National and global trends have centralised power in a small tier of political elites and at the apex of hierarchical bureaucracies. This has led to growing pressure for public accountability and for the elite to be responsive to the views of citizens.

In this situation, civil society offers an organized vehicle - which is complementary to state structures - for people to exercise citizenship, to confront poverty, to enhance their well-being and to promote their interests within the state and private sector.

For the lowest-income and most vulnerable groups, civil society may be a critical means to give voice to their experiences, values and interests, or to service their needs and demands, including those relating to health.