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Presentació de Gertrudes Machatine. 16 de novembre de 2011


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Pressentació de Gertrudes Machatine, assessora del projecte de reforçament dels serveis clínics de VIH/
SIDA a Moçambic (CHASS/SMT) de la Consultora Abt Associates i fins fa uns mesos Directora del Departament de Cooperació i Planificació del Ministeri de Salut de Moçambic (MISAU).

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Presentació de Gertrudes Machatine. 16 de novembre de 2011

  1. 1. Roles of Stakeholders in África Differences of Agendas By Gertrudes Machatine
  2. 2. Mozambique Location
  3. 3. Mozambique Socio Economic Demographic Information• The third national census in 2007, estimated the population at 20.530.714, of which women make up 52.3 % .• Per capita income is about US$ 294 in 2007• Human Development Index of 0.479 (2007) which is the lowest among all countries of the Southern Africa Development Community• Te Gini Index remainded about 0.40 between 1997 and 2003, showing high inequalities between the population while urban areas presented the worse ratios
  4. 4. Mozambique Socio Economic and DemographicInformation• Analisys of health expenditure suggests the existence of a positive correlation between Health expenditure per capita and health status indicators Mozambique is in the group of countries where expenditure increase would help improving the population health Mozambique is among the Southern Africa Development Community Countries with the lowest level of health expenditure per capita and very high rates of Infant Mortality
  5. 5. Mozambique National Health Account 2004-2006 Results: Per capita Expenditure and Infant Mortality (African Countries) 300 Taxa de Mortalidade Infantil (per 1000) 250 200 150 Moçambique 100 50 0 0 200 400 600 800 1000 Despesa em Saúde per Capita (USD)Nota:Taxa de Mortalidade Infantil (2003), fonte WHO-Afro StatisticsDespesa em Saúde per Capita 2006 em USD (PPP), Fonte: WHO, World Health Statistics 2009 22-11-2011 5
  6. 6. The per capita Gross Domestic Product in Africa 35000 30000 25000 PIB per Capita (USD) 20000 15000 10000 5000 Moçambique 0 0 200 400 600 800 1000 Despesa em Saúde per Capita (USD) Nota: PIB per Capita 2007 em USD (PPP), Fonte: World Bank World Development Indicators 2009 Despesa em Saúde per Capita 2006 em USD (PPP), Fonte: WHO, World Health Statistics 200922-11-2011 6
  7. 7. Health Status in Mozambique Level of Child and Maternal Mortality• Compared with the neighboring countries, Mozambique has a higher level child mortality and maternal mortality Comparison of mortality with selected countries 1200 1000 800 600 IMR U5MR 400 MMR 200 0 M ozambique M alawi Zambia Zimbabwe SSA Country
  8. 8. Health Status in Mozambique Trend of Child Mortality• Child mortality declines over time, however, the pace of decline is slow in the MDG perspective. U5MR Trend 230 210 190 170 U5MR 150 MDG 130 Current 110 Trend 90 70 50 2002 2003 2004 2005 2006 2007 2008 2009 2010 2015 Year
  9. 9. Health Status in Mozambique Trend of Maternal Mortality• Same pattern is also shown in Maternal Mortality Ratio MMR trend 1150 1100 1050 1000 950 MDGs MMR 900 Current Trend 850 800 750 700 2002 2003 2004 2005 2006 2007 2008 2009 2010 2015 Year
  10. 10. Health Status in Mozambique• Malnutrition is one of the most important health and welfare problems among infants and young children in Mozambique. 36% of all deaths in Mozambique that occur before the age five are related to malnutrition. Because of its extensive prevalence, moderate malnutrition (30%) contributes to more deaths than severe malnutrition (6%) ( WHO report on inequities in Maternal and Child health in MOZAMBIQUE)
  11. 11. Contribution of malnutrition to U5MR in Mozambique Source: Nutrition of young children and mothers in Mozambique, USAID 2006
  12. 12. One of the Goals of National Health PolicyTo Improve the health status of the population byproviding good quality care and accessibleservices, with the additional goal to strengthenthe economy, foster further employment andreduce poverty through economic multipliereffects.
  13. 13. Health System• What we do in the health system matters, is to close the social gaps in our society.• Ensure that health care reaches and involves all key groups.• Ensure that being disadvantaged , illiterated or living in particular regions is not a barrier to the uptake of health care or reduced access to services is fundamental.These indicate that there is an equally importantneed to address inequities existing acrosssocioeconomic and geographically identified groupsin order for reduce the burden of the healthproblem on average
  14. 14. Health System• needs to adopt different approaches to tackle inequities in maternal and child health.• In order to improve maternal health the focus must be primarily on improving coverage and quality of antenatal care by reducing barriers to accessing health services.• Addressing child malnutrition requires a stronger multi-sectoral approach, in particular, a joint effort with Public Works and Housing Sector
  15. 15. Way forward• It indicate also the need to promote competition between providers and seek collaboration with the private sector;• encourage economic multiplier effects and stimulate entrepreneurship among health managers.• This requires well paid civil servant to develop strategies, conduct participative supervision and quality reviews at Health Facility level without being tempted towards rent seeking. They should also wish to achieve consensus and ownership for their ideas among stakeholders.
  16. 16. Way forward• Introduce new approaches to organizing health system – Performance Based Financing or Incentive Based Financing could be among others an approach to consider.• Inform the public, to strengthen the consumer´s voice empowerment and to assure mechanisms for effective social marketing of the desired behaviour
  17. 17. Way forward• WHO, as the health specialized technical agency, has a clear role of providing assistance to the Government and development partners.• WHO contributes by providing technical assistance and catalytic/seed money, support innovative approaches and build capacity according to the core functions of the organisation as approved by governing bodies and member states.
  18. 18. Changing development partner´s culture, behaviors and procedures• Increase delegation of authority;• Monitoring on how well country offices follow policies agreed in HQ;• Cross-representation and reduction of numbers of Development Partners in country;• Use Board influence in partnerships to ensure adherence to policies;• Review adherence to codes of conducts and compacts as part of annual health sector reviews;• Improve coordination with Non Government Organizations.
  19. 19. Mozambique Special thanks to theorganizers of the meeting Thank you all