Realizing the Right to Health

Policy commitments to health care have expanded in many countries, but practice does not match policy. Health care is often a failure at the point of delivery.

While there are many initiatives to improve health outcomes around the world, the vast majority have focused on the mechanics of delivering care, including clinical training, drugs and infrastructure. Relatively few have sought to support communities in defending and advancing their right to health.

But there is growing recognition that to resolve failures in the delivery of health care, we must strengthen the accountability of services to local communities and patients.

In Mozambique, the Ministry of Health has developed a range of powerful policies and clinical protocols, including the 2006 Charter on Patients’ Rights and Obligations, which highlights human dignity and equality, prohibits discrimination on the basis of health status, and guarantees the confidentiality of patient information. The impact of these laws and policies, however, is undermined by insufficient dissemination, poor enforcement, low literacy rates, and power dynamics that deter those whose rights have been violated from pursuing redress.

Since early 2013, Namati’s defensores de saúde, or health advocates, have been working to address this gap between policy and reality by supporting communities in exercising their basic rights to health. Our model has evolved to involve three core elements:

  • increasing awareness of health policy,
  • pursuing solutions to specific grievances, and
  • facilitating dialogue between communities and health facilities to proactively identify and address system failures.

Namati’s education efforts aim to impart scientific information intertwined with specific health protocols so that patients can more effectively advocate for themselves. Health advocates follow up on grievances in collaboration with clients. We also engage with village health committees, aiming to transform what are often defunct groups—merely names on a list—into effective institutions for governance.

When we conducted our baseline assessment in early 2013, we found that while there were complaints boxes or registers in some health facilities in our catchment area, most had been untouched; one complaints book had not had a new entry in over six years. We are seeing that people are now beginning to come forward; day-to-day violations that affect many people are being noticed and reported.

Between March 2013 and March of 2017 health advocates and their clients had taken on a total of 1,851 grievances, of which 81% have been resolved.

Results have been promising and have included improvements in quality of care, access to services, infrastructure and essential medicines.

We track data rigorously on every case the advocates take on, and every community-facility dialogue they conduct. This information provides a powerful portrait of how health policy is working in practice, enabling us to propose systemic changes that can affect the entire population, not just those living in the catchments where our health advocates are active.


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