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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 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:
“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
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
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:
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.
Pressing for Privacy Rights - Silvia's Story
When Silvia's health continued to deteriorate she gathered her courage and went for an HIV test. But the testing room in which she was led was not private. She panicked and left. But the next day, she decided to take action.read more
Five Ways Legal Empowerment Efforts Can Improve Maternal Health
Mozambique's rate of maternal mortality is among the highest in the world. But legal empowerment efforts that help women understand exercise their rights can—and are —making a difference.read more
Delivering Maternal Rights and Justice in Mozambique
Mariamo gave birth to her son at the local health center—with the assistance of the center's cleaner. When the community health committee heard about the situation, they took action.read more
"I was ashamed to say what I had and how I felt..."
A community and health committee, with the support of a health advocate, take action to address the lack of privacy at their local hospital.read more
A Mother Empowered
In rural Mozambique a Namati health advocate and a young mother make a life-saving intervention.read more
Elias & Hortência
In late 2013, 29 year-old Elias began to notice that his body felt weak. His muscles ached, and he didn’t have the energy that he needed to tend to his fields. In November, Elias walked for over three hours to the nearest health center. Based on his symptoms, he suspected that it was malaria; he was surprised when the test came back negative. The nurse gave him a small satchel of paracetamol, and he made the arduous trek back home.read more
Sensitizing Health Workers to the Needs of the Elderly in Mozambique
Policy states that elderly patients should receive priority attention at health facilities, and should not be subjected long waits, but the patients Davide spoke with reported being neglected, even mistreated.read more
Talking Health Rights
At the 1st of May Health Center in Maputo, where HIV and TB patients seek treatment from an over-stretched public health service, there is a regular feature - Cacilda Fumo. Cacilda is Namati's health advocate - a compassionate champion of patient rights. This gallery and story illustrate the work she does and some of the people who benefit.view gallery
Delivery Amid Abuse
The first two times Alcina gave birth amidst verbal and physical abuse, she – and other mothers – had nowhere to turn. The third time was different.read more
'When I dance my heart feels good'
By any standards Lidia Jorge has a hard life. It was being made harder still by a careless health technician who put her on a treatment regime that made her sick. Namati's health advocate was able to intervene and make sure it didn't happen to anyone else.read more
The Missing Piece in the War on AIDS
Namati's Ellie Feinglass piece in the New York Times.read more
Full Prescriptions - Half Filled
Marizinha's doctor wrote her a prescription for 60 pills. Just enough for one month. However, the pharmacy tech at the health center dispensed only 30. “He acted like he had given me all of them,” she says.read more
The Loss and Delay of HIV Patients’ Lab Results
At a bustling health center on the outskirts of Maputo, Mozambique, nearly 8,000 patients living with HIV receive care and treatment. Despite the high volume, the health facility did not have a CD4 machine on-site for measuring the level of immuno-suppression in HIV patients. Blood samples had to be transported to a nearby hospital for analysis. Test results were frequently misplaced and delayed - sometimes for months.read more
Privacy for Patients
"We were afraid to go take our medicines because everyone who was waiting at the pharmacy pick-up window could see."read more
The Abdul Latif Jameel Poverty Action Lab
The Abdul Latif Jameel Poverty Action Lab (J-PAL) is a research center at the Massachusetts Institute of Technology. It has grown into a global network of researchers who use randomized evaluations to answer critical policy questions in the fight against poverty.visit site
World Bank Justice for the Poor
Namati Sierra Leone is collaborating with the World Bank Justice for the Poor Program on a randomized controlled trial to test two mechanisms for improving the accountability of health services.visit site
Médecins Sans Frontières
Namati works with Médecins Sans Frontières (MSF) to integrate health advocates into MSF clinics in Maputo.visit site
The Legal Aid Clinic at the Eduardo Mondlane University Faculty of Law.
Namati is working closely with the Mozambican League of Human Rights and the Eduardo Mondlane University Faculty of Law, both of whom are providing legal counsel on complex or high-level cases.visit site