How is civil
society currently involved in health?
Health reforms in the 1990s reduced the role of the welfare state
and gave a greater primacy to the market. Ensuring that health
systems meet priority health needs when resources are scarce
means having to make choices. Civil society now inevitably becomes
involved in making these choices.
policies of 'community participation' incorporate civil society?
Community involvement in health is a long-standing policy of
WHO, primarily linking community groups and NGOs to state health
programmes. It is claimed that the impacts on health have been
positive. Significant variability exists, however, in non-state
services. Membership organizations are often weak and poorly
linked to state services, and NGO services often fill gaps caused
by state or market failure. 'Participation' in health systems
implies not only action, but also control. Health authorities
often resist transferring authority to communities. After decades
of 'participation' in health systems, there are only isolated
examples of its success. But strong pressures exist for new forms