Quality Control, quarterly reports, and governance committees - learnings from Mozambique

Dear Friends, I recently spent a couple weeks with Namati’s right to health team in Mozambique. I’d like to share three practices that team has evolved to deepen their impact. I think these could have relevance for legal empowerment groups working in any sector, from land to legal identity to gender based violence. I would love to hear from network members: do your programs already employ strategies like these? Or could these be usefully adapted to enhance your work?

1) Regular and randomized quality control

Every month, “program officers” (who each supervise about 8 paralegals, known as defensoros de saude) randomly select 2 or 3 cases (salesforce does the random selection) and, for those cases, program officer reviews the file, discusses the case with the paralegal who handled it, and interviews the client. Program officer asks the client things like: were you satisfied with the way your case was handled? Were you satisfied with the outcome? Did you learn anything in the process? How can we do better?

This keeps the paralegals on their toes and keeps us all in touch with the direct experience of our clients. I could imagine some version of this working well in many paralegal programs.

2) Quarterly reports to government.

Every quarter, the team submits a report to the health ministry leadership at district, provincial, and national levels. The report provides highlights from the case data, describes patterns that the team is seeing, raises issues that need to be addressed. (For example, alerting officials that we’ve seen a particular health protocol implemented incorrectly in multiple clinics). The team usually follows up the report with an in-person meeting.

This keeps the government informed of our work, and sets up a regular opportunity to “turn the wheel” from grassroots experience to systemic change.

It is in part because of this regular reporting that we were asked to help draft a policy for the “humanization” of health services.

Would it be useful for paralegals in India do similar regular reports to the Ministry of Environment in the districts and states where we work? What about Sierra Leone? Citizenship paralegals? Organizations proecting community land rights reporting to ministries of land? Perhaps less relevant in places like Myanmar, where legal empowerment work is more under the radar?

3) Vitalizing Village Health Committees, and a dynamic conception of paralegal catchment size.

In principle, village health committees are a structure by which community members can take part in the governance of their health services. But in Mozambique, as in many countries, the committees have largely existed in name only. Defensoros have vitalized these committees-- ensuring that empty seats are filled with committed individuals, educating committee members about the full scope of their role and about the details of health policy. These committee members become our super-clients-- initiating many cases, and taking part in regular dialogue and advocacy with the health ministry.

In our best sites, these committees wonderfully embody the ideals of public spiritedness and citizen empowerment. As the committees become strong, the paralegals have come to play a smaller role, in turn allowing the paralegals to increase their catchment size to include another health facility. If we can reproduce this dynamic-- where paralegals reduce the intensity of their engagement and increase their catchment size over time-- it makes scale-up more plausible and less costly.

These committees are akin to the land management committees that our community land protection partners engage, or to “school management committees” in the education context… I’m curious as to whether there might be some useful learning between legal empowerment efforts across sectors, about what it takes to turn nominal structures into active, empowered governance institutions.