The Mozambican Association of Health Professionals (APSUSM) announced last week that starting on June 1, it will halt its activities in order to strike in demand of better salary and respectful working conditions.
The strike, which will last 25 days and possibly to extended, was announced by the president of the association, Anselmo Muchave, at a press conference held in Mozambique’s capital, Maputo city.
Before calling the meeting with the press, the group sent a letter to the Mozambican Prime Minister, Adriano Maleiane, on 11 May, asking for his intervention on the concerns that the association is going through. The same concerns, according to APSUSM, had already been presented to the National Director of Public Health, as well as to the Minister of Health, Armindo Tiago. However, there was no response.
At the press conference, the president of APSUSM, Anselmo Muchave, stressed that the health professionals are demanding better salaries and working conditions in the health units, at a time when there is a lack of work tools.
“The organization is also demanding that the government address the lack of work material, including gloves, serums and X-ray equipment. The lack of means exposes health workers to the danger of infections, responsible for deaths that statistics do not show. Patients are forced to buy serum in health units”, Muchave said.
According to the president of the association, the government, in negotiations with health professionals, has always favored doctors, but nurses are always put aside, hence the need to hold the strike.
The Citizen Observatory for Health (OCS) believesthat the strike by health professionals could negatively affect the National Health System and the services provided to users.
Among several factors that will negatively affect the health system, the highlight goes to the reduction in the capacity to provide care, given that the reduction in the number of nurses will make services slow, causing delays in care, as well as the cancellation of medical and surgical procedures.
With this situation, it is expected, on the one hand, that some professionals will be overloaded, as the lack of some may require more collaboration from those who may be available – doctors and other specialists. Consequently, these professionals will collapse due to fatigue, a sign of physical and psychological exhaustion. On the other hand, the lack of nurses can lead to a reduction in the supervision and monitoring of patients, originating medical errors, hospital infections and other complications.
For the OCS, nurses play a key role in managing medication, observing vital signs and responding to emergency situations. As such, their absence will compromise the safety and well-being of users.
Last year, the Mozambican Medical Association also proposed a strike, which only took place this year. At the time, these professionals were claiming anomalies registered within the scope of the implementation of the Single Wage Table (TSU), which was characterized by their remuneration cut.
Within the scope of the Economic and Social Plan and State Budget (PESOE-2023), it was noted that more foreign doctors would be hired, to the detriment of national doctors.
Lack of Equipment and Its Impact
Regarding the lack of work equipment, the OCS observes that that this will significantly harm nurses, as it exposes them to risks that could be avoided.
For example, the lack of equipment such as gloves, masks, aprons and spectacles may increase the risk of contamination during the provision of care to patients with transmissible diseases. In fact, the lack of adequate equipment can compromise the quality of care provided to patients, since they depend on it to monitor vital signs, manage medicines precisely, perform examinations and provide specific care. Although not in general, the current working conditions lead nurses to frustration, some feel undervalued in all aspects.
Looking at the recent OCS analysis (https://www.observatoriodesaude.org/analise-do-reo-2022mocambique-continua-a-depender-da-ajuda-externa-para-aquisicao-de-medicamentos/), based on the Budget Execution Report (REO 2022), about 42% of health sector expenditures last year came from external resources, which means that the National Health System still depends on external funding.
According to the REO, medicines account for a large proportion of total sector expenditure, and about 75% of this comes to the country through donations, which makes the deficit difficult to understand, given that a large proportion is donated by cooperation partners.
On the other hand, 80% of the investment expenditure, responsible for purchasing material for the development of the sector, also comes from external funds.
All these components, not to mention salaries, come from external funds, whose donations are already guaranteed.
However, it is known that the salary of a foreign doctor can be twice what a national doctor earns, so the State even spends more on these hirings. Therefore, the basic problems should be solved, because hiring foreign doctors is equivalent to spending money instead of solving the issues that plague the health system. In other words, the government should avoid hiring expensive labour in order to respond to expenditures that really affect the sector.
Nurse/Population Ratio
An analysis based on the Statistical Yearbook of Health 2021 indicates that the number of nurses in the National Health System (NHS) grew by 17% from 2019 to 2021, reaching 16 8241 nurses in 2021, of which 10 293 (51%) assigned to general nursing and 6 531 (39%) to maternal and child health. This number represents an increase of 14.6% compared to 2020.
Source: OCS based on Statistical Yearbook of Health 2019 – 2021
The national ratio of health technicians (national and foreign) per 100,000 inhabitants had a significant increase, rising from 110.2 in 2020 to 124.2 in 2021. The national ratio of nurses and doctors per 100,000 inhabitants in 2021 was 33.4 and 8.5 respectively, far below the standard of 230 per 100,000 inhabitants set by the World Health Organization (WHO).
Although the ratio of Health Technicians and Nurses /100,000 inhabitants shows improvement in 2021, Mozambique remains, however, among the countries in the world with the worst ratios of health technicians per 100,000 inhabitants: in Mozambique, the ratio of Nurses and ESMI (Mother and Child Services) per 100,000 inhabitants is 48, below countries such as Kenya (86.3), Zimbabwe (133.5), South Africa (511.4) or Brazil (760.1).
According to the National PLAN for the Development of Human Resources for Health 2016-2025 (PNDRH 2016-2025), the average ratio of beds per nurse was 1 nurse per 1 bed. The phenomenon occurs in all provinces with the exception of Niassa, Nampula, Maputo City and HCM. Regarding the ratio of maternity beds per MCH nurse, the provinces which presented a higher than average ratio of 1 maternity bed per 1 nurse were: Gaza, Zambézia, Niassa and Maputo City. Regarding the ratio of nurses and ESMI per doctor, the average ratio was 1 doctor per 6 nurses and ESMI. The only province which showed a favorable ratio was Maputo.