Equally, health organizations have the potential to facilitate and support such inputs. The need is to change the management culture in these organizations. Where health services are not confident of themselves or the stakeholders they are working with, they may be reluctant to give up control over resources, particularly for curative services, even while communities are ready to take on greater control, particularly for preventive and primary care services.

What must health services develop to engage more confidently in civil issues? This checklist makes some suggestions.