It is important to be clear
about the longer term impacts of working with social groups in
health. Communities and different organs of civil society have
experienced waves of state- or NGO-led social mobilization, often
issue-specific. Such interventions can leave them as isolated
and powerless at the end as they were at the beginning.
Powerful state or non-state
actors can affect civic movements in contradictory ways. On the
one hand, they can - even with benevolent intent - coopt and
take the energy out of civic movements, and water down their
positions or relations with their members. On the other hand,
they can also provide new skills, forms of interaction with authorities
and benefits that strengthen the confidence of civic groups and
their members and their interaction with the state.
The consciousness and capacities
that grow with civil involvement are important, as is the need
to respect the terms and interests that civic groups bring to
programmes (identified in the stakeholder analysis).