THE AGS COOPERATION FOR HEALTH IN MOZAMBIQUE

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THE AGS CO-OPERATION FOR HEALTH IN MOZAMBIQUE

• Africa Groups of Sweden (AGS) workshop, 28.04.07
• Uppsala, Sweden

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Contents

• Country context
• Health System in Mozambique historical overview
• Challenges for Health System in Mozambique
• The role of Co-operation
• Co-operation of AGS with Mozambique for more than
  30 years
• The Government Strategic Vision and the Future
  of Co-operation

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Country context (1)

• Population nearly 20 Million
• Absolute Poverty index 54,3 in 2004
• Epidemiological profile dominated by
  transmissible disease (Malaria, HIV, TB, etc) and
  SRH/MCH problems
• GDP/capita in 2006 US 318
• GDP expenditure on Health 3
• Public Health expenditure 14.1
• Government Development Strategy geared to reduce
  poverty and Accelerate Economic Growth

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Country context (2)

• Recurrent Health expenditure Availability
• From 8 in 2000 to US 14 per capita in 2006
• (but still far from US 40 recommended by WHOs
  CMH)
• Access to Health network
• 1 hospital/420,000 Inhabitants
• 1 health facility/15,500 Inhabitants
• Human Resources
• 1 health worker/1,500 Inhabitants (2,000 in 1997)
• 1 Mozambican doctor/33,000 Inhabitants (38,185 in
  1997)

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Health System in Mozambique historical overview
(1)

• Prior to 1975 (colonialism period)
• Mainly government and private-run urban hospitals
• Limited health services to the rural population
• Post-independence (1975)
• Massive departure of Portuguese doctors and
  nurses
• Major expansion of health services, mainly to
  rural areas
• Intensive training of basic and medium level
  health professionals, particularly MCH nurses,
  Medical Assistants
• Introduction of Primary Health Care approach
• Intensification of civil war in the 80s
• Disruption of the public health system and its
  gains destruction of health facilities, people
  fled to urban areas and neighbouring countries,
  including health workers

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Health System in Mozambique historical overview
(2)

• Peace agreement (1992)
• Complete recovery of rural health facilities(HF)
  destroyed and building of new HF
• No of HF 1,050 in 1992 to 1,336 in 2006
• Investing in HRH
• Training of health professionals 378 in 2000
  and 1,331 in 2006
• Consolidation of strategy of Delegation of some
  technical expertises to medium level
  professionals Surgical Technicians and MCH
  nurses (started in 1984)
• MDs 387 in 1990 and 798 in 2004
• Increased access to health services, and other
  public services
• 1,197 HF in 2001 to 1,336 HF in 2006
• Antenatal Care coverage 71 in 1997 to more
  than 90 in 2006
• Institutional Deliveries 44 in 1997 and more
  than 50 in 2006
• Fully vaccinated children (12-23 months) from
  47 in 1997 and more than 70 in 2006

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MDGs Indicators in Mozambique
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Challenges for Health System in Mozambique

• Major challenges
• Integrated and comprehensive provision of health
  services, PHC in particular
• Increase Human and Financial resources
• Improvement of management of both public and
  external resources available
• The HIV pandemic poses a significant additional
  pressure to the health system
• Seroprevalence rate in 2004 16.2
• More infra-structure and HR needed

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The role of Co-operation (1)

• Three distinct periods Two emergency periods and
  the current developmental time
• Emergency time (civil war 80s and post-war
  reconstruction early 90s)
• No refined coordination mechanisms during the
  emergency period gt priority criteria frequently
  under decision of cooperating partners
• Main areas of co-operation emergency
• TA medical doctors, nurses, and other areas of
  expertise
• Provision of drugs and medical supplies
• Direct provision of health services
• Training of Mozambican health workers
• Financial support to vertical programs

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The role of Co-operation (2)

• Main areas of co-operation for health
  development (from 1994 onwards)
• Gradual establishment of coordination mechanisms
  from Code of Conduct to SWAPs and implementation
  of three ones (co-ordination, monitoring and
  financing mechanisms)
• Budget support in the context of SWAP since 2000
• Still some financial support to vertical
  programs, but within the national policy
  framework
• TA mainly medical doctors, but also other areas
  of expertise
• Collaboration with national and international
  NGOs in the expansion and provision of health
  services
• Training of Mozambican health workers

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AGS more than 30 years of Co-operation with
Mozambique (1)

• Pre-independence (1967 1975)
• Moral and financial support to FRELIMO movement
  through campaigns and fund raising from Swedish
  Labour party, which included frequent visits of
  FRELIMO members to Sweden
• AGS specific support from 1968/9
• Fund raising
• Political mobilisation work through conferences,
  publications, information centres for the
  solidarity organizations
• Sending medical equipment and medicines

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AGS more than 30 years of Co-operation with
Mozambique (2)

• Post- independence
• 1976 deliver of medicines and the first surgeon
• From 1976 up to now 135 expatriates from
  different areas of expertise have worked in
  Mozambique, mainly in the north region
• More than 67.5 were medical doctors
• Others nurses, dentists, midwives, sociologists,
  psychiatrists, nutrition specialists, lab
  technicians, health science teachers, social
  workers, engineers, etc.
• Project implementation
• Oral health project (1985-1993) equipment and
  rehabilitation of dental clinics in Sofala and
  Maputo Central Hospital support to Beira Health
  Training Institution

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AGS more than 30 years of Co-operation with
Mozambique (3)

• Post-independence
• Project implementation
• Sofala project (1987-2001) Institutional
  Capacity Building in 2 districts housing for
  nurses, support to emergency services, Lab and
  Pharmacies, medical equipment and vehicles
• Emergency support civil war (1987-1996)
  refurbishment of health facilities, in-service
  training, rehabilitation and construction of
  health facilities
• Establishment and development of libraries of
  health sciences training institutions (1993-2005)
• In-service training on PHC (1994-2006) Capacity
  Building for health staff training at district
  level in Cabo Delgado province

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AGS more than 30 years of Co-operation with
Mozambique (4)

• Current support
• Continuing assistance by AGS
• HIV/AIDS (1987-2007) prevention activities,
  counselling and voluntary testing sites, youth
  friendly services, in-service training Cabo
  Delgado, Niassa and Nampula provinces
• School of Medicine (1993-2008) financial support
  to the traineeship of medical students in rural
  areas

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The likely impact of AGS Co-operation

• Impact on Mozambican Health Care System
• Rehabilitation and expansion of health network
  and services (financial support or direct
  investment)
• Quality improvement in health service provision
  TA, in-service training, refurbishment of health
  facilities
• Capacity building management, HR development,
  budget support,
• AGS has largely contributed to these outputs

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The Government Strategic Vision

• Government development strategy geared to reduce
  absolute poverty and accelerate economic growth
  (PARPA II, 2006-09)
• Keep the economic growth at a minimum of 5
• Reduction of poverty index from 54 to 36.4
• Priority sectors Infra-structures, Education and
  Health
• Increase access to water (41-53) and sanitation
  (35-37)
• Increase access to education (83 - 93)
• Increase access and uptake of health services and
  combat the main epidemic diseases in order to
  improve the health status these includes targets
  towards reaching the MDGs

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The Future of Co-operation

• The country still need external support, but in
  line with the Government framework (Government
  leadership, PARPA, harmonization mechanisms)
• SWAP as the way forward for financial support,
  including vertical programme support
• Improved collaboration with NGOs through
  contracting-out approaches and focus on
  government health priorities
• TA, mainly medical doctors will be needed for
  long time

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Thank you Obrigado Kanimambu