Grievance Redress Mechanisms in the Health Sector

In recent years, many governments in the Global South have integrated Grievance Redress Mechanisms (GRMs) into their governance structures to monitor and improve the provision of services. However, the implementation on the ground of these GRMs has yet to be fully explored. This study sought to plug this gap by mapping the complaint processes, assessing the capacities and motivations of health authorities, and evaluating the usage and perception of existing grievance systems in the health sector in northern Mozambique. An action-research-learning approach was used, combining qualitative and quantitative methods, including in-depth interviews, focus group discussions, and non-participant observations across 26 health units in Nampula and Monapo districts. The primary data was supported by lessons learned from case studies from South Sudan and Pakistan.

The findings reveal that grievance mechanisms, such as user health offices and complaint boxes, are scarce and often unknown to users, with only three health units equipped with user health offices. There is a significant distrust among users towards local grievance mechanisms, leading them to direct complaints to higher authorities instead. The study identified a predominance of informal practices aimed at protecting health units from scrutiny rather than addressing user concerns.

These findings highlight the need for a formalized and transparent grievance management system. The study recommends clarifying departmental roles in complaint management, enhancing training for health sector actors, and establishing a reward and sanction system to foster accountability. Strengthening grievance mechanisms and improving communication are crucial for increasing user engagement and trust in the health system.