Lessons from the PAHO–ASHA mission to strengthen speech-language services and advocacy.
Lobbying a national ministry of health or petitioning your school district's special education director may seem worlds apart, but the underlying advocacy architecture is the same: identify service gaps, build coalitions, gather evidence, and translate that evidence into policy. Global health missions make this process visible at scale. In July 2026, PAHO and ASHA launched a technical mission in the Dominican Republic after the Ministry of Public Health flagged shortfalls in speech-language pathology coverage, personnel training, and service organization.
That mission offers a live blueprint. The sections ahead unpack the transferable skills it reveals, the disparities that demand attention across borders, ways to measure advocacy impact, and a practical checklist for clinicians and students ready to move from caseload wins to systemic change.
Global health advocacy for speech-language pathologists, a form of international collaboration in speech-language pathology, means moving beyond the individual therapy session to shape who gets services, where clinicians are trained, and how governments fund communication care. Instead of writing goals for one client's articulation, you are pushing for a country to fund SLP training programs, for a ministry of health to recognize dysphagia as a clinical priority, or for a regional body to include communication disorders in universal health coverage plans.
School-based advocacy usually centers on caseload caps, workload models, and IEP compliance. Medical SLP advocacy tends to focus on reimbursement codes, hospital staffing ratios, and interdisciplinary recognition. Global health advocacy zooms out further. The unit of analysis is a population, sometimes an entire region, and the levers are workforce pipelines, licensure frameworks, and policy documents. A school SLP asks, "How do I serve 65 students this year?" A global health advocate asks, "Why does this country of 10 million have fewer than a dozen trained SLPs, and what would it take to build an SLP grad school curriculum?"
The access gap is stark. WHO workforce analysis covering 124 countries found that most countries in the African Region have fewer than one SLP per million people, while European Region densities can run up to 50 times higher.1 South African modeling projects a shortfall of roughly 2,800 audiologists and speech therapists in 2030 even under current trajectories, and even with a 300% supply increase, about 2,300 professionals would still be missing.2 Secondary estimates suggest roughly 1 billion people worldwide could benefit from speech-language services, yet only around 10% have access.3 Ratios in low- and middle-income countries can reach 1 SLP per 500,000 people or worse, compared with 1 per 2,500 to 5,000 in high-income settings.3
Domestic shortages compound the picture. ASHA's 2024 schools survey found that 78.5% of school employers reported job openings exceeding available candidates4, and the U.S. is projected to add roughly 28,200 SLP jobs between 2024 and 2034.5 In the UK, RCSLT estimates a minimum 15% workforce increase is needed against annual growth of just 1.7%.6
The ASHA-PAHO relationship, formalized in 2013, has become the working model for this kind of advocacy: a professional association, a regional health body, and national ministries co-designing needs assessments, training-of-trainers initiatives, and academic program development. Coalitions, not solo clinicians, move policy at this scale; a 2026 PAHO roadmap to strengthen speech-language and hearing services in the Dominican Republic shows the template in action.
Speech-language pathology workforce shortages are not confined to one country or setting. From underfunded health systems in low-income nations to suburban U.S. school districts struggling to fill caseloads, the data paints a consistent picture: demand for SLPs far outpaces supply, and the distribution of available professionals is deeply uneven.
The July 2026 PAHO technical mission to the Dominican Republic is a working template for how national health ministries can convert identified service gaps into a funded, staffed plan for communication disorders care. It also shows what modern SLP advocacy looks like at the country level: coordinated, evidence-based, and built on a partnership that has been operating in Latin America and the Caribbean for more than a decade.
The Ministry of Public Health (MISPAS) formally requested PAHO support after identifying gaps in service availability, organization, coverage, and specialized personnel training across the country. That request framing matters. Rather than an outside body arriving with a fixed agenda, the mission started from a government self-assessment, which is the model PAHO and ASHA have used since their collaboration launched in 2013. You can read PAHO's own summary of the visit at paho.org.
Over three days beginning July 27, 2026, national and international teams ran a structured diagnostic assessment. The mission opened with a workshop at the PAHO/WHO country office attended by Minister of Public Health Dr. Víctor Elías Atallah Lajam, Vice Minister of Collective Health Dr. Eladio Pérez, and SNS Director for Maternal and Child Health Dr. Martín Ortiz.
Site visits followed at three facilities where communication and hearing needs are most visible:
Teams also gathered input from academia, professional associations, and civil society organizations. The output is a consensus-based roadmap that will guide future technical cooperation, according to Dr. Bernardino Vitoy, PAHO/WHO Representative in the Dominican Republic.
Five partners share the work, and the division of roles is worth studying if you plan to pitch a similar effort in another country:
The Dominican Republic mission builds on a track record. The collaboration began in 2013 with needs assessments in El Salvador, Guyana, and Honduras, then expanded in 2016 to include Ecuador and Paraguay, and later Belize. By 2023, six countries were receiving support. The partnership uses a train-the-trainer strategy and earned the 2018 ASAE Power of Associations Summit Award.
Documented outcomes include:
For the Dominican Republic, the roadmap now underway is likely to follow this same arc from assessment to academic infrastructure to sustained service delivery.
Whether you are working with a ministry of health in the Dominican Republic or a school district in Ohio, effective advocacy rests on a handful of transferable skills. Global health missions like the PAHO-ASHA collaboration make these skills visible because the stakes and the stakeholders are laid out so clearly. Local practice often hides the same structure in plain sight.
Every advocacy effort starts with knowing who holds the levers. In global health work, that means ministries of health, national disability councils, and professional associations. In a school district, it is the school board, special education directors, and state education agencies. In medical settings, it is hospital administrators, insurers, and interdisciplinary care teams. Naming these players explicitly, rather than assuming someone else will speak for the profession, is the first move any SLP can make.
A single caseload spreadsheet rarely moves an administrator, but the same numbers reframed as access data can. Instead of reporting how many students you saw this month, show what percentage of identified need in the building or region actually received service, and what the wait list represents in lost instructional or developmental time. This is exactly the diagnostic approach PAHO's team used when it visited service sites and gathered input from academia and civil society before drafting a roadmap. The lesson translates directly: local SLPs who convert individual caseloads into service-gap arguments give decision-makers something they can act on.
No advocacy effort succeeds alone. The Dominican Republic mission pulled together public health officials, academic institutions, professional associations, and civil society groups because durable change needs buy-in from multiple sectors. Locally, that might mean partnering with occupational therapists, pediatricians, special education advocates, or parent groups. Coalitions carry more weight with legislators and payers than any single discipline speaking on its own.
The throughline from global health to your own workplace is simple: identify the gap, quantify it, name the stakeholders, and build allies before asking for change. SLPs who practice this cycle on a small scale (a single caseload, a single clinic) are better prepared to contribute when larger international or policy opportunities arise.
Advocacy is a core professional responsibility for speech-language pathologists, but the strategies, targets, and guardrails shift significantly depending on where you practice. Understanding these differences helps you choose the right levers and avoid ethical or legal missteps. Here is a side-by-side look at the three primary advocacy arenas.
| Dimension | School Settings | Medical Settings | Global Health and Legislative Advocacy |
|---|---|---|---|
| Primary advocacy targets | Federal education laws such as ESSA and IDEA, programs like PACE, salary supplements for school-based SLPs, and school choice policies | Reasonable productivity quotas, HIPAA-compliant technology, reimbursement models, scope of practice protections, patient access, and health disparities | State and federal health care and education policies, workforce development abroad, and expanded service coverage in underserved regions |
| Common levers | Analyze the potential for change within your district, identify stakeholders and build support, form advocacy committees, make connections with administrators and legislators, and develop a written action plan | Advocate directly with employers and hospital administration, participate in professional organizations, contribute to policy discussions, engage licensing boards and regulatory bodies, and educate both the public and policymakers | Contact the ASHA health care education and policy team for guidance on state and federal issues, coordinate through professional associations, and partner with international bodies such as PAHO for needs assessments and training initiatives |
| Key legal and ethical boundaries | All advocacy must align with ethical standards for school practice and be framed to support legally compliant service delivery under IDEA and related statutes | Efforts must respect HIPAA requirements, state licensure rules, and professional codes of ethics, particularly when pushing back against unsafe productivity shortcuts | In-house lobbying can trigger federal registration requirements once activity reaches a defined hourly threshold within a rolling four-week period, so SLPs should track their time and consult association guidance before sustained outreach campaigns |
| Who you are influencing | Principals, special education directors, school boards, and state education agencies | Hospital administrators, insurance companies, licensing boards, and regulatory agencies | Elected officials, government ministries of health, international organizations, and academic institutions developing SLP training programs |
| Biggest watch-out | Framing advocacy as a personal grievance rather than a student-outcomes argument can undermine credibility and raise employer-relations concerns | Sharing patient stories or outcome data without proper de-identification violates HIPAA and can expose you and your facility to penalties | Crossing from professional education into sustained lobbying without understanding registration thresholds can create legal liability for you or your employer |
The speech-language field is waking up to a structural mismatch: provider language capacity has not kept pace with the communities that need services. In 2026, ASHA estimates around 7.8% of members identify as bilingual, covering more than 85 languages.1 At the same time, 22% of U.S. residents ages five and older speak a language other than English at home.2
Workforce data make the disparity concrete. Roughly 14,958 bilingual SLPs may be matched against an estimated 3.4 million to 6.8 million non-English-speaking clients.3 The result is not only a staffing gap but a service gap: in one survey, only 21.5% of bilingual clients received intervention in both languages.2 Those pressures are not evenly distributed. What global health teams document in countries with uneven service distribution, U.S. districts see locally: public health speech-language pathologists and other specialists concentrated in urban centers while rural, low-income, and multilingual families wait.
School and medical settings face the same language mismatch, especially in rural or low-income communities where fewer bilingual providers are available. The shortage compounds the problem. In ASHA's 2024 Schools Survey, 78.5% of school-based SLPs reported openings exceeding job seekers.4 With about 13,700 annual openings and roughly 9,400 new graduates,5 rural and low-income districts tend to lose out first. A 2023 ASHA profile counted 19,899 multilingual members, about 8.6% of the profession,6 but those numbers have not closed the service gap.
The evidence points to three linked barriers: inconsistent practices for assessing English learners for speech therapy, too few language-matched SLPs, and limited cultural-linguistic training. The harm looks familiar: a child tested only in English, misidentified as having a disorder, or left out of family-centered decisions because materials are not in the home language. Family engagement is another pressure point. When caregivers are asked to interpret complex clinical terms for their own child, the advocacy partnership weakens and the family's most valuable observations can be silenced. Canadian data echo the risk: in a sample of 344 clinicians, 78% were bilingual, but only 24% assessed or treated in all client languages.2 National data do not yet provide one clean proportion of multilingual children receiving fully appropriate services; partial-service patterns are the clearest signal.
Advocates can start by asking what "appropriate service" means for a bilingual child: not a translated worksheet, but assessment and treatment that match the child's full language system. These steps turn the numbers into a mandate: close language gaps in clinical practice before widening them through policy neglect.
Ten speech-language pathologists from Majority World settings completed a year-long IALP/Tavistock Trust for Aphasia telementoring project focused on adults with aphasia.1 That small number captures how global health SLP work usually begins: a structured cohort, a clear clinical focus, and a local partner building long-term skills. You can start building that kind of international role without leaving your current job or graduate program.
Choose a participation tier that matches your time, licensure status, and comfort with cross-border work.
Students can enter through academic exchanges and joint training programs, supervised international SLP clinical placements tied to local service sites, and telementoring or research collaborations. The strongest placements are reciprocal and designed with host ministries, schools, rehabilitation centers, or community leaders, not informal service trips. If a full clinical rotation abroad is not possible, co-authoring a case study or developing training materials with an international partner still counts as a meaningful entry point.
Work through ASHA, PAHO, and universities to avoid duplicating effort. The ASHA-PAHO collaboration has supported needs assessments, academic program development, and training in Honduras, El Salvador, Guyana, Belize, and Ecuador.2 In Guyana, five new graduates were reported in 2021, with 11 more expected the following year,2 showing how capacity-building can produce country-specific results. The 2026 Dominican Republic mission with the Ministry of Public Health, the National Health Service, CONADIS, and ASHA points to current opportunities, though its outcomes are not yet known.3
The British Bangla Multidisciplinary Project aimed to increase Vietnamese clinicians' capability,1 making workforce development the central outcome rather than short-term service delivery. The WHO World Hearing Forum has also connected Cambridge Digital Health and Johns Hopkins University's Ayu telehealth project to extend hearing-health tools into underserved areas. These examples reward SLPs who can translate clinical judgment into training, mentoring, and systems work, whether they are in a classroom, a clinic, or a global partnership.
Advocacy impact is measurable when speech-language pathologists commit to tracking policy milestones as deliberately as they track treatment progress.
A logic model turns a broad goal into a chain of observable steps: activities such as coalition meetings or policy briefs lead to outputs like the number of stakeholders reached. Those outputs then produce short-term outcomes such as changes in knowledge or commitment, and only after that do policy changes and service access shifts appear. The Annie E. Casey Foundation guide recommends starting with a theory of change and naming the specific outcomes you expect.5 PATH's policy advocacy workbook adds the necessary campaign details: define the issue, state the goal, identify decision-makers, list tactics, and plan how to measure success.2 This sequencing prevents teams from declaring victory after a single workshop when the real target is a regulation change.
Use a policy tracking grid to record where an issue sits in the process. The National Association of Chronic Disease Directors' advocacy toolbox breaks this into six measurable categories: problem identification, policy analysis, policy development and adoption, education and outreach, policy implementation, and impact evaluation.1 For allied health and SLP teams, practical quantitative indicators include: - Access speed: referral-to-evaluation time in schools or outpatient clinics - Resource decisions: funding approved for AAC devices or a new SLP position - Policy change: legislation passed, regulation adopted, or agency guidance issued
The Physician Advocacy Documentation Tool separates quantity measures, such as people trained or media outlets engaged, from quality measures, such as whether legislation succeeded or learners applied the advocacy skill. Qualitative evidence matters equally. Stakeholder interviews, documented policy language, and case stories capture context that a count alone misses. A school-based SLP might document that a district strengthened school-based speech therapy eligibility by adding a communication screening protocol after a semester of advocacy; a medical SLP might track the adoption of a dysphagia screening policy in an acute care unit. The Policy Advocacy Engagement Scale offers another adaptable structure, with seven patient problem areas to monitor: biopsychosocial functioning, person-environment barriers, patient rights violations, gaps in patient-centered care, cultural responsiveness, access and affordability, and unmet mental and community care needs.4
Measurement is what separates a busy but invisible effort from a credible systems change. When SLPs record before-and-after access metrics, they can show that advocacy shortened evaluation waits, expanded services, or protected patient rights. Those outcomes are the ultimate reason advocacy matters: they connect everyday caseload wins to durable improvements in speech, language, swallowing, and hearing care. Without a measurement plan, policy wins can look like isolated anecdotes; with one, they become evidence that the profession can use to secure the next investment. For a state association, that might mean showing a decline in average evaluation wait times after a legislative ask; for a hospital team, it could mean documenting that a new swallowing screening protocol reduced aspiration events.
Where you practice shapes what you earn, and wage gaps between metros highlight why local advocacy for competitive pay and adequate staffing remains essential. The data below compares median annual wages for speech-language pathologists in some of the largest U.S. metropolitan areas. Understanding these differences can help SLPs build stronger cases when advocating for salary equity, funding, and workforce investment in their own communities.
Advocacy that works is systemic, not sentimental: it turns caseload wins into policy change, and the same evidence based approach that reshapes services in the Dominican Republic can reshape a school district or hospital back home.
Some advocates wait for a policy window; others create one with a single meeting. Quick-start advocacy is the second path: small, repeatable moves that build toward the caseload, reimbursement, and service-access wins covered in this guide.
Students can begin with the NSSLHA CSD Student Advocacy Hub, which includes templates, presentations, and scripts for advocacy meetings. Mark two deadlines: ASHA's Capitol Hill Day on September 22-23, 2026, and Virtual Student Advocacy Day on October 22, 2026.2 For meeting prep, email [email protected]; for state policy, email [email protected]; for reimbursement, email [email protected].3
This sequence mirrors global health advocacy: define the access gap, gather evidence, map the people who can change it, and ask for a specific action. The Dominican Republic mission used a diagnostic workshop, site visits, and stakeholder input before producing a consensus roadmap. At home, that same arc can start with one calculator run, one email, and one meeting.
