The European Commission’s first Civil Society Strategy, adopted in November 2025, sets out an ambitious direction for strengthening democratic resilience across the European Union. Its relevance for health systems is direct. Civil society organisations contribute to health equity, action on commercial determinants of health and evidence-informed policymaking. The Strategy focuses on protecting civic space, ensuring sustainable and transparent funding and improving participation in EU decision-making. Yet recent funding decisions in health and environmental programmes move against those objectives. The discontinuation of operating grants in the EU4Health 2025 Work Programme and reduced structural support in the LIFE Programme create tension between strategic commitments and the practical conditions that allow civil society organisations to operate independently over time.
Funding Decisions Create a Strategic Gap
Civil society organisations are non-state, non-profit actors operating in the public sphere. They contribute to democratic life through participation, advocacy, accountability and community representation. In health, these organisations support public interest objectives by engaging communities, monitoring policy implementation and maintaining dialogue with institutions.
The Civil Society Strategy gives EU institutions three clear priorities. It seeks to safeguard the civic space in which civil society organisations and activists operate. It aims to ensure sustainable and transparent funding. It also seeks to strengthen meaningful participation in EU decision-making. These priorities recognise that civil society contributes not only to service delivery but also to the quality of governance.
For health systems, the practical consequences are significant. Strong civil society partners support early warning, accountability and community engagement. These functions are important for resilient and equitable public health. Without the mechanisms and resources needed for long-term work, civil society organisations face reduced capacity to act independently and consistently.
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Recent sectoral funding decisions create a mismatch with these goals. EU4Health 2025 discontinued operating grants that had long supported public health NGOs. These grants represented less than 1% of the total budget. In the environmental sector, structural support under LIFE has also been reduced.
Core Funding Supports Public Health Functions
Operating grants enable functions that are difficult to fit into short project cycles. They support policy analysis, coordination of national members, EU-level dialogue, community outreach, advocacy, accountability and watchdog roles. These activities form part of the connective tissue of democratic governance and are also essential for effective public health systems.
Several types of EU-level civil society organisations have traditionally received, or been eligible for, operating grants through Framework Partnership Agreements. These include public health and health systems NGOs, patient and citizen umbrella organisations, disease-specific and thematic networks, rights-based and equity-focused organisations and cross-cutting coordination structures. Examples include networks focused on public health, health management, health equity, patient representation, cardiovascular disease prevention, diabetes, lung health, brain health, harm reduction, AIDS treatment and mental health.
Project-based funding supports valuable activities, but its design is time-limited and transactional. It ties funding to predefined activities. Core funding supports continuity, independence and engagement beyond discrete projects. These conditions matter when civil society organisations participate in agenda-setting, co-creation and ongoing governance.
During COVID-19, civil society organisations played an important role in reaching underserved populations and countering misinformation. Public health NGOs have also contributed to tobacco control, vaccination uptake, health promotion and action on non-communicable diseases. Environmental organisations play a comparable role in climate action, biodiversity protection and pollution reduction.
Governance Needs Coherence Across Programmes
The Civil Society Strategy provides a cross-sectoral vision for civil society engagement across EU policy areas. Its success depends on coherence across EU institutions and programmes. That requires better coordination across Directorates-General and a more constructive approach to interservice consultation.
The Strategy’s commitments also need alignment with sectoral funding decisions. Civil society contributions are central to public interest outcomes that serve broad societal needs rather than narrower objectives. Many special interest actors are better funded and more tightly organised. Public interest civil society organisations articulate wider democratic, social and health priorities that could otherwise remain underrepresented.
Funding decisions related to operating grants are taken jointly by the European Commission and Member States. A recent non-paper issued by 13 Member States raised concerns about the timetable and consultation arrangements for the discontinuation of NGO operating grants. The concerns point to procedural weaknesses before Member States could adequately assess trade-offs and consequences.
The immediate policy ask centres on reinstating and stabilising operating grants in EU4Health and LIFE. It also includes addressing procedural issues raised by Member States and embedding the Strategy’s principles in upcoming Work Programmes. Possible operational steps include inter-DG task forces staffed with operational-level civil servants, long-term partnership frameworks between the EU and civil society organisations and a monitoring framework with indicators aligned with the Strategy’s objectives.
The Civil Society Strategy sets a significant direction for democratic resilience, civic space and participation in EU decision-making. Its impact now depends on the conditions that allow civil society organisations to contribute consistently and independently. Stable operating grants, stronger institutional coherence and long-term engagement are central to that ambition. In health, these conditions support community engagement, accountability, public interest advocacy and equitable outcomes. Without alignment between the Strategy and sectoral funding decisions, the gap between democratic commitments and operational support will remain unresolved.
Source: Health Affairs Scholar
Image Credit: iStock
References:
Rajan D (2026) The European Union’s Civil Society Strategy: A Welcome Milestone That Now Requires Sustained Operational Support. Health Affairs Scholar: qxag097.
