Early in my career, I thought of policy as the thing that slowed programmes down. Policy approval processes. Policy compliance requirements. Policy frameworks that seemed disconnected from field realities. The people doing the actual work were in the field. The policymakers were in the capital, making decisions without enough information.
This view was not entirely wrong. Policy processes can be slow, poorly informed, and captured by interests that do not represent the communities they are supposed to serve. All of that is true.
But it is an incomplete picture.
What I have come to understand is that policy is where the conditions for effective public health are created or destroyed. A surveillance system that is technically excellent but not embedded in policy and regulation will not be funded, staffed, or protected when political priorities shift. A digital health intervention that is not aligned with national data policy will create legal and ethical risks that eventually terminate the programme. An immunisation strategy that contradicts national health policy will face resistance from the very government structures needed to implement it.
The field practitioner who says "I just want to do the work, not the politics" is describing a preference I understand, but a position that is ultimately untenable. Because the conditions for doing the work well are political. Funding, staffing, legal authority, institutional mandates, inter-agency coordination mechanisms, these are all determined through policy processes.
This does not mean every programme manager needs to become a policy specialist. But it means that effective programme implementation requires policy literacy: understanding what the current policy framework requires and prohibits, knowing who the relevant decision-makers are and how to reach them, being able to translate field evidence into language that is useful to policymakers.
The best public health practitioners I have worked with are able to move between field implementation and policy dialogue without losing effectiveness in either. That combination of skills is rare and valuable, and I am still developing it.