Namati is a Sanskrit word that means “to shape something into a curve.” Martin Luther King Jr. said that “the arc of the moral universe is long, but it bends towards justice.” We call ourselves Namati because we’re dedicated to bending that curve.

This video was generously produced by Skoll.org, a long-time partner of ours.

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A growing body of evidence globally indicates that maternity patients are particularly vulnerable to bribery, illegal fees, abuse, and neglect by health workers. Mistreatment of pregnant women — and the fear of mistreatment by pregnant women — is a significant barrier to facility-based deliveries and access to postpartum services.

The post Break the Silence: Denounce Bribery in the Health Sector appeared first on Namati.

It was during one of these assessments at Ndlavela Health Centre in Maputo that community members shared their concerns regarding the pharmacy technician’s failure to respect patient confidentiality. In organizing the queue to collect medicines, he regularly used expressions that revealed the type of illness people had come to treat, humiliating many patients and consequently undermining adherence to antiretroviral therapy (ART) for the treatment of HIV.

Simão, a 48 year old ART patient, was among those who shared their experience:

“I went to Ndlavela Health Centre for follow-up consultations. After being attended to, I went to the pharmacy to collect my medication as usual. While I was in the waiting area, the technician on duty said: ‘Those who have come to collect HIV medication go to the second window’. The attitude of the technician made me ashamed and embarrassed because the other people who were there looked at us and took notice of the disease we have. In fact, after this episode, I did not set foot in the hospital for some time because it really affected me.”

The health committee members and health advocate requested a meeting with the pharmacy manager and clinical director of the facility, Dulce Paulo. “It was not the first complaint that this health center had received involving the same health provider,” acknowledges Paulo. “He had repeatedly violated the rights of patients undergoing HIV treatment. This situation was worrisome as we had begun to register poor compliance at the pharmacy for drug collection.”

After discussing the issue with the health advocate and health committee, Paulo and the pharmacy manager met with the technician in question to give him a verbal warning and explain the importance of respecting patient dignity and confidentiality.

Over the course of the next month, the health committee and health advocate monitored the behavior of the pharmacy technician. To their dismay, his problematic actions continued. The health facility leadership consequently transferred him to the pharmacy warehouse, where he currently works as a stocker and packager of medicines, without any direct contact with patients.

As the clinical director concludes, “In coordination with members of the health committee and the health advocate it was possible to overcome the problem.”

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From January to December, Namati and our partners supported 25,000+ people in 6 countries to address injustices involving land, environment, healthcare, and citizenship. Together, we achieved remedies that directly improved the lives of 300,000+ people, and systemic changes that affected millions more.

We invite you to explore the stories behind these facts and figures in our annual impact report. 

In these pages, you’ll also discover how the Legal Empowerment Network drove our movement for justice forward by fostering deep learning among members across borders and by co-launching a global fund with the goal of investing $100 million in grassroots justice efforts worldwide.

The post 2021 Impact Report – Now Available appeared first on Namati.

One such patient, a 36-year old male who preferred that his name not be published, shared his experience. 

“I went for an appointment because I wasn’t feeling well. When I was in line, I started to experience stomach pains. I had to run around the health facility looking for a place to go to the bathroom. There was a toilet for patients, but after I peeked inside and saw how filthy it was I couldn’t bear to enter. I had no choice but to run behind a tree just to get some relief. It wasn’t a hidden thing. A lot of people were watching me in this situation, and I couldn’t escape from it. It was very embarrassing and upsetting for me.

“We have HIV-positive patients and TB patients taking drugs that can cause diarrhea. When these people go to a health facility without proper sanitation, they don’t feel comfortable. They think “let the diarrhea pass and then I’ll go to the hospital”. Others run the risk of missing their appointment. They prefer to stay at home where they are not surrounded by many people.

“Having experienced this shame when I went to the hospital, I took the opportunity to raise my concern at one of the health committee meetings here in the community. The committee invited me to help find a solution to this problem. We went to the health facility and asked to speak to the person in charge, but … he claimed to have no funds and referred us to the District Health Directorate. They too said “we also have no funds for the time being, but we will see what we can work out with our partners.”

Following several advocacy meetings, the District Health Director committed to finding a solution. A few months later, public toilets were built in Jangamo, Ravene, and Mutamba Health Centres.

“Today, everybody is comfortable. After seeing this issue resolved, I felt relieved. I felt very good because the benefit wasn’t just for me. It’s a benefit for the whole community. I think raising my concern was good for a lot of people.”

The Jangamo District Health Director, Carlos Issaca Simango, credited the collaboration between patients, the village health committee, and healthcare professionals for being able to resolve the issue.

“Following this joint work with the health committee and co-management committee, in coordination with development partners, it was possible to build conventional toilets in all the district health facilities which did not have them.  Our experience using the participatory health facility assessment process has made it much easier to ensure the equitable growth of all health facilities across the district, and we have seen greater user satisfaction with our health services.”

Banner image: A patient living with HIV (left) collaborated with a Namati’s health advocate (right), and village health committee members to ensure all health facilities in the district had toilets.

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In the process of gathering feedback from the community regarding the challenges they face in accessing care at Chamanculo Health Centre in Maputo, the village health committee heard numerous complaints about breaches of confidentiality and privacy during these vital post-test HIV counseling sessions. The sessions were being conducted collectively — with multiple patients receiving their results together — and in the presence of other staff who were regularly coming into the room to file patient records.

The lack of privacy undermined the patients’ willingness to share personal information and ask questions. “They didn’t feel comfortable when they came in for care as they were ashamed to talk about their lives in an environment where strangers were present,” explains Hermenegilda Naftal, a member of the Chamanculo health committee. “At one of the health committee meetings here in the community, patients went so far as to say that they are afraid to return to the hospital to continue their HIV treatment because of lack of sensitivity on the part of counselors who do not respect confidentiality.”

To address this problem, the health committee members, along with a Namati health advocate, met with the head of the HIV department and the director of the health center. Both of them acknowledged the problem and pledged to take action. The health facility director called a meeting with the counselors involved to discuss the importance of providing humanized services during counseling sessions. She also convened the health facility management and together they identified an unused room in the maternity ward that could be used to accommodate counseling services and address the privacy concerns.

“[N]ow you can see that the environment in which care is provided is healthy and complies with the standards recommended by the national health system,” says Dr. Regina Macovela, director of Chamanculo Health Centre.  “There’s also a sense that the providers are now more comfortable asking questions and talking with their patients. What I mean is that this problem was not only concerning for the health committee and the patients in terms of negatively impacting the demand for HIV testing; it was also negatively affecting health providers’ ability to do their work.”

The village health committee and health advocate have monitored the situation since the changes have been made and are happy to confirm that post-testing counseling sessions are conducted on an individual basis, in a room offering privacy and separated from the center’s filing cabinets.

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We are excited to share that the COVID-19 Grassroots Justice Fund has reached its goal of raising and distributing $1 million USD in rapid-response, flexible grants.

The second and final round of grantees includes 27 outstanding groups, all members of our network, who are rising to meet the challenges of the ongoing pandemic.

In Thailand, Community Resource Centre Foundation (CRC) is supporting communities to bring about the enforcement of environmental laws and seek remedies for harms caused by industrial projects. With gatherings and travel still restricted, CRC is using digital tools to assist community members to attend virtual public hearings, submit evidence, and move advocacy campaigns online.

In Kenya, Keeping Alive Societies’ Hope (KASH) is working to meet the justice and healthcare needs of the populations most affected by HIV, who face increased police brutality, homelessness, and limited access to treatment in the pandemic. Through radio campaigns, KASH informs these groups of their rights, ensures they have access to the COVID-19 vaccine, and sensitizes members of the public to the injustices they face.

Check out the full list of grantees — selected by a panel of leaders from across our community — on the COVID-19 Grassroots Justice Fund website.

Community members discuss local laws at a meeting in Kayin state, Myanmar. (Photo: Namati)

Members of the Legal Empowerment Network—now over 2,800 justice organizations from nearly every country—have struggled to rise to the challenges created by the pandemic while keeping their people safe. To support their vital work, we teamed up with several other partners in 2020 to create the COVID-19 Grassroots Justice Fund. With this second round of grantees, we have now fulfilled its goal.

We recognize that $1 million is a drop in the ocean. With more than half the world’s population facing injustices they cannot remedy, we need substantial and consistent investment in the essential work of grassroots justice defenders. Our community has been working hard to make that happen. The Legal Empowerment Fund (LEF), which launched in September, is a direct result of years of collective action. Recently the LEF, which aims to raise $100 million over 10 years, announced its inaugural open call for proposals, with a deadline of February 18th, 2022.

While the COVID-19 Grassroots Justice Fund has concluded, our work towards securing long-term financing for justice continues.

To the grantees and the thousands of others fighting for justice in the most difficult of circumstances: we see you, we thank you, and we stand with you.

With love and solidarity,

Vivek, Stacey, Sonia, Abby, and the whole team supporting the Legal Empowerment Network

This post was originally sent as a mailer to our subscribers.
If you would like to join our mailing list, click here.

The post We did it! The COVID-19 Grassroots Justice Fund has distributed $1 million to 60 grantees appeared first on Namati.

The nurse on duty quickly arranged for an ambulance to take her to Quissico District Hospital for a blood transfusion. Fortunately, Maria survived. Her baby, however, did not.

Later that night, as Maria was preparing to be discharged, a nurse approached and told her that she had to pay the equivalent of 70 USD for the blood and plasma she had received. It was a huge sum for Maria, who, like many Mozambicans, gets by on the food she farms and the small amount she makes selling some of her harvest at the market.

“I was outraged,” recalls Maria. “[But the nurse] said there’s no other way. ‘You can’t leave here until you pay. That’s the law.”

“[My family and I] borrowed money and pieced together half of the amount. We explained to her that after we buried the baby we would come back with the rest. The nurse said we could go but my health card and ID card had to stay with her to ensure I’d return.”

A week after the funeral, the nurse began to call, pressuring the grieving mother to pay. Maria was at a loss as to what to do. She needed her ID and health card back, but she had borrowed all the money she could.

“I was really sad,” confesses Maria. “First I lost my child, and then they charged me this fee. It was really so much money. … That’s when I called my cousin [for advice].”

Maria’s cousin put her in touch with Cézar, a Namati health advocate, and the Quissico village health committee (VHC). They explained to Maria that paying for blood or plasma is not, as the nurse said, “the law”. In fact, requesting payment for any health services or supplies that are supposed to be provided free of charge is punishable as a crime under Mozambique’s anti-corruption law, as well as the Ministry of Health’s anti-bribery policy, which Namati helped to instate.

They assisted Maria in reporting the incident to the hospital, and when the hospital asked for a meeting, they went with her. The nurse initially denied the charge, but at a second meeting, with the hospital director present, she confessed. She asked for Maria’s forgiveness and returned her money and documents.

From left to right: the Quissico District Hospital Administrator, Cézar (Namati health advocate), two members of the village health committee, and Maria

Maria says she was both happy and “relieved” when her money was returned. “First, because I had no way to return the money I had borrowed… And [because] I am now no longer afraid to go to the hospital… I went back and told my family and my community that if ever someone asks you to pay money for care at the hospital, they are robbing you. People didn’t know this before.”

Maria’s declaration is not an exaggeration. Few Mozambicans are aware of the laws and policies that protect their rights as patients, and some healthcare workers use this to their advantage.

Quissico District Hospital was infamous for bribery and illegal fees. During the regular education sessions that Cézar and VHC held on patients’ rights, numerous people had complained that they were made to pay for treatment. Those who did not pay were reportedly denied access to essential and, in some cases, lifesaving health services.

The hospital had attempted to address the issue but the power dynamics and fractured relationship between the community and the hospital proved to be major barriers. As the hospital director, Dr. Osório Trigo, explains: “Health providers tried to raise patients’ awareness about these things in the past, [but] no one ever approached them with concerns or complaints.”

Dr.Osório recognized that “patients [and] community members feel much more comfortable speaking with the VHC and health advocate.” After Maria’s case, he asked Cézar and the VHC if they would conduct a series of educational sessions for healthcare providers and patients specifically devoted to the National Strategy to Prevent and Combat Bribery in the Health Sector. They happily obliged.

Several months later, the VHC asked patients in the hospital and community about the practice of bribery. No new cases were reported.

“We’ve seen a huge change,” affirms Dr. Osório. “When it’s the voice of the community speaking, we can no longer ignore it. When they speak up we’re obliged to respond. … The health advocate and village health committee have really helped in terms of bringing the community and the hospital together.”

*name changed upon request

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Namati’s CEO, Vivek Maru, and legal empowerment advocate Rhonda Hamilton joined Hari Sreenivasan on Amanpour & Company to discuss environmental justice in the United States and around the world.

The segment, Our Lives Are Being Sacrificed”: The Fight for Environmental Justice, originally aired on CNN International and PBS on April 23rd.  You can now watch it on YouTube or by clicking the play button below.

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If, like me, you’ve felt blue at times during this last year, or tired, or hopeless, this 2019-2020 impact report might be a tonic. You’ll find here stories of ordinary people taking on grave injustice, and winning.

You’ll read how a grieving mother in Mozambique organized with her neighbors to end systemic corruption at the hospital they depend on. How communities in Myanmar stopped unlawful manganese mines from destroying their forests, water, and farmland. How residents from a low-income, majority African-American neighborhood in Washington DC forced the city’s largest infrastructure project to reduce its air pollution.

You’ll read how, tested by the pandemic, our global community of grassroots justice groups — over 2,400 organizations, from nearly every country in the world — has strived to meet this moment. How we came together to create the COVID-19 Grassroots Justice Fund, which has made more of that vital work possible.

Learning from our successes is important, because we face profound challenges. Several paralegals we work with in Myanmar are now in hiding, and one is in prison, because of stands they took in favor of democracy. Most team members with our partner in India are dealing with COVID themselves or caring for sick loved ones. In Peru, three Indigenous leaders — partners of our network member Derecho, Ambiente y Recursos Naturales — were killed in February and March 2021 for resisting illegal deforestation.

Worldwide, the share of the population in extreme poverty is likely to increase for the first time since the 1990s. The Director of the World Health Organization declared we’ve reached an era of vaccine apartheid. The global Democracy Index had its lowest overall score in 2020 since The Economist started tracking in 2006. And we are on course to experience catastrophic climate change, which will affect poor and exploited communities the most.

The only things that can conquer challenges like these are movements of people committed to justice. And our movement is stronger and more determined than ever.

We look forward to joining hands with you on the road ahead.

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