In the context of significant global economic and health challenges, especially following the COVID-19 pandemic, strengthening and institutionalising social participation must be a priority to advance health and well-being. Social participation – defined as empowering people, communities, and civil society through inclusive participation in decision-making processes that affect health across the policy cycle and at all levels of the system is a crucial element of good governance for health. The policy cycle involves situational analysis, priority setting, planning, budget, implementation, monitoring, evaluation and review, which occur at community, district, regional and national levels.
Social participation, based on equality, mutual respect and impartiality, is important for several reasons. First, it can contribute to more equitable outcomes by promoting the voices of marginalised and vulnerable populations and preventing undue influence by more powerful actors. Second, it can strengthen trust in public authority by ensuring that all affected constituencies are heard and that no one’s interests are misrepresented or neglected. Third, participatory mechanisms can be mobilised in an emergency to maintain trust and shape response measures. Fourth, social participation can contribute to more effective and sustainable reforms by fostering a sense of collective ownership and increasing the legitimacy of decisions made. FiPh, people, communities and civil society are important sources of knowledge to inform health policy processes. Finally, the inclusion of the voices of those whose needs and values health systems are designed to serve is vital for more responsive and equitable health systems.
In short, the participation of empowered people and communities in decisions that affect their health and well-being is the foundation of a responsive, equitable, resilient, accountable, and sustainable health system.
Ensuring a regular two-way dialogue can empower people and communities, as recognised in the primary health care approach. It should be seen as complementary to other one-way communication tools, such as surveys and polls. Social participation can be leveraged to advance complementary efforts related to improving service delivery, building health literacy, boosting risk communication and community engagement, tackling vaccine hesitancy, and addressing the social determinants of health to drive health equity anchored in a human rights approach.
In this context, accelerating progress, through the primary health care approach, towards goals of universal health coverage (UHC), health security, and the broader health-related Sustainable Development Goals (SDGs) cannot be made without the active engagement of people, communities, and civil society.
How do we institutionalise social participation for health and well-being?
To amplify the voices of people, in particular those living in vulnerable conditions and affected by marginalization, it is crucial to mitigate power imbalances and create and maintain safe spaces where everyone can meaningfully contribute and influence debates. This requires capacities to address barriers to participation, to prevent and manage conflicts of interest, as well as skilful facilitation. Effective legal frameworks and other mechanisms for preventing and managing conflicts of interest should be put in place to uphold the principle of impartiality.
Mechanisms for engaging populations in decision-making for health can be both mandatory (legally required for a decision to be adopted) and voluntary (led to the discretion of a particular body). Examples of social participation mechanisms include health assemblies, citizen juries, health councils, district committees, and citizen representation in various governing boards. These can be organised virtually and/or in person at all administrative levels of the health system and across the policy cycle. Mechanisms should be tailored to allow the participation of the lay public as well as users of specific health services.
Social participation will only work and lead to more equitable and effective policies if it is supported by mechanisms to ensure transparency, accuracy of information and reason-giving. There is significant evidence that participatory governance mechanisms are effective only when those who are participating receive timely and accurate information, when the decision-making process is transparent, and when choices of various policies should be justified.
Objectives/expectation
With the global community approaching the halfway point of the 2030 Sustainable Development Goals agenda, the objective is to strengthen, institutionalize and sustain social participation as a basis for responsive, equitable, resilient, sustainable and accountable health systems.
Recognizing that a universal feature of humanity is that human beings want to be able to shape their futures and that each country can build on its own traditions and institutions in finding ways to engage its populations more effectively, institutionalizing social participation for health and well-being requires the following actions by Member States, in line with national context and law, and with the support of the Secretariat:
1) To strengthen government capacity design and implement participation
2) To ensure equitable, diverse and inclusive representation
3) To ensure that social participation informs decision-making for health across the policy cycle and at all levels of the system
4) To systematize and sustain regular social participation, including through legal frameworks
5) To invest adequate, stable and predictable financial resources for social participation
6) To facilitate capacity strengthening and financial resources for civil society
7) To monitor, evaluate and review the quality and impact of social participation and support-related research.
The social participation movement
Despite various existing intergovernmental commitments to the principle of social participation - such as SDG target 16.7, the Astana Declaration on Primary Health Care, the UN High-Level Political Declaration on Universal Health Coverage, and the UN Human Rights Council resolution on equal participation in political and public affairs – all countries can do more to improve its implementation.
Given the significance of social participation for health, the Social Participation Technical Network was formed in 2019 to support and advise on the development of the WHO publication ‘Voice, agency, empowerment: Handbook on Social Participation for Universal Health Coverage’, which was launched in 2021. The Technical Background Paper synthesises key messages from the Handbook and national, regional and global multi-stakeholder consultations. These include regional consultations with Member States (PAHO, EMRO, SEARO, EURO), a national consultation in Thailand, a global public online survey, and constituency-specific consultative meetings with civil society, youth, parliamentarians and international agencies. At the same time, social participation has been gaining momentum in Regional committee resolutions.
At a World Health Assembly (WHA) side event in May 2023, various Member States announced their intention to pursue a resolution on institutionalising social participation for health at the WHO Executive Board and the WHA in 2024.
Relation to the existing work of the WHO
• In WHO’s Thirteenth General Programme of Work (GPW13), social participation sits within 1.1.4 (Countries’ health governance capacity strengthened for improved transparency, accountability, responsiveness and empowerment of communities), with a clear link to 1.1.1 (Countries enabled to provide high-quality, people-centred health services, based on primary health care strategies and comprehensive essential services packages), to accelerate progress towards UHC. Due to the cross-cutting nature of governance, social participation also advances the other triple billion targets, for example, risk communication and community engagement for health security, health promotion and social determinants for healthier populations and health equity.
• For the Fourteenth General Programme of Work (GPW14), which is in development, social participation is emerging as a central approach to strengthening health system governance and a core component of a primary health care approach for equitable progress towards UHC. It also promotes trust and strengthens health system resilience and accountability.
• Social participation is complementary to the work in other WHO departments and programmes to strengthen the engagement of communities and civil society to improve people’s health and well-being in countries.
• Social participation is distinct from initiatives to strengthen civil society and youth engagement in WHO’s corporate governance structure, such as through the WHO CSO Commission and Youth Council.
• There is close collaboration and coordination with the Health and Multilateral Partnerships team, the Secretariat and networks of UHC2030, and technical teams across WHO programmes to ensure synergies. The results of this resolution can meaningfully contribute to WHO's other work on civil society and community engagement, for example, by mobilizing political will and developing additional tools such as a monitoring and evaluation framework.
• FENSA is relevant but not directly related to this agenda of social participation, which focuses on government-led participatory processes with people, communities and civil society in countries.
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