1. What is „participation”?

„Participation is a process during which representatives of the society get to influence and indirectly control the decisions of public authorities when the decisions have indirect or direct influence on their own interests. This type of participation differs from traditional involvement in the electoral process and it is organized through different means.”

According to Citizens co-decide. Guide to social participation. K Wygnański, D. Długosz, Warszawa 2005

2. Is participation a privilege or a duty of public administration?

Participation is not only a privilege of citizens and patients. Participation is also a duty of public administration. In 2004, the Act on public benefit activities which established the obligation of collaboration with non-governmental organisations in relation to all public authorities was implemented in two forms important for participation:

  • consultations of projects of acts
  • creation of collective, socio-public consultation authorities

Participation = involvement in public consultations + involvement in decision authorities (local or central)

3. Do citizens in other EU countries have the right to participate in healthcare decision making?

Yes, they do. It is regulated by the EU law – recommendations of The Council of Europe No. R (2000) 5 concerning creation of citizens’ participation authorities and patients in the process of decision making regarding health. It the light of its provisions:

  • Governments of member states are to ensure participation of citizens in decision making on every level of healthcare system – national, regional and local
  • They are to create legal structures and determine the rules supporting citizens’ participation and patients’ rights

4. Who can participate?

Everyone can and should participate:

  • Patients’ representatives, patients organisations and associations
  • Individual patients
  • Citizens
  • The authorities – public administration of all levels – central and local authorities
  • Other system stakeholders – doctors, nurses, providers, pharmacists, producers

Participation is a mutual support of authorities and citizens in collective decision making.

5. Is participation profitable for public administration?

Yes, it is. Participation gives the authorities a number of benefits:

  • Better law
  • Easier change implementation
  • Better healthcare system
  • Smaller health spendings
  • Better governance
  • Better results of pre-election polls

6. What benefits participation brings to citizens?

Participation brings citizens the following benefits:

  • Influence on decision making process
  • Influence on the shape of system changes
  • Influence on public money spending
  • Satisfying the needs of social groups
  • Solving the problems of patient’s environment

7. How one may participate?

There are various ways of participation, such as:

  • Verifying
  • Informing
  • Researching, giving opinion
  • Engaging in public consultations
  • Regulation Impact Assessment (RIA) from the social perspective
  • Deciding in healthcare decision making authorities

Nevertheless, participation is mainly informing, consulting and co-deciding.

Informing. It is unidirectional relation – administration informs about decisions or procedures concerning citizens. Informing can be passive (access to information) or active (promotion, announcements, meetings etc.) in its form.

Consulting. This relations has bilateral character – administration proposes solutions and collects views on them. The process has phases – firstly the information about proposed solutions appears then follows collecting views on them.

Co-deciding. It does not consist in collecting views on administration’s proposals but in true partnership to create solutions. The parties collectively define problems and seek proper solutions. Communication has simultaneous character – process of creating solutions and their consulting occur at the same time. Participation is based on acknowledging the rule of partnership as a foundation of mutual relations of administration and citizens.

8. What is the ladder of participation and what are their levels?

  • they decide completely unilaterally and single-handedly, without informing the public;
  • they decide completely unilaterally and single-handedly, but they informing the public of their decisions after they’ve been made;
  • they decide completely unilaterally and single-handedly, but not only they inform the public of their decisions after they’ve been made but they justify their decisions impelling for their acceptation;
  • before making a decision they inform about their projects and acknowledge arising public opinion, they use them to some extend to change the content of the decision;
  • before making a decision they collect views of individual citizens (selected leaders, experts) or they use public hearings, telephone surveys, public opinion polls; before making the decision they actively collect views, they conduct public consultations with various social groups and their representatives (organisations) basing on requirements of the law and political will;
  • before making the decision they collect views within the statutorily appointed by the state public consultation and consultative bodies whose hearing is mandatory;
  • before making the decision they collaborate with social partners (negotiations, collective planning, and reaching consensus) and with them they find common ground and make collective decision for example in a form of an agreement or joint programme
  • they give the decision making over to groups or social partners and accept these decisions, possibly controlling their procedural legality and correctness as well as accuracy of the content of the decision in relation to the current legal system (for example, referenda, collective labor agreements).

9. What are the forms of participation available for polish patients?

Polish patients can be involved in:

  • Public consultations of legislative acts of Ministry of Health
  • Sejm or Senate Health Committee
  • Dialog for Health
  • Consultative Council of AOTMiT
  • Local decision bodies - hospital social councils, councils of public benefit, councils of health needs

10. What are the obstacles for participation? (on the basis of Citizens co-decide. Guide to public participation. K Wygnański, D. Długosz, Warszawa 2005)

The belief of some politicians that electoral mandate gives them the right to dismissive attitude in the debate towards emerging voices of organisations representing various social interests or inviting to collaborate only those organisations that these politicians consider their political allies.

Lack of politeness of some members of public administration in terms of cooperation with social partners. This manifests itself in a weak preparation of administration to conduct public consultations, ignoring some partners, failure to comply with the legal procedures governing consultations, handing in documents for consultations “at the last moment”, formalistic treatment of public consultation as a procedure, which purpose is only to avoid procedural allegations and public protests connected with the absence of any consultation.

There are no mature, organizationally capable and competent social partners to engage in dialogue with the public administration, prompting officials to claim that such consultation is just a waste of time.

Weak dialogue culture on the part of social partners, lack of attempt to understand the interests of the public administration or officials, demanding attitude.

The common practise of administration – the reluctance to dialogue with many partners and specific forcing of federalization - is reprehensible. It is true that it facilitates the work of the administration, but it can’t be the condition of the conversation.

11. What is the paradox of participation in Poland?

Health is the most important value for 65% of Poles (Social Diagnosis 2013).

The research of TNS Pentor shows that according to 80% of respondents patients’ representatives should represent citizens in social dialogue concerning health.


Patients’ organisations rarely are involved in making decisions related to healthcare. The level of social capital in Poland is low (14% is active in organisations and communities, 15% is active in local communities).


There is a need for active promotion of the idea of participation among patients and citizens! This is the task of the project implemented by WE Patients Foundation: Patients Decide.


Author: Ewa Borek

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