medicusmundi has been working in Mozambique for more than 20 years in strengthening the public health system based on the principles of Primary Health Care (PHC). We have devoted many efforts, both economic and institutional, and put great enthusiasm and energy over the years. What has happened in these 20 years? The reality is that PHC in Mozambique is clearly threatened by a number of factors, both internal and external, which are making its application unfeasible. Have we failed in our attempt? Has so much work made sense?
Sometimes we feel like “fish out of water” or “flying blind” in a context that is clearly walking in another direction. We strive to raise a flag and wave it virtually alone, or with very few allies. We realize that the discourse of PHC has become a dead letter, devoid of practical content and real political will, especially from the dozens of donors in the sector. Everybody knows that vertical programs are the prevailing trend in the sector. This environment, endemic in recent years, has a direct impact in many areas, especially in the educational field and in the field of academic research.
How many efforts are devoted in the country to conduct research on issues directly related to health system strengthening? Few … by analyzing the publications of the National Institute of Health (NIH) of the past 12 years, only 1% of published articles had some connection with the strengthening of the system.
What expectations can a future nurse or doctor have to work in a system whose basic pillars still suffer from serious problems, well known but neglected? How to motivate workers who see in the lucrative and non-profit private sectors a better-paid professional future?
It is evident that to keep on putting efforts exclusively on strengthening the supply of services will fail to reverse this situation. You need to get to the heart of future public health workers, and must fill the agendas of each decision-making meetings that occur in the country with scientific reason and evidence. It is therefore vital to promote the principles of action and the benefits of Primary Health Care, both in the field of teaching and in the field of research.
And, in this regard, medicusmundi has established strategic alliances with the Universidade Eduardo Mondlane (UEM), with the ISCISA, with the Health Training Centers, in order to work together in reviewing training curricula and reflect on them the importance of PHC to build a health system for all. This is the first step in order to have future workers committed to PHC. On the other hand, besides the aforementioned institutions, we are working on building alliances with national and international research groups (IESE, others) that can reverse the current trend and build a research agenda on health systems and PHC.
Strengthening and Promotion of PHC for public health systems strengthening should go hand in hand and feedback each other, in order to make evidence-based decisions and to have human resources who defend health as it is – a right for all.
Picture: Bruno Abarca