Executive Summary of Mozambique Report
This is the Executive Summary for the Report of the 2009 RAPIA implementation. The complete Report from 2003 can be downloaded at the end of this page.
Following the implementation of the Rapid Assessment Protocol for Insulin Access in 2003 many developments with regards to diabetes and Non Communicable Diseases took place in Mozambique. As part of the National Plan on Non Communicable Diseases a reassessment using the RAPIA was carried out in order to assess progress in the area of diabetes and provide a “lessons learnt” for the implementation of programmes and projects for other Non Communicable Diseases and also contribute to the ongoing projects with regards to diabetes.
What is clear from this assessment is that much progress has been made in Mozambique with regards to diabetes and Non Communicable Diseases in the period 2003-2009. In 2003 many issues were present including serious problems with access to medicines, training, patient education, etc. These problems have now been addressed and the foundations for a system to tackle the growing burden of diabetes are established. The recommendations presented in this report aim to build on these successes, reinforce and expand existing initiatives as well as develop new programmes to address new and continuing deficiencies.
The progress made in Mozambique in addressing the growing challenge of diabetes and Non Communicable Diseases should be applauded as the positive developments need to be put into context of a health system where the burden and attention remains linked to communicable diseases and only US$ 3.00 is spent per person per year on providing healthcare.
With the foundations of proper management of diabetes having been created, the next phase should focus on fine-tuning and improving the measures implemented to date as well as integrating these with the National Non Communicable Disease Plan. The action plans detailed in “Section 9. Action Plans” build on this as well as the recommendations described in “Section 7. Recommendations”. These are specifically for the areas visited during the 2009 implementation of the Rapid Assessment Protocol for Insulin Access, but can be applied and adapted to other areas where necessary.
Key Findings
Organisation of the Health System
o Development of chronic consultations at different levels of the Health System in Maputo
§ Some problems with staff originally trained for this role no longer present
o Close collaboration between Maputo Central Hospital and Mozambican Diabetes Association
o Mozambican Diabetes Association provides the main consultation for diabetes in Maputo
o Care for Type 1 diabetes based mainly at Maputo Central Hospital and Mozambican Diabetes Association
o In Beira the main location for diabetes care is at Beira Central Hospital
§ Problems with staffing
o No clear management of diabetes in Lichinga
§ Some patients seen at Hospital others at Health Centre
o In Xai-Xai there is no real organisation of diabetes care at the hospital
o There was a chronic consultation at the Xai-Xai City Health Centre, but now people with diabetes mixed with all other patients
- Data Collection
o WHO STEPS Methodology and Rapid Assessment Protocol for Insulin Access enabled baseline data on diabetes to be collected
o At all levels patient files and clinical registers could be found
§ Hard to use these as amalgamation of consultations versus patient numbers
§ Data not used in decision making
- Prevention
o Organisation of World Diabetes Days and “Health Fairs”
o Lack of tools for diagnosis and management of complications
- Diagnostic tools and infrastructure
o Availability of diagnostic tools has improved since 2003
§ Problems remain with strips for glucometers
- Drug procurement and supply
o No problems with cold chain
o Unequal distribution of insulin and medicines
o Irregular demand for mainly insulin, but also for oral medicines
o Problems with supply of syringes
- Accessibility and affordability of medicines and care
o Insulin available at 100% of hospitals visited
o 73% of public facilities visited had Glibenclamide and 53% had Metformin
o Implementation of 5 Mts (US$ 0.20) prescription fee
- Healthcare workers
o Since 2003 one particular aspect that the Ministry of Health has focused on is training
o Involvement of Mozambique with International Diabetes Federation AFRO in a number of key regional initiatives
o Healthcare workers in all Provinces in Mozambique have received training in diabetes and hypertension (total of 247)
- Adherence issues
o Main problem with adherence is poor knowledge/understanding of diet
- Patient education and empowerment
o 10 members of AMODIA have been trained as expert patients
o Development of training materials
- Community involvement and diabetes association
o Three branches of the Diabetes Association now exist
o AMODIA Maputo has now become a “one stop clinic” for diabetes care
o Problems with management exist at all branches
- Positive policy environment
o Since 2003
§ Creation of the Non Communicable Disease Department within the Ministry of Health
§ Approval in 2008 of the National Strategic Plan for the Prevention and Control of Non Communicable Diseases
Key Recommendations
Organisation of the Health System
o Strengthen management of diabetes at health facilities
- Data Collection
o Increase in training for various personnel with regards to the importance of data collection and its use
o Reporting back to those who collect data
- Prevention
o Develop materials adapted to local diet
o Involve nutritionist in diabetes consultations
- Diagnostic tools and infrastructure
o Standardisation of glucometers available in public sector
o HbA1c available at Central and Provincial Hospitals
o Development of a “toolkit” for detection of diabetes complications
- Drug procurement and supply
o Training and information of people involved in meds supply about different types of insulin
o Investigate applicability of supply system for HIV/AIDS meds and its applicability to diabetes
o Investigate problem with supply of syringes
- Accessibility and affordability of medicines and care
o Clarify regulation of 1 Mts or 5 Mts prescription fee for people with diabetes
o Discuss issue of Diabetes Association membership fee being viewed as a payment for care
- Healthcare workers
o Education adapted to each level of the health system and type of healthcare worker
o Increase on the job training at the Provincial level
o Increase practical and organisational training
- Adherence issues
o Develop materials for patient education
o Improve healthcare worker training
o Involve nutritionists in diabetes care
o Improve training of patient educators on these issues
- Patient education and empowerment
o Increase number of trained people with diabetes
o Involve AMODIA in patient education in all facilities
- Community involvement and diabetes association
o Improve management
o Define roles of AMODIA, clinicians and MISAU through renewing memorandum of understanding detailing the roles and responsibilities of each partner
- Positive policy environment
o Wide dissemination of National Non Communicable Disease plan
What is clear from this assessment is that much progress has been made in Mozambique with regards to diabetes and Non Communicable Diseases in the period 2003-2009. In 2003 many issues were present including serious problems with access to medicines, training, patient education, etc. These problems have now been addressed and the foundations for a system to tackle the growing burden of diabetes are established. The recommendations presented in this report aim to build on these successes, reinforce and expand existing initiatives as well as develop new programmes to address new and existing deficiencies.
It is clear that Mozambique has now developed the foundations to address the increasing burden of diabetes and other Non Communicable Diseases.
Copies of the report from the initial assessment (2003) and reassessment can be downloaded here:
Following the implementation of the Rapid Assessment Protocol for Insulin Access in 2003 many developments with regards to diabetes and Non Communicable Diseases took place in Mozambique. As part of the National Plan on Non Communicable Diseases a reassessment using the RAPIA was carried out in order to assess progress in the area of diabetes and provide a “lessons learnt” for the implementation of programmes and projects for other Non Communicable Diseases and also contribute to the ongoing projects with regards to diabetes.
What is clear from this assessment is that much progress has been made in Mozambique with regards to diabetes and Non Communicable Diseases in the period 2003-2009. In 2003 many issues were present including serious problems with access to medicines, training, patient education, etc. These problems have now been addressed and the foundations for a system to tackle the growing burden of diabetes are established. The recommendations presented in this report aim to build on these successes, reinforce and expand existing initiatives as well as develop new programmes to address new and continuing deficiencies.
The progress made in Mozambique in addressing the growing challenge of diabetes and Non Communicable Diseases should be applauded as the positive developments need to be put into context of a health system where the burden and attention remains linked to communicable diseases and only US$ 3.00 is spent per person per year on providing healthcare.
With the foundations of proper management of diabetes having been created, the next phase should focus on fine-tuning and improving the measures implemented to date as well as integrating these with the National Non Communicable Disease Plan. The action plans detailed in “Section 9. Action Plans” build on this as well as the recommendations described in “Section 7. Recommendations”. These are specifically for the areas visited during the 2009 implementation of the Rapid Assessment Protocol for Insulin Access, but can be applied and adapted to other areas where necessary.
Key Findings
Organisation of the Health System
o Development of chronic consultations at different levels of the Health System in Maputo
§ Some problems with staff originally trained for this role no longer present
o Close collaboration between Maputo Central Hospital and Mozambican Diabetes Association
o Mozambican Diabetes Association provides the main consultation for diabetes in Maputo
o Care for Type 1 diabetes based mainly at Maputo Central Hospital and Mozambican Diabetes Association
o In Beira the main location for diabetes care is at Beira Central Hospital
§ Problems with staffing
o No clear management of diabetes in Lichinga
§ Some patients seen at Hospital others at Health Centre
o In Xai-Xai there is no real organisation of diabetes care at the hospital
o There was a chronic consultation at the Xai-Xai City Health Centre, but now people with diabetes mixed with all other patients
- Data Collection
o WHO STEPS Methodology and Rapid Assessment Protocol for Insulin Access enabled baseline data on diabetes to be collected
o At all levels patient files and clinical registers could be found
§ Hard to use these as amalgamation of consultations versus patient numbers
§ Data not used in decision making
- Prevention
o Organisation of World Diabetes Days and “Health Fairs”
o Lack of tools for diagnosis and management of complications
- Diagnostic tools and infrastructure
o Availability of diagnostic tools has improved since 2003
§ Problems remain with strips for glucometers
- Drug procurement and supply
o No problems with cold chain
o Unequal distribution of insulin and medicines
o Irregular demand for mainly insulin, but also for oral medicines
o Problems with supply of syringes
- Accessibility and affordability of medicines and care
o Insulin available at 100% of hospitals visited
o 73% of public facilities visited had Glibenclamide and 53% had Metformin
o Implementation of 5 Mts (US$ 0.20) prescription fee
- Healthcare workers
o Since 2003 one particular aspect that the Ministry of Health has focused on is training
o Involvement of Mozambique with International Diabetes Federation AFRO in a number of key regional initiatives
o Healthcare workers in all Provinces in Mozambique have received training in diabetes and hypertension (total of 247)
- Adherence issues
o Main problem with adherence is poor knowledge/understanding of diet
- Patient education and empowerment
o 10 members of AMODIA have been trained as expert patients
o Development of training materials
- Community involvement and diabetes association
o Three branches of the Diabetes Association now exist
o AMODIA Maputo has now become a “one stop clinic” for diabetes care
o Problems with management exist at all branches
- Positive policy environment
o Since 2003
§ Creation of the Non Communicable Disease Department within the Ministry of Health
§ Approval in 2008 of the National Strategic Plan for the Prevention and Control of Non Communicable Diseases
Key Recommendations
Organisation of the Health System
o Strengthen management of diabetes at health facilities
- Data Collection
o Increase in training for various personnel with regards to the importance of data collection and its use
o Reporting back to those who collect data
- Prevention
o Develop materials adapted to local diet
o Involve nutritionist in diabetes consultations
- Diagnostic tools and infrastructure
o Standardisation of glucometers available in public sector
o HbA1c available at Central and Provincial Hospitals
o Development of a “toolkit” for detection of diabetes complications
- Drug procurement and supply
o Training and information of people involved in meds supply about different types of insulin
o Investigate applicability of supply system for HIV/AIDS meds and its applicability to diabetes
o Investigate problem with supply of syringes
- Accessibility and affordability of medicines and care
o Clarify regulation of 1 Mts or 5 Mts prescription fee for people with diabetes
o Discuss issue of Diabetes Association membership fee being viewed as a payment for care
- Healthcare workers
o Education adapted to each level of the health system and type of healthcare worker
o Increase on the job training at the Provincial level
o Increase practical and organisational training
- Adherence issues
o Develop materials for patient education
o Improve healthcare worker training
o Involve nutritionists in diabetes care
o Improve training of patient educators on these issues
- Patient education and empowerment
o Increase number of trained people with diabetes
o Involve AMODIA in patient education in all facilities
- Community involvement and diabetes association
o Improve management
o Define roles of AMODIA, clinicians and MISAU through renewing memorandum of understanding detailing the roles and responsibilities of each partner
- Positive policy environment
o Wide dissemination of National Non Communicable Disease plan
What is clear from this assessment is that much progress has been made in Mozambique with regards to diabetes and Non Communicable Diseases in the period 2003-2009. In 2003 many issues were present including serious problems with access to medicines, training, patient education, etc. These problems have now been addressed and the foundations for a system to tackle the growing burden of diabetes are established. The recommendations presented in this report aim to build on these successes, reinforce and expand existing initiatives as well as develop new programmes to address new and existing deficiencies.
It is clear that Mozambique has now developed the foundations to address the increasing burden of diabetes and other Non Communicable Diseases.
Copies of the report from the initial assessment (2003) and reassessment can be downloaded here:
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