Strengthening primary health care through Mozambique’s regional health strategy

Since 2019, Mozambique has embarked on a journey to strengthen its primary health care (PHC) services and community health efforts through a decentralized governance model. Supported by a collaborative effort between the Global Financing Facility (GFF) and the Global Fund to Fight AIDS, the World Health Organization (WHO ), the World Bank (WB), Mozambique has made progress in achieving many health goals. According to the 2023 Demographic and Health Survey, the under-five mortality rate improved from 97 in 2011 to 60 per 1,000 live births, and the neonatal mortality rate increased from 30 to 24 per 1,000 live births over this period. decreased (1). Additionally, Mozambique’s maternal mortality rate improved from 532 deaths per 100,000 live births in 2000 to 127 deaths in 2020, lower than the regional average (2). Addressing maternal mortality is a top priority under the Community Health Strategy (CHS), with the aim of quickly identifying pregnant women at risk and ensuring early referral from the community to more capable health facilities. The aim is to reduce mortality rates.

A religious sermon on maternal and child health at the Lasag Mustafa Mosque in Mozambique.
Credit: Interfaith Communication Platform for Health.

From national health policy to community health strategy (CHS)

UNICEF and WHO actively collaborated with the Ministry of Health (MoH) in 2021 to develop a comprehensive CHS and design its pilot implementation, which was subsequently approved by the Ministry of Health in 2022. WHO continues to provide technical support for strategic processes, pilots and development. Meanwhile, UNICEF is providing technical support for information systems, evidence generation, piloting and equipment procurement for community health workers (CHWs). GFF and the World Bank are providing financial support for the implementation of strategies in specific areas as part of the PHC Strengthening Program. The GF will provide financial support for comprehensive implementation of the strategy, including governance, CHW training and education, evidence generation, quality assurance, oversight systems, and overall system functioning at both national and local levels. To do. UNFPA supports the training and supervision of his CHWs in Reproductive, Maternal, Newborn, Child and Adolescent (RMNCAH) health services.

The initiative has a particular focus on the broader context of universal health coverage (UHC), with the provision of integrated PHC services, a significant package of community leadership and coordination, and well-trained Emphasis on providing consistent, higher quality care. CHWs are paid and given adequate support. WHO is providing technical assistance to ministries of health to develop a legal framework that formally recognizes CHWs and provides them with the opportunity to receive some form of remuneration. The CHS also complements the National Strategic Health Plan and the Provincial Strategic Health Plans of Tete and Niassa.

Visit of Director-General Tedros Adhanom Ghebreyesus during community activities in the Boane region of Mozambique in July 2023.
Credit: Jaime Machel

Expansion and maintenance of local medical services

One of the objectives of the pilot was to test a competency-based training curriculum for CHWs. As a result, the government adjusted its training strategy. Additionally, we actively seek feedback from partners at the community level to improve CHW performance.

MoH is guiding the implementation and scaling up of CHS. GFF, GF, WB, UNICEF and WHO are playing a key role by funding the expansion planning and implementation process, which aims to cover all 11 states in a phased manner.

Additionally, collaboration with parliamentarians played a key role in advocating for increased resources for primary and community health services, including investing in health determinants and promoting UHC. During the CHS implementation, WHO conducted introductory training sessions for Niassa, Tete and Maputo provincial parliamentarians on SDG targets and UHC, and strengthened their capacity to analyze health budgets and expenditures. On average, these sessions were attended by 40 to 60 MPs from the two major committees: the Committee on Health and Social Affairs and the Committee on Finance and Budget. This training has significantly strengthened MPs’ ability to oversee and understand challenges within the health sector at the local level. He also emphasized the importance of incorporating health considerations into all policies at the state level.

Summary of contributions by specific SDG3 GAP partners to Mozambique’s regional health strategy

Advance

CHS implementation remains challenged by a variety of factors, including extreme weather events such as cyclones, floods, and droughts that lead to internal displacement of people and disruption of health services. PHC networks must be strengthened by ensuring sufficient skilled staff and essential medicines and supplies, especially for vulnerable groups such as children, pregnant women, the elderly and young people. Strengthening this network will increase equitable coverage and access to essential health programs such as routine immunization and maternal and child care.

The Mozambican government’s response to the Global Plan of Action for Healthy Lives and Well-being (SDG3 GAP) monitoring survey calls for better coordination between development partners, with a view to aligning them more closely with national priorities. highlighted the need. The contribution of SDG3 GAP partners to Mozambique’s CHS underlines their commitment to strengthening collaboration among SDG3 GAP partners behind national strategies and plans to improve health outcomes. The CHS has become a key document guiding partner support to governments.

Collaborative efforts by partners to mobilize specific resources for country-led health interventions and collective actions are fundamental to sustaining progress in the health sector and meeting new challenges. For example, other joint initiatives to strengthen PHC include the National Acceleration to End Preventable Maternal Deaths, which integrates the Newborn Action Plan for All and incorporates the priorities of the Emergency Obstetric Care Network. Includes planning. These initiatives represent a unique opportunity to strengthen the PHC component of the health system, thereby enabling it to function optimally and respond to health needs at the local level, yet require significant funding. We are facing a shortage.

The potential for CHS to drive health sector reforms is an interesting prospect, as it will improve access to health services for the most hard-to-reach populations and facilitate Mozambique’s accelerated progress towards the health-related SDGs. .

What is the SDG3 gap?

The Global Plan of Action for Healthy Lives and Well-being for All (SDG3 GAP) brings together 13 institutions with key roles in health, development and humanitarian responses to help countries accelerate progress on health-related SDG targets. A series of commitments made by The added value of the SDG3 GAP lies in strengthening collaboration across government agencies to take collective action and provide support that is more tailored to country-owned and led national plans and strategies.

(1) Mozambique Demographic and Health Survey, 2022-2023

(2) World Bank, Mozambique. World Bank Gender Data Portal.