Where civil actors do not trust remedies within health systems, they may pursue redress for health related grievances outside the health systems.

In India, the Supreme Court in 1995 decided in favour of a citizens' action to use the Consumer Protection Act to defend their rights as patients against medical malpractice, when the state did not adequately address patient concerns (Mogedal & Hodne Steen, 1995).

Such legal remedies are generally more accessible to affluent groups, leaving poorer ones inadequately protected or served. Hence broader civil society watchdog roles have wider benefit, particularly where they are institutionalized in national health boards or councils or linked with a state facility such as an ombudsman.