Namati: Innovations In Legal Disempowerment For Health? A Sierra Leonean Case Study

Drawing on eleven weeks of fieldwork for Namati’s Health Accountability and Social Empowerment Program, this case study investigates whether Namati interventions reinforce existing formal and customary structures for the amelioration of grievances between health clinics, their associated staff, and intended beneficiaries. Furthermore, this study questions Namati’s role as an organization that fosters sustainable change at: the level of the grassroots in its ability to influence government health policy, and at the level of the elites in its ability to improve administrative and policy deficiencies in the area of health access. Finally, this study answers critical questions on the equity-enhancing effects of paralegal interventions towards beneficiaries of health services. An analysis of Namati using concepts developed in Harri Englund’s Prisoners of Freedom showed that: 1) Namati is not above scholarly critiques of development and multilateral institutions; 2) Namati works to enhance preexisting governance capabilities in the area of health access; 3) Namati works to enhance partnerships with local engines for health service delivery as a way to augment its interventions and solve the sustainability question; 4) Namati works to enhance the ability of claimants to understand the relevant health-related laws and maneuver within them; 5) Namati – unlike NICE in Malawi – works to contextualize its interventions by engaging with higher-level policy and administrative organs, despite some deficiencies and; 6) Namati paralegals are not immune to desires for status distinctions. The findings in this case study should be combined with future fact-finding missions in other districts in Sierra Leone to determine whether Namati and its donor partners should recommend scaled-up interventions