Civil society in health is diverse, ubiquitous, and can be helpful.
These characteristics are particularly important, as previous work published by the European Observatory on Health Systems and Policies has shown, in crises such as economic shocks, refugee flows, or pandemics. Civil society refers to a community of citizens linked by common interests and collective activity. The core definition of civil society is that it is the society we engage in as active citizens, which is neither part of the market nor part of the state. Institutions and organizations that make up civil society can include non-profit organizations (NGOs), religious organizations, labour unions and other agencies that serve society.
Civil society has supported COVID-19 responses through policy, services and governance
Civil society can play three basic kinds of roles in health – related to policy, services and governance – though any one organization is likely to play only one or two. Civil society organizations can have many different kinds of constituencies, from faith-based, to local, to membership services. This policy snapshot brings together some of the information featured on the COVID-19 Health Systems Response Monitor (HSRM) which has captured some of the many ways in which civil society organizations got involved up to (1 June 2020); however, data were not reported for all countries.
Civil society represents diverse viewpoints
Civil society can play a role in policy by developing policy alternatives, sounding warnings, representing views from populations that policymakers might otherwise miss, engaging in discussions about how policy ideas might work better, and communicating key health information to the relevant audiences.
During the pandemic, the Albanian Inter-Ministerial Committee on Civil Emergencies (KNEC), who responsible for handling the crisis, is attended by professionals and representatives of civil society and NGO leaders. Several Finnish NGOs, including Save the Children and the Finnish Red Cross, have joined a governmental campaign (“Finland Forward”) to support daily crisis communication. The Israeli Ministry of Health has also committed to translate all important health information into the relevant languages and disseminate to migrant communities via NGOs and employers.
Civil society has provided services and programs for different population groups
Civil society can play a role in services: delivery of services, ranging from local charity to working with government to deliver large-scale human and social services programs. These are perhaps the most obvious civil society responses, with many countries seeing outpourings of work on everything from helping the homeless to sewing masks and raising funds.
In Belgium, numerous humanitarian volunteer initiatives (including Médecins sans Frontières, Médecins du Monde, and theRed Cross) were set up to help marginal populations, including homeless people and migrants. In Israel, following a meeting with NGOs, the Ministry of Health instructed all health care providers to ensure that COVID-19-related treatment be given to all individuals, regardless of their insurance status or other concerns. In other sectors such as education, the Ukrainian Presidential Office and the Ministry of Education have collaborated with the NGO “Osvitoria” to launch a national project called “All-Ukrainian School Online” for students in Grades 5 to 11. Similarly, the Slovakian Ministry of Education has partnered with NGOs to create an educational portal for students and parents, intended to communicate with families, deliver teaching materials, and provide counselling to parents.
Governance related to professional regulation and labour relations has been important during the pandemic
Civil society can play a role in governance, such as the role in professional regulation that many professional societies occupy, or the place of social partners in many countries in managing labour relations in and out of the health care sector. In the case of COVID-19, governance challenges include amendments to health workforce rules in order to meet needs as well as changes to labour contracts so that programs like short-time work or temporary unemployment work as well as possible.
In order to relieve the emergency services, Belgium Red Cross volunteers have set up medical orientation posts at 20 hospital sites. Measures were also initiated by other Belgium NGOs as well as the army to help meet the surge in demand of health care workers. An Estonian NGO has created a database of inactive health professionals who might be willing to contribute to COVID-19-related activities. Similarly, a Serbian NGO cooperated with the Ministry of Foreign Affairs to enable Serbian medical workers working or staying abroad (mostly in Germany) to report their availability to temporarily return to Serbia to treat COVID-19 patients.
Civil society organizations have faced challenges and received support during the COVID-crisis
Civil society organizations can often be swift and low-cost because they can call on enthusiasm and volunteer labour, but many (if not most) lack financial cushions and are already extremely vulnerable.
In Finland, the ban on mass gatherings and the closure of NGOs (effective as of March 18th) has affected several NGOs providing mental health support as well as social welfare services. Government support including extending low-cost loans or supports, contracts for services, or other financial assistance might be crucial if civil society organizations are not to suffer just when others’ suffering means they are most needed. Including civil society organizations in short-time work (Kurzarbeit) might also be helpful.
Examples include the Canadian federal government, which has announced in early April support for food banks and other local food organizations through an investment of CA$100 million, provided to organizations such as Food Banks Canada and the Salvation Army. The Israeli government has been asked to financially support NGOs involved in the COVID-19 response. Also in early April, the Swedish government proposed to allocate SEK 100 million to civil society organizations working with victims of domestic violence.
Governments can utilize the benefits provided by civil society
Civil society organizations’ role in policy must also not be forgotten; while it might be tempting to exclude their expertise and representative voices when urgent decisions are being made, the incorporation of more voices will give policymakers ideas, information, and useful critique quickly and often in useful form. In Estonia, representatives of civil society are involved in the development and implementation of the national transition strategy, alongside researchers and members of the private sector.
Scott Greer, Sarah Rozenblum, Matthias Wismar, Holly Jarman