21:04] And so and it can be challenging because, yeah, you know, government also changes. Individuals change in their posts. So, you know, building relationships can lead to a situation where, you know, an investment or that relationship really changes in nature from one day to another. And, you know, governments always take into consideration many sectors and much more than the thing that you maybe want, which is health care. So it can be challenging. And it's also challenging to express to donors because, you know, that work can sometimes be hard to explain. Why is it taking so long and or why stop something to work in this country? Or what is the metric for success? And what's the KPI? And it's all much harder to define and explain when you work alongside with and supportive government and so can be challenging. But again, I think as a system change agent, as a system catalyst, at least in health care, you really have to make government part of your work. You have to put it at the center and you have to engage with them. [00:22:15][70.9]

English: [00:22:15] Claire, is there anything else? Is there any final message that you want to leave our our listeners with? Anything that you want to kind of put out into the universe for people to reflect on? [00:22:25][9.8]

Claire: [00:22:26] I guess a couple things just to end by saying, if you want to do this kind of work in the world, the three things you need to do are one. Adopt a mindset where you can take the long term right and be comfortable that it takes some maturity. And I'm certainly not there all the time, but to have some patience. Second is to find a group of people that you want to work with, right? And and it takes some experimentation and finding people that are you really groove with. But once you do, don't let them go. And in some ways, kind of what you do next doesn't matter. But ideally, find a mission together that you're all inspired by. And there's so many things right now, of course, in the world, from the intersection of climate and health to, you know, democracy and the impact of mis and disinformation that, you know, if you can find something that excites you and that team to work with and build a little patience and self-regulation. And that's really, you know, what's required. And the last thing I'd say is, you know, do your darndest to not get cynical and try to just stay with it. [00:23:25][58.5]

English: [00:23:36] That's it for today's show. Please don't forget to subscribe to System Catalysts so you don't miss out on a new episode. Also, do us a huge favor by rating our podcast and leaving us a review. Thank you all so much for joining us, and we'll catch you all in the next episode. Before we go, we'd like to thank our producers at Hueman Group Media. We'd also like to thank our incredible network of partners who are supporting our mission the Skoll Foundation, the Aspen Institute, Echoing Green, DRK foundation. Maverick Collective, Virgin Unite, Charlize Theron Africa Outreach Project, Boldly Go Philanthropy, Synergos, Forward Global, and New Profit. If you are interested in becoming a system catalyst and would like to learn more about our partners, please visit System catalyst.com. [00:23:36][0.0]

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