Membership organizations are often weak and poorly linked to state services…

Paradoxically, in many community based health programmes, states have built stronger collaboration with NGO service organizations, including international NGOs, than with their own national, membership-based civic organizations, such as trade unions.

This has weakened the involvement, and the development of the capacity, of these important national institutions in health sector work, including their possible role in health financing and provision. In contrast to well funded international NGOs, many national civic and grass-roots organizations struggle, amongst other problems, with:

  • how to access their own national public resources;
  • their capacity to manage and sustain programmes;
  • the negative attitudes and non-participation of health workers;
  • poverty and pressures on communities from other social problems;
  • difficulties in combining and balancing the roles of health providers and traditional, civic and elected leaders ;
  • how to build strong and active links with their own members (Loewenson, 2000).

(We explore this issue in more detail in the next module.)


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Involvement in health

"Community participation"

Financing health systems

Use of resources
Interactive exercise