1. DON’T FORGET THE ‘E’ IN “MORPHINE” International Pain Policy Fellowship: Advocacy & Communications

2. Ensure that government policy makers are familiar with the issues and prepared to take a lead role in improving access to pain relief Mindset Consult key stakeholders and partners and identify key barriers to access to pain relief and solutions to address them Organize Review national quotas from the International Narcotics Control Board as well as national importation, storage, and prescribing regulations to ensure that they are up to date or identify needed changes Regulations Establish budget for medication purchase, storage, and distribution. Estimate quantities by product and formulation, identify suppliers, secure product registrations, develop tenders, place and pay for orders, receive and distribute to regional medical stores Procurement Organize awareness-raising activities, in-service training, and continuing medical education; develop reference materials and guidelines; and sensitize health workers and administrators Health workers Establish pain treatment by trained clinicians, usually at large clinical centers or specialized clinical units (for example in cancer centers) Initiation Scale-up by integrating pain treatment into service delivery at regional and district hospitals and ensuring adequate geographical coverage to make pain relief accessible to all who need it in the country. Nationalization Create a sustainable stakeholder base in a country Empowerment From the start, interventions must focus on nurturing national palliative care associations, ministry of health staff, patient advocacy groups, and clinical experts to continue to develop and support high-quality, evidence-based pain treatment. Once nationalization is achieved, support for these groups must be ongoing, preferably through government funding mechanisms. Access is not achieved until this step is realized. M.O.R.P.H.I.N.E. Framework (GAPRI)

3. What is advocacy (to you)?

4. Specific, short-term actions directed at reaching longer-term vision Puts an issue on the agenda (as opposed to a ‘problem’) Collaboration – in various forms – is key Can involve lobbying, social marketing, community organizing, education, media engagement, and other tactics Makes people aware of their own power Common characteristics of advocacy

5. A basic advocacy process … What are the changes we want to see? DEVELOP POTENTIAL SOLUTIONS. What needs to be changed? CLAIRFY THE PROBLEM(S). Who influences these changes? IDENTIFY SUPPORTERS AND OPPONENTS. WHO HELPS? WHO STANDS IN YOUR WAY? How do we communicate what we want to change? CREATE MESSAGES AND OUTEACH PLANS SPECIFIC TO KEY AUDIENCE. How do we know we were successful? EVALUATE EFFORTS.

6. Considerations Establish interim goals. Advocacy is long-term. Balance supply and demand (ethical dilemma). Diversify champions. Share credit (and blame!). Recognize political and also public limitations. Align with popular, related health campaigns. Don’t forget the power of the “patient voice”!

7. Advocacy in Action!