Advocacy Toolkit on Social Participation for Universal Health Coverage, Health and Well-being

Social participation in health refers to the meaningful involvement of people, communities and civil society in decision-making across the entire policy cycle and at all levels of the health system. It ensures that health systems are not only designed for people but also with them, incorporating diverse perspectives to better address the needs of different populations and ensure no one is left behind. Strong and regular dialogues between governments, health institutions and communities is a key to effective primary health care and essential for advancing equity on the path to UHC. It leads to more responsive health policies and programmes, supports the development of inclusive health systems and helps build public trust in the health system.

Social participation for health enables individuals and communities to influence decisions that directly affect their well-being, fostering a sense of ownership and collective responsibility. This participatory approach promotes healthier behaviors, strengthens community resilience and reduces health inequalities by ensuring that marginalized voices are heard. Moreover, by leveraging collective knowledge and fostering social support networks, social participation enhances the sustainability and effectiveness of health initiatives.

Despite these recognized benefits, opportunities for meaningful participation in health-related decision-making processes are diminishing in some parts of the world. Restrictions on civil society and the exclusion of marginalized communities are widening disparities and eroding inclusive governance. For example, between 2018 and 2022, at least 209 organizations were shut down in Nicaragua, with approximately 137 of these closures occurring between January and May 2022.

Governments must prioritize social participation to build stronger, more resilient health systems. Policies and programs that are developed with public input are more likely to be effective, accepted and successfully implemented. Moreover, engaging communities fosters trust in governments and reinforces transparency and accountability in health governance. In times of crisis, strong social participation for health also enables swift, coordinated and community-led responses, promoting the efficient use of resources while ensuring that no one is left behind. This enables multi-sectoral approaches to ensure that hard-to-reach groups are included in response measures. Certain groups may be difficult to reach due to factors such as remote location, cultural practices, religious beliefs or even discriminatory laws. Social participation helps address the complex barriers to health-seeking behavior by fostering coordinated health system approaches through community structures. Civil society and communities have a deep understanding of the local context, and they know and understand the specific needs, challenges and barriers faced by affected populations. By involving them in the development of health policies and strategies, governments are better able to address these barriers through coordinated health system approaches and community-driven solutions.

Social participation is also crucial for strengthening pandemic preparedness and response (PPR). Inclusive, community-led processes ensure that emergency planning, risk communication and response strategies reflect the lived realities of affected populations. The COVID-19 pandemic underscored the importance of trust, local knowledge and community-based action in effective outbreak control. By embedding social participation into health governance structures before a crisis strikes, countries are better equipped to detect emerging threats early, reach vulnerable groups quickly and coordinate efficient and effective cross-sectoral action.

In short, social participation is a driver of equity and inclusivity, providing marginalized and underrepresented communities with a platform to voice their concerns and influence decisions and solutions that directly impact them. This approach helps reduce health disparities and ensure health services are accessible to everyone, everywhere.

1. For participation sociale to be impactful, it must be institutionalized within governance structures and supported by strong frameworks that promote meaningful engagement and accountability.

2. Ensuring inclusive representation is another critical element.

3. Dialogue and engagement mechanisms should be structured to facilitate continuous and meaningful interaction between governments, communities and CSOs.

4. Capacity building is also fundamental to encourage sustained social participation.

5. Finally, accountability and transparency are essential to maintaining trust and ensuring that social participation leads to concrete outcomes. Establishing mechanisms for feedback and evaluation helps track progress and demonstrates the impact of public engagement on health policies and programs.

Since the launch of  Voix, agence, autonomisation - manuel sur la participation sociale pour la couverture sanitaire universelle in 2021, there has been a noticeable increase in political commitment among Member States to promote social participation in health-related decision making processes. This commitment extends to regional levels, as seen in references to social participation in Réunions du Comité régional de l'OMS and resolutions and through initiatives such as the European Réseau Jeunesse4Santé established by WHO Europe. There have also been parallel efforts within the WHO to increase the engagement of civil society and youth through the WHO Youth Council and the Commission de la société civile.

In 2021, during a dialogue sur la participation sociale et la responsabilité, Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), emphasized that:

« Alors que nous construisons mieux et nous préparons aux urgences futures, nous devons responsabiliser la communauté, améliorer la gouvernance participative, rétablir la confiance dans la santé publique et renforcer la solidarité mondiale. Cela est vrai non seulement pour les situations d’urgence mais dans tous les domaines de la santé, et en particulier pour progresser vers une couverture sanitaire universelle.

Au 76e événement parallèle de l'AMS in May 2023, several Member States announced their intention to pursue a resolution on institutionalizing social participation at the 77th WHA in 2024. A series of multi-stakeholder consultations were then held to inform a Document technique, qui résume les actions prioritaires des États membres alors qu’ils cherchent à institutionnaliser la participation sociale pour la santé.

At the 77th World Health Assembly in 2024, Member States endorsed the first-ever resolution on social participation for universal health coverage, health and well-being. This endorsement was a critical step in  building responsive, equitable people-centered health systems for UHC and ensuring no one is left behind. It also represents a major step toward the implementation of the 2023 Political Declaration on Universal Health Coverage, in which world leaders committed to:

?Increase and sustain political leadership at the national level for the achievement of UHC by strengthening legislative and regulatory frameworks, promoting policy coherence and ensuring sustainable and adequate financing to implement high-impact policies to protect and promote people?s health, including by providing financial risk protection and comprehensively addressing social, economic and environmental and other determinants of health by working across all sectors through health-in-all-policies approach and by engaging stakeholders in an appropriate, coordinated, comprehensive and integrated, whole-of-government and whole-of-society approach, and to promote social participation,?

et

?Promoting participatory, inclusive approaches to health governance for UHC, including by exploring modalities for enhancing a meaningful whole-of-society approach and social participation, involving all relevant stakeholders, including local communities, health workers and care workers in the health sector, volunteers, civil society organisations and youth in the design, implementation and review of universal health coverage, to systematically inform decisions that affect public health, so that policies, programmes and plans better respond to individual and community health needs, while fostering trust in health systems.?

Civil society played a crucial role in shaping and building political support for the adoption of the resolution on social participation. In collaboration with civil society partners, the CSEM led the development of civil society priorities, gathering input from CSOs at global, regional and national levels. These priorities outline key actions for Member States to institutionalize social participation. CSOs also provided feedback on the draft resolution and coordinated outreach to Member States to strengthen support.

The adoption of the WHA77 resolution on social participation for universal health coverage, health and well-being and the 2023 Political Declaration on UHC are part of the broad effort to strengthen health systems for UHC. It is now critical for government authorities, international actors, civil society and communities to work together to translate these commitments into specific policies, laws, regulations and funding at the country level.

Through the WHA77 resolution, Member States and the WHO made the following key commitments to implement, strengthen and sustain regular and meaningful social participation in health-related decision-making across the system:

Commitments made by Member States:

1. Build government capacities
   • Strengthen public sector capacities for the design and implementation of meaningful social participation
   • Implement and sustain regular and transparent social participation using a range of mechanisms supported by public policy and legislation
2. Establish and/or strengthen participatory spaces
   • Enable equitable, diverse and inclusive participation, with a particular focus on promoting the voices of all those in vulnerable and/or marginalized situations
3. Develop policy and legislation
   • Ensure that social participation influences transparent decision-making for health across the policy cycle, at all levels of the system
4. Invest resources
   • Allocate adequate and sustainable public sector resources in support of effective social participation
5. Monitor and use data
   • Support related research and pilot projects and programs, including their monitoring and evaluation, to promote the implementation of social participation
6. Build the capacity of CSOs
   • Facilitate capacity building for civil society to enable diverse, equitable, transparent and inclusive social participation

Commitments made by the WHO (link):

The WHO will support Member States in implementing the resolution by:

• Advocating for the regular and sustained implementation of meaningful social participation, both within the health sector as well as across other sectors and multilateral organizations that affect health equity and well-being, as a means of accelerating equitable progress towards UHC, health security and health-related SDGs
• Developing technical guidance and operational tools for strengthening and sustaining social participation, including monitoring and evaluating implementation within countries, and providing training and technical support upon the request of Member States
• Documenting, publishing and disseminating Member States? experiences in implementing meaningful social participation through different types of mechanisms, at different stages of the policy cycle, and at different levels of the system
• Facilitating regular sharing and exchange of Member States? experiences of social participation
• Harmonizing technical support on social participation across WHO divisions and levels
• Reporting progress on the implementation of the WHA77 Resolution on social participation for universal health coverage, health and well-being to the WHA in 2026, 2028 and 2030.

Institutionalizing participatory health governance requires more than political endorsement; it demands strategic planning, long-term investment and adaptive implementation that reflects local realities. The following strategies, drawn from documented best practices across countries, highlight different pathways and enabling conditions for embedding meaningful participation into health systems and illustrate how CSOs can strengthen engagement and drive implementation.

1. Raise awareness and mobilize civil society actors

Broad engagement from across the civil society landscape is crucial. Many organizations working on health, equity and human rights may not yet be aware of the resolution on social participation or of how they can engage in participatory health governance.

Action for CSOs: Organize information sessions, share advocacy materials, and build broad alliances. Raise awareness about the importance of social participation and encourage other CSOs to become active in national and local advocacy efforts. Mobilize grassroots support and amplify community-led initiatives.

2. Engage directly with your government to demand action

Governments made clear commitments under the WHA77 resolution. Now they must be reminded, supported and held accountable to follow through.

Action for CSOs: Reach out to ministries of health and finance and other relevant government bodies to call for concrete steps toward implementing the resolution. Use tools such as joint letters, policy dialogues and public campaigns to urge governments to establish or strengthen participation mechanisms, and to allocate funding and institutional support.

Tool: Use the Social participation advocacy letter template to reach out to your government

3. Map existing participation mechanisms

Many countries already have some form of formal or informal participatory process. Both types of forums play important roles in fostering participation, and in some cases, informal processes can serve as a foundation for formalization and institutionalization. Understanding what already exists, within the health sector and beyond, is a critical first step toward strengthening or scaling these efforts. Recognizing the value of both formal and informal forums also allows for a more inclusive approach to participation and can guide efforts to build more structured mechanisms over time.

Action for CSOs: Conduct a rapid mapping or assessment to identify existing platforms (e.g., health councils, local forums, multi-stakeholder committees), evaluate their functionality and identify gaps. Use this information to advocate for the creation, expansion or improvement of participatory spaces based on what already exists.

4. Advocate for legal and policy frameworks

Strong legal and policy backing ensures that social participation is institutionalized and protected. Thailand?s National Health Act is a key example of how legislation can legitimize participation structures (see more information under ?Case studies?).

Action for CSOs: Advocate for the development, revision or enforcement of legal frameworks that formalize civil society and community participation in health policy and planning. Engage in consultations and legislative processes to ensure language on participation is strong and inclusive.

Tool: Use the Priorities and Messaging Paper to draft your messages.

5. Promote inclusive and equitable representation

To truly reflect the diversity of communities, participatory mechanisms must include marginalized and underserved populations.

Action for CSOs: Identify underrepresented groups, work to ensure their voices are included in policy processes and support their meaningful participation through coalition-building, advocacy and accompaniment.

6. Invest in capacity building

CSOs, including local organizations, grassroots groups, and others that may not traditionally engage at higher levels, can support communities and stakeholders to engage confidently and effectively in health governance. With the necessary guidance and capacity building, these organizations help bridge the gap and ensure that all voices, including those from less-established groups, are heard and involved.

Action for CSOs: Offer or facilitate training sessions on a rights-based approach to health, social participation, policy engagement and advocacy. Equip community members and local organizations with the tools they need to participate meaningfully.

7. Strengthen accountability and transparency

Transparent decision-making processes are key to building trust and achieving results. CSOs play a key role in monitoring commitments and reporting gaps.

Action for CSOs: Monitor government progress in implementing participatory commitments, publish shadow reports or community scorecards and advocate for mechanisms that ensure transparency and responsiveness from public institutions.

Tools: Refer to the Commentaire de la société civile sur le Rapport mondial de suivi (GMR) 2023 for inspiration, which highlights civil society?s calls to action for governments based on the results of the 2023 GMR and civil society perspectives on progress toward UHC. 

8. Advocate for sustainable resources and enabling environments

Participation needs funding, infrastructure and administrative support to function effectively. Too often, civil society and community actors are expected to contribute time, knowledge and representation without receiving the necessary resources to do so. In addition to securing resources for participatory mechanisms, it is also essential to ensure that community-based organizations and civil society actors receive adequate financing to operate effectively, especially at the grassroots level.

Action for CSOs: Engage in national budget advocacy to secure resources not only for the creation of participatory spaces but also for the sustained and flexible financing of civil society actors. Push for the establishment of safe spaces where civil society can participate free from external pressures or state influence, allowing for genuine and independent engagement. Advocate for these allocations to be embedded in national health strategies, UHC roadmaps and donor-supported mechanisms. Highlight how core funding and small grants can ensure consistent participation of marginalized groups and grassroots organizations.

Tip: Advocate with donors and global health agencies for funding mechanisms that directly support civil society?s convening, mobilizing and policy monitoring roles. This should include mechanisms that provide support to ensure civil society can contribute in a safe and independent manner, free from undue pressure.

9. Facilitate ongoing dialogue

CSOs are uniquely positioned to bridge gaps between communities and institutions, creating space for regular and structured engagement.

Action for CSOs: Coordinate community forums, stakeholder roundtables or public dialogues that promote mutual understanding, policy feedback and co-creation of solutions between government and communities.

Tool: Use the Mapping for opportunities for CSO Engagement to stay informed of national, regional or global opportunities to engage. 

10. Stay informed and engaged

Join forces with the wider civil society community to champion participatory governance and to promote knowledge sharing, strategic alignment and stay informed about opportunities to coordinate and actively engage in advancing social participation to drive meaningful progress on UHC.

Action for CSOs: 

• The Core Group remains active, with civil society representation, and convened in late 2024 to design a global multi-stakeholder network aimed at fostering collaboration and accelerating the implementation of the resolution. Stay tuned for more details.
• Join The Civil Society Engagement Mechanism for UHC2030 (CSEM), the global movement to build stronger health systems for UHC. The CSEM raises civil society voices to ensure that UHC policies are inclusive and equitable, and that systematic attention is given to the most marginalized and vulnerable populations so that no one is left behind. 

Tool: Join us by subscribing ici. CSEM membership is open to all civil society representatives working to advance health, financing, and governance agendas in support of UHC. As a member, you’ll receive all CSEM communications directly via email.

Thailand’s National Health Assembly (NHA) is a strong example of institutionalizing social participation in health governance. Established through the National Health Act of 2007, it takes a structured approach to policy deliberation that is characterized by:

1. Legal foundation: The NHA provides a formal mandate for public participation, creating legitimacy and sustainability for the process of social participation.
2. Inclusive representation: The assembly includes over 280 constituency groups (and growing), creating a space for diverse perspectives to be represented in health policy discussions.
3. Government-community interaction: Founded on the concept of the ?triangle that moves the mountain?, the NHA brings together three key groups?government officials, civil society and academic institutions?for iterative discussions on health policies.
4. Capacity building: The NHA has become a recognized and appreciated national public good, enabling evidence-based policy discussions and building civil society capacity to engage in policy-making processes.
5. Responsabilité et transparence: The NHA demonstrates strong transparency mechanisms through its open documentation practices. All background papers and draft resolutions are published online and widely disseminated, ensuring public accountability. The system is further strengthened by mandatory public hearing forums that provide spaces for open feedback and refinement of policy proposals.

Despite these strengths, the NHA faces challenges in translating resolutions into policy implementation, as resolutions are non-binding and require political will to enact. Nevertheless, the assembly has evolved into a recognized entity that has improved civic consciousness and demonstrated the need for multi-stakeholder ownership and collaboration for health solutions.

Brazil?s health council system is another institutional framework for social participation in public health governance. Established after the adoption of the 1988 constitution, these councils were designed to give citizens a voice in general (and health) policy formulation and oversight at all government levels.

However, a 2017 study of 4,742 health councils revealed significant implementation gaps. While 95.8% of councils were properly established by law, only a third had dedicated budget allocations. Only half had executive secretariats, and 30.1% maintained their own office spaces.

The Brazilian experience shows that meaningful social participation requires not just institutional frameworks but also sustained administrative support, financial autonomy and appropriate physical infrastructure to fulfill its democratic potential. The availability of data is also critical to evaluate the implementation gap and identify areas of improvement.

Senegal?s Comités de Développement Sanitaire (CDS) or Health Development Committees are community-based structures that manage local health services and ensure public involvement in health planning. They include diverse members such as women?s groups, youth and civil society actors. The committees have a legal mandate and legal body that are under the control of the Minister of Health and Social Action, and are established within each health center, post or structure.

CDS meetings serve as spaces for continuous dialogue between health staff and communities on regular health topics such as health insurance and essential medicines. These ongoing interactions help identify needs, assess performance and guide local health decisions.

However, despite being a legally mandated body that is meant to be inclusive by Senegalese law, there is little mention of capacity building or accountability and transparency, crucial elements for the effective implementation of participatory health governance.

In Madagascar, a reform of the strategic health planning mechanisms is underway, aiming to establish a bottom-up, participatory and results-based planning system across all regions and districts. This initiative seeks to develop localized health development plans that articulate priorities, goals and expected outcomes in alignment with the national health strategy and annual state budget.

These local health development plans will be developed, implemented and followed-up in a participatory way along the whole process, favoring the collective decision-making process and action. The committees leading this process will welcome representatives of local CSO, various communities of the area, users of the health system and diverse authorities and related stakeholders active in the health sector. These committees will then be leading the various steps for the elaboration of the District and Regional health development plans, and then collectively contribute to the implementation of the various activities and its follow-up. This way, the local actors will be able to make the voices of their communities heard in these decisive forums, and contribute to local health development plans that reflect the needs and specificities of their population. Social participation is paramount in this reform on the strategic planning of Madagascar, and will contribute to a more democratic health governance and a better prioritization of funding oriented by the community?s say.

This reform is presently being developed by the Ministry of Public Health of Madagascar, with the support of Action against Hunger, Action Socio-Sanitaire Organisation Secours and UNICEF, are providing technical assistance to the Ministry of Public Health of Madagascar in this development phase.

In Mozambique, a critical shortage of healthcare personnel?including peer educators and HIV counsellors previously funded by US foreign aid?has disrupted HIV testing and counselling services across several provinces. This has placed substantial strain on health facilities, compelling some individuals living with HIV to travel long distances to access care, including life-saving antiretroviral treatment (ART).

To address these immediate challenges, the local NGO organisation Regional Psychosocial Support Initiative (REPSSI), in partnership with Frontline AIDS through the READY+ (Resilient and Empowered Adolescents and Young People) programme, has supported an innovative community-based solution: the mobilisation of young peer supporters, known as Community Adolescent Treatment Supporters (CATS).

Initially trained to provide adherence support and sexual and reproductive health referrals within communities and clinics, CATS have expanded their role in response to the service gaps. Following targeted training, they are now conducting HIV testing and counselling in affected health facilities?temporarily filling critical gaps in service delivery.

This model highlights the potential of youth-led, community-based interventions to respond adaptively to public health service disruptions. While this is a short-term solution, it underscores the importance of investing in peer-led models that build local capacity, particularly in contexts where formal health systems are under-resourced. Sustained support and institutional recognition of such roles could enhance resilience and continuity in health service delivery, particularly for adolescent and young populations.

This customizable advocacy letter can be used by civil society and communities to engage with national or local decision-makers, such as ministries of health, parliamentarians or international partners.

How to use it:

• Adapt the language and content to your national or local context.
• Use it to highlight key policy demands, raise awareness of community needs or request specific actions.
• Send it out as part of a broader advocacy campaign or in response to relevant policy moments (e.g., budget cycles, national planning processes).

Tip: For a stronger impact, gather as many coalition and organization signatories from your country as possible to send this out as a joint letter.

This is a living document designed to collectively map and track key opportunities for civil society engagement at the global, regional and national levels. It serves as a coordination tool to identify relevant events, policy processes, advocacy moments and meetings where social participation can be promoted and advanced.

How to use it:

• Contribute to the document by adding upcoming opportunities such as national health planning cycles, UHC-related meetings, international days, regional forums and national policy dialogues.
• Use it to align actions, identify entry points for joint advocacy and foster cross-country collaboration.
• Refer to it during strategy meetings or coordination calls to plan shared interventions and amplify collective impact.

A concise summary of core messages, priority actions and talking points related to civil society engagement in health policy and UHC.

How to use it:

• Draw upon this content for public statements, social media, presentations or meetings.
• Tailor the messages to reflect the needs and voices of your communities and constituencies.
• Use it to brief allies and stakeholders on the importance of social participation for health.

This tool will be available soon.