Many civil society organizations (CSOs) play an essential role as service providers and advocates in health systems around the world. They can connect policymakers and providers to the communities they serve, promote smarter decision-making, and foster local ownership. If countries are going to make Universal Health Coverage (UHC) a reality, it will be side-by-side and in partnership with civil society.
The Honduras Ministry of Health partnered with non-governmental organizations to ensure effective funding, management, and stewardship of HIV prevention services. (Photo: MSH)
Delivering Essential Health Services
Although many low- and middle-income countries lack public sector healthcare infrastructure and human resources for health, civil society can help fill in the gaps. Governments can partner with CSOs through mechanisms such as grants and contracts to leverage these organizations’ capacities to avoid duplication, reduce inefficiencies, and increase access.
For example, the USAID-funded Leadership, Management, and Governance (LMG) Project, led by Management Sciences for Health, worked with the Honduran Ministry of Health from 2012 to 2016 to contract with NGOs to provide HIV/AIDS services to key populations. In total, the LMG Project helped the ministry sign 25 contracts with NGOs to provide education, prevention, and rapid testing services for nearly 40,000 people over three years.
The LMG Project has also worked directly with CSOs to scale up and improve the quality of their services. Through our work with the International Planned Parenthood Federation Africa Regional Office, we built the capacity of member associations in Uganda, Mozambique, Ghana, and Cameroon to train other member associations and partners in leadership, management, and governance skills. By working with Reproductive Health Uganda (RHU) to roll out the Leadership Development Program Plus (LDP+), their members were able to improve the quality and reach of services. For example, one center decreased stock-outs of antibiotics, while another increased the number of young people’s monthly access to sexual and reproductive health services by 175%.
Civil society’s active engagement in health service delivery is directly linked to supply-side factors influencing access and quality of care, two important areas for UHC.
Advocating for Clients and Workers
Beyond service provision, CSOs also play the role of advocates and champions. By coordinating and representing their constituents, organizations can amplify individual voices and share their stories with decision-makers. These relationships between CSOs and public policymakers can be influential in making health services more responsive to the specific needs of all population groups, because too often decisions are made without engaging them. By effectively engaging with civil society, the public sector can better connect national-level policies with community-level needs for more responsive health services.
A peer educator mobilizes clients for outreach services in the Kawempe area of Kampala, Uganda. (Photo: Geoffrey Ddamba)
In the Middle East and North Africa (MENA) region, men who have sex with men (MSM) are a key population at risk of HIV, but these men face entrenched stigma and discrimination that leave many of them unaware of their HIV status. The LMG Project partnered with the International HIV/AIDS Alliance to support CSOs in the MENA region to develop advocacy materials, such as a facilitator’s booklet for stakeholders interested in organizing sessions against discrimination and stigma. The partners advocated for a more favorable environment in communities where the levels of stigma and discrimination were preventing PLHIV and MSM from seeking medical assistance. Advocacy efforts contributed to making the voice of MSM heard by stakeholders working in the HIV response in the region and to reducing stigma in clinical and health care settings. National health authorities and national AIDS programs now better understand the specific vulnerabilities and needs of MSM. Sensitization of religious leaders (in Algeria and Lebanon) has helped to break the silence in the religious sphere surrounding the issue of sex between men. Stigma reduction and advocacy activities, including workshops and trainings with policymakers, lawyers, and police; meetings with journalists, religious leaders, social workers, health providers, educators, and psychologists; and media campaigns reached 3,020 individuals and 608 decision-makers.
Delivering on “health for all” will require governments and policymakers who understand the healthcare needs and demands of a variety of population groups. By working with a broad range of civil society partners, governments can better connect public policy and programs to the people and their diverse needs.
Achieving Health for All
Activists hold a candlelight vigil in Beirut, Lebanon. (Photo: Vivre Positif)
Civil society must play an active role in every country’s plan for reaching the sustainable development goal around UHC.
As service providers, staff need to be trained with essential leadership, management, and governance skills to enable them to efficiently provide and systematically scale up services, improve service quality, and become more cost-effective.
When CSOs play the role of advocates, these same leadership, management, and governance skills are needed to ensure organizations effectively represent the needs of their target population and are able to sustain themselves.
Political will remains a longstanding challenge to UHC because significant health system reform will be needed to achieve it, but the burden of this should not lie upon government alone. Instead, we should recognize the strengths and abilities of civil society organizations to engage citizens, advocate for change, and deliver on commitments.