13.8. Civil society involvement and
The engagement with civil society may profoundly affect
the ways in which policy makers understand and respond to the needs of people
all over the world (WHO, 2002). The responses to the HIV-AIDS epidemics is a
clear example where NGOs were at the fore-front of advocating and implementing
measures to address one of today’s most challenging public health emergencies.
The public health priorities, health management, health
prioritisation, and issues on poverty, human rights, justice, equity, rights
and responsibilities may take on new meanings and new dimensions with the
growing participation in decision-making of those who may be affected (Stahl et
al 2006). The involvement of NGOs in policy making at national, European and
international level is rapidly developing.
There is no comprehensive directory, mapping and
identifying health NGOs in the different Member States of the European Union.
Comparable data at EU level and in the different Member
States are lacking for several reasons:
The Civil Society has not yet been fully recognised as a
partner and actor in health politics at EU and national level, in most cases.
Political leadership would be needed to address this challenge and explore the
breadth of activities that this sector has to offer.
Secondly, the sector is very volatile and diverse in size,
scope and function. The term NGO covers a
diversity of situations, deeply rooted in the history
of Member States. Some NGOs are charities, others are networks with an
organisation-based membership, others have direct adherents. They work at
different levels: local, national, European or international levels.
Thirdly, there is no universally accepted definition of
civil society or organizations formed to represent civil society. Even within
Member States of the EU and the UN, the definition and classification of civil
society actors varies. Many use the term NGOs synonymously with Civil Society
A review of the NGO status in Europe has been published in
the web. The European Public Health Alliance is a European Platform of health
and health-related NGOs in Europe. The World Health Organisation has a long
track record of structured dialogue with NGOs, and 272 organizations were
granted an Official Relation Status, as of 2001.
In the present context, the working terms ”NGOs and civil
society” are used to describe organisations that have the four following
characteristics (Fazi and Smith, 2006):
They are established voluntarily by citizens seeking to
promote their concerns;
They are organised around the promotion of an issue
or the interests of a particular section of society;
They are autonomous from the State, which is
essential if they are to provide credible contributions from their numerous and
Finally, they do not aim at optimising profits.
“Health NGOs” are usually considered to fulfil two
main types of functions (Fazi and Smith, 2006):
- Service provision. Historically
a key activity of health NGOs. Most notably, for drug prevention, preventive
sexual and reproductive health, HIV AIDS, health care etc. Service providers
range from small, local community groups to transnational organisations. These
services are usually run by volunteers, a key element of active citizenship. In
addition, NGOs play an increasing role in the implementation of public
services, on behalf of their national state. Thus they fulfil a public mission.
- Political advocacy. Now a major
dimension of NGOs’ work. Advocacy involves influencing public policies, with a
wide range of activities ranging from research, education, or awareness raising
campaigns to direct contacts with policy makers. These are activities most
common to NGOs working at European level.
These organizations draw from community, neighbourhood,
work, social and other connections. NGOs have become an increasingly common
channel through which people seek to exercise citizenship and contribute to
social and economic change. As correctly stated by the European Commission in
the White Paper on Governance 2001 “many NGOs have an ability to reach the
poorest and most disadvantaged and to provide a voice for those not
sufficiently heard through other channels.” (European Commission, 2001)
The European Commission has defined the purpose and
function of NGOs and the Commission’s perspective. It observes: “NGOs can make
an important contribution to the development of democracy and civil society in
the candidate countries.” (European Commission, 2001) In welcoming the
expanding role and diversity of NGOs five positive roles have been recognized:
the views of specific groups of European citizens to the European Institutions;
to policy making: The key to NGO influence in lobbying is the provision of
credible policy advice. Decision makers give priority not to claims to
represent the concerns of the public but to evidence that would help them build
their own case. NGOs with recognised expertise are privileged and can create
links with insiders on the political arena;
to project management; and
contributing to European integration.
In addition, NGOs act as watchdogs. However, NG0s benefit from their mission statement and
goals: they are driven by values rather than profit, they act in the public
interest, they represent citizens, issues rather than clients and they also aim
at engaging citizens in the public sphere (Fazi and Smith, 2006).
NGOs are also important players in monitoring and
evaluating the application of Community Law at national level. They report back
on gaps and propose ways to improve the situation based on a field experience.
Along with informal and direct contacts with EU officials,
there are many ways a NGO can participate in the decision making process at EU
A first step is to participate as a stakeholder in the various fora, platforms
and working groups initiated by the European Commission, in particular DG
SANCO. Regular dialogues with policy makers can produce many positive results,
including better cooperation, enhanced NGO profiles as advisors for public
policies, and more rationale, cost-effective public health-oriented policies.
At European level, the European Commission has set up many of these fora. A few
examples include the EU Health policy Forum, the European Forum on Services in
the Internal Market and the Pharmaceutical Forum. However, intensive dialogue
with medium and small organisation, supported by proper funding is needed.
The European Commission is bound to consult with
stakeholders ahead of legislative proposals, in order to better assess the
impact that a proposal may have. Responding to consultations is also a way for
NGOs to make their voice be heard. As an example, recent consultation processes
that resulted in subsequent action from the European Commission comprise a
Green Paper on health services, on nutrition and physical
activity, on mental health, on the health strategy of the EU.
NGOs can also find allies among citizens’ elected
representatives. The Health and Consumer Intergroup was established
specifically to support MEPs in their legislative work. The Intergroup meets on
a bi-monthly basis and focuses on issues that are on the legislative agenda. It
aims at providing concrete results, inviting NGO experts and academics to
present evidence and work with MEPs on policy recommendations.