Focus: Health

Work to Do

Work to Do

May. 9, 2013

Mozambique's rural nature has created challenges in providing blanket healthcare coverage. Movement in the pharmaceuticals sector, however, could help attract further investment.

Government health spending, which hovers around 8% of total spending, is highly dependent on donor support, with up to 44% of the state healthcare budget sourced externally. However, health spending is on the rise, up from $699 million in 2010 to $858 million in 2011, an increase of over 22% in US dollar terms. The focus is on training new medical professionals, who often leave the public sector to seek more lucrative payment with the newly forming private healthcare sector. Health services are delivered in Mozambique at the primary level by around 650 health posts, 435 health centers, 27 rural hospitals, and eight district hospitals. At the secondary level, there are five general and seven provincial hospitals, while at the tertiary and quaternary levels there are three central hospitals. Private institutions have also now begun to open in urban areas, and service the country's high earners. There is approximately one health unit for every 15,000 people and approximately 40% of people, mostly rural, have limited access to these facilities.


Approximately 44% of Mozambique's health budget is provided through basket funding by over 20 donors. Most funds are provided directly to the Ministry of Health, while some are directed to specific areas or disease-affected regions. Spending on health care currently represents around 5% of GDP and just over 10% of the state's budget, below the 15% set out in the Abuja Declaration. Donors include the EU, which rarely provides direct healthcare sector budget support, the US, and the Global Fund. The US is the largest donor, providing upward of 35% of the total.

“Mozambique stands as a success story in Africa. It is one of the fastest-growing economies in Africa," says Dr. Babatunde Osotimehin, Executive Director of the United Nations Population Fund (UNFPA), while exemplifying the country. He also remains aware of the challenges the country faces; “Mozambique still depends on aid from other countries, especially in the social sector," he says, continuing, “Mozambique shares many of the challenges that other countries in Sub-Saharan Africa face: high levels of maternal mortality and a high prevalence of HIV/AIDS, a low coverage of medical doctors, few skilled birth attendants, and weak infrastructure and transportation." However, he adds weight to the argument that the solution lies in the education of the country's large youth population. “Mozambique's young population offers immense opportunities, but also calls for increased investment to ensure that education, health, and employment reach these young people," he concludes.

The country's education sector is also working with international partners to boost the number of qualified medical staff in the country. The country's Eduardo Mondlane University (UEM) and the US-based University of California, San Diego (UCSD) won a five-year, $12.5 million award from the US Medical Education partnership Initiative (MEPI) in 2010 to develop medical education infrastructure in the areas of training, research, and technology. New medical schools in Nampula and Tete will likely benefit from the growth in medical graduates, yet efforts must also be taken to keep doctors in the public sector.


While many struggle to find affordable health care, the country's wealthier residents are faced with a choice: go abroad for treatment or visit one of the country's new private healthcare institutions. “Revenues have steadily increased since we opened in 2010, so there is definitely a demand for private hospital care," said Peter Botha, CEO of Africa Medical Investments (AMI), which established a hospital in Maputo in 2010. There is also significant credit demand from health insurers and corporates that send their employees to the hospital. With the private healthcare sector focused solely on the main urban areas, AMI is also planning to open a new facility in Tete to complement its 35-bed setup in Maputo. Private firms are also suffering from an inadequate supply of doctors, with companies in the sector, as well as NGOs, working to attract them. “Medical doctors, experienced nurses, and health managers are leaving the public sector to join NGOs and private enterprises," said Dr. Osotimehin, with Botha reemphasizing that “there are excellent specialists in Mozambique, and they do well in their own right, but it is difficult for a private hospital to attract them because essentially they can pick and choose where they work."


The most significant development in 2012 was the opening of an anti-retroviral (ARV) drugs manufacturing factory in Maputo. Initially set to package, store, and distribute the ARV drug Nevirapine, the factory is later expected to produce over 370 million pills a year, including six kinds of ARV drugs, accounting for 226 million of the total, and 21 other, generic medicines. The project was developed in cooperation with the government of Brazil, which provided $23.5 million, while Brazilian mining giant Vale, which has significant operations in Mozambique, contributed $4.5 million.

The Brazilian government also donated the ARV drug Nevirapine in order for the Mozambican Medicines Company (SMM), which operates the factory, to run tests and develop its operational capacities. The country's first domestic pharmaceutical production plant is also expected to act as an investment pull.

According to Business Monitor International, the country ranked 22nd out of 30 in a pharmaceutical business environment rating in a study carried out in 2Q2012. The factory will also go a long way to combating the prevalence of HIV and AIDS in the country. According to the World Health Organization (WHO), 115 of every 1,000 adults between the ages of 15 and 49 are infected with HIV, and the disease also accounts for 10% of all deaths in children under five.