Mozambique health system
The National Health System (NHS) structure:
The National Health Service has a hierarchical structure with services provided at four levels of health care – primary, secondary, tertiary, and quaternary. The health system includes public, and private for-profit and not- for-profit providers. The public sector is the primary provider of health services. Through the decentralization policy of government, districts have become the administrative and implementation units for the provision of the public sector services, including health, in Mozambique.
The Government has gradually increased the number of health facilities in the country from 1,534 in 2015 to 1,652 in 2018.
The National Health policy is based on the principles of primary health care (PHC), equity and provision of quality services to the population. The focus on Primary Health Care implies that services are provided at the primary level in an integrated manner.
In 2017, 96% of persons reported seeking care for a fever in the past two weeks sought care from the public sector with less than 2% reporting seeking care from the private sector. Case management indicators showed that malaria accounted for 25% of cases seen. Children under five years of age accounted for 50% of cases and all were treated with an ACT.
Challenges
- Lack of the continued availability of rapid diagnostic tests (RDTs) and artemisinin-based combination therapies (ACTs) at service delivery points.
- Facility stockout challenges as well as availability of malaria products at service delivery points exist due to delays in the arrival of shipments.
- Shortage of health workers;
- Cost of reaching health care services due to distances involved;
- Quality of care offered to patients;
- Availability of medicines and equipment;
- Motivation of health workers;
- Waiting times
Health risk related to geographic position:
- The risk is higher in rural than urban areas
- 68% of the population lives in rural areas
- Malaria accounts for 31% of deaths in rural areas vs 24% of deaths in urban areas
Private sector
Although an estimated 85% of malaria cases are seen in the public sector, understanding and promoting the quality of services in the private sector is a component of the updated National Malaria Strategic Plan (NMSP). However, the NMCP faces many challenges in engaging with the private service providers. These challenges include lack of a harmonized reporting system and absence of legislation requiring the private sector to follow national case management guidelines.