The Covid-19 pandemic proved that the Mozambican government does not have the capacity to provide quality health services in times of crisis, taking into account the insufficient beds for patients in health facilities, as well as insufficient personal protective equipment for health professionals.
These findings are verified in the study carried out by the Citizen Observatory for Health (OCS), entitled: “Challenges of Policy Implementation in Times of Crisis and Mitigation Strategy”, presented by the Economist and University Professor Constantino Pedro Marrengula, at the Conference on Access to Health in Mozambique, which took place in Maputo, on June 30th and July 1st, 2022.
According to the research, the population increase, associated with the high fertility and birth rate in Mozambique, generates increased demand for health services, making the budgetary developments urgent, in order to respond to the population growth trend.
The data in the research indicates that although the nominal expenditure of the Health Sector has increased more than four times from 2010 to 2022 (from 8.9 to 41.3 billion meticais), in real terms the expenditure has not grown from 2013 to 2020. It means that the expenditure is not keeping up with the evolution of the general price level, with a reduction in real terms of 3 percent from 2021 to 2022.
For Marrengula, the health sector is one of the main social sectors and the budget allocation forecast for 2022 is 42.2 billion meticais and the growth rate compared to 2021, in turn, is 2.1 percent in nominal terms and a decrease of 3 percent, in real terms (2010 being the base year).
On the other hand, the researcher states that “the mobilized resources reached the amount of 60,592.2 million meticais, of which 28,602.3 million meticais (47.2 percent of the total allocation) correspond to internal resources and 31,989.9 million meticais (52.8 percent of the allocation) equals external resources.”
“The relative weight of external funds has been showing an increasing trend, in a context in which the level of execution of external investment expenditures has shown a downward trend”, says Simango, stressing that “the data indicate access to health services, on the order of 68 percent by the population, and quality with a low standard, and many areas are dependent on external funding, such as, for example, HIV medication.”
For health services to reach more people, according to the researcher, it is necessary to provide more resources and reduce the financial need. Therefore, the prevention of various diseases would have lower costs, therefore the researcher recommends “more investment in the prevention of all diseases, prioritizing those whose treatment has higher costs for the National Health System (NHS), these being greater than the prevention expenditure.”
According to Simango, the provision of supplements can be a mechanism for reducing costs in the prevention of chronic malnutrition, with the World Bank estimating that “it costs $10 to put a child under 5 years old well-nourished per year.”
“Recommendations similar to this have been made in national and international reviews, as an alternative for financing in the health sector”, the researcher said, adding that the fees collected should be earmarked for health expenditure, so that there are adequate services for society.
The study on Financing Health: Alternatives for Financing the Health Sector in Mozambique, presented by the Coordinator of the Financing and Public Expenditure Pillar of the Citizen’s Observatory for Health, Rogério Simango, points out that the health sector is one of the main social sectors and the budget allocation forecast for 2022 is 42.2 billion meticais and the growth rate compared to 2021. In nominal terms, in turn, the rate is 2.1 percent and the decrease is 3 percent, in real terms (2010 being the base year).
“The health sector budget is equivalent to 9.4 percent of total public expenditure, below the Abuja commitment (to allocate 15 percent of the state budget to the health sector) and compromises the achievement of the degree of execution of the sector’s activities, to the extent that in real terms, it shows a reduction”, says the researcher.
Furthermore, throughout the presentation, Simango pointed out that “the mobilized resources reached the amount of 60,592.2 million meticais, of which 28,602.3 million meticais (47.2 percent of the total allocation) correspond to internal resources and 31,989.9 million meticais (52.8 percent of the allocation) are equivalent to external resources.”
According to the research, the main sources of funding for the health sector include the State Budget (OE), allocated to the Ministry of Economy and Finance (MEF), which includes direct contributions from partners, Pro-Health funds and vertical programs.
“The relative weight of external funds has been showing an increasing trend, in a context in which the level of execution of external investment expenditures has shown a downward trend,” says Simango, stressing that “the data indicate access to health services in the order of 68 percent of the population, with a low standard of quality, and many areas are dependent on external funding, such as, for example, the medicine for HIV, Tuberculosis”, says the researcher.
For health services to reach more of the population, according to the research, more resources need to be provided, as well as it is crucial to reduce the financial need for users to access services. Therefore, the prevention of several diseases would have lower costs, hence it is recommended “more investment in the prevention of all diseases, prioritizing those whose treatment has higher costs for the National Health System (NHS), these being higher than the prevention expenses.”
Another recommendation of the study lies in the creation of a mechanism for providing supplements to reduce costs in the prevention of chronic malnutrition, with the World Bank estimating that “it costs $10 to put a child under 5 years of age well-nourished per year.”
“Similar recommendations have been made in some national and international reviews as an alternative for financing in the health sector,” the researcher said, adding that user fees should be earmarked for health expenditures to have adequate services for society.