Health care in Mozambique

After its independence from Portugal in 1975, the Mozambique government established a primary health care system that was cited by the WHO as a model for other developing countries.[1] Over 90% of the population had been provided with vaccination. During the period of the early 1980s, around 11% of the government budget was targeted on health care.[2] The Mozambique civil war led to a great setback in the primary health system in Mozambique. The RENAMO's attack on government infrastructures included health and education systems from 1980 to 1992.[3]

Health policy

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.[4] 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.[5]

In 2013, an integrated three-year plan for improved and expanded investment in public programming was implemented, including public health programming.[6] This plan, along with a medium term expenditure framework and a strategic health sector plan laid forth a plan for the country to develop, monitor, and evaluate poverty reduction and social progression initiatives.[6]

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.[7]

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.[8]

Medicines

The National Health Service depends on external financing to pay for medicine. There is considerable reliance on foreign non-governmental organizations. There is a small private sector in urban areas, and there are still traditional medicine practitioners. In the National Health Service prescribable medicines must be included in the National Medicine Form or in the List of Essential Medicines. Hospital medicine, some basic medicine and medicines distributed by Community Health Workers are free. Medicine dispensed by the primary care network in rural areas is charged at a standard rate of 20 Mozambican metical per prescription. The National Regulatory Authority of Medicines was established in 2017. The State Pharmacies Company runs community pharmacies. There is a black market and counterfeit medicine is circulated. The country has one of the lowest proportions of clinicians in the world. A National Health Service has been established, but only extends to about half the population. Those who can afford to often seek medical attention in South Africa.[9]

History
Four scenes from the first English hospital in Mozambique.

The Healthcare 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.[10] This period in history is also useful in defining periods of change in the country's health care administration.

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.[11] Shortly after Vasco de Gama set foot on East African soil in the 15th century,[12] colonization of the country began alongside Catholic intervention.[10] 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.[10] 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.[10] During this time, the country was plagued with violence and poverty in accordance with its struggle for independence from Portugal.[10] 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.[13]

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.[14] 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.[15] With the aid of this initiative, federal expenditure on health care was able to increase from US$4.6 billion in 1997, to US$7.5 billion in 2002.[6]

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.[16] 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.[15]

See also Health in Mozambique

References
  1. Walt, G., & Melamed, A. (1983). Toward a people's health service. London: Zed Books ISBN 0862321298.
  2. Gloyd, S. (1996). "Confrontation, co-operation or co-optation: NGOS and the Ghanaian state during structural adjustment". Review of African Political Economy. 68 (68): 149–168. JSTOR 4006246.
  3. Pfeiffer, J (2003). "International NGOs and primary health care in Mozambique: The need for a new model of collaboration". Social Science & Medicine. 56 (4): 725–38. doi:10.1016/s0277-9536(02)00068-0. PMID 12560007.
  4. 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.
  5. "Mozambique Strategic Plan 2016-2018" (PDF). Icelandic International Development Agency. Retrieved 4 November 2017.
  6. "WHO | Mozambique's health system". www.who.int. Retrieved 2017-10-28.
  7. Ooms, G; Schrecker, T (21 May 2005). "Expenditure ceilings, multilateral financial institutions, and the health of poor populations" (PDF). The Lancet. 365 (9473): 1821–3. doi:10.1016/S0140-6736(05)66586-5. hdl:10144/17293. PMID 15910956.
  8. 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.
  9. "Pricing & Reimbursement- Mozambique". Lexology. 16 November 2018. Retrieved 25 December 2018.
  10. Giesbert, Laura (February 2011). "The legacy of civil war: The case of Mozambique". German Institute for Economic Research. 7.
  11. Azevedo, Mario Joaquim. Historical perspectives on the state of health and health systems in Africa. Cham: Palgrave Macmillan, 2017.
  12. Bethencourt, Francisco, and Diogo Ramada Curto, eds. Portuguese oceanic expansion, 1400-1800. Cambridge: Cambridge University Press, 2007.
  13. 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.
  14. 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.
  15. 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 (inactive 2020-05-21). PMC 2567717. PMID 11953794.
  16. 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.
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