Health in Mozambique

A reference for the location of Mozambique within the continent of Africa

Health in Mozambique has a complex history, influenced by the social, economic, and political changes that the country has experienced. Before the Mozambican Civil War, healthcare was heavily influenced by the Portuguese. After the Civil War, the conflict affected the country's health status and ability to provide services to its people, breeding the host of health challenges the country faces in present day.

Mozambique faces a number of ongoing health challenges including both infectious and chronic disease. Limited access to quality food and water, high levels of poverty and inaccessible health services influence health and prevalence of disease among people in Mozambique. Through national and international organizations, public programming, clinical work, and education, Mozambique is working tto remedy these risk factors and to improve the health and wellbeing of its population.

Health Care System

The Health Care System in Mozambique has adopted various policies over the years in accordance with fluctuations in the health status of the population. Mozambique has experienced civic conflict, natural disasters, and more – all of which have contributed to the health challenges that the country has faced historically and in present day. One staunch divider of Mozambican history is the Civil War, which raged from 1975 to 1992.[1] This period in history is also useful in defining periods of change in the country’s health care administration.

Pre Civil War

Four scenes from the first English hospital in Mozambique.

Very little research on the subject of health in pre-colonial Mozambique exists today. However, according to historian Mario Azevedo, it has been agreed upon by experts in the field that collective national initiatives in health were not seen in Mozambique prior to the arrival of the Portuguese.[2] Shortly after Vasco de Gama set foot on East African soil in the 15th century,[3] colonization of the country began alongside Catholic intervention.[1] For the next 400 years, it is suspected that like many fellow Sub-Saharan African colonies, Mozambique’s health facilities were run by European Catholic missionaries in the area.[1] The Chicuque Rural Hospital opened in 1913.

Prior to the commencement of the Mozambican Civil War in 1975, the country had already been facing conditions of hardship since the 1960s.[1] During this time, the country was plagued with violence and poverty in accordance with its struggle for independence from Portugal.[1] Although very little is known about health initiatives in Mozambique throughout the nearly twenty-year period of violent conflict post-independence, it is known that period acted as a precursor and risk factor for many of the most prevalent health challenges the country faces today, due to the infrastructural health, environmental health, and social health impacts of war.[4]

Post Civil War

When the Mozambican civil war concluded in 1992, the country began making progress towards recovery through domestic and international aid initiatives.

One of the most notable international aid interventions was the Heavily Indebted Poor Countries Initiative, sponsored by the International Monetary Fund and World Bank.[5] In 1996, this initiative began helping governments reduce the debt they were incurring through public health spending, effectively encouraging them to promote these healthy initiatives in their countries.[6] With the aid of this initiative, federal expenditure on health care was able to increase from $4.6 billion USD in 1997, to $7.5 billion USD in 2002.[7]

The funds that governments saved with the help of the Heavily Indebted Poor Countries Initiative was left in the hands of poverty-reduction strategy papers (PRSP), whose primary responsibility was to ensure access of the poor to social resources - like health care - food security, and government transparency.[8] In Mozambique, two specific initiatives the PRSP pushed were (1) increasing community knowledge surrounding health challenges, diseases, and resources; and (2) preventing and slowing the spread of sexually transmitted diseases around the country through public health campaigns that increased public knowledge about modes of transmission and personal protection against STDs.[6]

More recently, domestic health policy initiatives have begun making their own contributions to improvements in the country’s health care, as well as through collaboration with international aid. In 2005, the Government of Mozambique formulated the National Public Investment plan – a nationwide initiative towards poverty reduction and social development.[9] Likewise, in 2015 the Government of Mozambique released Agenda 2025, which highlighted the goals for the countries long term social and economic growth as a framework for international aid partners around the world.[10]

In 2013, an integrated three-year plan for improved and expanded investment in public programming was implemented, including public health programming.[7] This plan, along with a medium term expenditure framework (MTEF) and a strategic health sector plan (PESS) laid forth a plan for the country to develop, monitor, and evaluate poverty reduction and social progression initiatives.[7]

Through the duration of these and more social programming in Mozambique post-civil war, an emphasis was placed on improving dispersion of resources for the prevention and treatment of Mozambique’s most prevalent health challenges, as well as towards improvement in public health education initiatives as a means of prevention.[11]

Substantial improvements in access to healthcare facilities has been made since the turn of the century, with increased governmental expenditure on health, increased funding towards the staffing and training of health facilities throughout the country, and a decrease in the population per clinic average by more than 50% from 1997 to 2007.[12]

Health conditions

Mozambique is plagued by a series of health conditions, both communicable and chronic. The most prevalent diseases in Mozambique include perinatal disorders, HIV, and malaria.[13] Many of said conditions in Mozambique are a result of similar risk factors, including the leading risk factor of malnutrition.[14]

Rufina Koreia (96 years old) in front of her house in Zembe village, Manica province of Mozambique, struggling with malaria.

Communicable diseases

Malaria

In Mozambique, malaria is a major cause of morbidity and mortality, especially among children and relating to maternal mortality.[15] For instance, a study in the early 1990s found that 15.5% of all maternal moralities in the Mozambican capital of Maputo were due to malaria.[16]

Malaria represents approximately 45% of all outpatient cases, 56% of inpatient cases at pediatric clinics, and 26% of all hospital deaths in Mozambique.[15] According to the Demographic Health Survey of 2011, the prevalence of malaria among children under the age of five years old is 46.3% in rural areas and 16.8% in urban areas of Mozambique.[15] This fact is supported by a study conducted by Ricardo Thompson et al. and published by the American Journal of Tropical Medicine and Hygiene, which found that malaria is more prevalent in suburban areas than in urban areas due to a higher dispersal of infection, more nesting sites, and a less dense population, making disease control more difficult.[17]

Malaria is endemic throughout Mozambique with seasonal peaks during and after the rainy season.[15] The seasonal intensity of transmission varies depending on the amount of rain and the air temperature.[15]

HIV/AIDS

In 2011, the prevalence of HIV/AIDS in Mozambique was 11.5% for civilians between the ages of 15 and 49.[18] The distribution of HIV/AIDS throughout the country is not even, with certain provinces, including the provinces of Maputo and Gaza, having incidence rates twice as high as the national average.[18]

In 2011, health authorities estimated that 1.7 million Mozambicans were HIV-positive, of whom 600,000 were in need of anti-retroviral treatment.[19] However, as of December 2011 only 240,000 Mozambicans were receiving this treatment.[19] In response to high rates of HIV incidence and low rates of treatment in Mozambique, the government implemented a national initiative to combat HIV/AIDS with anti-retroviral treatments at the day clinic level.[20] According to the 2011 UNAIDS Report, the HIV/AIDS epidemic in Mozambique appears to be slowing, as evidenced by the fact that in March 2014 over 416,000 Mozambicans were receiving anti-retroviral treatment for HIV/AIDS.[18]

HIV/AIDS continues to maintain a high incidence rate in females in Mozambique due to gender norms and religious involvement.[21] According to a 2005 study by Victor Agadjanian published in the Journal of Social Science and Medicine, women are deficient as compared to men in both knowledge of HIV/AIDS infection and prevention of the disease.[21] In the future, Mozambique may look towards religious institutions for public health campaigns related to HIV/AIDS in order to mitigate these disparities.[21]

Chronic diseases

Malnutrition

Mozambican children - often bloated bellies are a sign of malnutrition.

According to the World Health Organization (WHO), malnutrition affected 43.7% of Mozambican children between the years of 2005 and 2011.[22] The primary causes of malnutrition in Mozambique are poor diets, insufficient food intake, and multiple and/or reoccurring infectious diseases.[22] Similarly, in 2007 study by Cambridge University, it was found that over 2 million children suffer from Vitamin A deficiency, the most prevalent pediatric nutrient deficiency in the country. There has been steady progress over the past 20 years with declining rates of underweight children and deaths by malnutrition and its related consequences.[22] According to a study by Jan Low et al. published in the Journal of Nutrition, Mozambique is combating this deficiency using an integrated approach of both food and supplements.[23]

Maternal malnutrition is also a primary concern for Mozambique, as it has direct consequences on fetal and infant growth and disease prevalence.[24] Additionally, a 2003 study by Francesco Burchi published in the Journal of Economics and Human Biology found that an increase in maternal schooling, especially when supplemented with nutritional education, significantly decreases childhood malnutrition rates of those children raised by educated mothers.[25] Current public health interventions in Mozambique seek to reduce rates of malnutrition by studying risk factors of malnutrition and food insecurity in urban and rural areas,[26] as well as addressing historical and current social determinants of health at the primary health care level.[27]

Maternal and child health

One of few delivered successfully at a health post in a rural Mozambican village.

According to a USAID report, there has been significant expansion in maternal and child health programming since the turn of the century.[19] For example, the report cites that 97 percent of pregnant women in Mozambique now have access to pre-natal care.[19] Additionally, the Overseas Development Institute has stated that infant mortality and child-under-five mortality rates in Mozambique have both been reduced by over 50% between the years of 1997 and 2011.[12] Per the same source, maternal mortality rates also declined faster during this 14-year period than in any other sub-saharan country – falling from 692/100.000 to 408/100.000 between 1997 and 2011.[12]

Health resources for pregnant women in Mozambique have also been improving in order to be more accessible in recent years thanks to overarching government initiatives in human rights, which influence access to information, education, and resources to women in need.[28] In Mozambique 23% of women are of reproductive age and 46% are younger than 15. Because of this large proportion of women potentially requiring access to sexual, reproductive, and maternal healthcare, domestic and international initiatives have been in the works since 2000 to remove legal barriers to women’s access to these services.[28]

References

  1. 1 2 3 4 5 Giesbert, Laura (February 2011). "The legacy of civil war: The case of Mozambique". German Institute for Economic Research. 7.
  2. ↑ Azevedo, Mario Joaquim. Historical perspectives on the state of health and health systems in Africa. Cham: Palgrave Macmillan, 2017.
  3. ↑ Bethencourt, Francisco, and Diogo Ramada Curto, eds. Portuguese oceanic expansion, 1400-1800. Cambridge: Cambridge University Press, 2007.
  4. ↑ Iqbal, Zaryab (September 2006). "Health and Human Security: The Public Health Impact of Violent Conflict". International Studies Quarterly. 50 (3): 631–649. doi:10.1111/j.1468-2478.2006.00417.x. JSTOR 4092796.
  5. ↑ Asiedu, Elizabeth (September 2003). "Debt relief and institutional reform: a focus on Heavily Indebted Poor Countries". The Quarterly Review of Economics and Finance. 43 (4): 614–626. doi:10.1016/S1062-9769(03)00038-3.
  6. 1 2 Gupta, S; Clements, B; Guin-Siu, MT; Leruth, L (2002). "Debt relief and public health spending in heavily indebted poor countries". Bulletin of the World Health Organization. 80 (2): 151–7. doi:10.1590/S0042-96862002000200011. PMC 2567717. PMID 11953794.
  7. 1 2 3 "WHO | Mozambique's health system". www.who.int. Retrieved 2017-10-28.
  8. ↑ IMF Staff (June 2003). "THE REPUBLIC OF MOZAMBIQUE Joint IDA-IMF Assessment of The Poverty Reduction Strategy Paper" (PDF). World Bank. Retrieved 4 November 2017.
  9. ↑ Driscoll, Ruth; Evans, Alison (January 2005). "Second-Generation Poverty Reduction Strategies: New Opportunities and Emerging Issues". Development Policy Review. 23 (1): 5–25. doi:10.1111/j.1467-7679.2005.00274.x.
  10. ↑ "Mozambique Strategic Plan 2016-2018" (PDF). Icelandic International Development Agency. Retrieved 4 November 2017.
  11. ↑ Ooms, G; Schrecker, T (21 May 2005). "Expenditure ceilings, multilateral financial institutions, and the health of poor populations". The Lancet. 365 (9473): 1821–3. doi:10.1016/S0140-6736(05)66586-5. PMID 15910956.
  12. 1 2 3 Pose, Romina Rodriguez; Engel, Jakob; Poncin, Amandine; Mauel, Sandra (June 2014). "AGAINST THE ODDS: Mozambique's gains in primary health care" (PDF). Overseas Development Institute.
  13. ↑ Dgedge, Martinho; Novoa, Ana; Macassa, Gloria; Sacarlal, Jahit; Black, James; Michaud, Catherine; Cliff, Julie (January 2001). "The burden of disease in Maputo City, Mozambique: registered and autopsied deaths in 1994". Bulletin of the World Health Organization. 79 (6): 546–552. doi:10.1590/S0042-96862001000600011. ISSN 0042-9686.
  14. ↑ Lopez, Alan D; Mathers, Colin D; Ezzati, Majid; Jamison, Dean T; Murray, Christopher JL (2006-05-27). "Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data". The Lancet. 367 (9524): 1747–1757. doi:10.1016/S0140-6736(06)68770-9.
  15. 1 2 3 4 5 Mozambique, Disease prevention and control, Malaria. World Health Organisation, Accessed 26.06.14
  16. ↑ Granja, A. C.; Machungo, F.; Gomes, A.; Bergström, S.; Brabin, B. (1998-04-01). "Malaria-related maternal mortality in urban Mozambique". Annals of Tropical Medicine & Parasitology. 92 (3): 257–263. doi:10.1080/00034983.1998.11813288. ISSN 0003-4983.
  17. ↑ Thompson, Ricardo; Dgedge, Martinho; Enosse, Sonia M.; Mendis, Chandana; Barreto, Jorge; Begtrup, Kamilla; Gamage-Mendis, Asoka; Cuamba, Nelson; Hogh, Birthe (1997-11-01). "The Matola Malaria Project: a Temporal and Spatial Study of Malaria Transmission and Disease in a Suburban Area of Maputo, Mozambique". The American Journal of Tropical Medicine and Hygiene. 57 (5): 550–559. doi:10.4269/ajtmh.1997.57.550. ISSN 0002-9637.
  18. 1 2 3 UNAIDS World AIDS Day Report 2011. UNAIDS.org
  19. 1 2 3 4 "Global Health | Mozambique | U.S. Agency for International Development". www.usaid.gov. Retrieved 2017-10-28.
  20. ↑ Pfeiffer, James; Montoya, Pablo; Baptista, Alberto J.; Karagianis, Marina; Pugas, Marilia de Morais; Micek, Mark; Johnson, Wendy; Sherr, Kenneth; Gimbel, Sarah (2010-01-20). "Integration of HIV/AIDS services into African primary health care: lessons learned for health system strengthening in Mozambique - a case study". Journal of the International AIDS Society. 13: 3. doi:10.1186/1758-2652-13-3. ISSN 1758-2652. PMC 2828398. PMID 20180975.
  21. 1 2 3 Agadjanian, Victor (2005-10-01). "Gender, religious involvement, and HIV/AIDS prevention in Mozambique". Social Science & Medicine. Building Trust and Value in Health Systems in Low- and Middle- Income Countries. 61 (7): 1529–1539. doi:10.1016/j.socscimed.2005.03.012.
  22. 1 2 3 "Fighting malnutrition in Mozambique — SOS Children". www.soschildrensvillages.org.uk. Retrieved 2016-05-17.
  23. ↑ Low, Jan W.; Arimond, Mary; Osman, Nadia; Cunguara, Benedito; Zano, Filipe; Tschirley, David (2007-05-01). "A Food-Based Approach Introducing Orange-Fleshed Sweet Potatoes Increased Vitamin A Intake and Serum Retinol Concentrations in Young Children in Rural Mozambique". The Journal of Nutrition. 137 (5): 1320–1327. doi:10.1093/jn/137.5.1320. ISSN 0022-3166. PMID 17449599.
  24. ↑ "Child and adolescent health/nutrition - WHO | Regional Office for Africa". www.afro.who.int. Retrieved 2016-05-17.
  25. ↑ Burchi, Francesco (2010-12-01). "Child nutrition in Mozambique in 2003: The role of mother's schooling and nutrition knowledge". Economics & Human Biology. 8 (3): 331–345. doi:10.1016/j.ehb.2010.05.010.
  26. ↑ Garrett, James L.; Ruel, Marie T. (1999-11-01). "Are Determinants of Rural and Urban Food Security and Nutritional Status Different? Some Insights from Mozambique". World Development. 27 (11): 1955–1975. doi:10.1016/S0305-750X(99)00091-1.
  27. ↑ DR, Gwatkin; S, Rutstein; K, Johnson; E, Suliman; A, Wagstaff (2007). "Socio-economic differences in health nutrition and population. Mozambique 1997 2003".
  28. 1 2 "RELATÓRIO PRELIMINAR SOBRE A ABORDAGEM DOS DIREITOS HUMANOS (DDHH) NA SAÚDE MATERNA E NEO NATAL" (PDF). Retrieved 4 November 2017.
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