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

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Box 3.9: Health sector funding and the Abuja Declaration The 2001 Abuja Declaration on HIV/AIDS, Tuberculosis and Other Infectious Diseases, to which Mozambique is a signatory, includes a pledge, “…to set a target of allocating at least 15% of our annual budget to the improvement of the health sector” (OAU, 2001). The Health Sector Working Group in the joint government-donor review has observed that the “government” budget allocation for health expenditure as a proportion of overall expenditure has been consistently below this target. The figure was estimated by the sector to be 10.6 per cent in 2005 (GoM & PAP, 2006). Aside from considerations as to the usefulness of such relative targets, it should be noted that the Abuja Declaration makes no distinction between sources of funding. Thus, if the total Ministry of Health funding is considered, the Abuja target has been attained, having been missed once (in 2002) over the past five years (see Table 3.4). In addition, it should be noted that the distinction between “government” and “external” funds used in health sector planning documents is not a distinction between aid and domestic revenues. Much of the “government” component is donor financed for example, being made up of: (i) a recurrent component which is partially financed by General Budget Support, and; (ii) an investment component that is largely funded by external funds (for example, around 71 per cent of the health investment planned in the State Budget for 2005 was to be financed externally). The distinction is arguably more an indication of where the allocation decision over aid is made, which is at present predominantly conducted through negotiations between the sector and donors. The increased share of donor financing in the sector gives added emphasis to the importance of stable and predictable aid flows. At present, several donors in the sector still find it very difficult to commit to the increasingly important common funds more than one year in advance and, as at mid July 2006, for example, three donors had yet to confirm funds for 2007. The problem is even more pronounced for vertical projects, which often do not provide adequate financial data. This undermines intrasectoral strategic resource allocation. A key area where this directly impacts upon public health is HIV/AIDS, where the proliferation of projects and the discrepancies between these and official Ministry of Health policy. For example, external funds have been made available – particularly to NGOs – specifically to expand the number of voluntary counselling and testing (VCT) centres, known by their Portuguese acronym as GATVs, in contrast to the Government’s policy of incorporating health counselling and testing (ATS) into all health facilities (including, but not exclusively limited to, VCT for HIV). 44 More flexible aid modalities should also be prioritised in order to protect the sector from fluctuations in allocations of the internal component of the State Budget and give the central agencies (i.e. the Ministry of Planning and Development and the Ministry of Finance) leeway to make strategic resource allocation decisions. As in the education sector, the recent improvements in the information available to the Ministry of Planning and Development and the Ministry of Finance regarding total available resources within the sector (resulting from the move to place funds on-budget) need to be complemented with detailed resource planning between the three Ministries to ensure that required levels of internal funding are reconciled with allocations through the CFMP and the State Budget. 43 The three Common Funds are the “Prosaúde” general fund, the Common Fund for Medicines and the Provincial Common Fund. 44 GATV stands for “Gabinete de Aconselhamento e Testagem Voluntaria” and ATS for “Aconselhamento e Testagem em Saúde”. CHILDHOOD POVERTY IN MOZAMBIQUE: A SITUATION AND TRENDS ANALYSIS 123
Figure 3.29: Total sector resources and share of external financing, 2001 – 2005 400 65 350 63% 344 300 60 250 253 59% Million US$ 200 150 165 55% 209 54% 54% 178 55 100 50 50 0 2001 2002 2003 2004 2005 Global Health Funds Proportion of External Assistance [RHS] 45 Sources: Ministry of Health (2005 & 2006) The health sector has in recent years experienced difficulties with low execution rates. Sector data indicate that overall budget execution in 2005 was 73 per cent for current expenditure and 22 per cent for investment expenditure (Ministry of Health, 2006). Moreover, budget execution levels vary considerably between provinces and also between central and provincial levels. For example, execution rates varied between 71 – 98 per cent for current expenditure and between 0 – 64 per cent for investment expenditure amongst the provinces in 2005 (Ministry of Health, 2006b). 45 The problem arises due to slow and unpredictable disbursement of central government funds (which in turn is primarily a result of liquidity constraints), the complex budgetary procedures and schedules for different sources of funds and the difficulties arising from the non-payment of VAT on infrastructure projects by international partners (discussed in more detail in Chapter II and in the following Section). This issue highlights the importance of a coherent and concerted move to build the capacity of the sector, in particular in the area of planning and financial management at provincial and district levels. Dividing health funding as reflected in 2005 State Budget by the total estimated population gives a total level of budgeted health funding of around US$10.0 per capita. PARPA II aims to increase this amount to US$15 per capita by 2009 (GoM 2006, p. 103). However, if the total Ministry of Health funding in 2005 is used as the numerator, the health budget in per capita terms is about US$17.7 per person, of which US$10.4 per person was actually spent (Ministry of Health, 2006). 46 Although this was an increase from the previous year (US$13.3 per capita budgeted and US$9.3 per capita spent), it remains less than the recommended “minimum package” to meet basic health needs in low income countries of both the World Bank and World Health Organisation and below the average for Sub-Saharan Africa, which was estimated at US$31.9 in 2002. 47 45 Much of the information on provincial investments is not available due to a lack of information on external funds, explaining why some provinces realise execution rates as low as zero. 46 This is based on a total population figure for 2005 of 19.4 million (INE, 2005) and a total sectoral budget figure of US$344 million, of which US$202 million was executed. 124 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
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There are two principal drivers beh
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This has troubling implications for
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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 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: Table 3.4: Ministry of Health budge
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
Page 169 and 170: The Ministry of Education and Cultu
Page 171 and 172: sense of providing education for ev
Page 173 and 174: 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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