Realizing the Right to Health

The Challenge

Mozambique, like many other countries today, has progressive healthcare policies. But there are massive breakdowns in delivery: in many facilities, patients are treated disrespectfully, essential drugs are missing, or there is no privacy during medical visits.

Poor enforcement, fear, and power inequalities prevent those whose rights have been violated from seeking and receiving redress. These failures are a core reason that Mozambique has some of the worst health outcomes in the world.

A mother and her child visit with a healthcare worker.

Namati’s Solution

Namati is building a movement of grassroots health advocates to put the power of health policy in people’s hands. Health advocates help bridge the gap between policy and practice by strengthening the accountability of services to poor and vulnerable communities.

They break down policy into simple terms and help people navigate the system, walking alongside patients to overcome the social and structural barriers that undermine human dignity and access to care.

Health advocates engage in three kinds of work:

• increasing awareness of basic rights and health policy,
• facilitating dialogue between communities and health facilities to proactively identify and address violations, and
• pursuing solutions to specific grievances or “cases”.

“In the past, patients in labor who didn’t slip money into their health cards weren’t attended to. They had to give birth alone. But when we went with the health advocate and health committee to sit down with the nurse in charge, and we explained that pregnant women were choosing to give birth at home…[the] head nurse called a meeting and told them this had to stop, and now the midwives no longer demand bribes.”
– 26 year old female patient, Jangamo Health Cente

A mother and her baby

Addressing Barriers to Health Care

Since 2013, Namati has helped to resolve over 19,000 grievances in Mozambique.

In partnership with communities and health workers, we’ve addressed complaints related to provider absenteeism, mistreatment and neglect of women during labor, bribery, breaches of confidentiality around HIV testing and clinical consults, lack of information about diagnosis and treatment, misplaced clinical files, and lack of running water and functioning toilets at health facilities.

The majority of these grievances have been collective in nature – affecting anywhere from 10 to 20,000 people. Over the past two years, we’ve seen an average reduction of 43% in these types of violations at facilities with health advocates.

Problems always existed, but no one reported them. …We had complaints registers but the few complaints we received often remained without any response whatsoever. People were afraid to write down ‘Nurse X did such and such.’ But now people’s concerns are heard and the community is finally opening up and talking. With the existence of the health advocate and village health committee they get a prompt response, and the health providers change immediately.
– Maternal and child health nurse, Morrumbene Health Center

Advocating for Systemic Change

Namati tracks data rigorously on every case the advocates take on. In the aggregate, this data provides invaluable insight into how health policy is working in practice. We then draw on this information to advocate for systemic changes that can impact the entire population, not just those living in catchment areas where health advocates are active. The following are a few examples:

• Namati played a key role in writing Mozambique’s National Strategy for the Improvement of Quality and Humanization of Health Care and the country’s first national strategy to combat bribery in the health sector.
• Namati works with village health committees to conduct bi-annual health facility assessments, which gather detailed feedback from communities and health workers and assist them in addressing and monitoring barriers to care. After seeing the impact firsthand, the Ministry of Health (MOH) formally recognized Namati’s approach as part of its national humanization strategy. Aside from supporting the direct implementation of bi-annual assessments in 62 health facilities across 4 provinces, Namati has produced a guide to enable the use of this methodology across the country and is supporting trainings of MOH managers and health committee members even in places where we are not on the ground.
• Namati is supporting the Ministry of Health to create patients’ rights offices at every health facility in Mozambique, including developing a comprehensive training package and operations manual to guide the functioning of these offices.

In January of 2019, Namati established a Center for Training of Paralegals Focused on the Right to Health, through which we will offer tools and support to organizations in Mozambique and beyond.