August 7, 2024
How Business Can Catalyze Civil Society Participation in Healthcare Policy and Delivery
By Mark P. Lagon and Bennett Freeman
Over the last decade, restrictions on civic space—the room civil society groups enjoy to contribute to a country’s public life–have increased as the rule of law has eroded and freedoms of expression and association have become more limited around the world. This trend has constricted political participation and undermined progress on many critical issues, from corruption to public health.
At the same time, private sector leaders have committed to support civil society as partners and advocates—including through the UN’s Global Compact, Guiding Principles on Business and Human Rights and Sustainable Development Goal 16 on peace, justice and strong institutions. As civic space has come under growing pressure, the private sector has a vital stake in the rule of law, accountable governance and civic freedoms as the basis of sustainable and profitable business environments.
As we have learned so painfully during the COVID-19 pandemic, businesses have an especially important stake in civic society organizations as a critical enabling environment for public health. When unfettered, civil society supports and monitors public and private sector health initiatives and outcomes, encouraging accountability and exposing inefficiency. It is time for the global health and business communities together to demonstrate support for civic space as a matter of shared values and interests.
Civil society plays a unique role in healthcare in low- and middle-income countries, among others. Take infectious diseases. Given the deep trust they enjoy in communities, civil society groups are often best equipped to deliver lifesaving medicines and services, especially in cases where governments persecute or marginalize vulnerable groups. Throughout the global history of HIV, civil society has pushed governments to respond to the challenge and has supported research, program design and delivery across countries and communities. More recently, during the COVID-19 pandemic, civil society organizations moved quickly to support populations often underserved by national health systems, such as women and LGBTQ+ communities. The Global Fund to Fight AIDS, Tuberculosis and Malaria enables a substantial, active decision-making role for civil society on its board and multistakeholder committees in countries implementing programs, which has helped accelerate progress against both HIV and COVID-19.
Many viable health systems have their roots in civil society organizations initially founded to deliver healthcare when the government didn’t yet have the capability, such as in Bangladesh. In South Sudan, the world’s youngest country, civil society efforts to eradicate the Guinea worm helped create the foundation of the country’s nascent health care system. In Ethiopia, Liberia, Brazil and elsewhere, community health workers provide essential healthcare to their neighbors in remote regions that are otherwise outside the reach of the formal health system.
Yet civil society groups working to advance accessible healthcare all over the world increasingly find themselves stifled as targets of authoritarian and illiberal governments in 2023 and 2024. Governments in Kyrgyzstan, Uzbekistan and Myanmar, among others, have passed laws restricting the operations of civil society groups, including those in the health sector.
A wave of pressure on LGBTQ+ populations is gaining momentum. Earlier this year Ghana’s parliament passed a draconian bill that increases criminal penalties for consensual same-sex conduct and criminalizes individuals and organizations who advocate for the rights of LGBTQ+ people–including their health needs. This development follows Uganda’s 2023 legislation that allows for the death penalty for LGBTQ+ sexual activities and jail terms of up to 20 years for those who advocate for or promote the rights of this population. Earlier in 2023, Indonesia passed a new criminal code that outlaws all sexual relations outside of marriage–criminalizing LGBTQ+ sexual activity, since same sex marriage isn’t legal.
As outlined in the Global Fund’s Advocacy Roadmap to sustain progress against AIDS, TB and malaria, the private sector is a key partner in catalyzing robust civil society participation in healthcare policy and delivery. For instance, private sector leaders spoke up publicly and privately, individually and in unison, for LGBTQ+ rights in Uganda. The Open for Business Coalition, which includes Google, Microsoft, IBM, MasterCard, HSBC and Meta, released a public statement urging Uganda to drop the proposed legislation. In factsheets, press releases and websites, the businesses delivered a clear message: “policies designed to exclude minorities such as the LGBTQ+ community have a real cost – not only on people, but on business performance as well as national economic competitiveness.”
At least two major multinationals in the personal care and pharmaceutical sectors are making significant commitments. In 2021, Novartis added specific commitments to support civic space and human rights defenders to its overall Human Rights Commitment Statement. More recently, Unilever’s 2023 Principles on Human Rights Defenders and Implementation Guidance is the most comprehensive such commitment by any major multinational corporation.
A recent report, the Private Sector as Partner in Civil Society’s Essential Role in Global Health highlights concrete steps to preserve the vital civil society role in healthcare. The private sector can:
- Ensure that its consultations and negotiations with governments include and empower civil society and affected communities whenever possible–serving as a model.
- Advocate for the rule of law and civic freedoms both publicly and privately, whether individually and collectively together with other companies and stakeholders.
- Narrow the huge funding gaps for local civil society organizations engaged with healthcare monitoring, advocacy and implementation–particularly in places civil society is under threat.
- Contribute to capacity-building for those organizations through safe meeting spaces, communications support, financial and in-kind resources, pro-bono services and expertise on data and infrastructure security.
- Support organizations working to combat misinformation whether falsehoods about COVID-19 or other diseases, hate campaigns or authoritarian government propaganda.
Businesses can use their leverage with governments, partners and supply chains to protect the health of their employees and clients and defend against abusive government action and regulations that impact health. Private sector partnership with civil society will accelerate progress on health essential to growing prosperity, whether reducing maternal mortality, the spread of HIV or the risks of another pandemic. Such corporate responsibility can save lives and heal societies.
Mark P. Lagon is Chief Policy Officer at Friends of the Global Fight Against AIDS, Tuberculosis and Malaria, and former President of Freedom House and U.S. Ambassador to Combat Trafficking in Persons. Bennett Freeman is Associate Fellow at Chatham House and former Senior Vice President, Calvert Investments and Deputy Assistant Secretary of State for Democracy, Human Rights and Labor.