In Mozambique, health services are mostly provided by the public sector, and it is the responsibility of the Ministry of Health (MISAU) to enable the creation, planning and control of national health policies.
The health sector is the third sector that absorbs most resources from the State Budget (OE), followed by the Education and Infrastructure sectors, according to the methodology presented in the budget documents related to the economic and social sectors.
- This sector is divided into three levels: namely, the Central Level, which is represented by MISAU;
- The Provincial Level, which is represented by the Provincial Health Directorates (DPS); and
- Finally, we have the District Level, which is represented by the Health, Women and Social Action Secretariats (SDSMAS).
Therefore, it will be based on these levels that our analysis of allocations to the health sector in the period from 2015 to 2020 will be undertaken.
During the period under review, expenditure in the health sector absorbed around 22.6 billion meticais, which, in terms of total expenditure, means that around 9% was spent, still far from the commitments proposed in Abuja for the sector, recommending investment of at least 15% of the State Budget for health development.
As a percentage of total expenditure, spending in the health sector has not shown an upward trend in the past three years, meaning that it remains at around 9%.
Although, in 2015, there was a 9% growth in total expenditure, and then, in 2016, there was a 10% growth, there was (in 2017, 18 and 19) a reduction of 2 % and, in 2020, there was a reduction of 1% regarding the weight that the health sector represents in terms of total expenditure. On the other hand, despite the reductions recorded above, it was noted that compared to 2019, there was a nominal growth of around 32% in the resource bucket in 2020.
However, the current increase in resources is not reflected in the scope of the commitments established at the sector level.
(Graphic 1)
Source: OCS based on data from the BER 2015 to 2020
It appears that there are deviations that contribute so that the plans are not reflected in the executions, with an average of 19% below the expected in the period under analysis. However, the largest deviations occurred in the years 2016 and 2017, at less than 28% and less than 27% respectively, and finally dropped to less than 11% in 2020.
Graphic 2
Source: OCS based on data from the BER 2015 to 2020
In addition to absorbing the largest proportion of resources, the Operating Expenditures have been growing over the years. They corresponded to 68% in 2015 and increased to 75% in 2019. Therefore, it is expected that they will remain at the same levels in 2021.
The growth in current expenditures has jeopardised the building of health infrastructures, which does not contribute to the reduction of the average distance that the inhabitants travel to have access to a health unit, in a context in which this indicator has not registered significant changes in the last few years.
According to the data published annually by the National Statistics Institute (INE), the average distance that inhabitants travel to access health care has ceased to correspond to 12.4 km in 2015 to 12.3 km in 2019 – a fact that shows there is a greater need to make efforts to increase investments in order to guarantee the proximity of health services to the population.
Graphic 3
Source: OCS based on data from the BER 2015 to 2020
At the national level, it appears that the type of expenditure incurred within the scope of the State Budget (Operating Expenses) relates to Salaries, Compensation and Other Personnel Expenses, as well as Goods and Services. Among themselves, these expenses show very different weights.
Considering the weight of the operating expenses, it can be seen that, at the national level, Salaries, Remunerations and Other Personnel Expenses represent 77% of total budgetary achievements, while Goods and Services represent 23% and Expenses of Personnel Expenses. Capital, in turn, have zero representation.
Globally, the execution of operating expenditure, at the central level, encompassed a greater percentage of the existing resources and the lowest percentage remained at the district level.
The current growth in current expenses calls into question the improvement of efficiency and the performance of the sector in the medium and long term, with regard to the building of health posts and hospitals, training of doctors and nurses and the acquisition of medical equipment and items. On the other hand, this fact does not enable the reduction of the average distance that the inhabitants travel to have access to a health unit, in a context in which the indicators have not registered significant changes in the past years.
Graphic 4
Source: OCS based on data from the BER 2015 to 2020
In the 2020 financial year, among investment expenditures, 33% come from internal sources and 67% from external sources. These proportions constitute a significant change when compared to the situation at the beginning of the decade. In fact, in 2009, domestic and foreign investment accounted for 9 and 91%, respectively. The new structure in the composition of the sources of investment is explained by the tendency for foreign investment to decline over the last decade, although it increased by 79% from 2018 to 2019.
Graphic 5
Source: OCS based on data from the BER 2015 to 2020
Despite the current increase in the resource bucket – allocated to the health sector in recent years – it is still possible to observe that it is characterised by planning deviations in relation to execution. The increases referred to are not reflected in the scope of the Abuja commitments, established at the sector level when an observation is made of the weight of the execution of resources against total expenditure.
On the one hand, the largest percentage of expenditure has been earmarked for the operating component. On the other hand, it is observed that the growth of current expenditures calls into question the building of health infrastructures, as well as it is perceived that it does not contribute to the reduction of the average distance that people travel to have access to a unit health, in a context in which the indicators have not changed significantly in recent years. Therefore, the sector needs greater effort in increasing and boosting investment expenditures, in order to ensure that distances are shortened between health services and the populations.