In this blog Lynda Keeru reports back on the launch of the WHO Handbook on Social Participation in Universal Health Coverage. The webinar focused on educating participants about why social participation matters and presenting real life experiences of implementation. During the webinar, the tensions at play in the implementation processes also surfaced.
Dr Tedros opened by saying that the COVID-19 pandemic had demonstrated that societies are only as protected as their most vulnerable, and that equally engaged and empowered communities are the best defence against health threats.
Dheepa Rajan gave a brief overview of what the handbook is about and ran the participants through the key messages in the chapters. She indicated that the handbook’s main target audience are member states and governments; with its engagement modalities directly engaging with populations through communities and civil society. The overall goal of social participation is to achieve Universal Health Coverage (UHC). The handbook acknowledges that civil society plays a key role in strengthening social participation in policy and decision-making.
For social participation for UHC to be achieved, an enabling environment for participation needs to be created by evening out the playing field with the aim of empowering those who are weaker and less powerful. A participatory space is a powerful tool as it minimizes power asymmetries when designed in a manner that counters formal and informal barriers for equal participation. Social participation challenges societal conventions of whose voice should be heard, who should have agency over their own health and who should be empowered to meaningfully contribute to policy making.
The format and design of participatory processes influences the ability to effectively take on representation roles. Selection strategies should be balanced and transparent and formats should ensure that they lend legitimacy to participants. Some of the ways to make this happen include: having neutral facilitators, forming homogenous focus groups, having participants decide on meeting locations and trusting them with preparing the material that will be used.
In order to increase the capacities for meaningful government engagement with other stakeholders there is need to recalibrate the balance of power which is rooted in expertise, knowledge and speaking skills. Quality of exchange between these stakeholders is determined by the competency and capacity of the participants. A level playing field for all stakeholders gives everyone an equal footing and gives way for more honest and fruitful discussions that influence policy.
Recognition is the most fundamental dimension of capacities for equal interaction but the most difficult to build.
It is important to note that policy uptake is not always the priority in participatory governance processes. Value driven arguments and participation itself add value.
Fran Baum reiterated that real value must be accorded to the knowledge and experience of community members because they bring something that most public servants, international bureaucrats, technical people can’t bring. They know their community best – they live it, and they breathe it. The only way to make health services work, is by listening to the people whom it’s meant for and shaping the interventions around these needs, particularly those that are marginalized such as women, indigenous people, migrants and people living with disabilities.
WHO hopes to start working with a number of countries to implement the recommendations from the handbook. They will tie their efforts to UHC 2030 and CSO engagement mechanisms.
The handbook must be promoted widely to ensure that it influences change and especially ensure that it gets into the hands of governments as a practical tool for sustainable social participation. We are happy to be part of this promotion.
Event was organized by WHO, UHC2030, Health System Governance Collaborative, UHC-Partnership and PMNCH
Dheepa Rajan – Health Systems Adviser, WHO
Stephanie Seydoux – French Ambassador for Global Health
Ravi Ram – People’s Health Movement and Special Advisor, COPASAH
Joy Phumaphi – Executive Secretary, African Leaders Malaria Alliance
Fran Baum – People’s Health Movement