|Total population (2017)||27,909,798|
|Gross national income per capita (PPP international $, 2013)||1|
|Life expectancy at birth m/f (years, 2015)||56/59|
|Probability of dying under five (per 1 000 live births, 0)||n/a|
|Probability of dying between 15 abd 60 years m/f (per 1 000 population, 2013)||402/314|
|Total expenditure on health per capita (Intl $, 2014)||79|
|Total expenditure on health as % of GDP (2014)||7.0|
Data & Statistics
Country Health Topics
The Mozambique country health profiles provide an overview of the situation and trends of priority health problems and the health systems profile, including a description of institutional frameworks, trends in the national response, key issues and challenges. They promote evidence-based health policymaking through a comprehensive and rigorous analysis of the dynamics of the health situation and health system in the country.
- Health Systems Strengthening Cluster
- Governance of Health
- Health Information and Knowledge Management
- Knowledge Managements and Sharing
- Essential Medicines
- Health Financing
- Health Policies and Service Delivery
- Disease outbreaks
- Communicable Diseases
Challenges & achievements
- Noncommunicable Diseases
- Neglected tropical diseases
- Maternal Health
- Adolescent Health
Mozambique made considerable progress in terms of reducing the child mortality rate: the Demographic and Health Surveys of 1997 and 2003 show that the neo-natal mortality rate decreased from 59/1000 live births to 48/1000 live births while the infant and under five mortality rates decreased respectively, from 147 to 124 and from 219 to 178 per 1,000 live births.
Nevertheless, these mortality rates still remain high and, in spite of this significant progress, it is important to highlight that these gains have not been identical across the country. Disparities of the mortality rate and of the health outcomes are found among provinces, with the Northern provinces presenting the highest child mortality rates. Significant variations between urban and rural areas are also found.
Newborns die mainly due to premature birth, low birth weight, sepsis and neonatal asphyxia. Neonatal tetanus is still a concern in the country. That is understandable because, although 84.2% of pregnant women attend at least one antenatal care session, only 48% of the deliveries are institutional while the remaining occurs at home.
In 2006, data from the paediatrics wards of every hospital show that among the under-five years old, malaria remains the main killer (36.7%). This is followed by malnutrition (13.8%), HIV (12.4%), pneumonia (8.2%) and diarrhoea (3.1%).
The proportion of one year old children fully immunized against the six main preventable diseases (tuberculosis, polio, diphtheria, pertussis, tetanus, and measles) has increased from 47% in 1997 to 63% in 2003.
According to the WHO international classifications, stunting prevalence and underweight prevalence among children under five are very high (respectively 41 % and 24 %).
The main micronutrient deficiencies are: vitamin A deficiency (68.8%), iron deficiency anaemia (74.7%) and iodine deficiency (42% of children aged 6-12 years moderately iodine deficient). The overall prevalence of goitre in the country was estimated at 15%.
The main reasons explaining malnutrition are inadequate and/or insufficient dietary intake, multiple and repetitive infectious diseases, poor feeding practices (exclusive breastfeeding rate the 1st 6 months of life: 30% and nearly one quarter (22%) of children less than six months of age receiving other foods, in addition to breast milk).
Poor access to safe water and sanitation, and the low level of education of the mothers also contribute to the poor child health care and nutrition.
Maternal malnutrition in Mozambique is of particular concern considering the effect this has on foetal and infant growth as well as other birth outcomes. 8.5% of mothers of children under five years old have a body mass index or Body Mass Index less than 18.52 showing chronic energy deficiency.
Vulnerability to malnutrition is now also exacerbated by HIV which is becoming a major cause of under five years old mortality. The number of new HIV infections among children has continuously increased from an estimated 23.400 in 2000 to 37.300 in 2006, which represents about 102 new infections every day . By September 2007, there were 211 sites providing ARV, and 86000 ART beneficiaries, of whom 6320 children under the age of 15.
In 1998, the Ministry of Health adopted the Integrated Management of Childhood Illnesses (IMCI) as a main strategy to reduce child mortality.
Key partners are WHO, UNICEF, and USAID through its NGOs.
- Integrated Management of Childhood Illnesses (IMCI) is now implemented nationwide and 70% of health facilities at national level have at least one health worker trained on IMCI caring for sick children. The health facility survey carried out in 2005 with support from WHO and other partners showed a net improvement of the health workers skills on case management of the sick children.
- Multiple actions have taken place within the IMCI strategy in order to strengthen the system, such as:
- the incorporation of IMCI drugs into the essential drugs kits;
- the supply of drugs for injection needed for pre-referral treatment of seriously ill children;
- the establishment of Oral Re-hydration Therapy (ORT) corners;
- and the provision of bicycle ambulances to communities for emergency transport.
- In 2003, IMCI pre-service training was introduced in the curricula of health sciences training institutions and later at the medical school as a means of supporting the sustainability of the strategy.
- Since 2004, Mother and Child health nurses are trained on both Emergency Obstetric and Newborn Care.
- IMCI training material was updated in 2006, to address the 1st week of newborn life, and to include the HIV component as well as the new WHO recommendations related to breastfeeding, diarrhoea (the new ORS & zinc) and malaria treatment.
- Mozambique adopted in 2005 the Code of Marketing of breastmilk substitutes and drafted the infant feeding policy which addresses HIV issues.
- Along 2006 and 2007, Mozambique developed the newborn and child health policy and the newborn and child health strategic plan;
- The child health card was updated in 2007 to the new WHO child growth standards and also to include PMTCT;
- Establishment of a technical working group for maternal, newborn and child health within the Health SWAp under the leadership of the Ministry of Health.
- To achieve the Millennium Development Goal Number 4, meaning a reduction from 246 deaths per 1,000 live births in 1997, down to 82 in 2015;
- Strengthen national capacity including the provincial and district team in planning and implementing priority child health interventions taking advantage of the Reach Every District (RED) approach for scaling up towards universal access and coverage;
- Strengthen national capacity for effective monitoring and evaluation of child survival and use of the findings to improve the child health program implementation;
- WHO will continue to support the Ministry of Health to improve and strengthen collaboration and coordination mechanisms among child health related programs and among partners aimed at better delivery of integrated interventions through MNCH services;
- WHO will continue to advocate among partners towards a common agenda ensuring the continuum of care throughout the life course at all levels including the promotion of community based interventions and contributing to strengthening the health system.
- Renewed interest in strengthening community involvement and community based services.
- Enabling Environment Cluster
The Enabling Environment Cluster includes:
- Human rights
- Community involvement
- Health promotion
The WHO office in Mozambique is actively strengthening its role in providing technical support , in the field of Health and Human Rights, Documentation, Health Promotion Dissemination of Information and advocacy for people with disabilities. On the other hand, WHO in Mozambique supports the Ministry of Health in strengthening of community involvement and community based in the national plan and priorities for health. In order to improve quality, coverage and coordination of health interventions at community level.
The Health Promotion Unit helps to increase the capacity of the country to use health promotion strategies to address the broad determinants of health and assist communities gain control over, and improve their health through integrated action.
- Human Rights
Human rights are an internationally agreed upon set of principles and norms adopted at international and regional levels. Many international instruments refer to the right to health or health-related rights.
Promoting and protecting health and respecting, protecting and fulfilling human rights are inextricably linked:
Violations or lack of attention to human rights (e.g. harmful traditional practices, slavery, inhuman and degrading treatment, and violence against women) can have serious health consequences;
Health policies and programs can promote or violate human rights in their design or implementation (e.g. freedom from discrimination, rights to participation, privacy and information);
Vulnerability to ill health can be reduced by taking steps to respect, protect and fulfil human rights (e.g. freedom from discrimination on account of ethnicity, sex and social status and the rights to food and nutrition, water, education and adequate housing).
In light of the linkages between health and human rights, it is more and more important to increase awareness and to have an added systematic application of human rights to a range of public health challenges. In this context, the right to health is an important tool that can be used to tackle health inequalities.
Mozambique has ratified several major international and regional human rights treaties that address the right to health and a number of rights related to conditions necessary for health. However, Mozambique is not yet party to the International Covenant on Economic Social and Cultural Rights.
At national level, the Mozambican constitution (2004) refers to the protection and promotion of human rights, including the right to health. The rights-based approach is also reflected in other important strategic documents such as the Poverty Reduction Strategic Paper (PARPA II) and the National Declaration of Health Policy (Declaração Nacional de Política da Saúde).
- Lack of adequate human rights network to develop specific projects (including weakness of civil society);
- Limited strategic position in some priority health programs such as tuberculosis, malaria, etc.
- Key documents not available in Portuguese.
The WHO office in Mozambique is actively strengthening its role in providing technical, intellectual and political leadership in the field of health and human rights. Indeed, it has established strong links with partners at Ministry level, but also with the civil society to introduce the human rights based approach to health. At international level, WHO is also actively collaborating with the UN Special Rapporteur on the Right to Health, and his team.
WHO office in Mozambique is working towards the dissemination of information on health and human rights as well as important related subjects, such as the effects of discrimination on the response to HIV, or the rights of people with disabilities.
- Introduction of the notion of the right to health in the Health Sector Strategic Plan (PESS).
- Implementation of the recommendations made by the Special Rapporteur on the Rights to Health, who visited Mozambique in 2003.
- Collaboration with the Ministry of Justice for setting up the National Human Rights Commission and to tackle the issue of rights of HIV positive inmates.
- Community Involvement
In Mozambique, there is a renewed interest in strengthening community involvement and community based services. The Ministry of Health (MoH) considers that community involvement must be strengthened as an explicit and priority objective of the national plan for health in order to:
- Strengthen health interventions at community level;
- Achieve the Millennium Development Goals (MDGs);
- Face the human resource crisis;
- Improve quality, coverage and coordination of health interventions at community level.
- Limited number of people familiar with the community based approach for health at all levels;
- Need for the development of a programmatic approach to community interventions so that the community's role in the formal health system is identified and supported and that elements of their roles are captured in the health management information systems;
- The development of standards and training material for community-based prevention, treatment, care and support;
- The promotion of community based initiatives;
- Revitalization of a community health workers program as an intermediate solution to bring health care to remote areas;
- Sustainability of community health workers: issues of remuneration remain unsolved in Mozambique, development of better supervision mechanisms;
- Revision of the manuals for community health workers;
- Revision of the national strategy on community involvement;
- Development of tools for monitoring and evaluation.
Achievements & next steps
- Draft of the Plan of action to promote community involvement for health;
- National meeting on community involvement for health.
- To build capacity of the MoH and their partners to support communities' participation;
- To face the priority challenges at community health level to accelerate, promote and coordinate community involvement strategy and activities.
Despite numerous NGOs interventions, Mozambique is still facing various critical problems in the health sector and is not getting the targets at community level.
The proliferation of NGOs and programs in Mozambique has, at times, occurred at the expense of accountability and quality programming, and has led to fragmentation of the NGO "voice." It is a fact that NGOs tend to compete amongst themselves rather than to work together. Since the MoH is still not completely prepared to orient and control most of NGOs activities, the principles of collaboration between the MoH and NGOs need to be strengthened.
As it was confirmed by the recent creation of the health partners group on NGOs in July 2007, the MoH and NGOs agree that their health services are complementary and absolutely in need of optimal coordination through strategic partnerships and policies.
There are key priority issues that need to be strengthened:
- To establish a common diagnosis of the situation;
- To develop a data base and mapping on NGOs information and activities;
- To share best practices of NGOs evidence-based interventions;
- To create complementarities and efficient interventions in line with the MoH strategic plan;
- The development of the NGO unit at the MoH;
- To improve coordination and partnership mechanisms between the MoH and NGOs through a better contractual approach and policies documents;
- Health Promotion
Prof. Paulo Ivo Garrido H.E. the Ministry of Health mobilizing community during the celebration of Africa Malaria Day on 25 April 2007, in Zambezia
Health Promotion is the process of enabling people to increase, control and improve their health. Community involvement and participation are essential to sustain health promotion actions.
In 2001, The African Region endorsed the Health Promotion Strategy, whereby Member States are urged to develop national strategies incorporating policy frameworks and action plans to strengthen the institutional capacity for health promotion as well as provide support at various levels of the health system, as appropriate. The aim of the strategy is to foster actions that enhance the physical, social and emotional well-being of the people, and contribute to the prevention of leading causes of disease, disability and death.
Prof. Paulo Ivo Garrido H.E. the Ministry of Health mobilizing community during the celebration of Africa Malaria Day on 25 April 2007, in Zambezia.
Prof. Paulo Ivo Garrido H.E. the Ministry of Health mobilizing community during the celebration of Africa Malaria Day on 25 April 2007, in Zambezia.
The new structure of the MoH shows the high ranking given to Health Promotion by the Mozambican health authorities: there is a Health Promotion National Directorate with two Deputy National Directorates namely Health Protection, and Prevention and Disease Control.
A study conducted by the Ministry of Health (STEPS) has shown that non-communicable diseases (NCDs) are a matter of concern for health in Mozambique.
The country faces a lack of skilled professionals for Health Promotion, namely for strategic planning and monitoring and evaluation. Also, the unavailability of translated versions of WHO key documents in Portuguese contributes to keep a weak visibility of Health Promotion.
WHO and its partners are supporting a number of initiatives in the area of health promotion in Mozambique - Roll Back Malaria, Making Pregnancy Safer, Health Promoting School Initiatives, Road Safety - under the coordination of the Ministry of Health, jointly with other sectors of the government such as Education and Culture, Agriculture, Women and Welfare, Sports and Youth, Transport and Communications, and the Parliament. Many other actors are also part of these initiatives such as mass media (modern and traditional), civil society, national and international NGOs, religious groups, sports groups, traditional medicine practitioners, and other relevant stakeholders.
- Diseases that can be prevented - malaria, tuberculosis, respiratory infections, diarrhoea, sexual transmitted diseases, HIV infection, non-communicable diseases - are increasing sharply;
- Young people are more and more exposed to trauma, alcohol, tobacco and substance abuse;
- Developing and implementing a National Health Promotion Strategy;
- Training of Health Promotion staff countrywide;
- Improvement of coordination among partners.
Achievements & next steps
- Support provided to the Mozambique Association of Public Health (AMOSAPU) for the organization of two meetings for tobacco prevention and control for the Lusophone, Southern Africa and East Africa countries;
- Strengthened partnership with mass media;
- Support provided for the development of the health communication strategy of the National Program for Malaria Control (PNCM).
In the context of Roll Back Malaria (RBM) an Inter-Religious Campaign was established by 10 national faith leaders in Maputo, Mozambique. In 2006, these leaders requested the participation of the Washington National Cathedral and the Adventist and Development Relief Agency in moving forward with their dream of a Mozambique without Malaria.
National Campaign members include: the Roman Catholic Church, the Islamic Congress of Mozambique, the Islamic Council of Mozambique, the Anglican Church, the United Methodist Church, the Seventh-Day Adventist Church, the Hindu Community, Assemblies of God, the Christian Council of Mozambique, and the Baha'i Community. The Co Chairs of the IRCMM are Bishop Dinis Sengulane and Mr Hassan Makda.
This inter-faith group is implementing the first stage of its "Together Against Malaria" program in the province of Zambezia by providing health education, training, and community mobilization through trained faith leaders. Faith communities exist in every village in the country; therefore, faith leaders can reach their members and impact their attitudes and behavior related to malaria.
Mrs. Laura Bush during the Seminar, on the President's Malaria Initiative (PMI), held in Maputo in June 2007, announced the first grant to the Inter-Religious Campaign against Malaria in Mozambique. Through the President's Malaria Initiative, with a three-year, nearly $2 million grant that is expected to benefit over a million and a half people. The Adventist Development and Relief Organization provides program implementation support to the faith leaders, and Washington National Cathedral's Center for Global Justice and Reconciliation also provides support and assists with procuring additional resources for the project.
- Formulation of the national Health Promotion strategy;
- Support to the national campaign for sanitation and hygiene.
- Immunization and Vaccination Development
The Immunization and Vaccines Development (IVD) Cluster includes three programmatic areas:
- Routine Vaccination and New Vaccines
The IVD Cluster provides technical support to the Ministry of Health to reduce the level of morbidity, disability and mortality due to vaccine-preventable diseases. It aims at achieving and sustaining high immunization coverage; eradicating, eliminating and controlling diseases; and introducing new vaccines.
The Cluster provides technical assistance for monitoring the performance, quality and safety of the Mozambican vaccination system through identified indicators and compliance with the WHO list of pre-qualified vaccines.
To improve public health and lower the burden of infectious diseases, the Cluster assists the Ministry of Health in developing and implementing sustainable vaccination strategies promoting universal coverage. The impact of the strategies is assessed through on-going epidemiological surveillance and reliable laboratory confirmation.
Aiming at reaching regional and global targets, the Cluster supports the monitoring of the overall proportion of children and women who are vaccinated (immunization coverage), ensuring that all districts of Mozambique are well covered with vaccination services.
- Routine Vaccination and New Vaccines
Vaccination is a key priority to reverse the high child mortality of 97/1000 live births in Mozambique . As part of the Expanded Program on Immunization, the Mozambican national routine vaccination programme includes:
- Polio; measles; tuberculosis (BCG); diphtheria, pertussis, and tetanus (DPT1/3); hepatitis B; Hib, and pneumococcal (PCV-10) for children under one year:
- Tetanus for pregnant women.
According to the Demographic Household Survey (DHS) 2011, almost 64% of children had completed the full vaccination programme before the age of one year, compared to 63% in 2003 and 47% in 1997. The vaccination coverage is thus far below the global immunization goal of at least 80% coverage in all districts, and 90% nationally. The coverage is also unevenly distributed within the country. The province of Zambézia continues to have to lowest coverage rate of 47.3% in 2011. Furthermore, coverage varies between urban and rural areas. In 2011, the DHS reported coverage to be 75% in urban and 60% in rural areas compared to 81% and 56% in 2003, respectively.
Many districts have communities that are difficult to access with the existing health services infrastructure. Outreach programmes are therefore essential to improve coverage at district level. However, only 30% of fixed vaccination units are provided with transport needed to conduct outreach activities.
To increase coverage at district level, the Reaching Every District (RED) strategy was implemented in 131 districts out of 148 by 2012. However, the strategy faces irregularities and disruption in the implementation due to funding limitations. Furthermore, low population density in many districts makes the RED strategy costly though essential to increase the number of fully vaccinated children.
Another concern is the high level of dropout for DPT1/3 at district level. According to DHS 2011, the national DPT1/3 dropout rate was 17%. The most affected provinces with dropout rates above the national average were Cabo-Delgado (28%), Zambézia (27%), Nampula and Manica (both 19%).
Another key challenge for strengthening the vaccination system and increase coverage is the shortage of trained health personnel leading to fragile programme management. Poor infrastructure also complicates logistical necessities including the cold chain system and transport for outreach activities.
- PCV-10 was successfully introduced into the national immunization programme in April 2013.
- The Ministry of Health plans to introduce rotavirus into the childhood vaccination programme in 2014 and human papilloma virus (HPV) for women in 2016. An HPV demonstration project will be conducted in Manhiça district in 2014 and 2015, prior to the nationwide introduction of the vaccine.
- The African Vaccination Week (AVW) was introduced in 2008 as part of the National Health Weeks, taking place twice per year. Preparatory committees exit at national, provincial and district levels. These include Nutrition, EPI, social mobilization and health promotion units at each level. Results from African Vaccination Week 2013 include:
Oral polio vaccination
Nutritional screening (children measured mid-upper arm circumference (MUAC))
Family Planning – distribution of condoms
Surveillance is the continuous, systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice.
To monitor vaccination coverage and identify gaps, Mozambique introduced a weekly surveillance system in 1987. In1997 a case based surveillance system for polio was introduced, and further expanded for maternal and neonatal tetanus and measles in 2006.
Data collected through the surveillance system is reported to the global WHO Vaccine-preventable Diseases Monitoring System and summarised in the Mozambique Country Profile.
WHO UNICEF vaccine coverage estimates Vaccine/year 2011 2010 2009 2008 2007 2000 1990 BCG 91 90 90 90 90 84 59 DTP1 90 90 88 87 85 84 71 DTP3 76 74 74 75 75 70 46 HepB3 76 74 74 75 75 _ _ Hib3 76 74 74 _ _ _ _ MCV 82 82 80 77 75 71 59 PAB 83 83 83 83 82 75 37 Pol3 73 73 74 74 75 69 46
To monitor disease outbreaks, every health facility is obliged to notify the weekly caseload of a number of communicable diseases including measles, meningitis, and polio. In 2012, the most recent outbreak of measles was notified in Niassa province, Lago district.
Despite the surveillance systems in place, low capacity at facility level including shortage in human resources for health often causes delayed and fragmented data. Furthermore, many provinces are facing challenges in implementing vaccination programmes.
The fragile health infrastructure and limited human resources for health complicate disease control particularly for reaching international goals of polio eradication and measles elimination.
- In 2012, all provinces achieved the Non-Acute Flaccid Paralysis (AFP) rate of at least 2/100,000 children under 15 years;
- Diagnostics have been improved by using case definition;
- Continuous training of health workers in surveillance at provincial level;
- Introduction of countrywide measles case-based surveillance integrated into the already existing AFP surveillance system.
- Ministry of Health
- World Bank
- Eradicating Polio in the African Region: 2011 Regional Update
- GAVI Alliance
Logistical support is crucial for vaccination services. It aims at ensuring the availability of appropriate equipment and an adequate supply of high-quality vaccines and immunization-related materials to all levels of the vaccination programme. The main areas of logistical support include vaccine management and monitoring, cold chain management and immunization safety.
If the logistics programme is well-managed, it can help saving on programme costs by ensuring efficient programme implementation without sacrificing the quality of service delivery. On the contrary, poorly managed logistics systems can lead to high and unnecessary vaccine wastage, stock outs, or improper management of waste, resulting in increased operational programme costs, as well as negative effects on public health.
The planning of vaccination programmes is heavily reliable on accurate population data and precise information about inventory at health care facilities. Inaccurate data impairs the planning and management of vaccination services including the cold chain systems, which is the temperature-controlled series of storage and distribution ensuring quality and shelf life of the vaccines.
Mozambique faces several logistical challenges in increasing vaccination coverage and in introducing new vaccines into the national vaccination programme. The country is divided into 148 districts throughout 11 different provinces. Vaccination services are offered in approximately 1,372 fixed entities representing 98% of all health units in the primary and secondary health care system. Low population density of around 26 inhabitants per square kilometre on average complicates vaccination services and requires costly outreach vaccination programmes in most districts. Communication flow between district, provincial and central level is complicated by lack of access to communication tools including internet and limited human resources for health. This affects the ability to communicate needs and coordinate supply.
To ensure immunization quality and safety, only WHO pre-qualified vaccines are purchased via UNICEF procurement channels. Each Expanded Program on Immunization (EPI) unit is in charge of ordering and allocating supplies to the different provinces based on the feedback received from the respective provinces. Some vaccines are financed solely by the Government of Mozambique (BCG, OPV, measles, tetanus) and others are co-financed by GAVI Alliance (Diphtheria-Pertussis-Tetanus, Hepatitis B, Hib, PCV-10).
- Introduction of the pneumococcal PCV-10 vaccine in April 2013
- Cold chain inventory assessments conducted of 98% of all health facilities in 2012.
- In 2000, the Monthly Health Days (MHD) outreach strategy was introduced. The outreach services depart from health units to visit the communities in most of Mozambique’s 148 districts.
- Mental Health