SUPPORT-SYSTEMS (71) Q5 How can we support CSO participation in health policy processes? (4)

1 June, 2022

Dear Esha [Esha Chaudhuri, Canada]

Thank you for your reflection on how to fairly assess the role and impact of CSO organizations given the varied contexts in which these operate [ ]. You touched on the issue of asymmetry of “power” between the system and the stakeholders in this discourse. One of this week’s questions is “From your perspective, what are promising practices for creating greater space for civil society participation in health policy processes and for using evidence from civil society more effectively to improve health policymaking for UHC at national and global level?”. I would like to ask if you or others here at HIFA have experience with or have come across concrete examples where mechanisms (such as public consultations as part of a government-process or townhall or similar community-level gatherings that aim to create space for the public express their voice) have made an extra effort to mitigate power differences and ensure that a wide range of voices have been provided an equal opportunity to participate in the deliberation?

A report from the OECD – “Innovative Citizen Participation and New Democratic Institutions” ( - have examined the issue of creating equal deliberative processes in-depth. Unfortunately not open access anymore for some reason, but below is an excerpt that speaks to this week’s question on thinking about promising practices for civil society participation.

Kind regards


“In many traditional consultation processes, there is often an “open call” to recruit participants, either to an in-person meeting or to participate in an online consultation or forum. Participation is usually encouraged through advertising the opportunity via a variety of channels (online, social media, post, posters). Participation is open, so anyone who wants to is able to come in person or contribute online. In other instances, participants may be chosen by an institution through an application or selection process, such as before a committee hearing. There is a wealth of research that demonstrates that certain demographics tend to disproportionately participate, notably those who are older, male, well-educated, affluent, white, and urban (Dalton, 2008; Olsen, Ruth and Galloway, 2018; Smith, Schlozman, Verbe and Brady, 2009). Public authorities may also conduct consultations through a “closed call” for participants, meaning that politicians and/or civil servants might choose specific members of a community who have a particular expertise or experience needed to address a policy issue. In these instances, participation could be based on merit, experience, affiliation with an interest group, or because of their role in the community (see MASS LBP, 2017).

Both the open and closed calls result in non-representative samples of the community, meaning a group that does not mirror the wider population in terms of gender, age, socio-economic status, and other criteria. These processes also tend to be dominated by stakeholders and advocacy groups who are most affected by a decision and potentially have the most to lose (newDemocracy Foundation and UN Democracy Fund, 2019: 49). Depending on their purpose, these processes may thus result in outcomes that are not perceived as fair or legitimate since everyone does not have an equal opportunity to be selected.”

HIFA profile: Unni Gopinathan is a Senior Scientist aat Norwegian Institute of Public Health, Norway. Unni is joint coordinator of the HIFA working group on SUPPORT-SYSTEMS: How can decision-making processes for health systems strengthening and universal health coverage be made more inclusive, responsive and accountable?

Email: Unni.Gopinathan AT