Social Participation Works: Engaging those left behind to drive UHC

Social participation works! Social participation, especially the participation of communities who are often underserved, in governance is essential to create health systems that are trusted and adequately responsive to the needs of people. Civil society is best placed to understand the needs of affected communities and represent them in decision-making foras, especially prioritizing marginalized populations. To leave no one behind in progress toward universal health coverage (UHC), health policies and programmes must engage communities on the ground.

As part of the second edition of UHC2030’s multi-stakeholder review of progress made on UHC thus far, the State of Commitment to UHC Report, CSEM is working with a range of civil society organizations and community groups to coordinate country-level conversations with diverse populations on the state of health care access and progress to UHC thus far. Partners in over 20 countries will be convening community members, representatives of local civil society organizations, and other advocates to capture the real stories of progress made in UHC, share information from the community experience, and discuss the challenges and obstacles faced in accessing health care.

On the sidelines of World Health Assembly (WHA74), the CSEM and NCD Alliance along with Communities at the Heart of UHC, Global Health Council, International Federation of Red Cross and Red Crescent Societies, Save the Children and UNAIDS hosted a side event to enable these conversations at the global level. The event included a range of UHC stakeholders in order to advocate for the rights of those left behind to participate in health governance processes and amplify the importance of social participation at all levels.

Event Recording

Summary

The event was moderated by Dr. Khuat Thi Hai Oanh (Executive Director, Center for Supporting Community Development Initiatives, Advisory Group Member, CSEM) who is a champion for community engagement and health equity on many global stages. Dr. Oanh made clear that UHC is not about just splitting a pie but rather, about ensuring that those who are the hungriest – those who were historically left behind – get the bigger piece. “UHC,” she explained, “will only be a slogan without the participation of societies and communities who are left furthest behind.”

Ms. Eliana Monteforte (Director of Special Projects, Global Health Council; Advisory Group Member, CSEM) set the scene on the importance of civil society and community engagement in the UHC movement, noting that “civil society is often experiencing firsthand, or working with those experiencing first hand, the problems within a health system.” She was joined on the panel by Dr. Pierre Yameogo (Technical Secretary of Universal Health Coverage, Ministry of Health, Burkina Faso), who discussed Burkina Faso’s experience with a recent reform expanding access to health for women and children. Dr. Yameogo highlighted the role of civil society in accountability and monitoring in the implementation of this program as well as the many constraints faced by those advocates and other community health workers.

Mr. Farouk Hwedy (Health Team, Red Cross Society of Bosnia and Herzegovina) described his experiences as a migrant from Syria, including the challenges in accessing health, as well as the work of the Red Cross Society in Bosnia and Herzegovina. He underscored that communities of people on the move support and empower each other. Similarly, Mr. John Gikonyo (President, Renal Patients Society) described how people living with diseases have been instrumental in improving care for people requiring dialysis in Kenya. He advocated to engage affected communities early in policy and program development process to make sure the solutions presented are acceptable and effective for the end users.

The panel continued with Dr. Laurel Sprague (Special Advisor, Community Mobilization, Gender, Human Right and Community Department, UNAIDS), who presented lessons from the HIV response for civil society engagement and participatory governance. The evidence shows that where there is participation of affected communities in decision-making, access to quality health services improve. Dr. Sprague also linked the goals of achieving UHC strongly to the broader progress to other Sustainable Development Goals. Dr. Justin Koonin (Chair, UHC2030 Steering Committee; President, ACON) continued by emphasizing civil society and community participation in global platforms and processes. Dr. Koonin also noted the current momentum for transparent, participatory decision-making; COVID-19 has made more evident the inequalities that already existed in accessing health and offer an opportunity for countries to rebuild health systems with the voices of the communities they serve.

Participants in the discussion brought up challenges in engagement and examples of participatory governance. In the concluding summary, Carthi Mannikarottu (Communications Officer, CSEM) noted that institutionalizing participatory governance is not only a moral imperative but also an essential part of creating strong, effective health systems. To leave no one behind, everyone must be represented on the tables that matter and equipped with the resources and information required to make a difference.

A critical lesson from the COVID-19 pandemic is that transparent and inclusive decision-making needs to be prioritized in the health arena – both to create resilient health systems and drive progress toward UHC. The event noted that as health decision-making takes up more space in the public domain, there is momentum to push for further transparency and participation. This conversation will continue at the global, regional, and national levels. Civic space must be protected for these accountability activities and in health system governance more broadly, and governments must do more to engage civil society and communities in order to achieve #HealthForAll.

Follow-up

The CSEM and civil society partners will be continuing this discussion through UHC focus groups in select countries, where civil society and communities will share perspectives about the state of UHC commitments including equity, social participation and political leadership for health. Civil society organizations in countries that are participating in the VNR process this year are also invited to complete a survey by the State of the UHC Commitment team to provide more input. Invitations will be shared shortly.

For more information or to express interest, contact: csem@msh.org.