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 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:
- increasing awareness of basic rights and health policy,
- facilitating dialogue between communities and health facilities to proactively identify and address violations, and
- pursuing solutions to specific grievances or “cases”.
“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
Addressing Barriers to Health Care
Since 2013, Namati has helped to resolve over 19,000 grievances in Mozambique.
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
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:
- 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.
- 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 (MOH) formally recognized Namati’s approach as part of its national humanization strategy. Aside from supporting the direct implementation of bi-annual assessments in 62 health facilities across 4 provinces, Namati has produced a guide to enable the use of this methodology across the country and is supporting trainings of MOH managers and health committee members even in places where we are not on the ground.
- Namati is 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.
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.
Stories & Blogs
The Impact of Toilets in Health Facilities: A Patient’s Story
The lack of toilets in health centers in Jangamo District was compromising people's dignity and affecting the retention of some patients undergoing treatment for HIV. One patient shares his experience and what he did to help resolve the situation.
Paying for Blood: Bribery in Mozambique’s Healthcare System
Maria was nine months pregnant with her second child; she knew what to expect. But as she made her way to the local health center, Maria began to bleed. By the time she arrived, she was hemorrhaging.
Confidentiality in the Pharmacy Queue
A pharmacy technician's failure to respect patients' privacy kept people from collecting their medication. Together, the village health committee and the health center's management resolved the issue.
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.
Protecting Patients' Privacy During HIV Counseling
The post-test counseling session is a critical step in the treatment and prevention of HIV. But a lack of privacy at Chamanculo Health Centre in Maputo was keeping patients away — until the village health committee took action.
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.
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.
"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.
A Mother Empowered
In rural Mozambique a Namati health advocate and a young mother make a life-saving intervention.
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.
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.
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.
Break the Silence: Say No to Bribery in the Health Sector
This four-minute video testimony is a call to action for all of us – patients, family members, and health workers – to speak up and bring an end to bribery.
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.
'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.
The Missing Piece in the War on AIDS
Namati's Ellie Feinglass' piece in the New York Times.
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.
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.
Privacy for Patients
"We were afraid to go take our medicines because everyone who was waiting at the pharmacy pick-up window could see."
News & Resources
Os Direitos e Deveres das Pessoas Vivendo com HIV (The Rights and Responsibilities of People Living With HIV)
This brochure educates people living with HIV about their rights (including there rights to non-discrimination, confidentiality and universal anti-retroviral therapy) and their responsibilities, and it provides examples of common barriers to care.
O Direito à Informação na Saúde: O Direito de Pedir e Receber Informação (The Right to Information in the Health Sector)
This brochure educates communities about the type of information that they have a right to receive in relation to health services (hours of operation of health facilities, expected turnaround time for lab tests, and names of health providers, etc.), patient diagnosis and treatment (in relation to lab results, names of ...
Folheto Informativo Sobre Cobranças Ilícitas (Informational Brochure on Bribery in Health Facilities)
This brochure aims to educate communities about bribery in health facilities, including how to identify and report such cases.
O Dever de Assegurar a Privacidade nas Unidades Sanitárias (The Obligation to Ensure Privacy in Health Facilities)
Um folheto para os trabalhadores de saúde que se concentra em estratégias concretas para assegurar a privacidade nas unidades sanitárias. This booklet provides healthcare workers with concrete strategies for ensuring privacy in health facilities.
Manual de Formação de Paralegais, Defensores de Saúde e Agentes Comunitários: Direitos Humanos Para a Saúde e Acesso à Justiça (Training Manual for Paralegals, Health Advocates and Community Workers: Health, Human Rights and Access to Justice)
Este manual apresenta informação que pode ser usada na promoção e defesa do direito a saúde no geral e dos grupos vulneráveis e populações chave em particular. O principal objectivo deste manual é de ser uma ferramenta útil para capacitação inicial dos paralegais, defensores ...
Este folheto informativo explica a importância da carga viral para pacientes vivendo com HIV, incluindo como manter uma carga viral baixa, quando e como o teste de carga viral deve ser feito e o que significam os resultados do teste. ___ This informational brochure explains the significance of viral load ...
Informação Essencial Sobre Cuidados e Tratamento de HIV & Direitos das PVHIV (Essential Information About HIV Care and Treatment & Rights of People Living with HIV)
Este livrinho fornece aos leitores informações essenciais sobre o HIV; as políticas do Ministério da Saúde de Moçambique em torno do diagnóstico, cuidados e tratamento do HIV; e os direitos e deveres das pessoas vivendo com HIV previstos nas politicas e leis moçambicanas. ...
As pessoas vivendo com HIV/SIDA (PVHIV) vêm muitas vezes os seus direitos humanos violados devido ao estigma e discriminação associado a doença e as barreiras ligadas ao sistema de saúde que incluem, por exemplo, atendimento sem cortesia e falta de confidencialidade e privacidade. Estas violaçõ...
As pessoas afectadas pela tuberculose (TB) vêm muitas vezes os seus direitos humanos violados devido ao estigma e discriminação associado a doença e as barreiras ligadas ao sistema de saúde. As violações dos direitos humanos relacionadas à tuberculose incluem também acesso limitado ao rastreio e ...
A Carta dos Direitos e Deveres do Utente aprovada e adoptada em 2007 pelo Ministério da Saúde (MISAU) reafirma os direitos humanos fundamentais na prestação dos cuidados de saúde e protege a dignidade e integridade humana, bem como o direito à autonomia. É um instrumento através ...
Esta brochura, elaborada no âmbito da parceria entre a Namati e a FDC, tem como objectivo divulgar os direitos das trabalhadoras de sexo e dos homens que fazem sexo com homens em face da actuação da polícia, no atendimento, nas buscas e na detenção; as violações ...
O Direito à Saúde Manual De Formação Para Moçambique - The Right to Health Training Manual for Mozambique
Este manual é uma ferramenta prática para capacitar as comunidades sobre o significado do direito à saúde e como identificar e liderar em caso de violação destes direitos. O manual foi preparado para ser usado por membros das comunidades, organizações da sociedade civil (GAACs, OCBs, etc.), comités ...
A Practical Guide: Implementing and Scaling Up Programmes to Remove Human Rights Barriers to HIV Services
This guide has been developed to support implementers to plan, roll out and scale up effective, evidence-informed programs to remove human rights-related barriers to HIV services. (A case study about Namati's Right to Health program is found on page 71)
UNAIDS' Global Update for 2019 takes stock of the state of HIV epidemic around the world, including the advancements that have been made and the challenges that remain. (Namati's Right to Health work is highlighted on pages 134-136).
Despite expanding policy commitments in many poor countries, health care is often a failure at the point of delivery. Lack of information, poor enforcement, and power dynamics prevent those whose rights have been violated from pursuing redress. In Mozambique, grassroots health advocates work to address this gap between policy and ...
This guide contains a series of recommendations for both policy and practice focused on the identification, prevention and combat of bribery in the health sector in Mozambique. It is a practical tool that can be used by village health committees, activists, health advocates, community members, health ...
A ferramenta de levantamento dos desafios das unidades sanitárias (US) visa sistematizar os principais desafios e reclamações sobre qualidade e humanização dos serviços de saúde através da auscultação das comunidades, dos comités de saúde e de co-gestão e humanização, ...
For millions of people around the world, human rights violations are part and parcel of everyday life. Sexual violence, discrimination in housing, unwarranted dismissal from employment, unfair evictions, denial of child support, and police harassment are only a few such violations. These have a particularly harsh impact on people whose ...
Published in the journal Health and Human Rights, this essay suggests that two strands of social action which have hitherto developed separately — legal empowerment and social accountability — ought to learn from one another. Legal empowerment efforts grow out of the tradition of legal aid for the poor; they assist citizens ...
Bangladesh is stoking an emerging AIDS epidemic with violent police abuse of sex workers, injection drug users and men who have sex with men. In this 51-page report, Human Rights Watch documents rapes, gang-rapes, beatings and abductions by both police officers and powerful criminals known as mastans. Their targets — sex ...