Mozambique’s Assembly of the Republic (parliament) passed the 2021 State Budget on 4 November 2020 worth a price tag of 368 billion meticais, equivalent to 4,9 billion USD[1], of which 65% go to the operating expenses, 23% to investment and 13% to financial operations.
In the 2021 State Budget, the health sector got 37.4 billion meticais (half a billion USD), which represents 14% of the 2021 proposed budget, less financial operations and the debt service, and 10,1%, including State charges. The resources allocated to health represent an increase of 5.6% compared to the revised allocation of 2020 and an increase of 59% in relation to health expenditures in 2019.
The 2021 State Budget was drafted taking into account one of the priorities defined by the government in the allocation of resources for the fulfilment of public expenditure, in accordance with the strategic actions of the government’s Five-Year Plan (PQG) 2020-2024. Thus, the Health, Education, Agriculture and Rural Development sectors are the priority areas that collectively received resources with a combined weight in the budget of around 47% Between 2008 and 2017, sector expenditures increased from 7 billion meticais in 2008 to 15.5 billion meticais in 2012, reaching 20 billion meticais in 2013, essentially as a result of donor funding, driven in part by the introduction of new products such as vaccines. This translated into a real high growth in health spending. In 2014, growth was negative in the absence of major donor funding. Thereafter, spending in nominal terms has shown a slow growth trend (from 18 billion meticais in 2015 to 20 billion meticais in 2016) ,
[1] Este texto utiliza a taxa de câmbio de 1 USD= 74.42 MT, o que corresponde à taxa observada no dia 16.02.2021, informação disponível:http://www.bancomoc.mz/fm_mercadosmmi.aspx?id=10
Source: OCS based on CGE 2010-2019, SB 2020 and 2021
Health sector central administration gets slightly over half of the totality of funds allocated to the sector
For the current financial year, the central administration received just over half of all funds allocated to the sector, followed by the primary and secondary health care, provincial administration, quaternary health care, and tertiary health care (see Figure 1).
The central administration, comprising the Ministry of Health (MISAU), the Regional Health Development Centre (CRDS), the Centre for Medicine and Medical Goods (CMAM) and the National Institute of Health (INS) received 19.3 billion meticais, corresponding to 51.6% of the sector’s total budget. It should be noted that 62% of the amount is intended for operating expenses and 38% for investment.
Source: OCS based on LOE 2021
In the last decade, central level institutions absorbed an average of 59% of sector spending, provincial level institutions absorbed an average of 29% and at district level an average of 12%. However, in more recent years, allocations to districts have generally been much higher than at provincial level (UNICEF, 2019)[1].
Primary and secondary health care that is provided by SDSMAS and district hospitals together received 7.6 billion meticais, equivalent to 20% of the budget. The provincial administration that is overseen by the DPS received 3.8 billion meticais, corresponding to 10% of the budget. Likewise, quaternary health care comprising central hospitals and psychiatric hospitals received 3.1 billion meticais, equivalent to 8% of the budget.
Tertiary health care, which is provided by General and Provincial Hospitals, received 2.3 billion meticais, corresponding to 6% of the sector’s total budget. Finally, the area of research and teaching that is undertaken by the Institutes of Health Sciences received the lowest amount, 0.2 billion meticais, equivalent to 0.5% of the sector’s total budget.
The level of priority spending in the country has seen significant increases in recent years, however, it is important that efforts continue to be made to increase the proportion of resources for the sector, which will allow the achievement of internationally agreed targets.
[1] UNICEF, Proposta de Orçamento do Estado para o Ano Fiscal de 2019: Análise dos Sectores Económico e Social Moçambique
Maputo with greatest per capita public investment in health
Funding for to the Health Sector is allocated at different levels to institutions with autonomy to receive and manage these resources.
Taking the Health Sector budget for 2021 as a whole, the budgeted amount corresponds to a per capita allocation (per person) of 1.3 thousand meticais (17.1 USD). When excluding the envisaged expenditures with the Central Administration, the expenditure per capita decreases to about half, standing at 0.68 thousand meticais (8,8 USD).
According to the Monitoring and Budget Forum (FMO), the per capita allocation showed that in the last 5 years, for each citizen, only 14 USD was spent on health annually. The World Health Organization (WHO) suggests that countries should spend a little more than 60 USD per inhabitant for health services, which calls into question the improvement of Human Development indicators.
However, looking at the total package of resources allocated to institutions within each province, there is a large deviation in the per capita budget between provinces. In fact, while the sector’s per capita budget for the provinces of Zambézia, Nampula, Tete, Gaza, Niassa, Manica and Cabo Delgado show that the figures are lower than the national average of 0.32 thousand meticais, contrasting to the sum in the provinces of Inhambane, Sofala and Maputo which are above the national average per capita (Figure 2).
As such, a massive increase in investment in the health sector is necessary to multiply specific interventions in the provinces in order to combat the most deadly and most disabling diseases, as well as to strengthen the systems providing primary health care to the populations, especially the most disadvantaged and vulnerable.
Source: OCS base on LOE 2021
In the particular case of Maputo province, the budget resources allocated to it are more than twice the average per capita budget in the country. When compared to the other provinces, it was found that at a disadvantage are the provinces of, Nampula and Zambézia in comparison to the per capita budget of Maputo, which is 6 to 7 times higher than those geographic districts.
Looking at the fact that the provinces like Nampula and Zambézia have a larger territorial extension with a high population density (Nampula has 5,483,382 inhabitants and Quelimane 5,002,457 inhabitants), even so, the respective central hospitals absorb a considerably reduced volume of financial resources. compared to Maputo Central Hospital, with an average of 1,650.79 million meticais per year, just over 53% of the funds earmarked for central hospitals.
The severity of the sharp deviation from the per capita budget becomes more evident when one takes into account the size of the population that inhabits each of the provinces considered. In fact, taking into account the most recent population data, provinces with a per capita budget below the national average concentrate 77% of the country’s population, while the remaining 23% reside in areas that benefit from resources above the average per capita.
However, the country still lives a contradiction, where the population tend to defray expenses related to health services (to obtain certain drugs, medical examinations and treatments), although SNS is ‘free and universal’, due to the deficit in the provision of services. which reinforces the argument that the increase registered in the resources allocated from 2012 to 2017 were not sufficient to guarantee an improvement in the quality of health services provided to populations.