Invitation

Member States consultation on institutionalizing social participation in the WHO European Region Concept note Co-hosts: WHO Regional Office for Europe; Ministry of Health of Slovenia, Ministry for Health and Prevention of France, Ministry of Health and Care Services of Norway; WHO headquarters Date/time: 11 September 2023, 09:00–12:00 CEST Location: Webinar Background The principle of social participation for primary health care, universal health coverage and health system resilience has been endorsed in international agreements, such as Sustainable Development Goal target 16.7 (September 2015), 1 the United Nations Political declaration of the high-level meeting on universal health coverage (September 2019), 2 and the Astana Declaration on Primary Health Care (October 2019). 3 Moreover, as the COVID-19 pandemic has demonstrated, participatory governance is crucial as part of a whole-of-society response and in building and sustaining trust between the population and the health system. This was acknowledged in post-COVID World Health Assembly resolution WHA74.7 (2021). 4 Although each country has its own model for social participation, translation of this principle into practice has been limited, with participation often ad hoc and/or tokenistic. All countries can do more to improve how people, communities and civil society organizations participate in health system decision-making processes. In May 2021, WHO launched Voice, agency, empowerment – handbook on social participation for universal health coverage 5 (“the handbook”) to support Member States with guidance. Social participation has been acknowledged as a priority within primary health care, universal health coverage and resilience-related resolutions at meetings of WHO regional committees and the Health Assembly in recent years. In support of this agenda, various Member States are pursuing a Health Assembly resolution in 2024 to secure political will and move countries to take action towards institutionalizing social participation in health system governance. This was announced at an informal side event during the Health Assembly in 2023 by Slovenia and Thailand and with support from other Member States. 6 WHO has drafted a technical background paper synthesizing key recommendations from the handbook. This paper is being updated based on feedback from wide, multistakeholder consultations. There have been several regional consultations on this topic led by the WHO regional offices for the Americas (July 2022), South-East Asia (March 2023) and for the Eastern Mediterranean (July 2022), as well as 1 https://sdgs.un.org/goals/goal16. 2 https://www.un.org/pga/73/wp-content/uploads/sites/53/2019/07/FINAL-draft-UHC-Political-Declaration.pdf. 3 https://www.who.int/docs/default-source/primary-health/declaration/gcphc-declaration.pdf. 4 WHA74.7: https://apps.who.int/gb/ebwha/pdf_files/WHA74-REC1/A74_REC1-en.pdf#page=27. 5 https://apps.who.int/iris/handle/10665/342704. 6 https://www.uhc2030.org/news-and-events/news/wha-side-event-rallied-political-support-for-institutionalizing- social-participation-in-health-decision-making/. 1 constituency-specific webinar consultations (with civil society, youth, parliamentarians and global health agencies). It is within this context that the WHO Regional Office for Europe (WHO/Europe) is organizing an online consultation for Member States to lend their technical expertise, practices and country experiences to inform the priorities identified for the drafting of the resolution. As a champion of this process, Slovenia will co-host the online consultation with Member States of the WHO European Region. Objectives The main objectives of this consultation are as follows: • to build political support for a resolution on social participation at the Seventy-seventh World Health Assembly; • to identify regional priorities for inclusion as the resolution is drafted; and • to gather examples of social participation that can be shared in the work on health system governance for countries to benefit from one another’s experiences. Participants Member States will be invited to attend the online consultation with requests for the following profiles as part of their delegations: • health ministry representatives who are the technical leads for social participation or community engagement in health governance or planning directorates • health ministry representatives who are part of the delegations engaging with WHO governing bodies (the Executive Board and the Health Assembly). Meeting format The format of the meeting will be an online webinar. Information-sharing in advance In advance of the meeting, invitees will be sent the following documents: • draft technical background paper on social participation – for information • survey in English and Russian – for completion by 1 September Member States will be requested to complete the survey in advance of the online consultation. The survey will provide WHO/Europe with initial feedback on the priorities proposed in the technical background paper, as well as a brief status update on social participation in countries and on key priorities and challenges moving forward. The results from this survey will be presented during the online consultation. This approach is intended to prompt countries’ participation in the process and to gather more detailed feedback on the status of social participation across countries in the European Region. 2 Social Participation for Universal Health Coverage Technical Background Paper DRAFT FOR CONSULTATION © World Health Organization 2023. All rights reserved. This is a draft intended for review by Member States and all interested parties for the purpose of consultation on the draft text. The content of this document is not final, and the text may be subject to revisions before publication. The document may not be reviewed, abstracted, quoted, reproduced, transmitted, distributed, translated or adapted, in part or in whole, in any form or by any means without the permission of the World Health Organization.  Social Participation for Universal Health Coverage Technical Background Paper This Technical Background Paper on social participation synthesizes key messages from the World Health Organization publication ‘Voice, agency, empowerment – handbook on social participation for universal health coverage’1 (‘Handbook’). It has been developed as the basis for consultation to identify priorities for Member States to institutionalise social participation in health decision-making processes. This draft will be updated to reflect feedback from consultations later in the year. Key messages As attested through declarations and resolutions at global, regional and national levels, Member States agree on the importance and relevance of the principle of social participation in health governance. However, the principle of social participation is not sufficiently implemented in practice. This background paper identifies priorities for Member States to institutionalize social participation in health decision-making processes: (a) Investing adequate, stable and predictable financial resources for participation (b) Building government capacities to design and implement meaningful participation and facilitating the capacity strengthening of participants (c) Establishing and/or strengthening mechanisms for sustained regular participation (d) Monitoring and using data routinely to evaluate participatory processes and their impact on decisions made. 1. Introduction ................................................................................................................ 2 2. Relevant terms and concepts ...................................................................................... 2 3. Rationale for prioritization and investment................................................................. 6 4. Moving from principles to concrete action .................................................................. 8 5. The role of WHO in advancing social participation .................................................... 13 6. References ................................................................................................................ 14 1  1. Introduction This technical background paper is the basis for stakeholder consultations to identify priorities for Member States to institutionalize social participation in health decision-making processes. The World Health Organization Handbook2 provides the technical basis for this background paper. The Handbook was developed through extensive consultations with technical and civil society stakeholders as well as case studies from nine countries differing in geographies, income groups and types of government. The purpose of the Handbook is to provide technical support and practical guidance to WHO member states on steering engagement with the population, communities and civil society organizations to ensure their voices and needs inform decision-making in health. This technical background paper distils key messages from the Handbook to advocate for sustained prioritization and commitment to implementing social participation. Whilst many countries are making important efforts to involve and listen to their populations in health decision-making processes, all countries can do better towards institutionalizing and using such participation to consistently inform the decisions that are made across the health sector. 2. Relevant terms and concepts What is meant by “social participation”? The concept of participation has developed and evolved differently across regions and settings, as is reflected in the divergent terminology used. “Social participation” is used in this background paper to mean empowering people, communities and civil society organizations to have voice through participation in decision-making processes that have an impact on health and influencing the decisions that are made.3 Box 1: Who should participate for social participation?4 People, communities and civil society organizations entail three different types of ‘publics’: (a) The ‘unaffected’ public: assumed to be unfamiliar with the issues, i.e. lay citizen, ordinary people; (b) The ‘affected’ public: with relevant personal experience, e.g. of illness, i.e. service user, patient, consumer; (c) The ‘partisan’ public: with a special partisan interest, technical expertise, or professional identity, i.e. civil society organizations, professional associations, advocates. Community groups fall between the unaffected and affected publics, and patient associations fall between the affected and partisan publics. 2 What is meant by a ‘participatory mechanism’? A participatory mechanism is where government comes together with its population andcommunities, either directly or through civil society organizations as intermediaries. A key characteristic of a participatory mechanism is that the interaction should allow for a back-and-forth between participants and/or between organizers and participants, and not only be one-way. Methods used for purely communicating information to, or solely receiving feedback from a population group, (such as surveys, polls, interviews, radio, and TV programs etc.), are also important but these are distinct from and complementary to two-way dialogue. In general, multiple and different types of participatory mechanisms can, and should, be used by governments to inform decision-making processes, especially given that there is no single best participatory mechanism (see Boxes 2 and 3) and no one size fits all. Depending on the context, objective, participant profiles and country realities, a mix of mechanisms usually serves to balance out the cons of any single mechanism, allows for greater triangulation of findings, and increases the scope for populations to influence the decisions that are made. Thus, most country experiences of institutionalized social participation draw on a variety of the participatory mechanisms for meaningful engagement with their population. The table below summarizes the most common categories of mechanisms for social participation: 3  Table 1: Categories of social participation mechanisms Category Explanation Examples Open for all forums Open to everyone. Larger groups, aiming to Public forums and hearings, capture the diverse and divergent views from open-mic events, townhall many different segments of the population. meetings. Consultative methods Open forum for exchange, albeit with a smaller Consultative meetings, with attendance by and closed, usually invited, numbers of policy dialogue, stakeholder invitation representatives of population groups and technical consultations, focus groups. experts (and others). Deliberative Small group of selected participants. Emphasis is Public panels, citizens’ engagement methods on deliberative nature to elicit informed opinions juries, consensus from lay people and others about a specific health conferences, planning cells, topic. Key characteristics include preparing scenario workshops. participants with data & information, allowing sufficient time to reflect and deliberate, ensuring a non-intimidating environment. Fixed seats for the A fixed (at least for a certain time period) group Health council, health population/ of people coming together to make committee, district communities/ civil recommendations and/ or decisions. Certain seats committees, civil society society in are reserved for the lay population, community- advisory boards, administrative bodies based organizations, and/or civil society representation on steering representatives. The mechanism may be anchored groups and review boards. in a legal framework. 4 Box 2: Societal dialogue for health in Tunisia Box 3: Etats généraux de la bioéthique in The Societal Dialogue for Health (SDH) France program in Tunisia created multiple The Consultative National Committee on participatory spaces for exchange between Bioethics (CCNE) has the mandate to lead the population, communities, civil society, health drafting of a Bioethics law every seven years. In professionals and government: 2018, the CCNE used a variety of participatory Citizen’s meetings on health – Usually mechanisms to obtain broad- based input on organized at a regional level, these meetings topics of bioethicalrelevance. Based on were by invitation and sought ‘societal’ input on submitted statementsof interest on the EGS' specific health topics. Preparatory material was priority topics, the CCNE selected organization, put together by experts and the Technical associations and interest groups for more in- Committee beforehand. Especially civil society depth hearings. A combination of participatory opinions and views were sought on precise, mechanisms was used to reach out different more technical questions. types of target populations: Open mic sessions – These meetings aimed at Regional discussion events open to the general hearing from all parts of society and touched public – A self-selection strategy was used to upon more general, overarching health topics hear the voice of interested and affected people. such as what the future health system should The open-for-all events served to convey the ideally look like. openness of theCCNE approach. Focus groups – Focus groups were set up with Online consultation via website – This communities and groups who were not mechanism enabled inputs from those who may participating in other participatory mechanisms. not be able to attend the events in person. The Marginalized and vulnerable groups were online platform was used todisseminate in-depth targeted in these small group, homogenously information to and gather inputs from a broader constituted sessions. audience. Citizens’ jury – Approximately 100 people were Hearings for the partisan public – selected by lottery from each of the governorates Organizations, associations and interest groups to form a “citizens’ jury” with the task of that had submitted statements of interest were pronouncing a verdict on specific questions selected by the CCNE, based on special interest linked to specific themes. or expert knowledge, for in-depth hearings. National Health Conference – A large Citizens' jury – Citizens were selected by an participant list including citizen jury members, independent third-party to be part ofa jury, and associations, NGOs, trade unions, were asked to feed back on the process and parliamentarians, and many others came deliberate on the key topics enabling a more together here to validate policies and decisions. targeted and deeper engagement. 5  3. Rationale for prioritization and investment The reasons to prioritize and strengthen social participation are many: it is not just morally the right thing to do in pursuit of realizing the right to health for all, democracy, transparency and accountability; but it can also inform more responsive, equitable and effective health policy choices and help to achieve better health outcomes. Social participation is core to primary health care (PHC) and necessary for progressive realization of universal health coverage (UHC) Social participation is a core component of Primary Health Care (PHC), as a means to empower people and communities.5 PHC is a priority health system reform agenda for accelerating progress towards universal health coverage (UHC) - a noble goal that all countries have committed to as part of the sustainable development agenda. Progressive realization of the goal of UHC requires health systems reforms and policy choices that can be politically challenging and relate to who benefits and who is left behind. In the post-pandemic context of exacerbated societal inequalities and diminished trust in government and public services, more inclusive and participatory governance can help to overcome this disconnect. UHC is about ensuring necessary health services to all people without incurring financial hardship6 – what may be deemed ‘necessary’ cannot be de-linked from people’s perceptions and lived experiences, as well as civil society’s contextual expertise. Participatory processes can shape policies and plans to be more responsive and increase uptake. The universal goal of covering ‘all’ people requires overcoming health inequities, embedded in broader structural inequities. Certain population groups have worse health outcomes, warranting specific attention from the health system and adapted service delivery strategies. This starts with an in-depth understanding of why the health outcomes of these groups are poor and what structural and health barriers they face, which can only be ascertained through outreach and dialogue with those population groups. Social participation can be an important means to achieve a more inclusive health system and more equitable health policies that leave no one behind. In the past, the UHC discourse centered on health system reforms with particular focus on health financing and service delivery models, without adequately considering the necessary health governance reforms needed to underpin them. It is now high time to acknowledge the need for strategic governance reforms – including institutionalizing social participation - which can accelerate progress towards the health system performance goal of UHC. 6 Social participation fosters trust and health system resilience In preparing for future health emergencies and to build health system resilience, the need for a health system which people trust to be responsive to their needs cannot be overstated.7 Long- standing participatory mechanisms, embedded within health system operations, can help build that trust before a crisis occurs, so that in times of emergencies, governments can leverage these participatory mechanisms and thereby improve the effectiveness of risk communication and better contextualize response measures. Indeed, a coordinated whole-of-society response in times of emergencies was already envisaged in the International Health Regulations (2005) as well as the post-COVID 74th resolution of the World Health Assembly (2021).8 The Covid-19 pandemic exposed the weakness of emergency preparedness across countries, including high-income ones. In many contexts, where the health system struggled to respond, communities and civil society stepped in, demonstrating remarkable resilience by taking on tasks to protect against viral spread and reduce transmission, either substituting for or complementing health system operations.9 Unfortunately, communities’ and civil society’s Covid-19 response was mostly disconnected from the government response, with government losing out on valuable community insights for more adapted policies and adherence to pandemic restrictions.10 Insufficient government outreach and support to marginalized population groups during the pandemic exacerbated vulnerabilities and inequities, adding to the Covid-19 morbidity and mortality toll.1112 Integrating community resilience into the health sector modus operandi through social participation mechanisms brings government actions closer to people’s needs, strengthening foundations for preparedness for the next pandemic. Social participation advances health system accountability Institutionalized participatory mechanisms can also serve as mechanisms for shared ownership between governments and their population through collective, iterative processes of policy conception, review, and adaptation. Forums for dialogue and consultation provide opportunities for people to interrogate policy choices and monitor implementation. Participatory forums can provide space for people to air grievances and address poor performance, improving overall health governance and accountability. The importance of such social accountability measures is also echoed in the World Health Assembly resolution 69.1 that urges Member States to “show leadership and ownership in establishing effective health governance…through establishing and enhancing monitoring, evaluation and accountability mechanisms and capacities”.13 The integrity and legitimacy of the participatory mechanisms must be maintained through appropriate mitigation of potential conflicts of interest to ensure that narrow interests do not override overall public health. The deliberate inclusion of marginalized voices within these mechanisms can help expand policy 7 reach while balancing competing interests. Transparent access to knowledge and information as well as continuous documentation and communication of the results of participatory processes further enables duty bearers to be held accountable for decisions made. 4. Moving from principles to concrete action Member States have endorsed the principle of social participation in multiple intergovernmental commitments and resolutions, see Box 4. Yet, in practice, the necessary investments to translate the principle into action have been inadequate, with countries’ experiences of social participation often ad hoc, and fragmented due to the siloed nature of many health systems. All countries can do more to improve how people, communities and civil society participate in health decision-making processes and the extent to which their participation affects the decisions that are made, depending on their political context, policy and planning cycles, and resources. Box 4: Global commitments to participatory governance The 2030 Agenda for Sustainable Development, adopted by all United Nations Member States in 2015, sets clear targets around 17 collective goals that represent a commitment to action by all countries. Within Goal 16 of the Sustainable Development Goals (SDGs) on peace, justice and strong institutions, target 16.7 aims specifically to “ensure responsive, inclusive, participatory and representative decision- making at all levels”.14 This theme is explicitly articulated in the UN High Level Political Declaration on Universal Health Coverage that recognized that “the inclusion of all relevant stakeholders is one of the core components of health system governance” (Paragraph 20).15 The Declaration goes on to elaborate that engagement of all relevant stakeholders should be “through the establishment of participatory and transparent multi- stakeholder platforms and … partnerships, to provide input to the development, implementation and evaluation of health … policies …, while giving due regard to addressing and managing conflicts of interest … and undue influence.”16 The UHC Political Declaration reiterated Member States’ commitments in the Astana Declaration on primary healthcare in 2018 to “involve more stakeholders in the achievement of Health for All, leaving no one behind, while addressing and managing conflicts of interest, promoting transparency and implementing participatory governance.”17 Political will is decisive for effective participation, driving the prioritization and investment of human and financial resources, and this must be sustained over time to help foster a culture of participation. 8 This section highlights key interconnected priorities for Ministries of Health in order to move towards institutionalizing the principle of social participation. (a) Investing adequate, stable and predictable financial resources for participation As further sections will detail, moving towards the institutionalization of social participation requires strengthening the capacities of government cadres; facilitating the capacity building of participants; creating and sustaining participatory mechanisms; and monitoring and evaluating progress and outcomes – all of which require stable and predictable funding. Without stable funding, participatory mechanisms are likely to be more ad-hoc and peripheral to the health system modus operandi. Funding shortfalls can also lead to an over-reliance on volunteers or intermediaries whose interests may not always align with public health goals. These characteristics – of being stable and predictable – are perhaps more important than high levels of budget allocation to social participation. There are various ways to protect and sustain funding for social participation - for instance, through legal endorsement or earmarked funding (see Box 5). Box 5 Thailand: Regular government budget allocation for participatory activities in health The National Health Commission Office (NHCO) is a publicly funded parastatal body, mandated to implement the National Health Assembly (NHA) each year. The NHA is a three-day event geared at discussing prominent policy-relevant health issues with different population groups and civil society. Anchored in a legal framework, the statutory nature of the NHCO ensures the stable allocation of funding. It maintains a degree of independence from government ministries, and manages its own resources. The Thai Health Promotion Foundation (‘ThaiHealth’) is mandated to support health promotion activities with explicit funding to build the capacity of civil society for health sector advocacy, evidence generation, and building and maintaining ties to communities. ThaiHealth is an autonomous government body, whose revenue comes from a 2% surcharge of excise taxes on tobacco and alcohol, so somewhat less susceptible to government changes and politics. It may also be important for Ministries of Health to fund the participation of communities and civil society, as well as resourcing and/or facilitating capacity strengthening for meaningful involvement. This may require leveraging legal provisions for civil society to receive funding, or advocating for these to exist in their absence. 9  (b) Building government capacities to design and implement meaningful participation and facilitating the capacity strengthening of participants Meaningful participation requires adequate government capacity to convene, communicate and listen the voices of participants. This is acknowledged in a Pan-American Health Organization resolution from 2014 on expanding universal access to health, urging member states to “strengthen the leadership capacity of health authorities… for social participation”.18 While most government health institutions are well-endowed with medico-technical expertise, they may not acknowledge or prioritize the skills to manage a participatory mechanism - a task that is not as straightforward as it may seem. This capacity deficit has also been evident in the response to the Covid-19 pandemic when many governments struggled to bring civil society and community voices into the response, at times resulting in communities’ mistrust and misinformation.19 Policy-makers’ capacity needs involve knowing how to design and manage a participatory mechanism that allows for meaningful social participation, mitigates societal power differentials, manages conflicts of interest, respects and listens to experiential expertise, and facilitates dialogue that can inform a specific policy purpose. First and foremost, the role of power dynamics in participatory mechanisms must be acknowledged so that careful design can empower the voices of those who typically have less influence. This involves particular sensitivity to the barriers for historically marginalized or excluded groups. Building and strengthening capacities for social participation is a long-term process that requires deliberate and sustained efforts to overcome inequities and be more inclusive. Table 2 summarizes selected design considerations for meaningful participation, for which essential capacities must be built. Table 2: Design objectives for which key capacities must be built Design objective Explanation Actions Recognizing and managing Low socio-economic • Embedding the recognition of barriers the power differentials in status based on structural into the formulation of objectives. the health sector stakeholder and economic inequalities • Knowledge, understanding and analysis landscape, including one’s may result in low access of vulnerable communities and own role within it, to institutional structures population groups. for the most vulnerable • Addressing barriers to participation, population groups, including direct and indirect costs of including participatory attendance. processes. • Being mindful of and managing potential conflicts of interest. 10 Ensuring transparency in Transparency allows for a • Providing clear information to all regard to participant more level playing field stakeholders, on the objectives of the selection, objectives, roles across participants, and process, tools and techniques used, and and responsibilities, and for organizers to be held each participant’s role within it. governance of the accountable for their participatory mechanism. commitments. Using diverse dialogue Different techniques can • Facilitating techniques which involve all techniques adapted to the complement each other participants in an equitable way (e.g. different population groups. and strategically amplify location, seating positions, homogeneous people’s voice in discussion groups to avoid social participatory mechanisms. hierarchies, translation etc.). • Valuing experiential knowledge/expertise and relating this to technical expertise. Even where there are active mechanisms for public engagement, these rarely translate into appropriate policy uptake. In part, this may be due to low political priority for the topic under discussion. The link between public participation and decision-making is not automatic and requires careful translation – for which a specific skill is needed across various levels of government cadres. Not only do these skills need to be built but they must also be maintained and nurtured, particularly in light of staff turnover and movement. Governments hold a critical role in facilitating the capacity strengthening of populations, communities and civil society to know their rights, legitimately represent their constituencies, build coalitions, understand and interrogate relevant data and policy documents, and effectively interact with government on an equal footing. Communities and populations often need a stimulus to recognize how engaging in participatory mechanisms can be beneficial to their collective interest or improving their local health system. They need to be equipped with the technical skills to fully comprehend and analyze the details of the policy agenda, understand the policy process, and apply communication techniques for example, internet literacy or language skills, to raise awareness, for advocacy, monitoring and evaluation. Governments have an important role in providing funding or facilitating capacity strengthening, but it is crucial that the capacity-building activities should be owned by the civil society organizations or communities themselves. 11  (c) Establishing and/or strengthening mechanisms for sustained regular participation as opposed to ad-hoc interaction Participatory mechanisms and the capacities of its participants thrive on regular interaction and the opportunity to ‘practice’ meaningful debate and dialogue to improve health system performance. That very regularity, and continuous engagement across the policy and planning cycle, helps foster a culture of participation through a deeper understanding of how to engage and, more importantly, how to find joint solutions. Continuity is also pivotal for building relationships and networks between those who have a stake in health, despite differing views, forming an important foundation for mutual respect and understanding. These relationships, trust and respect take time to develop and go beyond individuals and short-term politics, requiring institutionalized structures and processes over the long-term with sustained funding and capacities. Governments can move towards more regularized participatory engagement over time through a variety of strategic and synergistic actions. These include building long-term partnerships with civil society and community groups; securing legal and/or institutional frameworks to sustain social participation; providing protected time within decision-making processes for adequate engagement; and evaluating and learning from how the participatory mechanism went to inform the way forward. Legislative frameworks that mandate a specific public entity to implement social participation mechanisms can be important for ensuring regular and sustained engagement over time. For example, the National Health Council in Portugal, and the Consultative National Committee on Bioethics in France are backed by legal provisions. Three key areas that need careful consideration in any legislative framework for participation are: representation and selection processes; roles and responsibilities in participatory mechanisms; and funding modalities. Ideally, all three aspects should be addressed concomitantly to ensure meaningful participation. Health ministries have a role in advocating for and shaping such legislation, which can provide some protection from waning political support. (d) Monitoring and using data routinely If social participation is integral to health system governance, then a robust monitoring and evaluation framework to measure progress is vital. Progress means not just the implementation of participatory mechanisms, but also an appraisal of how they are implemented, the quality of the dialogue itself, and crucially, their impact on the health decisions that are made and the priorities that are set. Both quick wins and longer-term impact should be pursued. The World Health Organization, as part of its technical mandate, will identify specific indicators to evaluate participation in health decision-making processes, with consultation at global and regional levels. This work will focus on key aspects towards institutionalizing participation as outlined in this 12 paper, such as financial investment, capacities, and regular or continuous engagement. It will also be important to specify how any proposed indicators can be captured using existing data collection mechanisms to avoid exacerbating the burden on country systems. Data collection will likely require government collaboration with private and non-governmental sources. There should also be consideration of targets and/or milestones, to help mobilize investment and assess progress. The indicators, and progress towards any stipulated targets, can then be reported by Member States through a collectively agreed upon mechanism for review. 5. The role of WHO in advancing social participation The WHO should champion social participation in health decision-making processes, delivering on its mandate to provide technical support to countries, such as capacity strengthening; document and share lessons/best practices; ensure cross-country and cross-regional learning and collaboration; develop a framework for the monitoring and evaluation of social participation; take stock of the situation in countries; and periodically report back to the World Health Assembly on progress made. This work should be done in close collaboration with civil society and community representatives, leveraging the networks of UHC2030. 13  6. References 1 World Health Organization (WHO). Voice, agency, empowerment: Handbook on social participation for universal health coverage. WHO; 2021. 2 Ibid. 3 As part of their stewardship role, it is of course important for governments to engage with other actors, such as the for-profit private sector and development partners, but these goes beyond the remit of social participation. 4 Rajan, D. et al. Beyond consultations and surveys: Enhancing participatory governance in health systems. Eurohealth. 2022;28.1: 9-13. 5 Empowering people and communities through social participation is one of the seven commitments in the Astana Declaration on PHC. WHO and UNICEF. Declaration of Astana on Primary Healthcare. 2018. 6 World Health Organization. World Health Report: Health Systems Financing: the Path to Universal Health Coverage. 2010. 7 Bollyky, T.J., Kickbusch, I., Bang Petersen, M. The Trust Gap: How to Fight Pandemics in a Divided Country. Foreign Affairs; 2023. Blair, R.A. et al. Public trust, policing, and the COVID-19 pandemic: Evidence from an electoral authoritarian regime. Social Science & Medicine; 2022;Vol:305. 8 WHA74.7. Strengthening WHO preparedness for and response to health emergencies. 9 Rajan D, Koch K. The health democracy deficit and COVID-19. Eurohealth; 2020;26(3):26-8. 10 Rajan, D. et al. ‘Build forward better’ must include heavy investment in government capacities to engage with communities and civil society. Eurohealth; 2021;27(1):54-59. CSEM. Results from the Civil Society Participation in the Covid-19 Response. 2020. 11 Mahase, E. Coronavirus: covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate (p. 1). The BMJ; 2020. 12 Lavazza, A., Farina, M. The Role of Experts in the Covid-19 Pandemic and the Limits of Their Epistemic Authority in Democracy. Front. Public Health; 2020; 8:356. doi: 10.3389/fpubh.2020.00356. 13 Sixty-ninth World Health Assembly; 2016. 14 https://sdgs.un.org/goals/goal16. 15 Political declaration on Universal Health Coverage. 2019. 16 Ibid. 17 Declaration of Astana on Primary Healthcare. 2018. 18 PAHO Strategy for Universal Health Coverage. 66th Session of Regional Committee. Oct 2014. 19 Rajan, D, et al. ‘Build forward better’ must include heavy investment in government capacities to engage with communities and civil society. Eurohealth; 2021;27.1:54-59. 14 Saatja: cps.pgh <[email protected]> Saadetud: 03.08.2023 17:56 Adressaat: <"Riina Sikkut">; <"Triin Uusberg">; <"Elen Ohov"> Koopia: <"Elen Ohov">; <"Triin Uusberg">; <"SM Info">; Ms K. Saarsalu-Layachi <[email protected]>; <[email protected]>; Kaisa.Mitt-Alvarez <Kaisa.Mitt- [email protected]>; <[email protected]>; <[email protected]>; KÖHLER, Kristina <[email protected]> Teema: Estonia, Invitation to Member States consultation on institutionalizing social participation in the WHO European Region 11 Sep. 2023 Manused: image001.jpg; image002.png; 230649_Concept note for the Member States consultation on institutionalizing social participation in the WHO European region.pdf; 230659_Survey link_Social participation regional consultation European Region.pdf; 230649_Social Participation for Universal Health Coverage, Technical Background Paper.pdf; 230649_Provisional Agenda_EURO consultation on social participation.pdf; EST.pdf Please see the attached correspondence sent from the World Health Organization, Regional Office for Europe. One or more attachments may be included. Veuillez vous référer à la correspondance ci-jointe du Bureau régional de l'Europe de l'Organisation mondiale de la santé. Une ou plusieurs annexes peuvent être jointes. Mit der Bitte um Kenntnisnahme der beiliegenden Korrespondenz (eine oder mehrere Anlagen), Weltgesundheitsorganisation, Regionalbüro für Europa. См. прикрепленное письмо от Европейского регионального бюро Всемирной организации здравоохранения (один или несколько прикрепленных файлов). Best regards, World Health Organization Regional Office for Europe UN CITY, Marmorvej 51, DK-2100 Copenhagen, Denmark European Region website: http://www.euro.who.int/en/home Global website: http://www.who.int/en/ Marielos Perez Longo Programme Assistant PGH Division of Country Health Policies and Systems WHO Regional Office for Europe Copenhagen, Denmark Email: [email protected] Web: https://www.who.int/europe/teams/policy-and-governance-for-health-through-the-life-course Follow WHO on Facebook | Twitter | YouTube | Instagram |LinkedIn WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ WELTGESUNDHEITSORGANISATION ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ Date: 03 August 2023 REGIONAL OFFICE FOR EUROPE BUREAU RÉGIONAL DE L’EUROPE Ms Riina Sikkut REGIONALBÜRO FÜR EUROPA Minister of Health ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО Ministry of Social Affairs Head office: Suur-Ameerika 1 UN City, Marmorvej 51, 10129 Tallinn DK-2100 Copenhagen Ø, Denmark Estonia Tel.: +45 45 33 70 00; Fax: +45 45 33 70 01 Email: [email protected] Website: https://www.who.int/europe Our reference: Your reference: Notre référence: Votre référence: Unser Zeichen: Ihr Zeichen: См. наш номер: На Ваш номер: Dear Madam, Member States consultation on institutionalizing social participation in the WHO European Region Monday, 11 September 2023, 09:00–12:00 CEST I have the honour of inviting you to join this virtual consultation on institutionalizing social participation, co-hosted by the Ministry of Health of Slovenia, the Ministry for Health and Prevention of France, the Ministry of Health and Care Services of Norway, the WHO Regional Office for Europe and WHO headquarters. We would be grateful for participation in this webinar by the Ministry of Health technical leads for social participation in the governance or planning directorates and by the focal person for international engagement with the WHO governing bodies. The concept note for the event is attached, together with the provisional agenda and the draft technical background paper, which synthesizes key messages from the WHO 2021 publication Voice, agency, empowerment – handbook on social participation for universal health coverage. The objective of the meeting is to hear Member States’ priorities for advancing institutionalization of social participation, reflecting on their country context and experience. The consultation will feed into the final technical background paper, which will be a reference document for Member States as they draft the resolution on institutionalizing social participation for the WHO Executive Board and the World Health Assembly in 2024. This event will provide an opportunity to share experiences and good practices across the WHO European Region and to hear about plans and commitments to advance the institutionalization of social participation across regions, in collaboration with partners in countries. The meeting will be in English with simultaneous Russian translation, and the documents will be in English and Russian. The link to join the webinar will be communicated in due course. We would be grateful if the Ministry could provide the names of its nominees to attend the online meeting no later than 30 August 2023. Please email this information to [email protected], with copy to Gabriele Pastorino, Technical Officer on Health Systems Governance ([email protected]). Finally, we kindly request your delegation to complete, by 1 September, a survey on the status of social participation in your country and feedback on priorities for institutionalizing social participation. The link to the survey is attached for your perusal. Yours very truly, Dr Hans Henri P. Kluge Regional Director UN City, Marmorvej 51 Tel.: +45 45 33 70 00 Email: [email protected] DK-2100 Copenhagen Ø Fax: +45 45 33 70 01 Website: https://www.who.int/europe Denmark Encls: Concept note for the Member States consultation on institutionalizing social participation in the WHO European Region Provisional agenda Social Participation for Universal Health Coverage, Technical Background Paper Links to survey on institutionalizing social participation in the WHO European Region Copy for information to: Ms Elen Ohov, Adviser, European Union Affairs and International Co-operation Department, Ministry of Social Affairs, Suur-Ameerika 1, 10122 Tallinn, Estonia Ms Triin Uusberg, Head, European Union Affairs and International Co-operation Department, Ministry of Social Affairs, Suur- Ameerika 1, 10129 Tallinn, Estonia H.E. Ms Katrin Saarsalu-Layachi, Ambassador Extraordinary and Plenipotentiary, Permanent Representative, Permanent Mission of the Republic of Estonia to the United Nations Office and other international organizations in Geneva, Chemin du Petit-Saconnex 28A, CH- 1209 Genève, Switzerland H.E. Mr William Mart Laanemäe, Ambassador Extraordinary and Plenipotentiary, Embassy of the Republic of Estonia, Frederiksgade 19, 4th floor, 1265 Copenhagen K, Denmark Ms Kristina Köhler, Liaison Officer, WHO Country Office, Estonia, Paldiski Road 81, 10617 Tallinn, Estonia –2– WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ REGIONAL OFFICE FOR EUROPE BUREAU RÉGIONAL DE L'EUROPE WELTGESUNDHEITSORGANISATION ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ REGIONALBÜRO FÜR EUROPA ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО Member States consultation on institutionalizing social participation in the WHO European Region Virtual meeting (Zoom meeting) 11 September 2023 09:00–12:00 CEST Links to survey on institutionalizing social participation in the WHO European Region All Member States participating in the consultation on institutionalizing social participation in the WHO European Region are kindly invited to fill in this survey, which aims to: • collect information on the status of social participation in countries and on priorities moving forward; • seek feedback on the draft technical background paper. Member States are kindly requested to submit their answers to the survey no later than 1 September 2023.  The survey in English can be accessed by clicking here.  The survey in Russian can be accessed by clicking here. WORLD HEALTH ORGANIZATION ORGANISATION MONDIALE DE LA SANTÉ REGIONAL OFFICE FOR EUROPE BUREAU RÉGIONAL DE L'EUROPE WELTGESUNDHEITSORGANISATION ВСЕМИРНАЯ ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ REGIONALBÜRO FÜR EUROPA ЕВРОПЕЙСКОЕ РЕГИОНАЛЬНОЕ БЮРО Member States consultation on institutionalizing social participation in the WHO European Region Virtual meeting (Zoom meeting) 11 September 2023 Original: English 09:00–12:00 CEST Provisional agenda 09:00–09:05 Welcome/opening Hans Henri P. Kluge, WHO Regional Director for Europe 09:05–09:10 Global process towards a World Health Assembly resolution on social participation Vesna Petrič, Ministry of Health of Slovenia 09:10–09:15 Social participation in the WHO European Region Natasha Azzopardi Muscat, Director, Division of Country Health Policies and Systems, WHO Regional Office for Europe 09:15–09:20 Reflection from co-host on the importance of institutionalizing social participation Ministry of Health and Prevention of France 09:20–09:25 Reflections from civil society: priorities for the social participation agenda Civil society representative from the WHO European Region 09:25–09:35 Presentation on the technical background paper Kira Koch, WHO headquarters 09:35–09:40 Presentation of findings from the survey on institutionalizing social participation in the WHO European Region Gabriele Pastorino, WHO Regional Office for Europe 09:40–11:50 From principles to action – plenary discussion among Member States on the state-of- the-art for social participation in their countries and key recommendations on: a) financial investment b) capacities c) repeated and regular participation d) monitoring and using data Moderator: Gabriele Pastorino, WHO Regional Office for Europe 11:50–11:55 Next steps Robb Butler, Executive Director, Regional Director’s Office, WHO Regional Office for Europe (to be confirmed) 11:55–12:00 Closing remarks from co-host of the meeting Cathrine Lofthus, Secretary General, Ministry of Health and Care Services of Norway 12:00 Closing of the meeting