It`s been more than 30 years since the dream to provide “Health for All” was launched in Alma Ata, and the strategy of Primary Health Care (PHC) was adopted as the most effective and efficient approach in order to achieve that goal. Are we closer to that dream today? Has PHC become the international benchmark for the strengthening of healthcare systems that ensure universal coverage? Is Mozambique an example to follow in this regard?
Indeed, the government of Mozambique, through its Ministry of Health, has stood up for PHC as the country’s main socio-sanitary strategy for the improvement of the health of the population. This approach has guided, as a theoretical framework, all health policies, following the recommendations established by the WHO itself, which considers that PHC may solve up to 80% of all the population’s health problems.
However, practical experience has shown that the government’s financial, human and institutional resources and, above all, the resources coming from its international partners, are not always employed in this direction. If evidence and international health policies show that this is the best option, if Mozambican national policies are based on this approach, how is PHC not prioritized in Mozambique? Are current approaches really working for the strengthening of the health system?
Through interviews with officials from the Ministry of Health, donors, international agencies, civil society representatives and Health Ministry’s civil servants themselves, the documentary “A Luta Continua” (“The Fight Goes On”), produced by Medicus Mundi and Kanaki Films, reviews the challenges and the difficulties encountered in Mozambique in order to set up a health system for all.
With a running time of 40 minutes, “A Luta Continua” highlights the circumstances and trends, some internal and some external, that have relegated PHC to a mere dialectic resource, far removed from its revolutionary original content. We encourage you to watch the documentary and to reflect upon its main issues. We just give you some clues that may help you understand the situation:
- The Health Sector is highly dependent on external resources. Over the last five years, more than 90% of the investment budget for this sector came from foreign aid.
- Aid is highly fragmented. In 2011, there were more than 26 donors in the SWAP (Sector Wide Approach, a coordination mechanism that brings together governments and donors within the Health Sector), some 150 NGOs, and several coordination mechanisms with similar or complementary roles to those of the SWAP. Seemingly, not all stakeholders share the same ideas. There are, in fact, multiple views of the health model the country should follow.
- Vertical interventions have increased considerably. The source of the funding (Global Fund, PEPFAR, etc.) is determining the design of health strategies. The original idea of PHC has been transformed into programmes to fight the three major diseases (VIH, TB and malaria). According to data from the SWAP, in 2007 only 23% of the health sector funding, including funds from donors, was allocated to Primary Health Care services. In 2013, only 19% of the health budget was allocated to district administrations, those in charge of the actual implementation of PHC.
- Structural adjustment measures promoted by international financial institutions have a significant impact on the health sector, especially due to budget cuts and their impact on investment and health workers’ wages.
- The democratic deficit generated by the current “global health governance”, led by certain agencies, philanthropic foundations and other organisations and private public partnerships that, far from strengthening national health systems, impose external agendas based on their own priorities.
And after reading all this, you may ask yourself: now what? What can we do to change all this? Of course there are alternatives and in medicusmundi we’ve got a crystal clear response to the present situation: Primary Health Care in Mozambique: Let’s make it real! Follow our blog and we will inform you of our vision of the health model Mozambique really needs and how to develop it through proposals that are both concrete and effective, and much more efficient than those being implemented at the moment in the country.
Ivan Zahinos Ruiz
Director of Cooperation Projects
Translated from Spanish by Silvia Aymerich