These problems signal that
policy designers have paid inadequate attention to making public
participation part of decentralization. They have failed to maximize
the potential contribution that community based organizations
or civic groups can make to health systems.
Civil society can act as a
critical missing link between grassroots groups and the state,
particularly where they have a good working relationship with
local government. Civil society can offer a vehicle for reaching
strata bypassed by the state, but more importantly for reintegrating
such strata into wider health systems that involve both the state
and the private sector.