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:
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.
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
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
'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
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
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
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