The previous modules have highlighted opportunities and institutional roles for civil society in health systems. Generating policy and institutional change demands leadership and skills often learnt outside the courses that are provided in formal health training. Many people use intuition and instinct for what is perhaps one of the most critical dimensions of their work.

This section aims to highlight some of the tools and approaches that do exist (to back intuition and instinct). Some, such as stakeholder analysis, results-based management, participatory reflection and action (PRA), negotiation or contracting require skills and experience if they are to be used effectively. There are organizations in all countries which have the capacities to use these approaches. The section outlines what these tools or approaches are, what they involve and some of the options available.

The forms of interaction noted in these materials, and the tools referred to here, do not indicate a shift from WHO's primary interaction with the state. They do suggest that WHO should widen its interactions to support civil-state networking. Such interactions create partnerships towards common goals. WHO needs to make its own role and interests clear to stakeholders.