Civil and community action is not a substitute for relevant, accessible, equitable health services. In fact, civil society action itself appears to be more effective and more sustainable when backed by an adequate standard of health services and public health systems (Loewenson, 2000b). Neither do health services alone provide the range of inputs needed to control public health problems. Even where health infrastructures are available, they may not be able to:

• provide information in the appropriate language
• ensure culturally appropriate care
• support community networks for prevention and follow-up of illness.

These are all important factors in access to care (Equinet, 1998). For example, the understanding of, compliance with and supervision of directly observed treatment systems (DOTS) demand social capacities and roles that can be enhanced and supported through civic organizations.