Child Poverty in Mozambique. A Situation and Trend ... - Unicef

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Box 3.6: PMTCT programme in two cities of Manica and Sofala provinces (Chimoio and Beira) Nine lessons learned from a quantitative and qualitative evaluation 1- Integration of PMTCT services into prenatal and primary care services is crucial. There is no evidence that incorporating PMTCT into normal Maternal and Child Health (MCH) services has diminished the number of mothers seeking prenatal services. On the contrary, the programme has demonstrated increasing programme attendance and adherence over time because women are empowered to make their own choices when PMTCT services are integrated into routine prenatal care. 2- The development of a successful PMTCT programme can be a catalyst to reinforce all components of the MCH programme. Many MCH programme elements are not directly dependant on PMTCT, but because of the increased vulnerability of seropositive mothers, it is imperative that associated services be strengthened. Further integration of PMTCT services should be pursued, including in institutional births, child monitoring, family planning, nutritional counselling, post birth follow-up, and partner counselling. 3- Health facilities and trained health personnel are the single most limiting factor in terms of project expansion. Health facilities and human resources in both cities are insufficient to meet the demands of the population. The shortage is particularly dire for PMTCT services. HIV testing and counselling is a timeconsuming procedure. Suggested standards for counselling sessions are 30-60 minutes per patient, with additional duties occurring in prenatal consultations, the maternity clinic and management of positive mothers clubs. Actions must be urgently taken to increase access to services and meet the demand of pregnant women. 4- Ongoing training needs must be regularly addressed. The provision of training is one of the most important functions of national and provincial management. Unless managers, counsellors, MCH nurses, and Day Hospital staff have appropriate knowledge, skills, and attitudes, the PMTCT programme is only partially effective. 5- Information, Education and Communication (IEC) can be a powerful mobilisation tool in increasing uptake of testing and associated PMTCT services. Expansion and standardisation of strategies and messages is needed to support a complete IEC campaign. In order to create motivation to seek follow-up care for mothers and their babies, the programme must develop a communications strategy aimed at developing an accurate perception of risk in men and women. High attendance at positive mothers clubs could be interpreted as evidence of the interest of the population in seeking information, education, and support concerning health care. 6- Stigma and discrimination against seropositive women are important aspects that must be considered in expansion of PMTCT services. Stigma must remain a key issue at all steps of planning and implementation of PMTCT programme. Clear strategies developed in partnership with PLWHA and community-based women’s organisations must be explored. 7- Greater partner involvement is essential. The experience of the project demonstrates that the participation of partners is possible; but greater participation must be stimulated through active outreach. A successful partner inclusion strategy must include the involvement of women themselves. 8- Women must be rallied as peer educators and programme advocates The best mechanism for mobilising women and encouraging adherence to the PMTCT programme is involving women themselves as activists – otherwise the programme runs a great risk of continuing to lose women. 9- Comprehensive monitoring and reporting systems can best illustrate programme successes and ongoing challenges. Identification of programme strengths and weaknesses can only occur with accurate and consistent collection and reporting of data. All project staff, from health workers to supervisors to manager must be included in development and monitoring of data systems Source: Prevention of Mother-to-Child Transmission of HIV in Manica and Sofala Provinces, A Quantitative and Qualitative Project Evaluation, Sarah Sheldon/DPS Manica and Sofala/HAI/UNICEF, July 2004. CHILDHOOD POVERTY IN MOZAMBIQUE: A SITUATION AND TRENDS ANALYSIS 109
The reduction of mother-to-child transmission of HIV is a key Government priority. The second National Strategic Plan to Fight HIV/AIDS for the period 2005 to 2009 (PEN II) sets out a target of PMTCT coverage of 90 per cent by the year 2009, building on the target established by the Ministry of Health in its HIV/AIDS Strategic Plan of 60 per cent coverage by the year 2008. In PARPA II, the target decreased substantially to 22 per cent by the year 2009, on the grounds that the country did not have the capacity to reach more ambitious targets. This decrease raised many concerns among co-operating partners and civil society organisations, who argued that it was much more cost-effective to accelerate the PMTCT programme and that alternative service delivery systems, notably through NGOs and community based initiatives, could be put in place for reaching more ambitious targets. However, international experience to date demonstrates that uptake of PMTCT in general averages about 50 per cent, reflecting the need to re-examine the approaches taken and to strengthen links to other health services, in particular reproductive and maternal/child health services. Experience has also shown that the biggest ‘point’ of drop-out is after counselling and testing, i.e. when it comes to actually taking the intervention. Uniformly, it appears that peripheral health units have a better uptake than larger units, the reasons for this are not very clear. In a country such as Mozambique where less than 50 per cent of women have an institutional delivery, broader health system development, improving access to health care, and access of women to information regarding their health and that of their children, will be imperative to increasing the uptake of an intervention such as PMTCT. B. Paediatric AIDS It is estimated that there were about 99,000 children under the age of 15 living with HIV/AIDS in Mozambique in 2006, a number expected to increase to over 121,000 by the year 2010. One in two infected children live in the four central provinces of the country. Among infected children, 80 per cent are children under five years of age. The number of new infections among children has steadily increased over the year, from an estimated 23,400 in 2000 to 37,300 in 2006, representing about 102 new infections every day. Projection indicates that this number will increase to over 40,000 by the year 2010, with 110 children becoming infected each day (Multisectoral Technical Group for the Fight against HIV/AIDS, 2004). Figure 3.20: Children living with HIV/AIDS: projection until 2010 140000 120000 100000 98700 105500 111600 116800 121200 80000 60000 40000 20000 0 2006 2007 2008 2009 2010 Source: Multisectoral Technical Group for the Fight against HIV/AIDS, 2004 – figures rounded 110 CHILDHOOD POVERTY IN MOZAMBIQUE: A SITUATION AND TRENDS ANALYSIS
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CHILDHOOD POVERTY IN MOZAMBIQUE A S
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ACKNOWLEDGEMENTS This report on the
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CONTENTS ACKNOWLEDGEMENTS………
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4. Access to schooling and attendan
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TABLES AND FIGURES List of tables T
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Figure 4.20: Estimated spending on
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GBS GDP GER GNI GoM HAART HDI HIPC
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MAP OF MOZAMBIQUE Zumbu Magoe M
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een strongly positive in recent yea
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Child protection concerns Chapter F
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vaccination or malaria campaigns, w
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1. Objective of the Situation Analy
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Box 1.1: Human rights conventions r
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of poverty, defined as: “Impossib
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Table 1.1: Deprivation-based indica
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The Ministries of Planning and Deve
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34 CHILDHOOD POVERTY IN MOZAMBIQUE:
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1. Introduction This chapter focuse
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Table 2.1: Progress towards the MDG
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3. Economic growth and macroeconomi
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Evidence as to what extent these
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The percentage of the population li
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Arndt et al. (2005) show that, on a
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B. Assessing childhood poverty In a
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Figure 2.9: Households living below
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severe deprivation. In the poorest
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The second PARPA for the period 200
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Box 2.3: Civil society engagement i
Page 59 and 60: A key cause of these weaknesses is
Page 61 and 62: One possible way forward in tacklin
Page 63 and 64: Box 2.4: Corruption and its impact
Page 65 and 66: (vi) Analysis of monitoring and rev
Page 67 and 68: There are two principal drivers beh
Page 69 and 70: This has troubling implications for
Page 71 and 72: 70 CHILDHOOD POVERTY IN MOZAMBIQUE:
Page 73 and 74: 1. Introduction Every child has the
Page 75 and 76: B. Severe nutrition deprivation amo
Page 77 and 78: Zambezia and Tete provinces. Severe
Page 79 and 80: If this downward trend continues, M
Page 81 and 82: Figure 3.5: Percentage of women rec
Page 83 and 84: Mozambique has achieved a continual
Page 85 and 86: The second reason is that deaths oc
Page 87 and 88: 5. Childhood illnesses A major publ
Page 89 and 90: Figure 3.9: Malaria prevention: use
Page 91 and 92: The 2005 Nutrition Survey conducted
Page 93 and 94: Box 3.3: Combating measles and poli
Page 95 and 96: (ii) Stunting prevalence (chronic m
Page 97 and 98: Alarmingly high levels of stunting
Page 99 and 100: Figure 3.16: Underweight prevalence
Page 101 and 102: There are 86 known salt producers r
Page 103 and 104: Among children, there were no varia
Page 105 and 106: Box 3.5: Infant feeding in the cont
Page 107 and 108: highly in PARPA II, which sets a ta
Page 109: Table 3.3: Overview of PMTCT progra
Page 113 and 114: It is only recently that paediatric
Page 115 and 116: 100 Figure 3.22: Use of safe water
Page 117 and 118: A. Inequitable access to and fundin
Page 119 and 120: The 2004/2005 IFTRAB survey also su
Page 121 and 122: provincial level reported that only
Page 123 and 124: Table 3.4: Ministry of Health budge
Page 125 and 126: Figure 3.29: Total sector resources
Page 127 and 128: Figure 3.31: Indicative per capita
Page 129 and 130: The agenda for expanding water supp
Page 131 and 132: and was revised in 2005. The on-bud
Page 133 and 134: supported by key sector stakeholder
Page 135 and 136: 1. Introduction Education is a fund
Page 137 and 138: B. Severe information deprivation a
Page 139 and 140: Secondary education consists of fiv
Page 141 and 142: Table 4.3: Gross and net enrolment
Page 143 and 144: Table 4.4: Gross enrolment ratio, a
Page 145 and 146: 57 per cent, compared with a NER of
Page 147 and 148: DHS data show that the wealth level
Page 149 and 150: Figure 4.11: Distribution of 11-yea
Page 151 and 152: Lack of literacy is directly correl
Page 153 and 154: In addition, there is a serious gap
Page 155 and 156: The IAF showed that in 2002/3 expen
Page 157 and 158: Absenteeism is also common among te
Page 159 and 160: to the need for two or even three s
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The system is faced with a number o
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• The school represents or is a l
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(iv) Impact of natural disasters In
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The associated large off-budget res
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The Ministry of Education and Cultu
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sense of providing education for ev
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172 CHILDHOOD POVERTY IN MOZAMBIQUE
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I. Introduction All children have t
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involving children. 45 per cent of
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Box 5.1: Street children in Maputo:
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Girls at greatest risk of abuse wer
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The aspirations expressed by the yo
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Against this background, Caia and C
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“Trafficking in women and childre
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Mozambique, girls aged 15-19 in the
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The survey indicates that 32 per ce
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Figure 5.5: School attendance among
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• Labour law does not define the
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- To use child labour (children age
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from their parents. Thus, the law d
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C. Birth registration - guaranteein
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such as hospitals and schools for b
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Sofala province also accounts for t
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Evidence points to worrying increas
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Figure 5.9: Primary school attendan
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activities to strengthen the capaci
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The responsibility for implementing
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214 CHILDHOOD POVERTY IN MOZAMBIQUE
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Conclusions Mozambique is one of Af
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planning in Mozambique, and has the
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7- Implementing social communicatio
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Form of Severe Deprivation Food Wat
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ANNEX II Calendar of the planning,
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ANNEX IV State Budget recurrent and
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REFERENCES AND MATERIALS CONSULTED
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Deaton, A., Ruiz-Castilo, J., and T
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Klasen, S. and Woltermann, S., ‘T
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Government of Mozambique, ‘Progra
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World Bank (WB), ‘World Developme
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World Bank (WB), ‘Mozambique Publ
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Ministry of Women and Co-ordination
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United Nations Children’s Fund (U
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Child Poverty in Mozambique. A Situation and Trend ... - Unicef

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