Background:

1
Background

• Mozambique situated in southern Africa
• Borders countries South Africa, Swaziland,
  Tanzania, Malawi, Zambia and Zimbabwe.
• Total area 801,590 sq Km
• 11 provinces and 133 districts
• Population 16,099,246 (July 2002 est.)
• 72 of the population live in rural areas
• illiteracy 60.5 of population

2
Mozambique

• Capital Maputo
• Pop- 2 millions

3
Health Status

• Population growth rate 1.13
• Birth rate 36.41 births/1,000 population
• Death rate 25.13 deaths/1,000 population
• Infant mortality 138.55 deaths/1,000 live births
• Life exp at birthtot population 35.46 years
  female 34.65 years male 36.25 years

4
Socio, historic political context

• 1458 1975 Colonial period
• June 25th, 1975 - Independence
• 1975 1992 civil war ? destroyed most of the
  infrastructures (mostly health, education tele
  and communications)
• Trained people left the country 5 doctors!!!
• Peace aggreement signed
• 1992 ? .... National reconstruction (after war,
  floods, ....)

5
ICTs Maputo

• 50 of the ICTs and related technologies are
  located in Maputo
• Survey 31000 and 2 10000 inhabitants share a
  computer and use internet respectively

6
Challenges

• How implementation is related with communication
  practices?
• What can we do about it?

7
Health system hierarchy
Health Information System
8
Health district Xai-Xai
9
Health Information System (HIS)

• information flows between levels paper-based
  (forms ? reports)
• data are collected at health facilities from
  communities, aggregated and collated at district
  levels
• communication did not always follow a fixed
  pattern
• communications depended on many external
  conditions, often out of control of the health
  officers responsible for communication

10
HIS

• The information collected at facility levels and
  handle at district level consists basically of
  aggregating the forms from the health facilities
  into district forms, which are then submitted to
  the province.
• Lack of skill and training of the personnel of
  the district health ? data are not kept in a
  systematic way on a health facility basis.

11
HIS

• Because of these problems of communications, the
  weekly and monthly health reports were sent to
  the upper levels very late
• Local people showed little motivation and
  commitment to communicate with the upper levels

12
HISP

• Mozambique in 1999
• Eduardo Mondlane University MISAU
• Pilot districts located in remote rural areas
  with relatively good infrastructure
• Actions
• Research
• Training seminars

13
Communication at different levels

• Health unit ? health district
• Health district ? province
• Province ? MoH (MISAU)

14
Counter networks ? Castells

• Globalization and Marginalization
• Exclusion vs Inclusion
• Health Information
• Information Communication Technology

15
System Develeopment context implementation

• The culture of communication
• Nature of work practices
• Methods/processes of communication
• Constraints to communication
• Experience with new ICTs
• How can new ICTs be integrated effectively into
  work practices at various levels
• Resistance to technology .. question of identity?

16
Expectations ...

• Assessment of current constraints to
  communication between district and provincial
  levels in HIS, and how these can be made more
  effective.
• Theoretical model to help understand the
  interaction between ICT and communication
  practices in the health districts.
• Help to produce social change on the ground in
  terms of improved information management in the
  district health system in Mozambique (???)