Mozambique’s health sector, like other sectors vital to the functioning of the State, has been facing a number of difficulties, particularly the lack of medical and surgical equipment, medicines for users and other essential inputs for the normal functioning of health units.
The improvement of working conditions and salary increases have also always been central items on the agenda of health professionals. However, when the Single Wage Table (TSU) was approved and implemented at the end of 2022, the discontent associated with the remuneration of this professional class became more severe due to irregularities detected.
“Amongst various aspects, we demand a dignified framework for specialist and general practitioners in the context of the TSU, taking into account the fulfilment of the statute of the doctor in the Public Administration, the review of overtime, as well as the revaluation of subsidies for housing rental, location subsidy and exclusivity, by about 40%”, said a document unveiled at the time by the Medical Association of Mozambique (AMM).
Within the current year, also in demand of salary increase, the Association of United and Supportive Health Professionals of Mozambique (APSUSM) began stopping the activities. The same strikes, however, were suspended twice, and the last time, within an interval of 60 days, there was an agreement between this association and the Government, through the Ministry of Health (MISAU).
Thus, in the context of the suspension of strikes by health professionals, the Citizen’s Observatory for Health (OCS) carried out work to monitor health units in order to understand how much the agreements between the parties are being complied with, given that reports of poor service, long queues and disrespect for the rights of the user (in the context of the Charter of Rights and Duties of the Patient [CDDD]) are circulating.
Without taking the health services as a whole as a point of research, we focused on prenatal care and maternity services in some health units in the city of Maputo, the Mozambican capital.
A priori, we visited the Malhangalene Health Centre. As simple users, we stood in line to find out about the behavior of health professionals and the functioning of prenatal consultation services. After witnessing the long queues and the impatience on the faces of the patients, we tried to understand what was behind the slow pace of the service.
A lady in a pregnant state, addressing our reporting team on the condition of anonymity, expressed her dissatisfaction with the services, calling them “inefficient and slow.”
“There is a lot of slowness”, the patient said, adding that “there are few professionals to assist patients. The patient can arrive at seven and be assisted at 12 or 13 hours for a basic service of routine consultations.”
According to the source, one health professional can be for up to 50 pregnant women “and even then, priority is given to those who pay bribes.”
Pregnant women forced to consult private clinics for ultrasound
The patient also revealed that the nurses force pregnant women to have ultrasound scans in private clinics so that they can pay high fees that are subsequently shared between the nurse who issues the guide and the clinic that allocates the ultrasound.
Without mentioning the names of the nurses or clinics involved in the scam, the patient states that “I was forced to go to a private clinic, where I paid 1,500 meticais to do an ultrasound. Instead of giving me a guide to a public hospital, where I could do the same exam at zero cost.”
“I believe the nurse earns a share of the money we pay at the private clinic. We are obliged to do so, without that we are subject to poor care in the subsequent stages of antenatal consultations, even at the time of delivery or postnatal consultation”, she explained.
Another patient confirmed the existence of this practice, calling it diabolical and therefore there is a need for it to be abolished once and for all.
“There is a slight will to privatize the public health sector”, he stressed.
With regard to the cleanliness of the health facility, however, the patients were unanimous in stating that everything is in order.
“As for the state of cleanliness, there is not much to complain about”, they said, adding that however it takes a long time to get care at the pharmacy.
“People have to queue up even when they are in a weakened state, squirming on the benches”, said a patient.
“The pharmacists are quite slow, they chat and when they do proceed with the service, they only provide iboprofen or paracetamol”, added.
Dark Scenario at Xipamanine Health Centre
We then went to the Xipamanine Health Centre, where we found a rather gloomy scene. It was just after dark. It was about eighteen o’clock. We went to the maternity department and this was the atmosphere: totally dark rooms, lighted mobile phone lanterns, a nurse (supposed to be the manager, though she didn’t look like) and an assistant. We found several people in the waiting line, among companions and pregnant women screaming at labor contractions.
It was Friday 23rd June. Disguised as patients, we asked why everything was dark and the assistant answered us in the following terms “we have no electricity”. What happened, did the credelec get zeroed out? She answers us that no, “it’s not about that. We were left without power because there was an accident, one was trying to burn a snake and the fire hit one of the electric cables.” At that point, we wondered where the snake came from. We were informed that the services will return to normality when the team from Mozambique’s publicly owned electricity company (EDM) has repaired the damage.
We interfered in the conversations of the patients who had been there for a long time, since thirteen o’clock. We learnt that only one nurse is on duty, and this one isn’t even working, she is simply handling her mobile phone and chatting with her servant colleague. We heard them both laughing, while on the other side the women were screaming because of the contractions.
“It would be nice if they didn’t restore the power. I’d sleep through tonight’s shift”, we heard the nurse say, a lady of average height and arrogant in her way of treating patients. In fact, as patients (in disguise) we were also victims of this lady’s mistreatment, when we asked the reason behind the absence of other professionals, how come the health unit of this magnitude was functioning with only two people, who were not even attending to pregnant women?
Mistreatment as a continuing manifestation of the health professionals’ strike
Even when the power was restored, an hour and thirty minutes later, we saw nothing to change. The pregnant women were just admitted to their rooms, without any examination or observation. Left to their fate, they lay in the despair of pain, without any heaven or earth. Those who had already given birth were silent in their rooms.
We approached an attendant who had just left a pregnant woman in the delivery room. With a visibly distraught face she told us “I have no hope that labor will go well. There are only two people working in this maternity ward, they charged me money to get her into good hands. I see the head nurse is not interested in working; this must be a continuation of the strike.”
The observation we drew from this scenario lies in the argument that the strike by health professionals is continuing, but quietly. It makes no sense that work is being done in this manner, as if merely doing a favor to the users, as if the hospital centers are someone’s private property. As OCS, we demand that the entities responsible for supervising the health units speak out, carrying out monitoring work to ascertain the facts reported here, so that the people involved in the misrepresentation of services are duly held accountable. We cannot continue to have a National Health System (NHS) that functions according to the rules of certain people.
Mavalane General Hospital acting in cold blood
In the maternity services, at Mavalane General Hospital, the problems are of all kinds, from mistreatment, slowness in care and disrespect of the Charter of Rights and Duties of Patients. These issues lead us to robust the argument that the strike is manifesting itself silently, it makes no sense that a hospital of this magnitude – composed of national and international specialists – is operating at “half gas.”
Some patients interviewed by OCS claimed to have stood in the queue for more than eight hours. Pregnant women sat long hours on benches, not knowing whether they would be admitted for labor or be sent back to their residences until they were properly ripe to enter the delivery service. The cries of pregnant women were heartbreaking, but on the other hand, one spotted professional walking from one place to another as if they had no work, some handling mobile phones and others simply chatting.
“The doctors and other health professionals are still on strike. But now they have changed their strategy. They simply don’t attend to people or attend to them very slowly. Everything is slow and boring”, said a man in his mid-thirties, who was accompanying his wife
According to this man, “the slowness may have to do with the successive salary arrears. The government has been very slow in paying salaries. Today, for example, State employees are working, but have not yet received their salaries. That could also be contributing to the poor attendance.”
In the infirmary, where women who have delivered babies are located, we hear from a woman who says she has been a victim of verbal and psychological violence from midwives.
“The mistreatment is obvious. They threatened to subject me to a caesarean section if I did not have the baby out by eighteen hours at the latest. The nurses were running out of time to continue assisting me, they wanted to leave early”, she said.
“There is a lack of psychological counselling”, she added.
Throughout her explanation, our source narrated an episode involving a patient who delivered a lifeless baby.
“She was simply informed that the baby was dead. It was all in cold blood, no conversation, no euphemism, no nothing”, she stated.
The source further revealed that after the delivery, there is no meal for the patients, not even a cup of tea or a bowl of soup.
“Soup and tea only exist when you are in the delivery room. Which means that without a meal from home, patients remain hungry after being in the delivery room”, he stressed.