Advancing health systems accountable to the people

Mozambique, like many countries today, has progressive health care policies – but there are massive breakdowns in delivery. In 2024, for example, a pregnant patient at a clinic in Marracuene District recalled feeling ashamed by the lack of privacy: “The nurse asked me to take off my clothes so she could examine me. I was traumatized because there were so many people looking.” When experiences like these accumulate, people lose faith in the health system. Many opt to stay away.

Our community paralegals—known locally as defensores de saúde — work to bridge the gap between policy and practice. We partner with communities and health workers to identify and overcome barriers to care and generate systems change. In Marracuene, we successfully advocated together for low-cost, high-impact renovations to ensure privacy.

“I feel a real sense of relief… women in labor are now cared for with dignity”, reports the clinic director.

Over the course of seven weeks in 2024, Namati and the Ministry of Health carried out a campaign to improve maternal health care based on community feedback around service-related barriers, directly reaching more than 33,000 women. The campaign prompted the drafting of detailed directives on humanized labor and delivery, which have since been adopted by the health leadership of both Inhambane and Maputo Provinces.

The directives oblige health workers at 267 health facilities across two provinces to provide dignified treatment to women in labor, including respecting diverse cultural beliefs and practices as long as they do not pose a risk to the mother or baby; to ensure a woman’s right to privacy, confidentiality, and attendance at any public health facility regardless of where she received prenatal care; and to enable women to be accompanied during labor by a friend or family member, including a male partner or husband. Namati is now collaborating with both provinces to ensure implementation of these directives.

Our Grassroots Impact at a Glance