Health Justice

Policy commitments to health care have expanded in many countries, but practice does not match policy. Health care is often a failure at the point of delivery. Community paralegals in Mozambique are working to address this gap between policy and reality by supporting communities to know and exercise their basic rights 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.


Namati’s Approach

Namati is building a movement of community paralegals that put the power of health policy in people’s hands. Known in Mozambique as “defensores de saúde” (health advocates), they help bridge the gap between policy and practice by strengthening the accountability of health services to poor and vulnerable communities. Health advocates engage in three kinds of grassroots work:


Increasing awareness of basic rights and health policy

Health advocates strive to make health-related laws, policies, and protocols accessible to everyone. They address groups of patients in health center waiting areas, breaking down policy into simple terms. They visit schools, farmers’ associations, women’s cooperatives, and HIV support groups. They go door-to-door, speaking with people in their homes. Increasingly, they also engage the public through radio, newspapers, and television.

Facilitating dialogue between communities and health facilities to proactively identify and address violations

Health advocates work with communities to take a more proactive role in the governance of their health services. To do so, we engage an existing structure: the village health committee……


Pursuing solutions to specific grievances or “cases”

Fear of retribution and imbalances of power tend to silence the most vulnerable citizens when their rights are violated. Health advocates help people navigate the system, walking alongside patients to overcome the social and structural barriers that undermine access to care.

Together, they document the problem clearly, analyze it in relation to health policy, and formulate a potential solution. Whenever possible, advocates and patients aim for amicable resolution with local facility staff.

Our Results

In 2018, Namati health advocates empowered communities and health workers to understand existing policies, resolve breakdowns in healthcare delivery, and improve life-saving services for entire communities.


People empowered

Namati health advocates helped over 2,000 individuals, including patients, health workers, and village health committee members, to understand and use policies to resolve grievances with healthcare delivery.



Together, health advocates, community members, and health workers successfully addressed over 1,000 complaints related to the mistreatment and neglect of women during labor, bribery, breaches of confidentiality around HIV testing, lack of information about diagnosis and treatment, and lack of running water and functioning toilets at health facilities.


People positively affected

Resolutions to breakdowns in healthcare delivery in 2018 improved life-saving services for the more than 180,000 people living in the health facilities' catchment areas.


43% Reduction in Violations

Over the past two years, we’ve seen an average reduction of 43% in key policy violations at facilities with health advocates, including…  –> View the report

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:

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Writing healthcare policies

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.

Improving health facility assessments

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 formally recognized Namati’s approach as part of its national humanization strategy.

Namati has produced a guide to enable the use of this methodology across the country and is now supporting the training of ministry managers and health committee members.

Helping establish patients' rights offices nationwide

Namati is currently 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.

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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 Centre, Inhambane province, Mozambique