by Sara Bertucci, Policy Manager and Milka Sokolovic, Director General
Civil society in Europe ends the year at a crossroads, and nowhere is this felt more sharply than among health NGOs. As this first year without operating support from EU institutions draws to a close, the bloc is negotiating a new financial framework in which the prospect of lower investment and weaker ambition on both urgent health priorities and civil society participation is alarmingly real. At the very moment when evidence shows that strong, independent civic actors are indispensable for healthy societies and democratic, evidence-based policymaking, the funding that sustains this work is receding. Rather than consolidating the lessons of the pandemic and recent crises, the current trajectory risks a thinner, more fragmented approach to health and democratic participation at EU level.
Our end of year reflections therefore turn on a pressing question: how can we, as civil society, continue to deliver on our mission effectively, while navigating an ever more challenging environment in which our existence is made precarious and our legitimacy increasingly contested?
Civil society on the brink, despite evidence of its impact and irreplaceable role
A familiar refrain has echoed through panel discussions, news articles and the many coffee conversations that take place daily across Brussels: civil society is being stretched to breaking point precisely when the European Union needs it most. This warning, voiced in different ways across many fora, captures a shared unease about the mounting pressure on civic actors at a time of deepening social, health and democratic challenges.
Over 2024–2025, EPHA’s work on civic space, funding cuts and democratic resilience in the health ecosystem has shown a pattern: expectations of civil society keep growing, while core support gets eroded. Health NGOs are asked to monitor and contribute to policies, bring in citizens’ voices, counter disinformation and hold powerful interests to account; all the while, the resources that make this possible are withdrawn. The absence of operating grants in the 2025 EU4Health Work Programme, coupled with proposals to fold the programme into broader EU budget lines with no earmarking for health civil society in the next EU budgetary cycle, starkly embodies this broader squeeze on the very organisations that safeguard health policy’s transparency, evidence base and accountability.
An external study underpinning the European Commission’s EU4Health interim evaluation tells a different story from the one implied by current budget choices. The study confirms NGOs receiving operating grants deliver on their commitments, meet agreed targets, and use public funds responsibly and meaningfully, actively bringing technical expertise and community input into EU health policy. The study also highlights that these grants are hardly replaceable for sustaining independent, long-term efforts in prevention, health equity, and patient rights.
We hope those who made it this far into this editorial won’t settle for the line: scrapping these grants is regrettable, yet inevitable belt-tightening in tough times. We are witnessing a process that risks diminishing civil society’s voice in the spaces where evidence, accountability, and watchdog roles are most needed. With operating support to civil society being a marginal fraction of the EU health and overall budget, it’s hard to see how this delivers economic, let along social, gains.
A needed course change: EPHA’s commitment, and evidence from the field
As 2025 ends, we remain convinced that the EU still has time to correct course, recommitting to a thriving civic space and a robust health architecture. Immediate action is needed to reinstate operating support for civil society within the 2026 EU4health Work Programme. And, in the longer term, the focus needs to stay on designing the next EU budget so that it can tackle health and democratic challenges.
EPHA and its members stand ready to continue delivering, bringing evidence to the table, amplifying communities’ voices, and working with institutions to build healthier, equitable, and resilient societies. To do so, we need a policy and funding environment that gives due weight to our proven contribution and provides the stability required to plan beyond the next project call. The hope for the year ahead is that EU leaders will consider the evidence, heed the warnings, and choose to invest in health(y) civil society.
Against this backdrop, we reiterate the strong appreciation for the many partners and allies across sectors and institutions who have spoken up, built coalitions, and provided key support to defend civic space and health funding in these challenging times. Their support has helped keep attention on what is at stake and has shown that having civil society as a strategic partner remains a smart and effective choice, in health and beyond.
Many of them have contributed to this edition: Carlotta Besozzi from Civil Society Europe explains why an ambitious EU Civil Society Strategy is now indispensable; Vesna Kerstin Petrič from the Ministry of Health of Slovenia discusses how to bring the World Health Assembly Social Participation resolution to life in EU governance; EPHA advisor Philippe Vandenbroeck examines the systems impacts of eroding civic space; and Faustine Bas-Defossez from the European Environmental Bureau shows why cross-sector solidarity is central to safeguarding democracy, the environment and public health.
Europe’s leaders are quick to say that health is an investment, not a cost. The same holds true for the civic infrastructure that supports it. Yet both remain the first line of budgetary sacrifice. Whether the next decisions treat health and civil society investments as assets or as expendable costs will determine the direction of travel. The window to correct course is narrow, but it is not yet closed. What Europe does with it will matter.