Health care in Mozambique

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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. 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 country's 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

Hospitals

In 2019, there were 1,579 medical facilities in Mozambique. Besides hospitals, other facilities included rural and urban health centers.[17] In 2020, the government of Mozambique announced plans to build 49 new district hospitals.[18]

Hospitals in Mozambique
Name Province Type of hospital Coordinates Ref
Chiúre Hospital Rural Cabo Delgado Province Rural 13°22′57″S 39°47′04″E / 13.3825°S 39.7844°E / -13.3825; 39.7844 (Chiúre Hospital Rural) [17]
Hospital de Mocímboia Da Praia Hospital Rural Cabo Delgado Province Rural 11°20′58″S 40°21′31″E / 11.3494°S 40.3586°E / -11.3494; 40.3586 (Hospital de Mocímboia Da Praia Hospital Rural) [17]
Hospital de Montepuez Hospital Rural Cabo Delgado Province Rural 13°07′38″S 38°59′55″E / 13.1272°S 38.9986°E / -13.1272; 38.9986 (Hospital de Montepuez Hospital Rural) [17]
Hospital de Mueda Hospital Rural Cabo Delgado Province Rural 11°39′46″S 39°33′13″E / 11.6628°S 39.5536°E / -11.6628; 39.5536 (Hospital de Mueda Hospital Rural) [17]
Metuge Hospital Rural Cabo Delgado Province Rural 12°56′05″S 40°21′01″E / 12.934616°S 40.350294°E / -12.934616; 40.350294 (Metuge Hospital Rural) [17]
Miteda Hospital Rural Cabo Delgado Province Rural 12°02′36″S 40°08′43″E / 12.043319°S 40.145186°E / -12.043319; 40.145186 (Miteda Hospital Rural) [17]
Pemba Hospital Provincial Cabo Delgado Province Provincial 12°57′57″S 40°29′43″E / 12.9658°S 40.4953°E / -12.9658; 40.4953 (Pemba Hospital Provincial) [17]
Chibuto Hospital Rural Gaza Province Rural 24°41′22″S 33°31′58″E / 24.6894°S 33.5328°E / -24.6894; 33.5328 (Chibuto Hospital Rural) [17]
Chicumbane Hospital Rural Gaza Province Rural 24°59′40″S 33°33′02″E / 24.9944°S 33.5506°E / -24.9944; 33.5506 (Chicumbane Hospital Rural) [17]
Chokwe Hospital Rural Gaza Province Rural 24°31′39″S 33°00′18″E / 24.527439°S 33.005138°E / -24.527439; 33.005138 (Chokwe Hospital Rural) [17]
Cidade Chokwe Hospital Gaza Province Rural 24°32′07″S 33°00′20″E / 24.53528°S 33.00567°E / -24.53528; 33.00567 (Cidade Chokwe Hospital) [17]
Mandlakazi Hospital Rural Gaza Province Rural 24°42′44″S 33°53′10″E / 24.7122°S 33.8861°E / -24.7122; 33.8861 (Mandlakazi Hospital Rural) [17]
Xai Xai Hospital Provincial Gaza Province Provincial 25°04′06″S 33°39′30″E / 25.0683°S 33.6583°E / -25.0683; 33.6583 (Xai Xai Hospital Provincial) [17]
Chicuque Rural Hospital Inhambane Province Rural 23°49′04″S 35°20′52″E / 23.817854°S 35.347654°E / -23.817854; 35.347654 (Chicuque Hospital Rural) [17]
Hospital de Quissico Hospital Distrital Inhambane Province District 24°42′44″S 34°26′24″E / 24.712205°S 34.439931°E / -24.712205; 34.439931 (Hospital de Quissico Hospital Distrital) [17]
Inhambane Hospital Provincial Inhambane Province Provincial 23°52′45″S 35°25′57″E / 23.8792°S 35.4325°E / -23.8792; 35.4325 (Inhambane Hospital Provincial) [17]
Massinga Hospital Distrital Inhambane Province District 23°19′55″S 35°22′55″E / 23.332003°S 35.382°E / -23.332003; 35.382 (Massinga Hospital Distrital) [17]
Vilanculos Hospital Rural Inhambane Province Rural 21°59′04″S 35°19′16″E / 21.9844°S 35.3211°E / -21.9844; 35.3211 (Vilanculos Hospital Rural) [17]
Catandica District Hospital Manica Province District 18°03′S 33°10′E / 18.05°S 33.17°E / -18.05; 33.17 (Catandica District Hospital) [17]
Espungabera Hospital Distrital Manica Province District 20°27′10″S 32°46′20″E / 20.4528°S 32.7722°E / -20.4528; 32.7722 (Espungabera Hospital Distrital) [17]
Gondola Hospital Rural Manica Province Rural 19°04′38″S 33°38′30″E / 19.0772°S 33.6417°E / -19.0772; 33.6417 (Gondola Hospital Rural) [17]
Hospital de Chimoio Hospital Provincial Manica Province Provincial 19°06′56″S 33°26′56″E / 19.115652°S 33.44899°E / -19.115652; 33.44899 (Hospital de Chimoio Hospital Provincial) [17]
Manica Hospital Distrital Manica Province District 18°56′26″S 32°52′31″E / 18.9406°S 32.8753°E / -18.9406; 32.8753 (Manica Hospital Distrital) [17]
Chamanculo Hospital General Maputo General 25°57′03″S 32°33′25″E / 25.950743°S 32.557036°E / -25.950743; 32.557036 (Chamanculo Hospital General) [17]
J.Macamo Hospital General Maputo General 25°56′52″S 32°32′42″E / 25.9478°S 32.545°E / -25.9478; 32.545 (J.Macamo Hospital General) [17]
Maputo Central Hospital Maputo Central 25°58′02″S 32°35′24″E / 25.9673°S 32.5899°E / -25.9673; 32.5899 (Maputo Hospital Central) [17][19]
Mavalane Hospital General Maputo General 25°55′54″S 32°35′09″E / 25.9317°S 32.5858°E / -25.9317; 32.5858 (Mavalane Hospital General) [17]
Hospital Da Matola Hospital Provincial Maputo Province Provincial 26°02′48″S 32°20′03″E / 26.046712°S 32.334093°E / -26.046712; 32.334093 (Hospital Da Matola Hospital Provincial) [17]
Hospital de Xinavane Hospital Rural Maputo Province Rural 25°02′44″S 32°48′19″E / 25.0456°S 32.8053°E / -25.0456; 32.8053 (Hospital de Xinavane Hospital Rural) [17]
Machava Hospital General Maputo Province General 25°54′51″S 32°31′58″E / 25.9142°S 32.5328°E / -25.9142; 32.5328 (Machava Hospital General) [17]
Manhiça Hospital Distrital Maputo Province District 25°24′33″S 32°48′29″E / 25.4092°S 32.8081°E / -25.4092; 32.8081 (Manhiça Hospital Distrital) [17]
Maputo Private Hospital Maputo Province Private 25°56′35″S 32°36′42″E / 25.943013°S 32.611574°E / -25.943013; 32.611574 (Maputo Private Hospital) [20]
Alua Hospital Distrital Nampula Province District 13°56′08″S 39°55′30″E / 13.9356°S 39.9251°E / -13.9356; 39.9251 (Alua Hospital Distrital) [17]
Angoche Hospital Rural Nampula Province Rural 16°13′46″S 39°54′28″E / 16.2294°S 39.9078°E / -16.2294; 39.9078 (Angoche Hospital Rural) [17]
Hospital Central Nampula Hospital Central Provincial Central 15°07′23″S 39°15′43″E / 15.1231°S 39.2619°E / -15.1231; 39.2619 (Hospital Central Nampula Hospital Central) [17]
Marrere Hospital General Nampula Province General 15°07′10″S 39°11′22″E / 15.1194°S 39.1894°E / -15.1194; 39.1894 (Marrere Hospital General) [17]
Moma Hospital Distrital Nampula Province District 16°45′45″S 39°13′22″E / 16.7625°S 39.2228°E / -16.7625; 39.2228 (Moma Hospital Distrital) [17]
Monapo Hospital Rural Nampula Province Rural 14°54′35″S 40°20′00″E / 14.9097°S 40.3333°E / -14.9097; 40.3333 (Monapo Hospital Rural) [17]
Nacala Porto Hospital Distrital Nampula Province District 14°29′27″S 40°44′01″E / 14.490936°S 40.733554°E / -14.490936; 40.733554 (Nacala Porto Hospital Distrital) [17]
Namapa Hospital Rural Nampula Province Rural 13°42′59″S 39°49′21″E / 13.7163°S 39.8226°E / -13.7163; 39.8226 (Namapa Hospital Rural) [17]
Ribaue Hospital Rural Nampula Province Rural 14°56′47″S 38°19′15″E / 14.9464°S 38.3209°E / -14.9464; 38.3209 (Ribaue Hospital Rural) [17]
Cuamba Hospital Rural Niassa Province Rural 14°48′08″S 36°32′04″E / 14.8022°S 36.5344°E / -14.8022; 36.5344 (Cuamba Hospital Rural) [17]
Lichinga Hospital Provincial Niassa Province Provincial 13°18′39″S 35°15′04″E / 13.3108°S 35.2511°E / -13.3108; 35.2511 (Lichinga Hospital Provincial) [17]
Marrupa Hospital Distrital Niassa Province District 13°11′52″S 37°29′56″E / 13.1978°S 37.4989°E / -13.1978; 37.4989 (Marrupa Hospital Distrital) [17]
Beira Hospital Central Sofala Central 19°51′00″S 34°52′36″E / 19.849887°S 34.876659°E / -19.849887; 34.876659 (Beira Hospital Central) [17][21][22]
Hospital de Muxungue Hospital Rural Sofala Rural 20°23′25″S 33°56′06″E / 20.3902°S 33.935°E / -20.3902; 33.935 (Hospital de Muxungue Hospital Rural) [17]
Hospital Distrital Caia Hospital Distrital Sofala District 17°50′08″S 35°20′35″E / 17.8356°S 35.3431°E / -17.8356; 35.3431 (Hospital Distrital Caia Hospital Distrital) [17]
Hospital Rural Buzi Hospital Rural Sofala Rural 19°52′58″S 34°35′34″E / 19.8828°S 34.5928°E / -19.8828; 34.5928 (Hospital Rural Buzi Hospital Rural) [17]
Hospital Rural de Marromeu Hospital Rural Sofala Rural 18°17′56″S 35°57′16″E / 18.2989°S 35.9544°E / -18.2989; 35.9544 (Hospital Rural de Marromeu Hospital Rural) [17][22]
Hospital Rural de Nhamatanda Hospital Rural Sofala Rural 19°16′17″S 34°12′15″E / 19.2713°S 34.2043°E / -19.2713; 34.2043 (Hospital Rural de Nhamatanda Hospital Rural) [17]
Hospital Provincial de Tete Hospital Provincial Tete Provincial 16°09′09″S 33°35′02″E / 16.1525°S 33.5839°E / -16.1525; 33.5839 (Hospital Provincial de Tete Hospital Provincial) [17]
Mutarara Hospital Rural Tete Province Rural 17°27′05″S 35°04′44″E / 17.4514°S 35.0788°E / -17.4514; 35.0788 (Mutarara Hospital Rural) [17]
Songo Hospital Rural Tete Province Rural 15°35′56″S 32°46′03″E / 15.599°S 32.7674°E / -15.599; 32.7674 (Songo Hospital Rural) [17]
Ulónguè Hospital Rural Tete Province Rural 14°43′23″S 34°21′47″E / 14.7231°S 34.3631°E / -14.7231; 34.3631 (Ulónguè Hospital Rural) [17]
Zumbo Hospital Distrital Tete Province District 15°36′53″S 30°26′22″E / 15.6147°S 30.4394°E / -15.6147; 30.4394 (Zumbo Hospital Distrital) [17]
Alto Molocue Hospital Rural Zambézia Rural 15°38′48″S 37°43′40″E / 15.64669°S 37.727695°E / -15.64669; 37.727695 (Alto Molocue Hospital Rural) [17]
Gile Hospital Distrital Zambézia District 16°08′47″S 38°22′21″E / 16.1464°S 38.3725°E / -16.1464; 38.3725 (Gile Hospital Distrital) [17]
Gurue Hospital Rural Zambézia Rural 15°27′45″S 36°59′01″E / 15.4625°S 36.9836°E / -15.4625; 36.9836 (Gurue Hospital Rural) [17]
Maganja Da Costa Hospital Distrital Zambézia Province District 17°18′34″S 37°30′32″E / 17.3094°S 37.5089°E / -17.3094; 37.5089 (Maganja Da Costa Hospital Distrital) [17]
Mocuba Hospital Distrital Zambézia Province District 16°50′26″S 36°59′15″E / 16.8406°S 36.9875°E / -16.8406; 36.9875 (Mocuba Hospital Distrital) [17]
Morrumbala Hospital Distrital Zambézia Province District 16°53′59″S 35°44′26″E / 16.89972°S 35.740693°E / -16.89972; 35.740693 (Morrumbala Hospital Distrital) [17]
Quelimane Hospital Provincial Zambézia Province Provincial 17°52′56″S 36°53′14″E / 17.8822°S 36.8872°E / -17.8822; 36.8872 (Quelimane Hospital Provincial) [17]
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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. S2CID 153404316.
  5. ^ "Mozambique Strategic Plan 2016-2018" (PDF). Icelandic International Development Agency. Retrieved 4 November 2017.
  6. ^ a b c "WHO | Mozambique's health system". www.who.int. Archived from the original on May 16, 2009. 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. S2CID 37412604.
  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. ^ a b c d e 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. ^ a b 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. hdl:10665/268700. 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.
  17. ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au av aw ax ay az ba bb bc bd be bf bg bh bi bj "A spatial database of health facilities managed by the public health sector in sub-Saharan Africa". World Health Organization. February 11, 2019. Archived from the original on April 22, 2019. Retrieved May 8, 2020.
  18. ^ "49 new district hospitals to be built in Mozmbique". Construction Review Online. 11 December 2020. Retrieved January 15, 2021.
  19. ^ "Maputo Hospital Central" (PDF). UCLA Health. Retrieved January 15, 2021.
  20. ^ "Homepage". Maputo Hospital. Retrieved January 15, 2021.
  21. ^ "Beira Hospital". World Health Organization. Archived from the original on April 13, 2016. Retrieved January 15, 2021.
  22. ^ a b "Two hospitals in Sofala Province". French Development Agency. Retrieved January 15, 2021.
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