Changes have been made, but on average only once every 10 years”. They improved responsiveness and increased community participation for setting priorities and health-related performance targets. A network of almost 150 local users’ groups {juntas) is well-established, which actively collaborate with the CCSS to discharge a wide range of responsibilities. As well as mediating public queries/complaints and generally seeking to improve relations between the CCSS and users, juntas' activities include identifying local service needs and assisting in procurement decisions (for a new ambulance, pain clinic or mammography kit, for example), assisting in local epidemiological surveillance (particularly of infectious disease such as dengue), organising blood donations, and, organising local health promotion activities.