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).