This Guide mostly focuses on how a child can be involved and supported in individual decisions regarding his/her health. 

However, greater routine integration and inclusion of child participation and perspectives at other levels of policy, planning, service design, delivery and evaluation can result in better informed decisions that also bring great benefit to children in general and individually. General Comment 12 of the CRC  states that children should also “contribute their views and experiences to the planning and programming of services for their health and development”, including on “how to promote children’s capacities to take increasing levels of responsibility for their own health and development”. 

In relation to health care delivery, children should be given the opportunity to provide confidential or anonymous feedback on their health care experience after they have used services by means of “experience of care” feedback, satisfaction questions or other methods. 

Tools such as Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs)   are increasingly being adopted in paediatric population. 
Similarly, engaging children in the design of training curricula for health professionals, of information material or of new health facilities brings important insights and benefits for children that use services in future. 

Enabling and facilitating children to discuss and share their views collectively, by participating in regular children’s councils, advisory groups (for example of ‘expert-patient’ children with specific chronic conditions) or other forums and networks, not only provides channels for informed feedback to influence change in care delivery or design, but can also increase mechanisms of peer-support between children. 

This type of structured participation is increasingly institutionalised in hospitals or other health organisations and rely on participatory approaches where the child is not only a respondent but also engaged in meaningful dialogue. When integrated and facilitated on a regular basis within health services, these approaches also provide platforms to increase the accountability of decision-makers and health professionals to children.