This document discusses the roles of stakeholders in improving health outcomes in Mozambique. It notes that Mozambique has high rates of infant and child mortality compared to neighboring countries, as well as a high maternal mortality ratio. Malnutrition contributes significantly to child deaths in Mozambique. The national health policy aims to improve health status and reduce poverty. Addressing inequities across socioeconomic and geographic groups is important to reduce the health burden. A multi-sectoral approach is needed to tackle child malnutrition and improve antenatal care coverage. Development partners should increase coordination and delegation to national authorities to strengthen the health system.

1. Roles of Stakeholders in África
Differences of Agendas
By Gertrudes Machatine

2. Mozambique Location

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. Mozambique Socio Economic and Demographic
Information
• 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. 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 Statistics
Despesa em Saúde per Capita 2006 em USD (PPP), Fonte: WHO, World Health Statistics 2009
22-11-2011 5

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 2009
22-11-2011 6

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. 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. 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. 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. Contribution of malnutrition to U5MR in Mozambique
Source: Nutrition of
young children and
mothers in Mozambique,
USAID 2006

12. One of the Goals of National Health Policy
To Improve the health status of the population by
providing good quality care and accessible
services, with the additional goal to strengthen
the economy, foster further employment and
reduce poverty through economic multiplier
effects.

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 important
need to address inequities existing across
socioeconomic and geographically identified groups
in order for reduce the burden of the health
problem on average

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. 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. 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. 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. 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. Mozambique
Special thanks to the
organizers of the meeting
Thank you all