Gilda Mandlaze is a 22-year-old girl who is paraplegic. She lives in Chokwé, a rural town and capital of Chokwé District in the province of Gaza, Mozambique. She stopped going to school when she was on the 9th grade at Chokwe Secondary School because she had no money to buy school material or pay for transport. She lives far away from her parents and needs to take care of her younger cousin whose parents have gone to South Africa. To support herself and her cousin, Gilda always tried to do small tasks like wash clothes and prepare peanut butter, but she could not gain enough money as she is physically challenged.
Year 2017 brought good news to Gilda. A new project, Hlayisa, was launched. The project is implemented in 19 districts in Maputo, Inhambane and Gaza provinces, including Gilda’s home town Chokwe.The main objective of Hlayisa is to enhance and improve HIV treatment, nutrition, general health outcomes, and livelihoods of people living with HIV - children, women and families. One of the activities is the establishment of and facilitated access to economic strengthening opportunities to ensure sustainable livelihood for vulnerable adolescent girls and young women.
One morning Gilda went to chat with her neighbor Lucia. There she heard to her surprise that a girls’ club had started a few weeks ago in the community and had identified the local school as a safe space for meetings. The club’s activities included a savings group. As Gilda listened on, she reflected on her needs to get money to buy food, clothes and to be able to go back to school. Read more
The Wine Health Center is located in Bebedo Township, Nhamatanda district, with about 10,682 inhabitants, distributed in 5 Communities with 4 employees that provide health services at the doors of SMI, Maternity and General Medicine Consultation.
During the Quality Service Monitoring exercise, in particular in the phase of gathering evidence using the Community Scorecard (CPC), the CS de Vinho was identified as one of the CS with problems in the provision of quality services to the users, specifically for the FP services, and the local community preferred to go to the CS of Mutondo (which is approximately 10 km away) in search of better services, since it was not satisfied with the services rendered at CS de Vinho.
After several community meetings, the last meeting (Interface) was held between community representatives, community authorities and health providers, with the administrative authorities. At this meeting, several aspects related to the quality of FP health services in the health unit were discussed and the priorities of each area were harmonized, culminating in the elaboration of an action plan to materialize the concerns presented by the communities as well as the providers of Cheers.
At the follow-up and monitoring stage of the agreed priorities, it was possible to verify the improvement of most of the issues raised during the evaluation, and were witnessed by the community during a devolution meeting and supported by the district health authorities that recognize the importance of CPC in improvement of the quality of services provided by the health unit. thus, the highlighted and witnessed aspects are:
• There have already been changes in Maternity care. The nurse is more present and, when she is absent, another nurse is indicated to attend to the parturients. On the other hand, midwives no longer deliver, they only support the nurse.
• The community complained about prescription of over-the-counter medications. SDSMAS have already allocated revenue blocks and technicians are passing revenue to users.
• The community complained about the technicians' constant absence from work hours. At the moment, the technicians are still in the working hours and reduced the exits in the working hours.
• In the CS of Wine, the Management Committee (GCC) was not in operation. The same has been revitalized which ensures the monitoring and maintenance of priorities. At this moment, the GCC activities and meetings with the US are in the process of being scheduled.
In this way, the CPC brought a different dynamic to the level of this health unit, having improved the interaction and joint work between providers and the local community, as well as increased demand for services, abandoning the practice of traveling to the CS of Mutondo in search of of the best services.
Get to know the story of Ana Gilda Maria Tomé, 36 years old, married, 5 children, who lives in the neighborhood of Mutauanha, Post Administrative of Muatala, in the district of Nampula, province of Nampula, Mozambique. In February 2018, Ana Gilda narrated to the Netting Malaria project field team on how the Community Dialogues (CD) run by the Netting Malaria brought about a significant change in her family behavior and impact on their improved health.
“I and my family went very badly, because all of us – my children, husband and I – always suffered from malaria and other diseases. My children stayed days without attending school, because they were sick (could not get out of bed). I thought it was any witchcraft that was made against our house. In fact, before participating to the CD sessions promoted by N`weti s trained facilitators, in their malaria project, I would not accept to have my house sprayed by the Ministry of Health brigades. I thought that household spraying was used to distribute cholera and other diseases. And then, mosquitoes would not end up inside my house only because it has been sprayed.”
In fact, the Ministry Provincial Directorate’s Malaria Control Program reported in 2016 that one of key challenges of the Malaria program was resistance faced in the communities’ adherence to Intra-Domiciliary Pulverization (IDP) campaign, although being this one effective strategy to eradicating malaria. This is why, the Netting Malaria promotes CD weekly sessions, to promote discussions on locally established beliefs over malaria prevention strategies and help correct misconceptions.
“When I learned that there was a group that promoted debates on issues related to malaria prevention in my community, I went to hear what was going on in these debates. After attending the six - weekly meetings, I realized that in - home spraying was one of the best ways to prevent malaria. This year, when I heard that the health brigade was going through the neighborhoods, spraying the houses, I was worried about when they would arrive in my neighborhood. And the day they arrived at my house I agreed to spray my whole house. Actually, even if there was no spray campaign I would ask the staff to come and do the work at my house.”
And now, Ana Gilda, starts to feel the impact of having accepted the MoH team to spray her house.
“With Spraying, in my house we were free of mosquitoes, cockroaches, and besides we were free of malaria that was previously the disease that did not end in our family. Today I want to advise everyone who is in the same situation as I was previously, to accept these methods of prevention, because they are effective and safe.”
From February 18 to 22 in Nampula and from February 25 to March 1, 2019 in Sofala training of OCB`s, health providers, facilitators and supervisors in Community Scorecard (CPC).
The Community Punctuation Card ( CPC) is a tool for monitoring and evaluating the quality of health services, which allows a participatory evaluation of the public services developed in the communities. For the case of the present project, the CPC is the tool selected to be used in monitoring the quality of family planning services. To this end, facilitators, field supervisors, health technicians, members of Co-Management and Humanization Committees and CBOs will be formed.
Over the next four weeks, N'weti will release a series of texts analyzing funding for the health sector in Mozambique. This is the dissemination of learning and advocacy material resulting from research that culminated in the report entitled Health Sector Development Assistance Architecture in Mozambique.
To begin with, we share research brief 01, entitled The Collapse of a Condemned Success Financing Architecture, which summarizes the historical trajectory of PROSAUDE, one of the health sector funding mechanisms, contextualized in the Broad Sector Approach (SWAP). The analysis seeks to contribute to the improvement of the mechanism, presenting its challenges and its milestones of success. Indeed, the case of Mozambique has often been cited internationally as a notable example, and the Common Fund has enabled improved government leadership, a greater strategic focus and effective use of aid. Concerning the challenges, there are problems with procurement, the ability to absorb funds, salary incentives awarded without compliance with standards and, finally, excessive centralization of resources in the Ministry of Health. Check out the main discussion in the document and share with us your opinion.
#Unpacking_DAH_MOZ_Health_Sector
This Research Brief1 highlights the contextual narratives of Mozambique’s adherence to the Health Financing Facility (GFF). The reflection herein is based upon a triangulation of the documentation research methods, field work in three of the country’s provinces (Nampula, Zambézia and Gaza), in depth interviews and focal group discussions. The work underlines that: (i) the process of adherence to GFF, both by MISAU and the financing partners, was relatively precipitated by a particular context of a financial crisis, which was worsened by the hidden debts and lack of credibility of the multi-actors coordination mechanisms, with particular emphasis on PROSAÚDE; (ii) with regards to implementation, GFF is fundamentally based on two instruments, namely the Investment Case (CI) and the Health Sector Financing Strategy (EFS). Undeniably, the former elaborates the action lines in terms of intervention methods, while the latter functions as a CI financing instrument which, in addition to the sector component, it carries with it a political dimension which is not just electioneering, or of legitimisation of the government, but also of economic interests of the political elite. It can thus be concluded that GFF requires a more increasingly assertive coordination among the various management levels in the sector. This will lead to greater decentralisation, in order to avoid the risk of reproducing the authoritarian centralisation of the sector, which might have contributed to the failure of the previous financing mechanisms. The current reflection is structured in two parts: firstly, it deals with the narratives of adherence to the mechanism and, secondly, it touches on the implementation dynamics, while at the same time drawing the initial impressions about the quick wins of the new financing mechanism.
This Research Brief1 highlights the contextual narratives of Mozambique’s adherence to the Health Financing Facility (GFF). The reflection herein is based upon a triangulation of the documentation research methods, field work in three of the country’s provinces (Nampula, Zambézia and Gaza), in depth interviews and focal group discussions. The work underlines that: (i) the process of adherence to GFF, both by MISAU and the financing partners, was relatively precipitated by a particular context of a financial crisis, which was worsened by the hidden debts and lack of credibility of the multi-actors coordination mechanisms, with particular emphasis on PROSAÚDE; (ii) with regards to implementation, GFF is fundamentally based on two instruments, namely the Investment Case (CI) and the Health Sector Financing Strategy (EFS). Undeniably, the former elaborates the action lines in terms of intervention methods, while the latter functions as a CI financing instrument which, in addition to the sector component, it carries with it a political dimension which is not just electioneering, or of legitimisation of the government, but also of economic interests of the political elite. It can thus be concluded that GFF requires a more increasingly assertive coordination among the various management levels in the sector. This will lead to greater decentralisation, in order to avoid the risk of reproducing the authoritarian centralisation of the sector, which might have contributed to the failure of the previous financing mechanisms. The current reflection is structured in two parts: firstly, it deals with the narratives of adherence to the mechanism and, secondly, it touches on the implementation dynamics, while at the same time drawing the initial impressions about the quick wins of the new financing mechanism.
Read more: GLOBAL FINANCING FACILITY (GFF). pdf
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Today, December 12th, is the International Day of Universal Health Coverage. In a context where the global trend is to focus more on addressing health systems - as opposed to the notion of health systems - there is much has been discussed on how to ensure quality health care for all. Indeed, the “accelerators” of the Sustainable Development Goals (SDGs) in point 7 can be a concern with increased funding for health determinants. The SDGs also call for greater engagement with communities to achieve Universal Health Coverage and not just accountability issues. It is in this Framework, and considering the accumulated experience in this field, that N'weti shares with readers the policy brief: For an Accessible National Health System to all in Mozambique.” This policy brief seeks to highlight the centrality of the health service user in formulating and monitoring sector policies, as opposed to the prevailing dynamics characterized by the predominance of external actors and dominant elites in the planning and budgeting processes. To make this user participation possible, the document suggests a series of actions, some of which are opening the space for public policy construction to the various social actors, interests and needs; Major role of MISAU in the design and monitoring of health policies and systems.
In order to provide knowledge, skills and techniques of methodology for community dialogues and the flow of data generation, from 20-24 March 2020, N'weti trained 8 Community Assistants, 8 Promoters and a Technical Support Officer within the scope Vale a Pena Project (VaP), a social marketing initiative and offering quality contraceptive services for teenagers and young people, implemented by a consortium formed by PSI (as leader of the consortium), N'weti and Tuya Consulting with financial support from DFID, in the following districts: Chonguene, Manjacaze, Chibuto and Limpopo in the province of Gaza and Mongicoal, Mogovolas, Larde, Lalaua, Murrupula, Melema, Mecuburi and Meconta in the province of Nampula.
The implementation of this project is based on the Human Centered Design (HCD) approach, which allows a better understanding of the socio-cultural context and the barriers that adolescent and young girls face when seeking FP services. Based on these learnings, the project uses customized strategies and solutions that become catalytic models for creating an environment that contributes to social and behavioral change in the demand and provision of contraception services targeted at adolescents and young people in Mozambique.
