The health system in Mozambique is provided by the “Ministério de Saúde” (MISAU), Ministry of Health through hospitals, health centres and health posts. MISAU spent approximately (at the average exchange rate) US$ 167,796,000 or US$ 9.00 per capita in 2001.

The Health budget is a priority for Mozambique, it will cut from other areas before cutting from health. MISAU has 2 areas of expenses:

• Current (medicines and salaries)
• Investment

Donors sometimes give funds for specific programs. This can either be by Mozambique providing a specific project and then finding a donor or the project proposed by MISAU is part of strategy of donor. Sometimes donors fund part of a project and ask government to fund another part, this sometimes limits some projects. For example donors will help with building hospital, but not recurrent costs.

The current financing policy is based on the principle that all Mozambicans should have access to quality care at an equitable price. [1]

The public sector is complemented by services being provided by the Private sector (mainly in large cities) and NGOs.

There are 3 levels of organisation of health, national, provincial and then finally at the district level.

Mozambique has 3 main Central hospitals in each region located in Maputo (which is also the final referral hospital for the whole country) for the Southern region, Beira for the Central region and Nampula for the Northern region.

The lowest level of care is provided by Health Posts (total of 638, 27,674 people per Health Post). Between the Central Hospitals and the Health Posts there are the following types of health dispensing units:

• Health Centres (516, 34,217 people per Health Centre [2])
• Rural Hospitals (total of 25, 706,240 people per Rural Hospital [1])
• Provincial or General Hospitals (total of 12, 1,471,333 people per Hospital [1])

These different centres provide different services and have different types of personnel present. These vary between centres and between cities.

At both hospitals and some health centres the first port of call is the Banco de Socorso (literally Bank of Help). This serves as the equivalent to the emergency room, but unfortunately due to the workload of the health centres and hospitals it is not always used for this purpose.

Resources are not equally allocated throughout the country. The divisions are primarily between urban and rural populations and between the poor and rich. [1] It is important to note that in most instances those who can afford to seek care in South Africa and sometimes even Portugal.

The challenges that Mozambique faces with regards to health are:

• 30-50% of the population have access to basic preventive and curative health services, which means that they live within 10kms of a health facility ([1] and discussions with key stakeholders)
• High level of Communicable Diseases (13% of adults living with HIV/AIDS, 18,108 cases of Malaria per 100,000 [3])
• Lack of staff (599 "Superior Health Personnel" [2] in the whole country, including 400 Mozambican doctors)
• General lack of resources from “paper and desks to medical equipment and medicines”

It is also important to note that Traditional Doctors or Curandeiros, play an important role in providing health care to both rural and urban populations. As many people do not have access to modern medicine, Curandeiros are their only source of care.

In MISAU’s 2001-2005 Strategic Plan has as its aim to achieve for all Mozambicans health levels close to those of the rest of sub-Saharan Africa with access to basic health services and good quality through a health system that responds to its citizen's expectations. The mission to improve the health services is guided by the following principles:

• Efficiency and equity
• Flexibility and diversification
• Partnership and community participation
• Transparency and accountability
• Integration and coordination

Mozambique’s law on Non Communicable Diseases states that care for people suffering from chronic conditions should receive all the aspects of their care for free.

References:

1. Chao, S, Kostermans, K. Improving Health for the Poor in Mozambique The Fight Continues, 2002, The World Bank:Washington D.C.

2. Instituto Nacional de Estatistica, Statistical Yearbook, . 2002, Instituto Nacional de Estatistica: Maputo.

3. UNDP, Human Development Indicators. 2002, UNDP

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