Discussions with CPAG members led not only to project-specific insights but also to broader conclusions that can guide how citizens and patients are included in health-related decision-making. In health promotion and disease prevention, investment choices often rest with professionals or finance departments, yet the people most affected — citizens — rarely have a real say. The recommendations below outline how to change this and make engagement meaningful and sustainable.

Avoid tokenism

Citizen involvement must be meaningful. If engagement starts too late, it becomes symbolic rather than influential. To work well, citizens should be involved early, when ideas are being shaped, and their input should be flexible enough to fit the fast or slow pace of complex projects.

Clarify goals and communication

Health projects are often complex and difficult to follow. Explaining the main goals, key concepts, and how different parts connect is essential for inclusion. Messages should be simple, clear, and accessible not only for experts but also for the general public.

Turn feedback into action

Collecting feedback is not enough — people need to see how their input is used. When feedback disappears into a “black box,” trust is lost. Clear processes are needed to show how citizen voices shape decisions, and regular updates should be given on the impact of their contributions.

Strengthen communication practices

Good communication is central to engagement. Project goals, activities, and results should be shared in formats that people can easily understand. Technical terms and financial concepts should be explained in plain language, supported by lay summaries, case studies, videos, and other tools that make findings relevant and accessible.

Create enabling structures for involvement

For citizens to participate fully, structures must support their role. Complex procedures or unclear expectations can make involvement difficult. Using straightforward processes, simplifying language, and offering support where needed lowers these barriers. Compensating citizens for their time and expertise also shows that their input is valued equally.

Capacity building for citizens and professionals

Citizen involvement works best when both sides are well prepared. Citizens may need training or background information to feel confident in complex areas like health financing or investment models. Equally, professionals need guidance on how to listen, respond, and integrate citizen voices effectively. Structured capacity-building helps balance power and improve the quality of dialogue.

Measuring impact of engagement

To move beyond rhetoric, engagement should be monitored and evaluated with clear indicators. For example: How many citizen recommendations were taken up? Did policies or testbed activities change as a result? Transparent reporting on these outcomes builds credibility and trust and shows that engagement has real value.

Ensure long-term engagement

Citizen involvement should not end when a project finishes. Mechanisms are needed to keep citizens and patients engaged in future initiatives, spin-offs, and policy processes. Sustained participation builds trust, provides continuity, and ensures that lived experience continues to guide health investment decisions over time.

Moving forward

These recommendations highlight that citizen engagement cannot be treated as optional or symbolic. It is a condition for better, fairer, and more sustainable health investments. By building trust, ensuring feedback is acted on, and creating long-term structures for involvement, decision-makers can make health financing more inclusive and effective.