The financing of the health system in Mozambique is marked by the fragmentation that also characterizes the architecture of development assistance in the country and is expressed, for example, in the high degree of external resources that do not go through government management instruments (outside the budget). Among the challenges are the centralized and verticalized structure, the high degree of dependence on external donors and their priority agendas, and a persistent underfinancing of the sector.
Authors: Elis Borde, Eliana Martínez-Herrera, Mariana Gutiérrez-Zamora Navarro, Janet Dulá, Policarpo Ribeiro, Ivan Zahinos, Joan Benach
Technical support: Medicus Mundi and National Institute of Health (Mozambique)
Funding: Spanish Agency for International Development Cooperation (AECID) and Open Society Foundations (OSF)
Social inequalities in access to health services and social inequalities in health have persisted over time and the underlying barriers have not been sufficiently addressed. There is no single answer to explain this situation, but the results of this study revealed some elements that make it possible to relate the depth and extent of social inequalities in health in Mozambique with the seriousness of health problems in the country, the fragmentation of the health system, incomplete decentralization, and the lack of financing of the health sector in the country.
Authors: Elis Borde, Elias Sete Manjate, Nicholas Soyombo, Gabrielle Lima Silva, Eliana Martínez-Herrera, Mariana Gutiérrez-Zamora Navarro, Janet Dulá, Policarpo Ribeiro, Ivan Zahinos, Joan Benach
Technical support: Medicus Mundi and National Institute of Health (Mozambique)
Funding: Spanish Agency for International Development Cooperation (AECID)
Escola Saudável (ES) is an initiative within the scope of the project “The social determinants of health: the best strategy against COVID-19 in Maputo (2021-2023)”, implemented by medicusmundi, in partnership with the Department of Health and Action Social Network of the Maputo Municipal Council and the Media Institute of Southern Africa (MISA-Mozambique), with funding from the Municipality of Barcelona.
In August last year (between 27th and 30th) medicusmundi carried out a diagnostic study of the health services' functioning, needs and response processes in order to reduce and prevent malnutrition in the Namuno district. This work was done in conjunction with different district services (SDSMAS, SDPI, SDAE, SDEJT), Health Committees, caring mothers in the villages of Potomola and Mahari, the Wiwanana Foundation, SolidarMed and the World Food Program (WFP) . The evaluation showed that the high levels of illiteracy and, consequently, the lack of knowledge on how to prepare food and eat a balanced diet are the main causes that are behind the high levels of malnutrition registered in Namuno. To this is added the practice of agriculture that favors commercial purposes more than own consumption.
Between 17 and 20 September last year, in the district of Ancuabe, an evaluation of the functioning processes, needs and response of health services was carried out with a view to reducing and preventing malnutrition. This diagnosis, results of which are now being released, involved the participation of several district services (SDSMAS, SDPI, SDAE, SDEJT), Health Committees, caregiving mothers from four villages and some NGOs operating in that district (Wiwanana Foundation, SolidarMed and Aga Khan). The survey concluded that the lack of knowledge about how to prepare and preserve food, the restriction of consumption of some foods due to myths, taboos, habits and customs, illiteracy and insufficient water sources and dams for irrigation, are the aspects that most contribute to the prevalence of malnutrition in Ancuabe.
This document presents a report that was prepared from a bibliographic and documentary review, considering government publications, global funds, local and international NGOs as well as foundations on the financing of the health system, especially in Mozambique.
Based on the diagnosis made in September 2019, in November of the same year the Multisectorial Group, composed of the District Services (SDSMAS, SDPI, SDAE and SDEJT), the Wiwanana Foundation, Solidarmed and Aga Khan prepared, together with medicusmundi, an Action Plan to improve the fight against malnutrition. The objective was to establish easy ways of intervening, with concrete and coordinated actions between all sectors, giving particular importance to training, awareness, education and supervision activities. Of this plan stands out the holding of regular lectures in the communities, with the inclusion not only of women, but also of the heads of families (men), as one of the key actions to prevent and reduce malnutrition in this district. Also noteworthy is the decision to set up a Technical Group to resolve the lack of coordination previously identified between the different actors, which will now hold meetings for planning and assessing activities at district level.
This manual is a compilation of different materials about the “GRAVITATIONAL METHOD USING BÓRAX, an alternative to the use of mercury in the artisanal extraction of gold", produced as part of the implementation of the projects “Reducing the negative impact of artisanal mining on individual, community and environmental health” and “Artisanal Mining: Environmental and Cultural Rights in Cabo Delgado Province”, implemented by medicusmundi and Centro Terra Viva, with funding the Generalitat Valenciana and the European Union, respectively.
Access to quality health services is crucial for good and balanced health. This report aims to provide solid scientific evidence about access to the health system in Mozambique and the social inequalities that affect that access. For this purpose, a descriptive and multivariate analysis of the Family Budget Survey (IOF is the Portuguese acronym) of Mozambique 2014/15 was carried out, with regard to health needs, severity of diseases, use of health services and reasons for non-use, problems with the quality of received care and direct payments.
Environment I is a module that provides basic and elementary knowledge about caring for the environment. The document contributes to generating significant positive and responsible change, particularly in Artisanal and Small-Scale Mining sites.
From 10 to 13 September 2019, a survey of the health services' functioning processes, needs and response took place, in the Montepuez district, in order to reduce and prevent malnutrition. This evaluation involved the participation of several district services (SDSMAS, SDPI, SDAE, SDEJT), Health Committees and caregiving mothers from four randomly chosen villages. The results of this diagnosis are now made known by medicusmundi and reveal, as the main aspects contributing to the high rates of malnutrition in Montepuez, the following: low access to food, shortage of funds to acquire them, poor knowledge about nutrition and consumption of inappropriate water.
In December of last year, Montepuez hosted an important meeting of the Multisectorial Group in order to define the joint Action Plan to improve the response of its Programs to Combat Malnutrition. The Group, made up of the District Health Services (SDSMAS), Planning and Infrastructure (SDPI), Economic Activities (SDAE) and Education, Youth and Technology (SDEJT), had previously participated, in September of the same year, in a diagnostic study led by medicusmundi to assess the problems and needs associated with malnutrition. The Plan that is now made known prioritizes the training and qualification of teams and the implementation of actions such as the development of community education materials, the promotion of debates, campaigns and culinary demonstrations, the opening of fish tanks, among others. It is also worth mentioning the creation of a Technical Group to ensure better supervision and coordination of all activities.
Environment II is a training module that provides basic and elementary knowledge about environmental management in areas degraded by artisanal mining, in order to contribute to generating significant positive and responsible changes in the environment in which mining activities are carried out. This module complements the Environment I, Knowing and Caring for Our Environment brochure.
In August 2019, the Namuno district underwent a study to identify the needs and problems that contribute to the high rate of malnutrition in the population. Based on the results obtained, medicusmundi, together with the Multisectorial Group, defined an Action Plan to improve the capacity to respond to this problem. The working group involved different District Services (SDSMAS, SDPI, SDAE and SDEJT) and NGOs such as the Wiwanana Foundation, SolidarMed and the World Food Program (WFP). The improvement of collaboration and information sharing on the different actors was one of the aspects that deserved greater attention, resulting in the creation of a Technical Group to ensure joint planning, data crossing and more effective action in communities. Among the activities defined, training and awareness-raising activities are highlighted, namely lectures and campaigns on nutrition, culinary demonstrations, radio debates and the creation of nutrition groups in schools. It should also be noted the need to assess the levels of production and nutritional security in the community and to form water committees.
Associations and legislation are part of the objective of making the artisanal mining activity more dignified. One of the vectors used to achieve this objective is the promotion of associations among mining operators. Therefore, in a nutshell, this brochure presents the main aspects of associativism.
This module was produced with the aim of reinforcing the contribution to a process of dignification of artisanal mining, a process that began recently in the country, through the systematization of a more comprehensive knowledge on the part of artisanal miners and their organizations, in order to improve mining techniques, including mechanisms for participation in decision-making spaces that affect the sector.