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EPHA welcomes the announcement from the European Commission that the EU4Health programme will continue the operating grants (OPGs) mechanism in 2024, and that a call for the framework partnership agreements (FPAs) for 2025-2026 will be published. The continuation of the OPGs and the announcement of FPAs signals a returning support to health civil society, consistent with their essential role in EU policymaking and in improving public health for all. This announcement follows a long-standing campaign from EPHA and the EU4Health Civil Society Alliance calling for sustainable funding for civil society.  

This announcement comes at the times when Civil Society Organisations (CSOs) across Europe are facing increasing barriers. This includes a shrinking civic space, a lack of meaningful and structured civil dialogue, difficulties regarding the right to information, and in not so rare cases, restrictions of their activities, pressures, smear campaigns, or prevention from carrying out their monitoring role. In addition, all CSOs are facing difficulties in accessing and securing safe, regular, long-term and sustainable funding. 

The importance of sustainable funding  

Access to sustainable and regular funding, particularly through operating grants and multiannual financial frameworks, allows CSOs to: 

• Remain independent, 
• Plan their activities long term, 
• Have stronger impact. 

This, in turn, enables the civil society to efficiently, sustainably, and independently: 

• Advocate for the public interest in policy-making processes, 
• Bring their critical expertise to EU health policymaking, 
• Give a voice to the citizens, in particular vulnerable groups, 
• Adapt to circumstances, respond to emergencies, support community resilience 
• Support the European Commission in delivering on their priorities and EU policy objectives, 
• Play the watchdog role, essential for safeguarding democracy and the rule of law at all levels of governance, 
• Promote European values. 

A multiannual financial framework specifically allows CSOs to continuously adapt to the changing realities and adjust to potential public health emergencies as they occur. This is especially essential in the times of permacrisis, as it helps civil society to rapidly respond to emergencies and support community resilience, demonstrated as critical in the COVID-19 pandemic and the Russian invasion of Ukraine. This was highlighted by the World Health Organization’s Director-General, Dr Tedros Ghebreyesus, who stressed that the pandemic had demonstrated the need for “all-of-society approaches that incorporate civil society and communities”. 

EPHA’s and the EU4Health Civil Society Alliance’s commitment to the issue of sustainable funding  

EPHA and the EU4Health Civil Society Alliance have been at the forefront of advocating for the continuation of the OPGs for health CSOs, particularly through multiannual financial frameworks (Box 1). This campaign became especially intense in 2021, when the OPGs were discontinued from the EU4Health Work Programme. Since then, the operating grants were reinstated on a yearly basis, until the recent announcement from DG SANTE. 

The recommendations for sustainable funding for CSOs by the EU4Health Civil Society Alliance and EPHA further include improvement of conditions around the operating grants mechanism, such as: 

• improvements to the timeline, such to allow for a regular (multi)annual dynamic, in which an overlap between proposal writing and reporting is avoided, funding of activities for all 12 months of a calendar year is allowed, and space for strategic planning is secured; 
• make the eligibility criteria more inclusive, as these, based on financial independence criteria going back two years, lead to the exclusion of CSOs from applying to the Operating Grants, undermining the overall objective of supporting an independent voice of civil society, 
• lower co-financing rate, as the challenge of securing 40% of co-funding from own resources excludes NGO with limited fundraising capacity; 
• increase of overall budget allocated to the operating grants, to secure funding for a larger number of CSOs. 

Finally, both EPHA and the EU4Health Civil Society Alliance in their manifestos call for a European Civil Society Strategy, to guarantee protection measures for civil society, secure capacity building, and ensure sustainable funding mechanisms. 

If the voices of the marginalised are not heard, they cannot be served 

The area of people’s health, as well as the capacities of national healthcare systems that vary significantly across Europe, are where the unjust social inequalities are most visible. This is exactly where civil society has proven an effective partner in European Health Programmes, generating EU added value by sharing best practices and exchanging knowledge, by partnering and building bridges, by listening and amplifying the voices in their communities, and those of their members and partners, incorporating them into the policy discussion, and by partnering in policy implementation and running initiatives on the ground on national and regional level.  

In volatile circumstances, the EU4Health Programme can only deliver on its objectives to secure health for all with a clear, publicly signalled, long-term commitment to involve health civil society, and recognise the role they play in health policy development. If the voices of all marginalised are not heard, they cannot be served.