By Vesna Kerstin Petrič,

Throughout my career in public health and global affairs, one lesson has been constant: the most effective, resilient and humane health systems are built in partnership with civil society. Yet at a moment when Europe faces growing polarization, democratic backsliding and persistent health pressures, it is troubling to see civil society organizations (CSOs) confronted with political pressure, mistrust and, in some cases, funding cuts. Their advocacy is too often seen as a threat rather than an asset.

NGOs are links to the people

Health systems today are navigating unprecedented challenges: economic instability, the COVID-19 pandemic, climate-related crises and widespread misinformation. International reports show that progress toward development goals is lagging, vulnerabilities are rising, and inequalities are deepening. Decision-makers and health professionals are under immense pressure to sustain health systems while delivering universal health coverage (UHC) and high-quality care for all.

In such a complex environment, it is difficult to imagine meeting people’s needs, especially those most at risk, without trust-based cooperation between governments, professionals and CSOs, grounded in shared values and goals.

Slovenia’s experience demonstrates that social participation (SP) is not only a cornerstone of democracy; in healthcare, it is essential for reaching those most vulnerable and marginalized. In the 1990s, while some neighbouring countries experienced HIV rates among intravenous drug users as high as 60%, Slovenia avoided such an epidemic. This success came from sustained public investment in CSOs working closely with communities and supported by primary-care professionals to provide needle exchange, anonymous testing and methadone maintenance programmes.

The value of SP extends beyond infectious disease control. During the devastating floods in Slovenia in August 2023, CSOs filled critical gaps in mental health and psychosocial support. Youth organisations, supported by the Ministry of Health and health professionals, were for example instrumental in advocating for stronger tobacco control, showing that those most affected often generate the trust needed for real change. Ensuring health literacy in people who are “hard to reach” rarely happens through health professionals alone; it succeeds through collaboration with CSOs working in communities, across generations, cultures and vulnerabilities. 

This is why Slovenia and Thailand, supported by Norway, France, Tunisia and Brazil, championed the World Health Assembly resolution on SP for UHC, health and well-being. The resolution recognises SP not as an add-on but as a necessity for effective governance, successful policy implementation and strong, trusted health systems. It underscores that meaningful, structured participation, especially by youth and marginalized groups, produces better decisions, stronger legitimacy, a sense of ownership and improved outcomes.

Civil society under siege

At a high-level UNGA side event on SP and health equity this year, leaders, including the presidents of Slovenia and Kenya, emphasised that inclusivity is essential for achieving health goals. Yet many European policy processes still treat civil society as optional or inconvenient. This is a mistake.

As Slovenia’sPresident Nataša Pirc Musar noted: “By empowering and institutionalizing social participation, we build trust in our health systems and align services with the needs of diverse communities.”

Many countries and their ministries of health recognise this and are eager to implement SP. International civil society networks actively contributed to the WHA resolution and are ready to support its implementation, promote good practices and contribute to informed decision-making at global level.

For SP to work, investments are essential. Funding for CSOs remains a challenge everywhere. Slovenia has invested for decades in institutionalising SP through legal frameworks for citizen involvement, co-financing CSOs, and platforms for sharing best practice. We ensure that investments are evidence-based by fostering close cooperation between CSOs and professional organizations. This is responsibility of a dedicated unit within our public health institute that provides training, facilitates communication and promotes results across sectors. We know that long-term investment requires continued evidence of impact. WHO is well placed to help countries demonstrate this.

What is needed now is collective mobilisation. No single actor can succeed alone. Governments, CSOs, youth organisations, researchers, parliamentarians and the media must work together to rebuild trust and break silos. WHO and Member States, alongside global civil society networks, have a key role in documenting and sharing evidence of what works, to sustain investment in SP and CSOs.

The WHA resolution provides a roadmap. Europe should use it, within the EU and globally, to strengthen participatory mechanisms and place people at the centre of health governance. Democratic resilience and public health depend on it, and there is no better time than now to expand civic space.