, Brooklyn, USA.
Namati Moçambique, Maputo, Mozambique.
BMC Public Health. 2020 Jul 10;20(1):1084. doi: 10.1186/s12889-020-09190-7.
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.
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.
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 rights-claiming. 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.
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.
法律赋权和社会问责是两种越来越多地被用于解决中低收入国家医疗保健差距的策略，包括未能提供应有的服务以及临床和人际护理质量差。本文是对莫桑比克一项法律赋权努力的解释性案例研究，该努力雇佣社区律师并培训村卫生委员会（VHC）。研究目的是探讨社区律师如何解决案件，律师对卫生服务的影响以及他们的工作如何影响社区与地方一级卫生部门之间的关系。
该案例研究有两个组成部分：（1）对 24 例患者/社区对卫生系统不满的案件进行回顾性审查；（2）对该计划和计划背景进行定性调查。通过对案件直接参与人员进行结构化深度访谈（IDIs）来完成案例审查。定性调查包括对地区、省和国家卫生管理人员以及 Namati 工作人员进行半结构化关键信息访谈（KIIs）。此外，还与卫生倡导者和 VHC 成员举行了焦点小组讨论（FGD）。
案件解决赋予了客户一种赋权感，立即带来了相关卫生机构服务质量的具体改善，似乎引发了权利主张的良性循环。该计划还导致了客户与卫生系统之间关系的初步改善。我们确定了案件解决的三个关键机制，包括：加强卫生部门的行政能力，降低卫生提供者的交易和政治成本，以及提供者对行政制裁的恐惧。
本研究有助于有限的关于卫生系统中法律赋权案件解决机制以及混合法律赋权和社会问责方法的影响的文献。未来的研究可能会评估案件解决的可持续性；中央、省和地区各级治理受到类似计划的影响程度；以及法律赋权所涉及的不同案件组合对计划成功的影响程度。
