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

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There is significant variation between provinces in terms of resource allocation and expenditure (see Figure 3.30), and allocation of resources is not fully consistent with the health status indicators pattern. Estimated expenditure per person in 2005, for example, varied from approximately US$2 per person in Zambezia province to approximately US$5 per person in Maputo City, while data from the 2002/03 IAF suggests that 17.6 per cent of the population in Zambezia reported having been ill in the previous week compared to a much lower 10.6 per cent in Maputo City (Van den Broeck, 2005). 48 It should be stressed however that the amounts in Figure 3.30 are only very broadly indicative of differences in spending and are in no way meant to capture all resources spent – expenditures by the General Common Fund, the Common Fund for Medicines and some off-budget projects are not captured and neither are expenditures on central-level administration in Maputo. Figure 3.30: Indicative per capita provincial health expenditure, 2005 14 12 US$ per habitant 10 8 6 4 2 0 Niassa Cabo Delgado Namp. Namp. Zamb. Tete Manica Sofala Beira Inhamb. Gaza Central Central Hospital Hospital Maputo Maputo Province City Maputo Central Hospital Allocated Executed Note: All allocation and expenditure figures include own receipts, recurrent budget, investment budget and provincial common fund. Source: Adapted by the MPD from Ministry of Health, 2006 Including the Nampula, Sofala and Maputo City Central Hospitals in the provincial figures would produce even greater disparities. This is not common practice in sectoral calculations of per capita expenditures because the Central Hospitals are intended to be of benefit to the entire population in the region, not simply the province in which they are located (Maputo Central Hospital also aims to provide some specialist nation-wide services). Their inclusion is however justified in an analysis focusing on the poorest members of society, who have lower mobility and are often unlikely to seek formal medical attention at all, let alone journey to a hospital in a different province. Were the Central Hospitals to be included in provincial per capita calculations, inter-provincial disparities in health spending would be even higher, as is illustrated in Figure 3.31. 47 The World Development Report of 1993 recommended a minimum package of US$12.00 per capita for low-income countries. Other estimates are: US$9.24 standard under the “Better Health in Africa” (World Bank, 1994); and US$35 prescribed by WHO’s Commission on Macroeconomics and Health (WHO, 2002) to meet basic health needs towards the year 2007. The figures for Sub-Saharan Africa are taken from World Bank (2005), Table 2.14 – Health: expenditure, services and use. 48 Niassa’s per capita expenditures are very high due to the higher costs involved in providing basic services in remote rural areas. CHILDHOOD POVERTY IN MOZAMBIQUE: A SITUATION AND TRENDS ANALYSIS 125
Figure 3.31: Indicative per capita provincial health expenditure, 2005 18 16 14 US$ per habitant 12 10 8 6 4 2 0 Niassa Cabo Delgado Nampula* Zambézia Tete Manica Sofala* Inhambane Gaza Maputo Province Maputo City* Allocated Executed Note: *Includes Central Hospitals. All allocation and expenditure figures include own receipts, recurrent budget, investment budget and provincial common fund. Source: Adapted by the MPD from Ministry of Health, 2006 These disparities in budget allocation have been attributed in part to weak links between the health sector’s annual planning and resource allocation system, the sub-sectoral strategic plans developed by some directorates and the broader sectorwide planning system, specifically the lack of clear prioritisation of objectives and any attempt at costing within the PESS, which outlines the overall strategy of the health sector. A fundamental difficulty in producing costings within the sector is the lack of information on unit costs. In addition to disparities in health expenditure between particular provinces and districts, disparities also exist between expenditure on primary and tertiary health facilities. This is of particular importance when talking about children, since tertiary care facilities tend to be in urban areas (while child morbidity and mortality rates are higher in rural areas) and they focus on less cost-effective curative care, rather than more wide-reaching preventive care. A recent study to evaluate approaches to supporting health sector development at the provincial level found that in the five studied provinces, governmental health expenditures were biased towards higherlevel facilities (Costa et al, 2006). A number of recent studies have noted the high proportion of health expenditure on tertiary facilities in Mozambique as compared with other countries (Costa et al 2006 and WB 2004b). It is estimated that 38 per cent of health care expenditure is made on the tertiary care level, a figure that differs considerably from the figure in South Africa (25 per cent) and in Uganda, Malawi and Ethiopia (around 11 per cent). B. Water sector According to the State Budget, the proportion of total public resources allocated to the water sector was 2.8 per cent in 2003, 2.3 per cent in 2004 and 2.5 per cent in 2005. However, the financial information provided by the sector, which captures much more external assistance, suggests that this proportion is around 5 per cent of the total budget (GoM and PAP, 2006). Of those funds, roughly two-thirds are 126 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:
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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 and 124: Table 3.4: Ministry of Health budge
Page 125: Figure 3.29: Total sector resources
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
Page 175 and 176: 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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