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

provincial level reported that only 20-35 medical doctors graduate each year, and only
5-6 specialists are trained annually, with the gaps being filled by expatriate doctors,
who account for more than a third of the physician positions in the country (Costa et
al 2006). In addition, the study found that the distribution of health workers is uneven
due to a lack of sufficient incentives for them to locate to rural areas, particularly at
district level. The deployment of staff to rural areas is particularly problematic in the
field of maternal and child care. The provinces most adversely affected were Sofala,
Zambézia, Nampula, Manica and Inhambane (Costa et al 2006).
There are significantly more unqualified than qualified health workers in the health
sector. In 2004, for example, of 20,105 public servants employed in the sector, less
than 3 per cent were medical doctors, 15 per cent were mid-level health professionals
(tecnicos medios de saude), 29 per cent were health assistants (“assistentes tecnicos
de saude”), 11 per cent were health auxiliaries (“auxiliaries tecnicos de saude”) and
42 per cent were general service staff (carreiras de regime geral) (MISAU 2005b).
Estimates on the number of workers in the water and sanitation sector infected
by HIV/AIDS indicate that in 2002, 983 out of 6,618 workers in the sector were
living with HIV/AIDS - with 472 workers in the Southern region, 388 in the Central
region and 124 in the North (CBE 2005). The rate was higher among women than
among men. Such a high prevalence rate has a huge impact on the human resource
capacity of the sector and highlights the need to strengthen human resource capacity
and skills within the sector, particularly at the sub-national levels, and to establish
programmes that strengthen staff knowledge of HIV prevention and promote
behaviour change.
E. Poor quality infrastructure
The poor quality of infrastructure is a challenge impeding child survival and
development in both the health and water sectors. Many existing health facilities are
without electricity, adequate water supplies or basic equipment. In the water sector,
although poor coverage remains the main problem, another major barrier to access
and use of safe water is the frequency with which existing water points break down.
The National Water Directorate estimates that approximately 30 per cent of the water
supply facilities that have been constructed in recent years are non-operational. This
breakdown of water points can be attributed to various factors, including the lack
of means to undertake adequate preventive maintenance (such as accessible spare
parts); the poor quality of services delivered; inadequate community empowerment
to take action; and insufficient time spent in creating demand for services (through
strengthening community/family knowledge and skills in regard to safe hygiene
practices and their impact on health).
F. Natural disasters
Mozambique is a country prone to natural disasters, including cyclones, floods
and repeated drought, which can have dramatic consequences on the lives of the
affected population. In rapid onset emergencies, such as flooding or cyclones, health
infrastructure is damaged and roads or paths made inaccessible, reducing people’s
already limited access to health services. In extreme cases (such as the severe
flooding of 2000 and 2001), displaced populations move to temporary accommodation
centres, where health facilities vary in quality and coverage, depending on
accommodation centre management, the scale of displacement and accessibility to
supplies and equipment. The public health risks of epidemic outbreaks are significant
for people living in accommodation centres. However, it should be noted that, in
some instances, temporary accommodation centres allow wider coverage of some
120 CHILDHOOD POVERTY IN MOZAMBIQUE: A SITUATION AND TRENDS ANALYSIS