By Esvénia Viola, Concern Universal, Mozambique

The health sector in Mozambique faces many challenges, corruption, disruptions in the supply of essential drugs, poor service, confidentiality breaches etc. This situation is especially severe in the most remote areas of the country, thus contributing to low quality service, low indicators of maternal and child health, among others. For these and several other strategic reasons Concern Universal, in the implementation of Saksan project "Knowledge, Skills and Action Network for Social Accountability" funded by the World Bank, decided to intervene in some of these areas. With this intervention we are reaping evidence of the real Mozambique and through constructive dialogue influencing decision makers to change and or improve national health strategies and policies. To do this, from the early stages of program implementation we have aligned our approach to the existing legal framework, hoping to bring lasting changes.

At the district level – the targets the program’s intervention, the above-mentioned phenomenon of "corruption, ruptures in the supply of essential drugs, poor customer service" is visible, and since one of the purposes of Saksan program is to increase the involvement of the actors on the supply side and the actors on the demand side on issues of quality delivery of health services specifically in maternal and child health and access to anti-retroviral treatment, we are implementing activities that contribute to constructive engagement, contribute to increased knowledge of rights and obligations of users, rights enshrined in the mother law of Mozambique, the Constitution, and through spaces for interaction and dialogue, reducing the reluctance and fear that communities have to demand their rights.

We know that the way ahead is long and we are aware that for this to happen is really necessary for both sides, (i) health providers: understand the importance of citizen's opinion for improving the delivery of services, transparent management of medicine, reduction/elimination of corruption and behavior change (humanization of care, confidentiality and respect; (ii) users: to perceive, understand and accept both health conditions, as well as industry conditions to provide basic primary health care services to improve not only the physical health of users, but health in the truest sense of "health of the whole community."

Our implementation strategy towards the achievement of this purpose begins with the awareness of the rights and duties of both sides, and materialization of spaces for dialogue because while citizens/communities need to realize or be aware that the right to health is enshrined in law mother in Article 89, the service providers should remember that it has a duty to provide quality services, to fulfill their duty in exemplary manner, and be open for civil society to monitor its service delivery in order to improve these, "Article 116 ".

This effort, although recent, is bringing results. An example was the completion of the first public hearing on health "Privileged space for justification and accountability, in which health sector leaders (managers, technicians, nurses, etc.), leaders from other related sectors (district planning managers, district government, etc.), provide clarification on the quality of health services provided to users of health facilities", an event that took place on June 30 in Maúa district, Niassa province.

We hope that these events will introduce profound changes in engagement and improvements in the provision of general health services and specifically of child maternal health and access to antiretroviral treatment services.

As GPSA partners, we have the opportunity to learn from the experience of other partners and in the future we intend to share results achieved by our intervention and thus discuss, reflect, analyze and hopefully introduce changes that improve similar intervention aspects developed by other partners.


Testimonials from participants of the 1st Health Public Hearing held by the Saksan program

District director of Maúa

What are your impressions after this event?

This hearing opens space for a great interaction, information exchange, knowledge sharing and mutual learning about our reality. The communities are demanding their rights. Some things do not depend on us and other things are inevitable (eg. individual behaviors/attitudes can dilute efforts of the whole team), we know we have to improve and these meetings help us to reflect to introduce changes. We will continue working because our greatest value is life. demanding toilets, decent space for care and hospitalization are citizen's rights.

District Director of Women’s Health Social Action – answering questions from civic groups and users of health services in  Maua.

District Director of Muembe - Inacio Chaibo Ndala

What are your impressions after this event?

I look forward to this type of event to happen in my district, helping communities to approach the hospital and the health care professionals to improve our behavior. I believe that working together with civic groups and communities we can develop strategies that will bring change, for the government, people and health professionals.

What impact events like this can bring to Muembe?

I begin by recognizing that this is a learning process, which will help us change/improve the way we act. I have no fear and from this meeting we are seeing how things can happen. For me it was very important to participate in this event and I look forward to happen in my district because the community has not had space to speak. When we have government visits they are not at ease. This space should be permanent to jointly set strategies, find the causes and solutions.


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