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.

Do existing 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 of participation.