Strategic Approach 2 - Health Services Quality Monitoring (Health Accountability)

The AE 2 aims, essentially, to mobilize the communities in order to facilitate their participation and engagement in processes of monitoring the quality of the provision of public health services at local level, with a view to improving the quality of these same services through the identification and resolution of identified problems, based on the use of Community Punctuation Cards (CPC). The CPC is a tool that allows the users of public health services to participate, in an organized way, in the monitoring and evaluation of the quality of these services. It creates conditions for the interaction, "healthy dialogue" between the community and service providers, aiming to identify gaps, concerns and needs, and also to find consensus and alternatives for improving public health services provided to the citizen / community. CPC is used to inform and solicit community members of their opinions about the quality of public health services. By providing opportunities for direct dialogue between service providers and the community, the CPC process "empowers" citizens to make their voices heard and to demand the provision of quality public health services.

With this tool, N'weti aims to ensure that users have a voice in improving the quality of the services they receive and to create greater accountability and mechanisms of accountability on the part of the providers, thus helping to create bases in the communities that foster an environment of constructive dialogue between users and providers and catalyze social and behavioral changes.

In this way, we intend to contribute to creating bases in the communities for an environment of constructive dialogue between users and providers and to catalyze the necessary social and behavioral changes leading to better health services, both in terms of PF and malaria.

With the quality monitoring component of public health services of FP and Malaria we intend to contribute to demystify the main individual and institutional barriers associated with the access and use of these services as well as to reinforce knowledge and contribute to the communities to make informed, consequently, have more and better health.

CBOs and Nweti partner CSO platforms, from which about 90% of Community Facilitators come from, will ensure monitoring of these services through a permanent dialogue with the various committees (Co-management and humanization and health) established for various levels.

The development of these approaches will be supported by a set of specific tools already in use in the N'weti programs, such as the Community Punctuation Card (CPC), the anti-malarial monitoring form and policy briefs. To this end, the main tools of quality monitoring of these services will be adapted, aiming, among other aspects, to combine in a single tool some of the quality indicators defined by MISAU and others defined by the community as users of these same services. A rigorous training process for CBOs and community facilitators will be carried out for both interventions, to which will be added an intensive technical support process to ensure that it meets the quality standards that N'weti has printed for interventions of this nature. The strengthening of the Committees for Co-management and Humanization will be fundamental to ensure the necessary interconnection between the various stages of this process, its participative character and the required sustainability.

The implementation by N weti of the monitoring of quality of health services using the CSC is relatively recent. In fact, the CSC pilot cycle was carried out at the end of last year in the southern zone and in early 2015 was the expansion of this initiative for the province of Nampula.

Mozambique has a favorable political and legal context for the participation of citizens in monitoring the quality of public services, which is very positive. For example, the Local State Law (LOLE), the Basic Law of the Organization and Functioning of Public Administration, and the provisions governing financial decentralization give rise to a greater participation of citizens in the monitoring of public services. At the level of the health sector a set of instruments and policies reinforce the desiderato to guarantee the participation and involvement of the citizen in the monitoring of the health services, among them the Strategy of Promotion of Health; the Community Involvement Strategy; the National Strategy for the Improvement of Quality and Humanization of Health Care, the Family Planning Strategy and Contraception among others. However, there are still huge challenges for the active participation of the citizen to materialize and produce visible effects on the functioning of the public administration. There are a number of reasons, ranging from the lack of government openness to criticism, weaknesses of citizens and civil society organizations regarding effective forms of dialogue and pressure on the government, socio-cultural barriers, fears of reprisal, political connotation, among others .

This report is drawn up in the context of the actions to monitor the quality of health services carried out by N weti. Being the relatively new N weti experience in this area, the document reflects some aspects related to CSC implementation. The report begins with a section describing briefly the political-legal context that informs citizens' participation in monitoring public services in Mozambique. The following is the methodological approach used by N'weti in its actions to monitor the quality of health services using the Community Scoring Card (CSC). Reference is made to the health units evaluated and to the characterization of the groups of participants involved in the evaluation process.

Central part of the document is reserved for the presentation of perceptions of users and providers around the quality of services provided by eleven health units in the province of Nampula. This section focuses on a more comparative analysis of the perceptions of both actors, followed by a brief discussion of the results of community and provider perceptions. Following are two sections which address the main priorities out of the interfaces and the implications for advocacy and the other dedicated to reference some changes in attitudes and practices in health units evaluated induced by the CSC.The document concludes with a conclusion and indication of a set of challenges and lessons learned by N weti in the implementation of the CSC.