Under the implementation of the project “Sou Cidadão” (which means I am a Citizen), financed by the European Union through the Support Program for Non-State Actors (PAANNE II), the Citizen Observatory for Health (OCS) highlights the removal of the barrier of clothing in access to Health Units as one of the main gains.
According to Clélia Ponja Liquela, OCS project manager, speaking on Tuesday (March 28), in Maputo, at the Workshop on Balance and Sharing of Experiences regarding the initiative, several advocacy actions were carried out to ensure that the services provided by the National Health System (SNS) were more accessible and inclusive.
As a fundamental gain of the project, argues the manager, the Ministry of Health (MISAU) has decided to eliminate barriers in access to health services based on clothing and appearance.
“This was a gain. Today any citizen can access health units without being barred by their appearance or the clothes they wear”, Liqula said, explaining that another major gain has to do with the advocacy that has been carried out for the revision and updating of the Charter of Rights and Duties of the Patient (CDDD).
Regarding the CDDD, the OCS carried out a series of activities that consisted in submitting a petition to the Ministry of Health, as well as holding meetings with the Commission of Constitutional Affairs, Human Rights and Legality of the Assembly of the Republic, the Mozambican parliament, requesting its revision, since it is decontextualized for the current reality.
According to Ponja, the revision is already underway, and new guidelines have been incorporated. Currently, this time, it is in the appreciation phase for its subsequent approval.
“In addition to these issues, and because we also advocate for transparency in the health services, we managed to get MISAU to publish more information and reports on how to manage hospital resources”, the manager said, later adding that “the project ends here, but the activities continue. The OCS will continue to work on these fronts until we have a quality, equitable and inclusive health system.”
Despite these positive results, she recognized that there are several challenges, the main one being the need to continually advocate in networks and partnerships, covering more remote areas of the country.
“As a follow up to the work already started, we will continue to establish partnerships with other civil society organizations, as well as with different parts of the Government. We also want, through our work, to reach more distant regions, we don’t want to stay only in urban centers, we would like to go more to the districts and remote zones.”
“So, we want to do work not only at this centralized level, we would also like our work to be more inclusive, to bring in particularities of persons with disabilities, who face challenges in terms of access to the Health Units themselves, as well as to medicines.”
There is a Need to Strength Mutual Dialogue
For his part, the Executive Director of the OCS, Jorge Matine, argued that, as progress registered throughout the Sou Cidadão Project, in addition to the issues of clothing and CDDD, the dialogue between the monitoring groups of the public services has been strengthened.
“It is not easy. As we should know, we operate with different dynamics in terms of understanding some governance indicators, quality assessment, coordination of services, ensuring the participation of individuals in the design and also in the monitoring of public services.”
“We all came out as winners because we learned and today, we are stronger because we are invited by the Government or other partners who are managing public services so that we can participate in the planning and design of activities.”
According to Matine, in all activities inherent to public health services, OCS always invites partners from the Government and other monitoring organizations, as it is only by working in partnership that progress can be made.
In another development, he pointed out as another gain the advocacy for the end of illicit charges and the reduction of the user fees applied in some Health Units.
On the other hand, the quality of services, the absence of service providers, as well as the scarcity of resources for hospital operation are also other issues that make the range of concerns of the OCS.
“This was a project that, above all, we implemented at the time of the Covid-19 pandemic, where a large part of the public services was operating with limitations, some of them closed”, he noted.
As an example, he highlighted the fact that several consultations and surgeries were cancelled, which is a learning experience for understanding the challenges that the public system has in providing health services for all.
The OCS Executive Director reiterates that for the results achieved to last, the space for dialogue between civil society and decision makers must prevail.
“How can we ensure that actions, like the barriers we had for clothing, do not return to public service? That we don’t go back to having services limited or being barred because of clothing, religion, ethnicity or physical characteristics?”, he questions, reiterating the need to establish a permanent dialogue.
IMPROVEMENT IN SERVICE DELIVERY
In its turn, the CESC agreed that with the implementation of this initiative, the Government, at institutional level, is already starting to respond to the concerns of the citizen.
As an example, the operations manager at CESC, Berta Bunguele, said that the allocation of means and human resources to address the concerns of the communities is already being registered.
“We are also beginning to notice that there are changes in terms of quality in service delivery, as well as noticing that there is a reduction in cases of absenteeism or delay in starting activities in the health units. This is very good”, she acknowledged.
“We have also noticed that the community participates in the management, through the co-management committees created in the health units, and they also already make some enquiries to understand how the control of medicines is done, as well as the dissemination of information at the community level”, she added.
The responsible of the project at CESC, André Manhice, explained that “I am a Citizen” is an initiative to support non-state actors, financed by the European Union. The project comes to an end after five years of implementation, having contributed to the improvement of the quality of education and health services.
The CESC, at the level of the health sector, was making interventions in the communities, through the assessment of the quality of the service, such as monitoring the delivery of services in the communities, and based on this, it was doing advocacy actions at the national level, for the benefit of the communities.
“In general terms, what we have noticed with the implementation of the project the significant improvement of Government actions in the Sanitary Units”, he stressed.
As an example, he said that in the Health Units of central province of Sofala, central province of Tete and southern province of Inhambane there was a greater investment to improve the quality of the waiting rooms for pregnant women and improvement of service provision by the health technicians.
In these health units, he said that there are no longer many complaints about poor service, as well as about the diversion of medicines, because the community itself participates in the process of managing them.
He also said that there has been improvement with regard to the allocation of technicians.
“Essentially, our approach is to show that if there is interaction and dialogue between the community and the district. It is possible to identify and solve the problems of the community”, he concluded.
The “I am a Citizen” project, which is already in its final phase, is an initiative funded by the European Union which aimed, among several objectives, to improve the quality and efficiency of public services provision in Education and Health in five provinces, by strengthening the involvement of citizens and civil society organizations in monitoring services and advocacy of public policies.