Thank you for all your contributions to this discussion so far. We are compiling these and will produce a synthesis to help inform future efforts.
A question that occurs to me is the following: Is civil society participation always a good thing, or can it go wrong? Can civil society participation have a negative impact on health policy? What about different CSOs (and other stakeholders) with different agendas, selecting and presenting different evidence?
I suspect that there may indeed be specific examples of civil society intervention that have inadvertely (or deliberately) led to less-than-optimal health policymaking.
The definition of 'optimal health policymaking' is arguable, but in the context of this discussion I think we are talking about 'evidence-informed policymaking', which WHO describes as ensuring that 'the best available research evidence is used to inform decision-making... characterized by systematic and transparent access to and appraisal of evidence as an input into the policy-making process.'
The key feature here is 'systematic and transparent access to and appraisal of [all available] evidence'. We can immediately see potential problems with evidence provided by civil society (or indeed any stakeholder). As Maria Eugenia Aponte-Rueda (Venezuela) said earlier today: "What kind of Organization are we talking about? Which are its mission and vision?". Each CSO (whether NGO, faith-based organisation, professional association, community group or other) will have its own priorities, mission and agenda. There will inevitably be cherry-picking of evidence (intentional or otherwise) to advance these objectives. Cherry-picking will in turn lead to greater visibility of some kinds of evidence as compared with others. And CSOs with the greatest power and the most compelling communications team will be in a position to unduly influence the policy agenda to fit with their mission (in the same way that powerful for-profit companies can influence the policy agenda for the benefit of their shareholders).
I invite HIFA members to consider two related questions:
1. How do individual CSOs use evidence to advance their cause? Can they do this in a way that does not sideline other causes?
and, perhaps more importantly:
2. How can policymakers and decision-makers be supported to assess all available evidence (including national/local evidence) while avoiding undue influence by specific, cherry-picked evidence?
Best wishes, Neil
Joint Coordinator, HIFA SUPPORT-SYSTEMS
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HIFA profile: Neil Pakenham-Walsh is global coordinator of the HIFA global health movement (Healthcare Information For All - www.hifa.org ), a global community with more than 20,000 members in 180 countries, interacting on six global forums in four languages in official relations with WHO. HIFA brings stakeholders together to accelerate progress towards universal access to reliable healthcare information.
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