Reflections from Dr Stephanie Williams and Dr Lucas de Toca, Australia’s new Ambassador for Global Health

In the final episode of Contain This this season, we are joined by Australia’s Ambassador for Global Health, Dr Lucas de Toca PSM, and the former Ambassador for Regional Health Security, Dr Stephanie Williams, to reflect on how Australia delivers assistance for health in our region and what they see as the key challenges and priorities.

They discuss how Australia’s role in supporting our region to build resilient, equitable health systems has changed over the COVID-19 pandemic, the new International Development Policy and other recent changes, and how this will be reflected under the new Partnerships for a Healthy Region initiative.

Our speakers on this episode: 

• Dr Lucas de Toca, Australian Ambassador for Global Health
• Dr Stephanie Williams, former Ambassador for Regional Health Security

We encourage you to join the conversation on X at @AmbGlobalHealth.

Transcript

Please note: We provide transcripts for information purposes only. Anyone accessing our transcripts undertake responsibility for assessing the relevance and accuracy of the content. Before using the material contained in a transcript, the permission of the relevant presenter should be obtained.   
 
 The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government. 

Dr Lucas de Toca 00:18

Hello, I'm Dr Lucas de Toca, Australia's Ambassador for Global Health, and I lead the Global Health Division in the Department of Foreign Affairs and Trade. Before we start, I'd like to acknowledge the traditional owners throughout the land in Australia, here in Canberra, the Ngunnawal people and other families with connections with the lands and waters of the ACT and broadly across our vast continent. We recognise the continuing connection to land, waters, and community and pay respects to elders past and present. For the final episode of Contain This for this season, I'm speaking with a very special guest, Dr. Stephanie Williams, former Ambassador for Regional Health Security at DFAT and now Special Adviser to the Chief Medical Officer at the Australian Department of Health and Aged Care. We wanted to take the opportunity to have a conversation about Stephanie's reflections on her time as Ambassador and to speak about my new role as Ambassador for Global Health. It's also particularly daunting to be interviewing for my first podcast, the host of so many podcasts before me. We hope you enjoy the conversation.  

Welcome, Steph, although you could be welcoming me because this is my first Contain This and you've done this many times. But good to have you on. 

Dr Stephanie Williams 01:27

Well, welcome, Lucas.

Dr Lucas de Toca 01:28

So I thought we could start with your reflections on your time as Ambassador for Regional Health, Security and DFAT in general. What were the major achievements and challenges that you've faced in that time?

Dr Stephanie Williams 01:39

I should have also said, other than welcoming you to the podcast, congratulations on your appointment as Ambassador for Global Health, in addition to your hat as FAS, it's really terrific. And it's also a good moment, as you said to look back and think about the last few years. And my reflections on the previous position of Ambassador for Regional Health Security, I think it's really the timing is really relevant here. I started on the 6th of March 2020, which was we were well into spread of the respiratory virus then. But on the 10th of March COVID was declared a pandemic by the WHO. So the focus of my time in the role has been almost entirely on COVID, and the COVID vaccine response of the Australian Government, that was 2020 through to almost mid 2022. And I think you know, when I think about doing public health, it's really to be part of the collective. So when I talk about achievements, they're really shared achievements across DFAT, health, and our geographic colleagues, other government departments and technical partners. But I think the ‘what’, you know, what stands out of what we collectively achieved was, you know, more than 60 million COVID vaccine doses to partner countries in Southeast Asia and the Pacific that came in to complement on the on the very practical early support on advice and oxygen and PPE and deployed AUSMAT teams. That's the ‘what’ but, you know, I think it's the ‘how’ which I think we should be proud of. And when we went out to our partners in 2022, across the region, what they valued about Australia's assistance was how responsive we were, how we listened in real time in crisis time to what their actual needs were, if it wasn't PPE, for example, if it was additional money to support recruitment of nurses back into the Fiji health system, and the quality of the way in which we worked. And if you had to sum down to like the summative achievement, beyond direct and practical support for health and human lives, I think we did also collectively elevate the strategic partnership we have in health in the region over those few years. 

Dr Lucas de Toca 03:53

And I must say in my early engagement and in this new role as Ambassador for Global Health in Fiji and Tonga, with colleagues across the Pacific and Southeast Asia, that's one thing that has come out really strongly; the ‘how’, the fact that Australia's role in how flexible and, and honest in your in your engagement in the department's engaging with the region was has really changed the tone of how we work with partners in the region and that's something that we can build on from that fantastic work throughout the pandemic. But now, though, I mean, still a pandemic on but we're out of the emergency phase of COVID. Coming out of that and with the experience on that fantastic work that you and the rest of the team did in those years. What are the key priorities in the Pacific and Southeast Asia now in our immediate region, for health?

Dr Stephanie Williams 04:41

You know, it's really, like it's really tempting to list a whole range of health and health system priorities as you asked. And I thought about this a lot, not just for this podcast, but generally and what the role of DFAT is, as a development partner. And as a bilateral security, trade, and development partner with many countries in the region. We also are a multilateral actor and funder. And, you know, in health, our role is to deliver good health assistance. And as an ambassador, your role, which we'll talk about later, is to also bring the wealth of Australian expertise to bear in how we engage in countries in our region, and also multilaterally. So I think our role is nuanced. It's not to set health policy, but to be positioned to respond to health priorities of our partner countries, which is a subtle, but important difference and do that in a way that is responsive and those attributes that you just talked about, which is a, you know, a precious gain we've made to sustain about listening and being responsive. But obviously, there are some parameters around what we do. We can't just say, “yeah, we'll respond to any health priorities that you have”. Because in health, the list is always endless. So you know, just before I talked about that, and you reflected on the feedback we got from countries in how we've worked in the region. And when we did that in 2022, and through talking to I think, all 18 partner countries in the region, about what were their challenges emerging from COVID and how did they see in Australia positioned to respond. But if I was just to make a summary of the common challenges we heard from countries in the region, as they emerged from COVID, it was around workforce, clinical care, public health service delivery workforce, the link between the workforce and delivery of primary health care packages and restoring essential service delivery. I think there was shared many challenges in digital health and the digital health agenda. We heard quite a lot that pandemic preparedness remained a focus of many of these countries that didn't want to lose the gains they made in COVID. And then in some, not all countries, you know, the access to measures vaccine access and, and Pandemic specific products, but also the capacity to manufacture or produce or partner with those who are more directly support them came out as priorities. So, I mean, that's what I recall from the kind of 2022 consultations, which is the perfect moment then to actually turn back to you, Lucas, about how you and the department have turned that into partnerships for a healthy region and how it's responding to those priorities that we learned about last year and this year.

Dr Lucas de Toca 07:37

That's actually a great segue. And I really liked how you approached the previous answer with the ‘what’ versus the ‘how’, because I think that's a very strong framing for how we approach health development assistance, but more broadly, international development assistance under the new international development policy that Ministers Wong and Conroy launched a couple of months ago, which, of course, still has a strong focus on education, on health, on the sectors that we need to support and work with our partners to develop but it has a much stronger emphasis in how we do things and why we do them. In fact, it starts with a bit of a thought piece in chapter one about who we are as a country and what our identity is grounded in First Nations perspectives, with the longest continuous culture in the world, but also hailing from 300 ancestries and we're a global player, that brings that richness and that diversity to the table and we engage with our neighbours in the Pacific and Southeast Asia. And, and we translated that, and you'd have too, because you were leading the consultations of the design, into the partnerships for a healthy region initiative, which is a flagship programme for regional health investment from 23 to 28. And it really captured the strength of the COVID engagement and all of the work that you guys built up in the region, but segments that expansion from a very health security communicable diseases focused approach to a broader whole of health system approach that, of course still has an a significant focus on communicable diseases, health protection, health security, that makes sense in the context of international development and making sure that our region stays safe. And it goes broader to include workforce and not just feel that they have a communicable diseases related workforce, but more broadly, psychosocial issues, non-communicable diseases, and even more importantly, cross cutting issues become a priority. So work on gender and gender equality, disability, and social inclusion, centering First Nations perspectives, recognising climate change and health as a cross cutting issue as well as One Health noting that that goes beyond just climate change, a whole environment, whole of ecosystem health. And, and then incorporating other flagship programmes that DFAT was running like sexual and reproductive health and rights investment across the Pacific and Southeast Asia. We're the biggest player in investing in sexual and reproductive health and rights in the area, bringing that all together into one cohesive programme logic that responds to the to the needs of the region, and hopefully contributes to long term health outcomes. That was a very significant shift in that expansion. And we are now at a very exciting time of working with, with our partners, both partner governments and institutions, many Australian, some from the region to programme this these next few years of investment. But the idea is that it will all come together, including with a lot of domestic initiatives to connect what we're doing in Australia with the region, but also to enrich what we're doing in Australia with what we're learning from what our partners in the region are doing. And with diminishing resources with workforce pressures with higher challenges in the post emergency phase of the pandemic space, unless we make sure that our programmes are well integrated and all contribute to, to some that is greater than the whole that is going to have some that we will just be chasing small priorities and chasing issues as opposed to be able to build sustainable change, which is what we are trying to do with this new initiative.

Dr Stephanie Williams 12:27

So in what you've described, then as a partnerships for a healthy region, taking a more whole of health system approach, in a way the name for the Australia's health ambassador, almost had to change from regional health security to global health. Can you talk about what that means in practice? And I guess a related question is, does it signal a turning up of effort for your role in some of the global negotiations going on currently, be that on a pandemic, accord or amendments to the IHR? 

Dr Lucas de Toca 13:04

Thanks, Steph. I mean, you practically answered it. But yeah, the answer is, your role was already the regional security ambassador was already playing quite a significant global role. And then as our investment was broadening from the initial health security initiative, to a more whole of health system approach, you're already doing more than health security proper. So part of this is essentially changing the name of the role to reflect what the latest stages of that role was doing, but also acknowledging that is changing a little bit in that post pandemic space. So as you recognise our investment is broader than health security. So it makes sense to just focus on health in the broadest sense. And while the focus remains in the region and that's a really important thing, one thing that we wanted to avoid was the perception that going from regional to global means that the focus is more global. Where the reality is that my main mandate, when it comes to the global health system is to ensure that it delivers for the Pacific that it, delivers for Southeast Asia. So it's using the multilateral levers that Australia is a big player in and we're part of, to make sure that it works for a region. But as you say, there's a significant focus on global issues at the moment with crunch of the negotiation for the WHO pandemic instrument in the next six months, and the reform to the International Health Regulations, and making sure that Pacific voices, Southeast Asian voices, our region's voices, are well represented in those fora. And we can play a significant role there, is a big part of this role. But ultimately, it still remains a very Pacific and Southeast Asia focused position across bilateral, regional, and global programmes. And part of that is my initial engagement, which has been very focused in the region with Fiji and Tonga in the last couple of months. And hopefully, PNG early next year.

Dr Stephanie Williams 15:08

I've been watching that keenly, on multiple channels Lucas, and you're much more adept at some key channels than I ever was, especially on LinkedIn. So I'm following your initial tour very closely, and with interest, and of course, great support. But can you tell us more tell me more about like communication specifically, and how, how you're approaching that as Ambassador for Global Health. 

Dr Lucas de Toca 15:36

I don't think I can compete with podcasts extraordinaire, Dr. Williams, but I'm doing my best through this. Look, I think that the comms approach is not that different from yours. And in the sense that the main thing that we need to do is to continue to be focused on listening, we have a lot to learn from the region that has brilliant activities and initiatives going on, with incredible imagination and but also use of 1000s of years of traditional knowledge incorporated into, into best practices that are really showing the way so listening is a big part of our of our comms approach, making sure that we are engaging with the right people. So meeting as many health leaders from our region as possible. That's probably my main thing in the elements of the of this role, both from government but also from communities now, health leadership across not necessarily just the identified top leaders, and making sure that I understand the priorities, but also what they see as a solution and how we can slot in to support what they're already doing. But we're not going to come in with a solution, we need to come behind what local leaders know their solutions are we, we can support we can provide technical advice, we can provide funding, but ultimately, it's people from the community who know exactly what we need, what they need, and not us. And then engaging, zooming out engaging with global organisation to understand their priorities and pressures and see how we can continue to advance our region's priorities in those forums and make sure they deliver for our area. But we also contribute to a stronger global health architecture that is ready to respond to the inevitable, next pandemic, but that we'll also do everything we can to prevent that next pandemic. And then I want to have the opportunity to explain how we are supporting health in our region and globally. And that's there's a bit of a dual role in engaging with international audiences to make sure that the role of Australia in the global health world is understood and what we're doing can be understood and contested. And it can be a discussion and can be well informed, but also domestic audiences. This is taxpayers' money that is invested in development. And it's important that the Australian public understands the importance of these investments and what these investments are doing, plus, where we can leverage the significant Australian expertise and knowledge that we have all throughout, from First Nations primary care remote clinics to big research institutes in the cities. So creating that opportunity for debating and engagement. To do that, we will have to continue to use a range of channels, including our website, different social media platforms, and yes, we've been experimenting a bit on LinkedIn hopefully that goes well and also conversations directly with partners. So we will explore a variety of ways to continue to engage and we will welcome feedback from podcast listeners as well as partners on how that works best.

Dr Stephanie Williams 18:45

It's so great to talk to you Lucas in your role as Ambassador for Global Health and also to hear, like your vision for the listening and learning from the region nested in, you know, who we are and how we do it. And I just think it sounds like a really exciting, next phase.  

Dr Lucas de Toca 19:02

Thanks Steph. It is both daunting and exciting to take over this role after you. But I also wanted to take the opportunity to congratulate you and thank you for your fantastic work as Principal Sector Specialist and as Ambassador for Regional Health Security over the past few years and the transformational change that you delivered in the region in the most difficult circumstances and wish you all the best with your exciting new role working with the Chief Medical Officer in the Australian Department of Health and Education which is which is really exciting. Thank you, Steph, for joining me for the final episode of this season of Contain This and to our listeners, I hope you've enjoyed the season. Please follow us on X at ambglobalhealth for updates on Australia's support for health in our region and globally.