Grievance Redress Mechanisms (GRMs) – formal processes for assessing and resolving complaints – are viewed as empowering citizens in the global South, but the effectiveness and of such mechanisms are often questioned. New evidence from Mozambique sheds light on how GRMs can be better designed and trusted by those using them.
A recent study by the POTENCIAR programme provides a renewed perspective, alongside academic literature and experiences of developing GRMs for health programmes in Mozambique, Pakistan, and South Sudan.
In Mozambique, GRMs, such as complaints boxes, help desks, community forums, and call centres, enable citizens to record complaints about the poor provision of a service, public good or duty. For example, citizens may raise issues with the way they receive medicine in a health facility, the state of roads in a neighbourhood or discrimination by a police officer.
Can GRMs be more than paper tigers?
GRMs aim to resolve complaints and empower citizens to raise their voices. This may be done immediately by righting a wrong, communicating what actions will be taken in the future or explaining why something cannot be resolved in the expected way due to wider circumstances. This is called ‘closing the loop’. Whilst it is essential to not unduly raise citizens’ expectations, it is also important to understand whether GRMs can be more than powerless paper tigers.
As discussed in a POTENCIAR webinar on this topic, many governments in the global South have implemented GRMs to monitor and improve the provision of services, often with support from donors. In Mozambique’s health sector, the current National Strategic Plan (2014 -2024) refers to the intention to “improve the quality of the services provided, through the guarantee of humanisation in care based on user-oriented services”. Naomi Hossain and colleagues point out that this phenomenon has paradoxically occurred as the space for other types of civic action has been closing.
Why do complaint systems matter?
The growing move to establish GRMs raises questions about motivations: are they genuinely intended to offer opportunities for raising citizens’ voices, or do they reflect a misplaced faith in bureaucratic solutions to rectify poor service provision? Worse, are they driven by the need to fake responsiveness or to divert, dilute and quell citizens’ anger?
There are a range of ‘good’ reasons for establishing GRMs from both the government and citizen’s perspective, including:
- Technical considerations that view feedback and resolutions to improve public services.
- Increasing demands from citizens for accountability and the humanisation of services that have long operated with impunity.
- Progressive governments may install complaints systems to tap their democratic potential, hoping that citizens will form participatory bodies to help govern them and advise duty bearers.
- Intra-governmental motivations for using citizen-generated data to monitor agencies and actors within the government
As should be clear from at least two of these, GRMs are not only a matter of technical design and information flows but they need to also carefully consider power relations.
Designing for a ‘complaints’ ecosystem
The existing literature on GRMs in the Global South, alongside new evidence from Mozambique provides lessons for how to develop effective GRMs within an ecosystem where complaints are addressed and outcomes trusted:
GRMs should be designed with existing cultures of and community structures for complaint raising.
POTENCIAR’s study indicates that, in northern Mozambique, community liaisons or local leaders are the main channel through which people express their grievances on health service delivery. This is in part due to high illiteracy rates and the inaccessibility of other more formal GRMs, but also due to the existing informal culture that is particularly prevalent in the context of rural Mozambique.
To improve trust, GRMs must be staffed by and owned by the users of the services.
GRMs should directly include those using the services they are designed to improve or be integrated within existing structures, such as civil society organisations.
In Mozambique, there is a fear of repercussions when complaints cannot be lodged with a trusted community member. One of the requirements for processing complaints using formal GRMs such as complaints books and hotlines is the identification of the complainant, which often deters users from using these mechanisms. Even liaisons between the community and health facilities, such as co-management and humanisation committee members, are not wholly trusted at times, due to their proximity with service providers at health facilities.
GRMs should provide multiple routes for raising complaints.
Citizens do not always have the capacity or means to lodge complaints through written methods, telephone helplines or internet platforms. They may also fear face-to-face meetings with service providers or users’ committees made up of local authorities. Accordingly, GRMs should offer multiple safe ways to lodge complaints, ensuring that they are inclusive of diverse capacities and hidden power structures.
POTENCIAR identified multiple GRMs present in health facilities in northern Mozambique, namely as complaint and suggestion boxes, complaint books, co-management committees, and telephone contacts. There is also a strong guiding policy framework in the health sector for GRMs. However, authorities need to recognise that those who operate these GRMs must become more aware of the relational and power-related obstacles to users utilising these GRMs, and that they need to be adapted to make them more amenable and user-friendly for the most marginalised and powerless users.
GRMs require the buy-in of frontline staff and those duty-bearers that govern them.
Front-line staff may perceive GRMs as an extra burden to workloads or as unwanted surveillance mechanisms. Accordingly, the benefits of GRMs must be explained to them, and incentives to collect and respond to complaints offered. Similarly, it is crucial that duty bearers at higher levels, from senior civil servants to politicians, are interested in the functioning of GRMs. This can give them the ‘teeth’ often needed to ensure poor performers improve or are sanctioned.
POTENCIAR observed several health providers and authorities who understood the need to improve both the humanisation of health services and the mechanisms for managing complaints. Leaders of health facilities and co-management committees expressed an interest in acquiring more training and learning from the experience of other health facilities in the country.
However, there is a fear on the part of service providers that receiving more complaints and grievances without the ability to offer improved services, will lead to stronger feelings of unmet expectations within the health sector. To address this concern, the promotion of mutual learning with other contexts should include experiences that show how the strengthening of GRMs may have contributed both to the improvement of working conditions of health providers and to an increase in the level of user satisfaction with the quality of the services received.
Unlocking the potential of GRMs
It’s clear that GRMs are not quick fixes. POTENCIAR’s evidence from northern Mozambique shows that GRMs are embedded in the power and politics of the places, institutions, and state-society relations they seek to change, and therefore progress takes time. Their design must account for both the demand (raising complaints) and supply (responding to complaints) sides of their functioning. This entails securing buy-in from citizens and duty-bearers, building their capacities where necessary, and always ensuring safety is prioritised.
Importantly, GRMs cannot be faceless. They must create opportunities for citizens to engage duty bearers and, in turn, duty bearers to explain the way they govern. This should go some way to ensuring the trust in GRMs is built and that they fulfil their potential to transform how and by whom services are delivered, in Mozambique and beyond.
