Roles of Stakeholders in África Differences of Agendas

By Gertrudes Machatine

Mozambique Location

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

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

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Mozambique National Health Account 2004-2006 Results:

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

Per capita Expenditure and Infant Mortality

(African Countries)

Moçambique

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Despesa em Saúde per Capita (USD)

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The per capita Gross Domestic Product in Africa

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

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Health Status in MozambiqueLevel of Child and Maternal Mortality

• Compared with the neighboring countries, Mozambique has a higher level child mortality and maternal mortality

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Mozambique Malawi Zambia Zimbabwe SSA

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Comparison of mortality with selected countries

IMR

U5MR

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Health Status in MozambiqueTrend of Child Mortality

• Child mortality declines over time, however, the pace of decline is slow in the MDG perspective. U5MR Trend

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Health Status in MozambiqueTrend of Maternal Mortality

• Same pattern is also shown in Maternal Mortality Ratio

MMR trend

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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)

Contribution of malnutrition to U5MR in Mozambique

Source: Nutrition of young children and mothers in Mozambique, USAID 2006

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.

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

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

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.

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

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.

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.

Mozambique

Special thanks to the organizers of the meeting

Thank you all