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

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The study found that those living in rural areas were five times more likely to have to sell something to pay for healthcare as those living in urban areas (WB 2004). This information on poverty as a leading barrier to healthcare is consistent with the 2003 DHS results, which found that 57 per cent of women considered that the main barrier to accessing health services was finding the money to pay for treatment. The legislative and policy framework in Mozambique relating to user fees has been revised on many occasions, leading to a lack of clarity regarding basic inpatient drugs, which are in principle free of charge, and non-basic outpatient drugs, for which there is a charge. The application of user fees therefore tends to vary from district to district, leading to inequities. In spite of social protection mechanisms in place for the most vulnerable, such as fee waivers or reduction in fees for specific target populations, such as children under five, pregnant women, the elderly or the poor, the 2002 Expenditure Tracking and Service Delivery Survey found that in a large proportion of district health facilities such mechanisms were not implemented. This was particularly the case with regard to drugs. Among the surveyed facilities, 95 per cent charged full fees to children, 70 per cent charged full fees to retired soldiers, 66 per cent charged full fees to the elderly and retired and 39 per cent charged full fees to the poor (WB 2004). Corruption is also a problem in the health and water sectors and illegal over-charging, which affects the poorest families disproportionately, is thought to be commonplace. The national Survey on Governance and Corruption, indicated that in a list of 31 public institutions, households considered that the National Water Directorate was the third most dishonest institution, followed by the Ministry of Health in the fourth place (Austral Consultoria e Projectos, Lda 2005). (ii) Physical accessibility After lack of money for treatment, the distance from healthcare facilities was the second problem to accessing healthcare cited by women in the 2003 DHS. The 2004/2005 IFTRAB survey indicated that 56 per cent of households were one hour or more on foot from the nearest health facility, with a significant disparity between urban areas and rural areas (18 per cent in urban areas and 72 per cent in rural areas being more than one hour away from a health facility). In Zambezia province the proportion of people more than one hour from a health facility reached almost three quarters (73 per cent) and in Cabo Delgado, Nampula and Tete was about two thirds. This contrasted with Maputo province (one in ten people more than one hour away from a health facility) and Maputo city (only 2 per cent more than one hour away). Figure 3.27: Access to health facilities: time taken by households to reach the nearest health facilities on foot Less than 15 minutes 15% One hour or more 56% Between 15 and 29 minutes 14% Source: IFTRAB 2004/2005 Between 30 and 59 minutes 14% CHILDHOOD POVERTY IN MOZAMBIQUE: A SITUATION AND TRENDS ANALYSIS 117
The 2004/2005 IFTRAB survey also suggested a correlation between households whose heads had no education and poor access to health facilities, with 69 per cent of households whose heads had no education one hour or more from the nearest health facility, compared with only 17 per cent of households whose head had secondary or higher education. One must be cautious in interpreting these correlations however, as areas with poor education supply (and hence poor levels of education amongst the population) are also likely to lack other social services. Thus, while it is undoubtedly the case that better educated people are more likely to seek out social services, this effect is probably less pronounced than a first examination of these correlations would suggest. In terms of the distance travelled to collect water, the 2003 DHS found that the average time travelled was about 20 minutes, with people in rural areas needing three times more time than those living in urban areas (29 minutes and 9 minutes respectively). In 2005, the ratio of inhabitants per health facility (hospitals, health centres and health posts) was on average 15,462, which was worse than in 2004 and 2003 with ratios of 15,154 and 15,018 respectively (MISAU 2006). In 2004, there were on average 421,600 inhabitants per hospital, with a ratio varying from 729,100 in Zambezia province to 214,800 in Maputo City (MISAU, 2005b). B. Low levels of education among mothers The education level of mothers is strongly correlated with children’s well-being. Mothers with little or no education have less access to information on issues such as nutrition and the prevention, symptoms and treatment of diseases. In the Northern region where the literacy rates among women are the lowest (82 per cent nonliteracy rate among women according to the 2004/2005 IFTRAB), mortality levels among children are the highest (above 200 deaths per 1,000 live births among underfive children). The 2003 DHS indicated that children of mothers with no education were 130 per cent more likely to die before reaching the age of five than children of mothers with secondary level education. However, as noted above, education levels will be lower where access to social services in general is lower, suggesting that while education levels are undoubtedly of fundamental importance for child outcomes, this measure is also capturing a general lack of access to services (as opposed to only reflecting the benefits from education). More generally, since poverty and mothers’ level of education are strongly correlated, it becomes difficult to assess the relative contribution of each to children’s chances of survival. Still, the low access to education and information for women/mothers clearly remains a key constraint to reducing mortality levels among children. 118 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
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A key cause of these weaknesses is
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One possible way forward in tacklin
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Box 2.4: Corruption and its impact
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(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 and 110: Table 3.3: Overview of PMTCT progra
Page 111 and 112: The reduction of mother-to-child tr
Page 113 and 114: It is only recently that paediatric
Page 115 and 116: 100 Figure 3.22: Use of safe water
Page 117: A. Inequitable access to and fundin
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
Page 161 and 162: The system is faced with a number o
Page 163 and 164: • The school represents or is a l
Page 165 and 166: (iv) Impact of natural disasters In
Page 167 and 168: 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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