The Vital Role of Civil Society in Strengthening Health Systems: A Call for Empowerment and Collaboration

By Vesna Kerstin Petrič

Throughout my career in public health and global affairs, one lesson has been constant: the most effective, resilient, and humane health systems are built in partnership with civil society. Yet at a moment when Europe faces growing polarization, democratic backsliding, and persistent health pressures, it is troubling to see civil society organizations (CSOs) confronted with political pressure, mistrust, and, in some cases, funding cuts. Their advocacy is too often seen as a threat rather than an asset.

NGOs are Links to the People

Health systems today are navigating unprecedented challenges: economic instability, the COVID-19 pandemic, climate-related crises, and widespread misinformation. International reports show that progress toward development goals is lagging, vulnerabilities are rising, and inequalities are deepening. Decision-makers and health professionals are under immense pressure to sustain health systems while delivering universal health coverage (UHC) and high-quality care for all.

In such a complex environment, it is difficult to imagine meeting people’s needs, especially those most at risk, without trust-based cooperation between governments, professionals, and CSOs, grounded in shared values and goals.

Slovenia’s experience demonstrates that social participation (SP) is not only a cornerstone of democracy; in healthcare, it is essential for reaching those most vulnerable and marginalized. In the 1990s, while some neighboring countries experienced HIV rates among intravenous drug users as high as 60%, Slovenia avoided such an epidemic. This success came from sustained public investment in CSOs working closely with communities and supported by primary-care professionals to provide needle exchange, anonymous testing, and methadone maintenance programmes.

The value of SP extends beyond infectious disease control. During the devastating floods in Slovenia in August 2023, CSOs filled critical gaps in mental health and psychosocial support. Youth organizations, supported by the Ministry of Health and health professionals, were instrumental in advocating for stronger tobacco control, showing that those most affected often generate the trust needed for real change. Ensuring health literacy in people who are “hard to reach” rarely happens through health professionals alone; it succeeds through collaboration with CSOs working in communities, across generations, cultures, and vulnerabilities.

This is why Slovenia and Thailand, supported by Norway, France, Tunisia, and Brazil, championed the World Health Assembly resolution on SP for UHC, health, and well-being. The resolution recognizes SP not as an add-on but as a necessity for effective governance, successful policy implementation, and strong, trusted health systems. It underscores that meaningful, structured participation, especially by youth and marginalized groups, produces better decisions, stronger legitimacy, a sense of ownership, and improved outcomes.

Civil Society Under Siege

At a high-level UNGA side event on SP and health equity this year, leaders, including the presidents of Slovenia and Kenya, emphasized that inclusivity is essential for achieving health goals. Yet many European policy processes still treat civil society as optional or inconvenient. This is a mistake.

As Slovenia’s President Nataša Pirc Musar noted: “By empowering and institutionalizing social participation, we build trust in our health systems and align services with the needs of diverse communities.”

Many countries and their ministries of health recognize this and are eager to implement SP. International civil society networks actively contributed to the WHA resolution and are ready to support its implementation, promote good practices, and contribute to informed decision-making at the global level.

For SP to work, investments are essential. Funding for CSOs remains a challenge everywhere. Slovenia has invested for decades in institutionalizing SP through legal frameworks for citizen involvement, co-financing CSOs, and platforms for sharing best practices. We ensure that investments are evidence-based by fostering close cooperation between CSOs and professional organizations. This is the responsibility of a dedicated unit within our public health institute that provides training, facilitates communication, and promotes results across sectors. We know that long-term investment requires continued evidence of impact. WHO is well placed to help countries demonstrate this.

What is needed now is collective mobilization. No single actor can succeed alone. Governments, CSOs, youth organizations, researchers, parliamentarians, and the media must work together to rebuild trust and break silos. WHO and Member States, alongside global civil society networks, have a key role in documenting and sharing evidence of what works to sustain investment in SP and CSOs.

The WHA resolution provides a roadmap. Europe should use it, within the EU and globally, to strengthen participatory mechanisms and place people at the center of health governance. Democratic resilience and public health depend on it, and there is no better time than now to expand civic space.

Strengthening Health Systems Through Civil Society: A Call to Action

By Vesna Kerstin Petrič

In my extensive career in public health and global affairs, one enduring truth stands out: the most effective, resilient, and humane health systems are forged through partnerships with civil society. Yet, at a time when Europe grapples with increasing polarization, democratic backsliding, and persistent health pressures, it is disheartening to witness civil society organizations (CSOs) facing political pressure, heightened mistrust, and even funding cuts. Often, their advocacy is perceived as a threat rather than a valuable asset.

NGOs as Vital Links to the Community

Today’s health systems are confronted with unprecedented challenges, including economic instability, the lingering effects of the COVID-19 pandemic, climate change, and widespread misinformation. International reports indicate that progress toward development goals is faltering, vulnerabilities are escalating, and inequalities are intensifying. Decision-makers and health professionals are under immense pressure to sustain health systems while striving to deliver universal health coverage (UHC) and high-quality care for all.

In this complex landscape, meeting the needs of the most vulnerable populations is nearly impossible without building trust-based cooperation among governments, health professionals, and CSOs, all grounded in shared values and goals.

Slovenia: A Case Study in Social Participation

Slovenia’s experience exemplifies the significance of social participation (SP) as a cornerstone of both democracy and healthcare. In the 1990s, while some neighboring countries witnessed HIV rates among intravenous drug users soaring to 60%, Slovenia successfully avoided such an epidemic. This achievement stemmed from sustained public investment in CSOs, which worked hand-in-hand with communities and primary-care professionals to implement essential services like needle exchanges, anonymous testing, and methadone maintenance programs.

The importance of SP extends far beyond infectious disease control. For instance, during the catastrophic floods in Slovenia in August 2023, CSOs played a crucial role in delivering mental health and psychosocial support. Youth organizations, with backing from the Ministry of Health and health professionals, advocated for stronger tobacco control, highlighting that those most affected often cultivate the trust necessary for genuine change. Enhancing health literacy among hard-to-reach populations seldom relies solely on health professionals; it thrives through collaboration with CSOs engaged in diverse communities, generations, and vulnerabilities.

Recognizing this, Slovenia and Thailand, with support from Norway, France, Tunisia, and Brazil, championed a World Health Assembly resolution emphasizing SP for UHC, health, and well-being. This resolution asserts that SP is not merely an additional feature but an essential component of effective governance, successful policy implementation, and robust, trusted health systems. Moreover, it underscores that meaningful engagement—especially from youth and marginalized groups—leads to better decisions, stronger legitimacy, a sense of ownership, and improved outcomes.

The Siege on Civil Society

At a recent high-level UNGA side event on SP and health equity, leaders, including Slovenia’s and Kenya’s presidents, underscored the necessity of inclusivity in achieving health goals. However, many European policy processes still regard civil society as optional or inconvenient—an oversight that can have dire consequences.

As Slovenia’s President Nataša Pirc Musar aptly stated: “By empowering and institutionalizing social participation, we build trust in our health systems and align services with the needs of diverse communities.”

Many nations and health ministries recognize the importance of SP and are keen to implement it. International civil society networks played an active role in shaping the WHA resolution and are prepared to assist in its application, advocate for best practices, and contribute to informed decision-making at the global level.

To ensure SP materializes, investments in CSOs are crucial. Yet, funding remains a persistent challenge worldwide. Slovenia has, for decades, invested in institutionalizing SP through legal frameworks, co-financing initiatives, and platforms to share best practices. We depend on evidence-based investments via close cooperation between CSOs and professional organizations, coordinated by a dedicated unit within our public health institute that provides training, facilitates communication, and promotes results across sectors. Long-term investment demands ongoing evidence of impact, and WHO is ideally situated to help countries illustrate this.

A Collective Call to Action

The time for collective mobilization is now. No single entity can succeed in isolation. Governments, CSOs, youth organizations, researchers, parliamentarians, and the media must unite to rebuild trust and dismantle silos. WHO and Member States, alongside global civil society networks, play a vital role in documenting and disseminating evidence of effective practices to sustain investments in SP and CSOs.

The WHA resolution offers a roadmap for progress. Europe should seize this opportunity, both within the EU and globally, to enhance participatory mechanisms and place people at the heart of health governance. The resilience of our democracies and the health of our populations hinge on this imperative, and there has never been a better moment to expand civic space.

Together, we can build health systems that are not just resilient but truly reflective of the communities they serve.