WHA side event rallied political support for institutionalizing social participation in health decision-making

There was a full house at the Restaurant Vieux-Bois for the WHA side event, Institutionalizing social participation for PHC, UHC and health security. The event, which took place on 22 May in Geneva, was co-hosted by Thailand, Slovenia, Norway, Brazil, Tunisia, Madagascar, UHC2030, CSEM and UHC Partnership. Please find the recording of the session here.

“This is one of the most important events. Finally, we have gathered here with a particular aim – Slovenia and Thailand want to mobilize others… for a resolution on social participation [at the WHA] next year,” announced Dr Vesna Petric, Chair of the WHO Executive Board, at the start of the event, noting support of others, including Norway and France.

This was followed by a series of statements of support from Ministers of Health. The honorable Mr Anutin Charnvirakul, Deputy Prime Minister, Minister of Public Health and Chair of National Health Commission, Thailand called on countries to institutionalize social participation before the next crisis. “We need all of you here to #WalkTheTalk,” he said. He explained how Thailand’s robust foundation of social participation mechanisms – underpinned by the National Health Act in 2007 and sustained through earmarked investment – were leveraged for the COVID-19 response. “The government is too small to solve big problems, and too big to solve small problems – we need social participation”, followed Dr Suwit Wibulpolprasert.

“Our event is relevant as ever,” began Ms Ingvild Kjerkol, honourable Minister of Health and Care Services, Norway. “To enhance resilience in the face of multiple crises, governments should prioritize building public trust as a policy objective.” She went on to explain how social participation is a key driver of public trust. She noted the critical role of citizen input on Norway’s framework for priority setting; legal frameworks and institutions; and fairness, equality, inclusivity, diversity and transparency for fair processes and to avoid tokenism.

Dr Nísia Verônica Trindade Lima, honorable Minister of Health, Brazil, framed social participation as “one of the guiding principles of the health system,” urging for it to be seen “as a core topic for health,” not a side event. She outlined the country’s architecture for social participation, with Health Councils at Federal, State and Municipal levels, and emphasized the importance of accessibility, accounting for racial, cultural, gender and socioeconomic diversity.

We were moved from principles to action by the WHO Assistant Director-General, Universal Health Coverage and Life Course, Dr Bruce Aylward, speaking on behalf of the WHO Director General. He welcomed Member States’ pursuit of a resolution, asking “what works, and how to make it stick?”. He also noted the importance of stable financial resources, government capacities, sustainable mechanisms and measurement, stating that “without monitoring and data we aren’t accountable”. Reaffirming that “social participation is right at the heart” of the DG’s agenda, he cited the WHO Youth Council, CSO Commission and CSO Dialogues.

Dr Dheepa Rajan from WHO then shared a video on social participation and presented priority actions for Member States to move towards institutionalization, drawing on the Handbook on social participation for universal health coverage and the Technical Background Paper, and calling for everyone to participate in the survey by 25 June. She explained how social participation is core to primary health care and necessary for equitable progress towards UHC and health system resilience, promoting trust, transparency and accountability. She summarized the growing momentum since the Handbook’s launch, including DG-CSO dialogues, the Social Participation Technical Network’s advocacy strategy, WHO’s technical background paper, Regional Committee resolutions, and consultations at country, regional and global levels and with a range of constituencies. She then honed in on four concrete priority actions for Member States: investing adequate and stable financing; building the capacity of government as well as participants; ensuring regular, sustained mechanisms; and monitoring and evaluating the quality of participation and its impact.

Dr Petric convened the panel for a series of country and constituency perspectives. We heard from Mr Fernando Zasso Pigatto, President of the National Health Council in Brazil, who said that “participation is about bringing the state and society together… making government action more effective, efficient, accurate, transparent and democratic”. He explained how participation helped tackle vaccine deniers during COVID-19, and continues to guide public health policies in Brazil.

Dr Weerasak Putthasri, Deputy Secretary-General, National Health Commission Office, Thailand expanded on the Deputy Prime Minister’s remarks, adding that Thailand hosted the SEARO regional consultation in March, mandated by the Regional Committee resolution, then just last week held a national consultation where civil society stressed the need for active engagement in monitoring. “I think momentum in the South-East Asia region has been ignited… I really hope we can keep up momentum across all regions to WHA77.”

Ms Azra Herceg, Secretary of State for Primary Health Care and Public Health, Slovenia, spoke on behalf of the honourable Minister, explaining how “a lack of confidence and trust” prevails until we reach the most vulnerable populations, which was most effective through participation.

“We are committed to implementing the societal dialogue recommendations” in the national health policy, affirmed Mr Sabri Bachtobji, Permanent Representative of Tunisia to the UN, who spoke on behalf of the honorable Minister. He added that participatory health governance is an important pillar of health systems strengthening, and institutionalizing this process with a legislative and operational framework is a priority.

Ms Christina Williams, Policy, Advocacy, Research Lead, Commonwealth Youth Health Network, Jamaica, called for “capacity building and compensation” to facilitate meaningful engagement of young people in health decision-making processes. “The most powerful thing young people can bring is their lived experiences” she added. And this needs to be institutionalized. “We can’t rely on you being passionate about us,” she stated. “There should be a strategy in place so you must engage me.”

Dr Lauren Paremoer, People’s Health Movement, South Africa, stressed the need for truly inclusive health decision-making processes. She noted that although participatory processes have been implemented in South Africa since 1941, communities’ recommendations “went nowhere.” This undermines people’s trust in the system. The translation of UHC as health insurance is constrained by the fiscal envelope, and “it’s important to be honest about that,” she added.

The moderator invited interventions from the floor.

Christian Rabaud, Director General of Health, France stated that “effective mechanisms for social participation empower vulnerable groups to claim their rights.” As such, social participation must be a core principle in UHC reform processes. However, effective conflict of interest management is key.

Gaudenz Silberschmidt, Director, Health and Multilateral Partnerships congratulated the Executive Board Chair for putting social participation on the agenda and rallying members during a retreat last year. “WHO should lead by example,” he said, citing the WHO Youth Council and CSO Commission’s call for diversity. “The key point is the culture shift, be open, listen, learn, engage, and manage risks,” he added.

Dr Natasha Azzopardi-Muscat, Director, Health Systems, WHO EURO, expressed her commitment to the social participation agenda, thanking Member States for their leadership. Pragmatic approaches at the regional level include an inclusive pan-European mental health commission with active involvement of youth: “We can’t talk about the health of young people, without young people.” She also highlighted the importance of participatory processes for national planning. Referring to the Tallin conference in December, which will focus on trust and transformation, she stated that “our health systems are losing the trust of people if we don’t work with and through civil society.”

Dr Awad Mataria, Director, Health Systems, WHO EMRO stressed that “trust cannot be built during a crisis, it must be built before by engaging with people.” He added that institutions are vital to facilitating participation and build trust.

Dr Justin Koonin, Co-Chair, UHC2030, put it simply: “We cannot achieve UHC without social participation”, he said, calling for strong content on social participation in the outcome document of the UN High-level Meeting on UHC, linking this to Action Agenda 6.

Help Age International asked how we can reach the furthest behind first through participation so that systems and services work for them.

Finally, for the closing segment, Dr Suraya Dalil, Director, WHO Special Programme on Primary Health Care, said social participation is “a core instrument for empowerment” that must be systematic. It’s about the social contract for UHC: determining “who makes decisions and who is affected by those decisions.”

Professor Zely Arivelo Randriamanantany, honorable Minister of Public Health, Madagascar expressed that he felt energized by the commitment to advance social participation in the room, and inspired to do more and better at home as Madagascar is pursuing participatory strategic planning at the district level. “Giving voice to everyone is essential to leave no one behind,” he stated.

As countries pursue a resolution on social participation at next year’s WHA, WHO is facilitating a consultation process on priorities for institutionalizing social participation. Please complete the survey on the background paper by 25 June 2023, and register to join the upcoming webinar consultations for youth on 15 June and civil society on 20 June.