Namati is thrilled to feature Margaux J. Hall as our first guest blogger. We will be regularly featuring guest bloggers from around the world to showcase developments and promising innovations in legal empowerment. We hope to highlight candid, first-hand perspectives from practitioners and experts in the field. Guest bloggers are invited to write about current projects they are undertaking, and how legal empowerment models and techniques play a role in advancing this work. Namati does not endorse any particular view or opinion that a blogger may share or promote.
We want to hear your feedback. Please write to us with comments and suggestions, by sending an email to email@example.com.
Justice in health care delivery: a role for Sierra Leone’s paralegals
April 2012- I recently attended a community paralegal training hosted by Namati on promoting accountability in health care delivery in Makeni, Sierra Leone. During the training, a community paralegal named Elizabeth Massalay talked about bringing her niece to a clinic in Moyamba district to receive immunizations that the government provides free of charge thanks to the Free Health Care Initiative (FHCI), which offers free health services to pregnant and breastfeeding women and children under five. Mothers queued for free immunizations, painting a hopeful picture for a country that ranks 180 out of 187 in the 2011 Human Development Index and where almost one in three children die before reaching the age of five.
However, against this promising backdrop, Elizabeth saw that the nurse was demanding six cups of rice from each mother before providing the immunization. Elizabeth was witnessing how breakdowns within state institutions—including absent nurses, improper use fees, and “leakage” of up to 30% of FHCI drugs (according to government and UNICEF statistics)—undermine health care delivery. Responding to such breakdowns requires an understanding of health policy and regulations—what the state must provide and to whom—and knowing where and how to apply pressure when the state fails to do so.
In Sierra Leone, community paralegals (lay persons trained in the law) are on the front line of navigating administrative accountability channels. Although Sierra Leone has only about 200 practicing lawyers, paralegals provide basic justice services in approximately 36% of the country’s chiefdoms. Paralegals can contribute something unique and important to health service delivery, beyond what health workers alone can offer. This is because effective health care delivery requires not only adequate staff and health inputs—it also requires accountability. Elizabeth intervened, telling the nurse that any charge was improper under the FHCI, and remained at the clinic the rest of the day to monitor the nurse. In the long run, a paralegal like Elizabeth might engage the village health committee, a local accountability structure tasked with ensuring effective clinic operations, and make unannounced visits to the health clinic to monitor FHCI services.
Yet Elizabeth’s story also illuminates the challenges in achieving “legal empowerment” in service delivery. To greatly impact services, community paralegals must tackle injustices with origins far more complex than the actions of an individual nurse. What if the nurse has inadequate training? What if, despite the FHCI’s promises, the nurse lacks drugs? Such community-level problems are challenging to diagnose, monitor, and solve, and they often pit paralegals against powerful interests in the community and beyond. Ultimately, paralegals should aspire to become less essential in solving these problems by engaging citizens in the avenues for redress and emboldening citizens to engage institutions themselves. Such empowerment is essential to the broader and exigent missions of ensuring quality, sustainable health care delivery under the FHCI and creating a robust civil society to hold government accountable.
The World Bank’s Justice for the Poor program, with support from the Nordic Trust Fund, is working with Namati to track paralegals’ work. The program will assess whether paralegals improve service outcomes and serve as a useful complement to more traditional accountability tools such as scorecards, community compacts, and non-financial awards that the government of Sierra Leone is also currently evaluating with the World Bank’s support.
This blog post also appeared on the World Bank’s blog, “Investing in Health.”
About the Author
Margaux J. Hall is a consultant in the Justice Reform Group of the World Bank Legal Vice Presidency based in Sierra Leone. Her work focuses on justice reform and governance, particularly in the delivery of essential services. Before joining the World Bank, Margaux conducted development and governance research in South Africa as a Fulbright Fellow and in East Africa as a Harvard University Frederick Sheldon Fellow. Margaux also worked at a private law firm, where her practice focused on litigation and government and internal investigations. Margaux’s recent publications include Avoiding Adaptation Apartheid: Climate Change Adaptation and Human Rights Law, forthcoming in the Yale Journal of International Law, and Answering the Millennium Call for the Right to Maternal Health in the Yale Human Rights & Development Law Journal. Margaux graduated from Stanford University, with honors and distinction, and Harvard Law School, cum laude.
Last updated January 30, 2013.
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Last updated: February 2, 2023
Welcome to the namati.org website (the “Site”) and the Legal Empowerment Network Forum (the “Forum”) operated by Namati, Inc., a Delaware corporation (“Namati”, “we”, “us” or “our”). We share your concern about the protection of your personal information online.
This Policy describes our privacy practices and sets out your obligations and ours with respect to your use of the Site and the Forum. This Policy applies only to the Site and the Forum and does not necessarily apply to our offline collection of information.
Namati may collect and retain two types of information about Site and Forum visitors: (i) personal information that individual visitors voluntarily provide when interacting on the Site or Forum or on certain other occasions (such as via forms or in emails); and (ii) tracking data, which is data that is automatically collected from every Site and Forum visitor as they use and browse the site.
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Our use of your Information involves various forms of communication with you, including:
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Namati is concerned about the privacy protection of children who access the Internet and this website is not intended for children and we do not knowingly collect data relating to children. Accordingly, the Site and Forum are not intended for use by anyone under the age of 16, and we do not knowingly collect information from anyone under 16 years of age without the consent of a parent or guardian.
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It is important that the personal data we hold about you is accurate and current. Please keep us informed if your personal data changes during your relationship with us.
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Request access to your personal data (commonly known as a “data subject access request”). This enables you to receive a copy of the personal data we hold about you and to check that we are lawfully processing it.
Request correction of the personal data that we hold about you. This enables you to have any incomplete or inaccurate data we hold about you corrected, though we may need to verify the accuracy of the new data you provide to us.
Request erasure of your personal data. This enables you to ask us to delete or remove personal data where there is no good reason for us continuing to process it. You also have the right to ask us to delete or remove your personal data where you have successfully exercised your right to object to processing (see below), where we may have processed your information unlawfully or where we are required to erase your personal data to comply with local law. Note, however, that we may not always be able to comply with your request of erasure for specific legal reasons which will be notified to you, if applicable, at the time of your request.
Object to processing of your personal data where we are relying on a legitimate interest (or those of a third party) and there is something about your particular situation which makes you want to object to processing on this ground as you feel it has an impact on your fundamental rights and freedoms. You also have the right to object where we are processing your personal data for direct marketing purposes. In some cases, we may demonstrate that we have compelling legitimate grounds to process your information which override your rights and freedoms.
Request restriction of processing of your personal data. This enables you to ask us to suspend the processing of your personal data in the following scenarios:
Request the transfer of your personal data to you or to a third party. We will provide to you, or a third party you have chosen, your personal data in a structured, commonly used, machine-readable format. Note that this right only applies to automated information which you initially provided consent for us to use or where we used the information to perform a contract with you.
Withdraw consent at any time where we are relying on consent to process your personal data. However, this will not affect the lawfulness of any processing carried out before you withdraw your consent. If you withdraw your consent, we may not be able to provide certain products or services to you. We will advise you if this is the case at the time you withdraw your consent.
You will not have to pay a fee to access your personal data (or to exercise any of the other rights). However, we may charge a reasonable fee if your request is clearly unfounded, repetitive or excessive. Alternatively, we could refuse to comply with your request in these circumstances.
We may need to request specific information from you to help us confirm your identity and ensure your right to access your personal data (or to exercise any of your other rights). This is a security measure to ensure that personal data is not disclosed to any person who has no right to receive it. We may also contact you to ask you for further information in relation to your request to speed up our response.
We try to respond to all legitimate requests within one month. Occasionally it could take us longer than a month if your request is particularly complex or you have made a number of requests. In this case, we will notify you and keep you updated.
If you live in an EEA Member State, all of which have adopted the EU GDPR and national , you have a right to lodge a complaint with your relevant supervisory authority about this policy and its application. The European Commission has a list of EU national data protection authorities here:
If you live in the United Kingdom, you have a right to lodge a complaint with your relevant supervisory authority, the ICO, about this policy and its application:
The Policy was updated in July 2022 to comply with the General Data Protection Regulations.