India: Civil society participation and effectiveness of coalitions in the pandemic response

The good governance paradigm for public health embodies a whole-of-society approach, in which the engagement of civil society organizations (CSOs) is essential to increase the resilience of communities to threats to their health and well-being. The participation of CSOs addresses the eight criteria of good governance, i.e. participation, consensus orientation, accountability, transparency, responsiveness, effectiveness, equity and abidance by the rule of law, and is an especially critical part of the “participation” criterion.

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the importance of social participation in health systems, as it fosters trust in the government, which in turn is key for the effectiveness of the COVID-19 response. CSOs are entities that are under neither the State, the market nor the family; they are non-State, not-for-profit, voluntary, non-coerced, self-governing entities, with the overarching goal of promoting democratic principles, often with an emphasis on human rights and social justice. CSOs may engage with the government or the health system in two main capacities: for service delivery and for shaping health policy.

While individual CSOs can engage with governments (with varying degrees of effectiveness) and extensive literature is available on the theoretical and empirical aspects of such engagement, coalitions of CSOs also engage with governments and health systems. In coalitions, civil society can cover different population sub-groups and health needs more broadly and may (or may not) also have greater influence and credibility in the eyes of policy-makers. In the Indian context, little literature is available on the role of formal CSO coalitions in health systems, especially in shaping policy. Even less is known about the role of health CSO coalitions in shaping policy during the COVID-19 pandemic.

We examined the role of CSO coalitions in shaping health policy and how their participation has been sustained. As Government engagement with individual CSOs is also common, we included information on the engagement of individual CSOs in order to obtain a comprehensive, in-depth picture of the engagement of CSOs.