For all groups, participation
must be seen to affect outcomes and produce visible results.
Equally, participation should enhance the possibilities for meaningful
public input, including from the poorest groups, rather than
provide one more bureaucratic structure that distances systems
from knowing about, understanding and addressing pressing health
issues. These conditions mean that there can be no prescriptions
or simple paths to supporting effective civil involvement or
civil-state relations in health. It calls for judgement, key
informant input and taking advantage of existing initiative and
capacities. The next section outlines some of the tools that
may be used for this and ways of assessing the effectiveness
of work with civic groups.