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‘We all have the same right to have health services’: a case study of Namati’s legal empowerment program in Mozambique

Resource type
Authors/contributors
Title
‘We all have the same right to have health services’: a case study of Namati’s legal empowerment program in Mozambique
Abstract
Background: Legal empowerment and social accountability are two strategies that are increasingly used to address gaps in healthcare in low- and middle-income countries, including failure to provide services that should be available and poor clinical and interpersonal quality of care. This paper is an explanatory case study of a legal empowerment effort that employs community paralegals and trains Village Health Committees (VHCs) in Mozambique. The research objective was to explore how community paralegals solved cases, the impact paralegals had on health services, and how their work affected the relationship between the community and the health sector at the local level. Methods: The case study had two components: (1) a retrospective review of 24 cases of patient/community grievances about the health system, and (2) qualitative investigation of the program and program context. The case reviews were accomplished by conducting structured in-depth interviews (IDIs) with those directly involved in the case. The qualitative investigation entailed semi-structured Key Informant Interviews (KIIs) with district, provincial, and national health managers and Namati staff. In addition, focus group discussions (FGDs) were held with Health Advocates and VHC members. Results: Case resolution conferred a sense of empowerment to clients, brought immediate, concrete improvements in health service quality at the health facilities concerned, and seemingly instigated a virtuous circle of rightsclaiming. The program also engendered incipient improvements in relations between clients and the health system. We identified three key mechanisms underlying case resolution, including: bolstered administrative capacity within the health sector, reduced transaction and political costs for health providers, and provider fear of administrative sanction. Conclusions: This study contributes to the limited literature regarding the mechanisms of legal empowerment case resolution in health systems and the impact of hybrid legal empowerment and social accountability approaches. Future research might assess the sustainability of case resolution; how governance at central, provincial, and district level is affected by similar programs; and to what extent the mix of different cases addressed by legal empowerment influences the success of the program.
Publication
BMC Public Health
Volume
20
Issue
1
Pages
1084
Date
12/2020
Journal Abbr
BMC Public Health
Language
en
ISSN
1471-2458
Short Title
‘We all have the same right to have health services’
Accessed
11/03/2021, 21:22
Library Catalogue
DOI.org (Crossref)
Citation
Schaaf, M., Falcao, J., Feinglass, E., Kitchell, E., Gomes, N., & Freedman, L. (2020). ‘We all have the same right to have health services’: a case study of Namati’s legal empowerment program in Mozambique. BMC Public Health, 20(1), 1084. https://doi.org/10.1186/s12889-020-09190-7
Sectors / Setores
Geography / Geografia