Against the odds: Mozambique's gains in primary health care

Research reports and studies
June 2014
Romina Rodríguez Pose, Jakob Engel, Amandine Poncin and Sandra Manuel
In the early 1990s, Mozambique was one of the world’s poorest and most aid-dependent countries, having endured 16 years of civil war, drought and economic devastation since achieving independence in 1975. During the past 20 years of relative stability, greatly improved security and sustained growth, Mozambique has made significant progress in the provision of primary healthcare, reducing under-five and infant mortality rates by over 50% since 1990. Efforts to address high levels of maternal mortality have been detrimentally affected by the onset of the HIV/AIDS pandemic, but here too access and utilisation indicators show an encouraging trend. The country has also made significant strides in closing disparities in access and health outcomes – especially in infant and child mortality rates – between cities and the traditionally under-served rural areas.

Within the context of improved security and sustained economic growth, several factors – both within and outside the health system – have contributed to progress. These include: increased domestic and foreign financing to support the implementation of a comprehensive policy framework in which maternal and child health, and responding to the HIV/AIDS crisis, have been prioritised; the steady expansion of health services and facilities to undersupplied areas; and rising effective demand, spurred by education and community outreach efforts. Despite numerous persistent challenges – including low quality of care, continuing inequalities and the substantial impact of the HIV/AIDS pandemic – Mozambique provides important lessons to other countries aiming to scale up health provision rapidly in a post-conflict setting. These particularly include the importance of focusing on distance and education as barriers to access, using innovative and low-cost human-resource policies to scale up health personnel quickly, and of moving towards more coordinated systems of aid disbursement.

Corrections and clarifications

The full report was amended on July 1st 2014 and July 9th 2014 to correct text errors relating to the length of Mozambique's civil war (16 years, not 15 years) and the date of independence (1975, not 1974).