The decentralization of the health sector in Mozambique face several constraints and some of them include: (i) the implementation of legal framework to support local participation in health, especially in healthpromotion and disease prevention has been complex because of challenges faced by local governments due to lack of experience andtechnical capacity, and by central government concerns about maintaining the constitutional right to health and possible political manipulation; (ii) the provision of health services is influenced by institutional factors, in particular the (in)capacity of the state and its (lack of) independence from private interests, i.e. it is controlled by a privileged minority that does not prioritise the basic health needs of thevast majority of the population; (iii) In the current decentralisation scenario, the chain of accountability and responsibility is quite diluted and porous, not obliging any government body to ensure excellence inthe provision of services. Users and citizens face many difficulties innavigating the system, especially because they are not clear which government body they should turn to in order to demand accountability that goes beyond clinical care in health centres and hospitals.

To address these and other challenges the present analysis provide thefollowing recommendations to the Government and HealthPartners Cooperation: (a) the government (Ministry of Finance) should complete the process of reforming fiscal decentralisation, defining thetax framework for OGDP, so as to improve the possibility of provincial governments collecting their own revenue; (b) the government (Ministry of Finance) should improve the fiscal transfer system in general by introducing elements of equity and establishing objective criteria (a formula established by law) for sharing resources between health units, while also respecting equity factors; (c)The government (MISAU) should further decentralise administrative procedures for the execution of macro-processes provided for in SISTAFE and e-SISTAFE for healthunits, especially health centres and posts, rural and district hospitals, transforming them into UGB. This same exercise will allow greater andbetter control of the own revenue collected locally. MISAU will need to create human, technical and technological capacities in these healthunits. Read more...