A school to train activists for the right to health in Mozambique

Health is much more than the absence of disease and working to improve its conditions transcends biomedical research.

These are some of the starting points for the reflection of the members of the Aliança para a Saúde, a coalition of ten civil society organizations that work in the field of health in Mozambique, but that have tried to give their commitment a twist, at the same time, innovative and renovating.

Their approach tries to lay the foundations for citizen demands and for this reason they focus their work on three pillars: training, research and advocacy on public policies.

One of the key pieces of this strategy is the Escola de activismo em Saúde (School of health activism).

It is a platform to give citizens the tools to become activists for that right, a structure that aims to improve the training of activists and make their claims more efficient.

This new school has been thought of as the lever that will trigger the process for change to occur.

The 'Escola de activismo em Saúde' is a platform to give citizens the tools to become activists for the right to health

During the last year, the center has offered courses, for example, in "social determinants of health", which is the theory that goes beyond the clinical approach to care and focuses on economic, social, environmental or cultural issues;

It has trained in the use of digital tools for communication and political advocacy, and has improved knowledge in nutrition or primary care.

More than a hundred activists from Mozambican social organizations have participated in these activities, which combine digital and face-to-face formats to increase their reach.

Training activities of the Aliança para a Saúde held in Maputo. Miranda Munhua / APS

In reality, the struggle in Mozambique for health improvements has a very long journey, but the Aliança intends to respond to new challenges and threats. “Health is being commodified and the privatization of services influences the lack of access, because most of the population cannot pay for them,” explains Violeta Bila, Aliança coordinator, at the Médicus Mundi headquarters in Maputo. The expert also highlights the inequalities in the country: "The further you move away from the center of the cities, the more difficult it is to access and the situation is increasingly worrying."

“With the training that [citizens] will receive,” says Graça Júlio, coordinator of the program against gender-based violence at Fórum Mulher, from the Mozambican capital, “citizen awareness will be awakened and the possibility of working for the recognition of their rights and It will lead them to act as agents of change.” Júlio hopes that this pressure will influence the programs and policies adopted by the authorities.

The new focus of the Aliança and the heterogeneity of its members leads it to present itself as a movement rather than as a formal entity. The list of promoters is made up of Medicus Mundi and its long experience in supporting the country's primary health system; N'weti, which has made communication its tool for transformation, and the Associação de Litigância em Direitos Humanos, specialized in judicial processes; organizations that emphasize the fight against gender discrimination or sexual and affective diversity groups, such as Fórum Mulher, Lambda or Hopem;associations focused on monitoring the actions of the authorities or strengthening civil society, such as the Observatório do Cidadão para Transparência e Boa Governação no Sector de Saúde (OCS) or Centro de Aprendizagem e Capacitação da Sociedade Civil (CESC), and others with very limited areas of action such as Saber Nascer, dedicated to maternal and child health, and Kuhluka, which focuses on the fight against gender-based violence.

The fight in Mozambique for sanitary improvements has a very long journey, but the Aliança intends to respond to new challenges and threats.

At the birth of this coalition is, as Graça Júlio says from Maputo, a way of “approaching health work from the deconstruction of ideas that approach it only from the point of view of the disease”. Those “social determinants of health”, which appear repeatedly in the conversations with all the representatives of the organizations that make up the Aliança. Violeta Bila, who is also MedicusMundi's advocacy coordinator in Mozambique, considers that the need to broaden the approach has become "particularly evident" with the arrival of covid-19. "It has become clear that a multidisciplinary and integrated approach was necessary to solve the problem," says Bila, and clarifies: "It is not just a clinical problem, but a social, cultural, environmental or transport problem,and that is what we want to show”.

The Aliança assumes and defends that the fight for the right to health is multidimensional, as specified by Ilundi Durão de Menezes, coordinator of the communication department for social and behavioral change of the N'weti organization. This expert recalls that in Mozambique "the health network is fragile, deficient and incipient in terms of its coverage, equipment, human and financial resources" and that for this reason "the space of influence of the citizen is essential to contribute to the progress and improvement of health outcomes”. However, he explains that the capacity of civil society to claim rights is “embryonic” and has many social, cultural and material limitations.

De Menezes also draws attention to other issues that condition activism, from the fear of reprisals by the authorities to "the historical conditions of conformity inherited from colonization", passing through some "opportunities for participation and access to spaces of decision conditioned to a social and gender construction”, that is, designed for men of a certain class.

In addition to the Escola, the Aliança makes a commitment to research work that is proposed as a way of gathering essential knowledge for claims. “Our proposal, for example,” says Clélia Pondja, research coordinator at the Observatório Cidadão para Saúde, “is very much geared toward our evidence-based advocacy, so for us it's very important to do research.”

The coordinator of the Aliança para a Saúde summarizes how the three pillars of the coalition's strategy are related: “The investigation serves to obtain the evidence for an informed incidence. Training offers civil society the skills to confront or dialogue with the system. And, finally, advocacy actions are the channel for training and research to bring about changes”.

Therefore, one of the merits of this movement for the right to health in Mozambique is the construction of a network that multiplies. Ilundi Durão de Menezes foresees that "the broadening of the base of citizenship rights and the synergies between the actors in the health sector will provide Mozambican civil society with greater solidity towards universal health coverage". Meanwhile, Violenta Bila insists that “the Mozambican Constitution recognizes universal access to healthcare, which is public, free and a right; but in practice it is not applied”. For this reason, Bila emphasizes unity: “In order for that right to be recognized and to achieve success in that defense, we have to work as a network, in a coordinated manner. That makes the voice much more powerful than when it is an entity or a person, who claims”.

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