Spring 2015 Program Update: Realizing the Right to Health

Namati’s right to health program aims to improve quality of and access to basic health services using a combination of methods including greater literacy of health care and health policy, facilitated clinic-community dialogue, and pursuit of legal and administrative remedies for breaches of policy or health-related rights.

We have been engaged in this work in collaboration with local Mozambican partners since late 2012. In March of 2013, we began working in primarily rural areas of two districts of Southern Mozambique. In April of 2014 we launched a partnership with Medicos Sem Fronteiras (Doctors Without Borders) in a number of communities in Maputo and on its outskirts, and in March of 2015, we expanded to two bustling health facilities in Matola. Namati Moçambique was established as a national NGO in July of 2014. We have grown today to a staff of 25.

When we launched our program in early 2013, we found that there was virtually no community participation in governance of the health sector. While there were complaints boxes or registers in some health facilities, most had been untouched; one complaints book had not had a new entry in over six years. And although the Ministry of Health assigns significant importance and responsibility to village health committees, this has not yet translated into investment towards their training or support. When Namati began implementation over two years ago, there was not a single functioning village health committee in our program catchment areas. In several instances there were lists of names of committee members on file at district level, but when we actually went into the communities we discovered that a number of these individuals were not even aware that they were on the committee. In other cases, committees had simply dissolved or become inactive.

Namati’s health advocates, together with government partners, have supported the creation and revitalization of 31 village health committees. We have been working alongside these committees to engage them in grievance redress, as well as to support them in quarterly planning during which we identify and analyze problems and advise them on collective action and advocacy.

By March of 2015 Namati had helped to resolve over 500 service delivery failures, including drug stockouts, lack of water supply, nurse absenteeism, and breaches of privacy and confidentiality. We are seeing that communities are now beginning to come forward; day-to-day violations that affect many people are being noticed and reported. We are slowly chipping away at the culture of silence. Some recent examples of grievances we have successfully addressed include:

  • At one health center, a patient living with both HIV and tuberculosis placed a complaint regarding the delay in them receiving antiretroviral therapy (according to national MOH policy, all HIV-positive individuals who have TB co-infection qualify to begin HIV treatment immediately.) With our health advocate’s intervention, the patient started on antiretroviral therapy and began receiving nutritional support. In addition, the director of the health facility then instructed all staff on the importance of following this protocol, and as a result 15 additional patients in the same situation have since started on lifesaving treatment.
  • At another health center, the bathrooms for use by outpatients were closed for over a month as the result of poor hygiene and blocked pipes.   Patients were urinating and defecating in the grass just behind the facility.   Our health advocate worked with the directior of the health facility to resolve this issue, and the bathrooms were re-opened.
  • Namati successfully argued for mobile clinics and static community health workers to be sent to several isolated rural areas that previously had no access to healthcare providers.
  • At one health facility, Namati registered a collective grievance regarding chronic lateness of the nurse responsible for pre-natal consults. Our health advocate worked with the director to call a meeting of maternal and child health providers, during which the group discussed patient rights and the importance of respecting working hours. The health advocate then monitored the situation and reported improvements, both in terms of tardiness, and a related increase of 50 per in the number of prenatal exams conducted per day.
  • In another clinic, we advocated for improvement in terms of triaging gravely ill patients; in the past, these patients were required to wait in long lines, often unattended to for hours. With the intervention of the health advocate and village health committee, these patients are now prioritized for consults (this is MOH protocol but was not being observed in practice)

Our efforts to increase knowledge of health policy and inspire people to action have benefited not only community members but also health providers – many of whom themselves do not have access to the tools, support, or essential information they need to work effectively. While we have encountered some resistance, generally speaking government health providers view our health advocates as a resource; they often approach our health advocates for assistance in resolving issues that they themselves have been unable to resolve, such as drug stock-outs, chronic staff tardiness, and bribery.

Namati is using aggregate data from our grassroots efforts to advocate for systemic improvements to healthcare delivery systems. We are working hand in hand with Mozambique’s Ministry of Health at the central level to develop the new five-year national strategy for Quality and Humanization of Health Services, which until now has focused almost exclusively on clinical quality.

Namati’s work in Mozambique won a regional Humanization Award from the Ministry of Health in 2013 and a national award in 2014.




June 3, 2015 | Ellie Feinglass