Governance and participation in health

Citizen Participation in Budgeting: Prospects for Developing Countries
Moynihan DP: Participatory Budgeting, The World Bank, Washington DC: 55-87

Participation is important in developing countries as a means of improving the performance and accountability of bureaucracies and improving social justice. There are two basic criteria for participation: it should be broadly representative of the population and should involve meaningful discourse that affects public decision-making. Reviews of participation in Poverty Reduction Strategy Paper (PRSP) processes show that these criteria have not been met in most cases. However citizen involvement in budgeting has been more successful. Citizen participation made local service delivery more efficient and effective in the country cases reviewed. In most of the case studies, NGOs analysed the budget and mobilised citizens. These NGOs seek to represent the poor and disseminate their views to the government. They do not offer direct citizen involvement, but without their involvement participation would be reduced. Budget participation can influence governments even where they have not embraced direct involvement of citizens in decision-making. This depends on NGOs communicating analyses of spending choices, public service effectiveness, and budget execution to the public, media, and elected officials. A key policy implication for donors is therefore targeted support to civil society. However, donors and NGOs often overlook the importance of government administrations in implementing participation.

Citizen Voices, Community Solutions: Designing Better Transparency and Accountability Approaches to Improve Health
Transparency for Development: Harvard Kennedy School, USA, 2017

This study was designed to address the question of whether a community-led transparency and accountability program can improve health outcomes and community empowerment, and, if so, how and in what contexts. To answer this question, researchers and civil society organization partners co-designed a program that would activate community participation in improving maternal and newborn health outcomes. This report presents the design of the work that was implemented in 200 villages in Tanzania and Indonesia and studied using a mixed methods impact evaluation. The team faced challenges including how to best foster community participation, how to structure the information gathering and sharing component, how to facilitate social action in communities, and how to ensure communities review their successes and failures in implementing social actions.

Citizens must engage and respond to new global crises
United Nations Development Programme: 21 June 2009

Climate change and the current global economic crisis bring an unprecedented opportunity to transform global governance, which must start giving priority to human development and citizen engagement, civil society organisations said at the launch of Platform HD2010 in New York on 5 June, a partnership that will include civil society in addressing the current global crises in the poorest countries. The partnership’s recommendations will contribute to the 20-year review of the United Nations Development Programme’s (UNDP) Human Development Report. Civil society representatives have called on the UNDP to create and expand opportunities for citizen engagement in development initiatives and to work together in addressing the concerns of the poor, who have been the hardest hit by the current economic and climate crises. The partnership will also contribute to the ten-year review of the Millennium Declaration and the Millennium Development Goals, both of which are taking place next year.

Citizens’ agenda for Africa’s development
African Monitor: 2010

This document reports efforts that were made across Africa to gather grassroots opinions to reflect the views and aspirations of ordinary Africans in shaping the policy agenda for the forthcoming decade. It found that Africa is endowed with natural and human resources whose development is in the interest of world security due to its global strategic importance. Meanwhile, the increasing return of the diasporas is raising the demand for accountable governance and economic development. The current so-called development is exclusionary and does not reach the intended beneficiaries - hence their minimal access to basic services such as health, education, water and sanitation. The report makes a number of recommendations, like replacing the current unjust and exclusionary development ideal with one that is values-based and sustainable, spelling out the Millennium Development Goals need to be spelt out properly for the African and Western public with the emphasis on detailing the public good, ensuring that African governments operate with financial transparency especially in the extractive sector, and making civil society, professional associations, social movements and business entrepreneurs catalysts for engendering accountability from governments, NGOs, donors and big businesses. Agriculture, food security and the informal sector should be prioritised by African governments and those who support Africa’s development, and the skills and remittances of the returning African Diaspora must be harnessed and used to ensure good governance on the continent.

Citizens’ agenda for Africa’s development
African Monitor: 2010

Five years remain for the achievement of the Millennium Development Goals (MDGs) and more needs to be done in Africa to meet the goals for governance and economic and social development. This document reports grassroots opinions from across Africa for shaping the policy agenda for the forthcoming decade, 2011–2020. African Monitor argues that the current development paradigm is exclusionary and does not reach the intended beneficiaries, hence their minimal access to basic services such as health, education, water and sanitation. The report provides a number of recommendations, proposing a values-based and sustainable development ideal to replace the current one and arguing that the MDGs need to be spelt out properly for the African and Western public, with the emphasis on public benefits. African governments should operate with financial transparency and civil society, professional associations, social movements and business entrepreneurs should be catalysts for engendering accountability. Agriculture, food security and the informal sector should also be prioritised by African governments and those who support Africa’s development.

CIVICUS calls on world leaders to make countries accountable for failing aid commitments at OECD summit
CIVICUS: e-CIVICUS 538, 26 May 2011

World leaders should use the Organisation for Economic Cooperation and Development (OECD) 50th anniversary forum to press for concrete improvements in sustainable development and fighting poverty, CIVICUS said at the opening of the two-day summit in Paris, France, on 24 May 2011. The 34-member institution should make clear that real improvements in poverty eradication depend on countries living up to their aid commitments, CIVICUS said. The organisation stated that it is critical that OECD leaders assess the impact of their efforts and the policies being advanced by international financial institutions to tackle poverty and climate change. The gap between commitments and aid pledges in 2011 has widened. In 2005, members of the OECD Development Assistance Committee (DAC) collectively promised to commit 0.56% of gross national income to aid. However, in 2010 aid has reached just 0.32%. At current levels, there is little chance that more than a handful of countries will reach the agreed commitment of 0.7% by 2015, CIVICUS warns, arguing that aid effectiveness is being damaged by inflated budgets, a lack of transparency and the failure of several large countries – namely Germany, Italy and Spain - to honour their commitments laid out in the Accra Agenda for Action.

CIVICUS World Assembly Report 2012: Montreal Civil Society Commitments for a New Social Contract
Delegates of the Eleventh CIVICUS World Assembly: November 2012

At the end of the Eleventh CIVICUS World Assembly, held in September 2012, the various recommendations made by delegates were analysed and distilled into 15 key commitments for civil society to implement as it seeks to work more effectively to promote equity and to challenge and change the rules of engagement between citizens, the state and other holders of power. Some of these commitments call for greater networking and smarter partnerships between formal civil society organisations and new social movements and social media technologies. The significance of encouraging local and voluntary participation, maintaining community connections and addressing marginalisation was highlighted. Other commitments argued for work within an equity and human rights based framework that includes sustainability and demands accountability to citizens, not external funders. Civil society also needs to be less dependent on governments and seek alternative financing models, like social and crowd-sourced funding. The commitments further call for civil society organisations (CSOs) to be innovative, strategic and have an assets-based approach, develop a better understanding of private sector involvement as well as develop CSO capacities for negotiation and analysis of power.


Civil society actors have become more visible, active and influential within health and health systems. Understanding their role, the factors influencing them and the health outcomes they produce is important to anyone wishing to improve public health. This website presents an annotated bibliography of research on civil society and health prepared as a collaboration between the World Health Organisation's Civil Society Initiative and Training and Research Support Centre. The research focused on three theme areas: Civil society - state interactions in national health systems; Civil society contributions to pro-poor, health equity policies; Civil society influence on global health policy.

Civil Society and Key Populations: Considerations for the Global Fund's New Funding Model
ICASO: April 2013

In late 2012, the board of the Global Fund to Fight Malaria, Tuberculosis and AIDS approved a new funding model (NFM), which significantly changes the manner in which funds are allocated, applied for, awarded, disbursed, and monitored. The NFM was formally launched on 28 February 2013, though it will remain in a transitional phase until 2014. While there is much promise in the NFM, there are many questions, some of which are raised in this report. The Fund has established a framework for the core aspects of grant funding under the NFM, but there remain countless details to be uncovered through real-world experience and regulated by Fund policy and protocol. This report reviews the key components of the NFM from a civil society and key population perspective, with a focus on its impact on AIDS programmes. Incorporating the views of leaders from key populations and civil society around the world, the report provides a summary of some current top-level concerns related to the roll-out of the NFM and offers recommendations on how to implement the NFM in a manner which is responsive to and inclusive of civil society and key populations, and ultimately which has the greatest impact on ending the AIDS epidemic globally.

Civil Society and Social Issues in Health: Community in Action for Health
Berry S: Geneva Health Forum, 31 August 2006

The traditional top-down approach to development is widely criticised as being inappropriate to meet the needs of local populations, especially the very poor. In order to improve this situation, some development organisations and non-governmental organisations (NGOs) favour approaches that integrate local communities in policy formation and implementation. Health, an important aspect of development, necessitates active involvement of the local population. The community remains the key actor in improving its own health standards and communicating its requirements to governments.