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Objective <p>In 2024, the 77th World Health Assembly adopted a resolution on social participation for health (SPH), underscoring the importance of inclusive health system decision-making to achieve universal health coverage. Inclusion-oriented SPH is key to achieving health equity, enabling the needs and perspectives of marginalized communities to reflect in decisions, yet many initiatives fall short. A realist review sought to determine the contextual factors influencing the inclusiveness and outcomes of SPH reform initiatives, alongside their mechanisms of influence.</p> Methods <p>Studies were sourced through a comprehensive search focused on social participation, health reform, and inclusion. Following title-abstract screening, quality and relevance were rated using adapted 0–5 scoring. The sub-analysis presented here mapped SPH reform processes, outcomes, geographic spread, and strategies and resources for inclusive SPH.</p> Results <p>150 studies were retrieved. Strategies to enhance inclusiveness focused on ensuring access to platforms, tailoring recruitment, and employing culturally safe approaches, and were undergirded by diverse (e.g., financial and technical) resources. 50% of studies reported the nature of diversity in participatory processes, while others addressed qualitative aspects of inclusion/exclusion.</p> Conclusions <p>While efforts have enhanced inclusiveness of social participation in health systems decision-making, challenges of meaningful engagement and exclusion remain. There may be no single point or threshold at which complete inclusiveness of social participation for health may be achieved, but it is clear that for populations overall as much as for particular “left behind groups” there are key entry points that may help overcome limitations and barriers.</p>

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Inclusiveness of social participation for health reform: findings from a realist review

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年5月29日

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  • Shraddha Mishra,
  • Neymat Chadha,
  • María Eugenia Esandi,
  • Camila Serrao,
  • Rodrigo Hernan Acuña,
  • Surya Surendran,
  • Amandeep Saini,
  • Ines Aristegui,
  • Devaki Nambiar

摘要

Objective

In 2024, the 77th World Health Assembly adopted a resolution on social participation for health (SPH), underscoring the importance of inclusive health system decision-making to achieve universal health coverage. Inclusion-oriented SPH is key to achieving health equity, enabling the needs and perspectives of marginalized communities to reflect in decisions, yet many initiatives fall short. A realist review sought to determine the contextual factors influencing the inclusiveness and outcomes of SPH reform initiatives, alongside their mechanisms of influence.

Methods

Studies were sourced through a comprehensive search focused on social participation, health reform, and inclusion. Following title-abstract screening, quality and relevance were rated using adapted 0–5 scoring. The sub-analysis presented here mapped SPH reform processes, outcomes, geographic spread, and strategies and resources for inclusive SPH.

Results

150 studies were retrieved. Strategies to enhance inclusiveness focused on ensuring access to platforms, tailoring recruitment, and employing culturally safe approaches, and were undergirded by diverse (e.g., financial and technical) resources. 50% of studies reported the nature of diversity in participatory processes, while others addressed qualitative aspects of inclusion/exclusion.

Conclusions

While efforts have enhanced inclusiveness of social participation in health systems decision-making, challenges of meaningful engagement and exclusion remain. There may be no single point or threshold at which complete inclusiveness of social participation for health may be achieved, but it is clear that for populations overall as much as for particular “left behind groups” there are key entry points that may help overcome limitations and barriers.