Mozambique National <strong>Human</strong> <strong>Development</strong> Report 2007population is 1/4000, which is one of the lowestinternationally and in the region. Even more abysmalis the ratio of doctors to the public: there is just onedoctor per 30,000 inhabitants. The figure reachesone doctor to more than 100,000 inhabitants in thepoorest areas in the interior of the country.In recent years, these indicators were undergoingrapid development, but now they are beginning tocome under threat due to the advance of the disease.HIV and AIDS is also killing nurses, doctors, laboratorystaff, pharmacists, dentists. In some health units,there are sectors which sometimes stop functioningbecause the sole technician died of AIDS. This situationis much worse under Mozambican conditions,where a very considerable number of the peripheralhealth units function with a single health technician.This situation will require redoubled efforts to stepup the training of doctors, nurses and other healthtechnicians to deal better with this problematic of AIDS,in terms of the provision of care, treatment of opportunistinfections, antiretroviral treatment and otheractivities concerning the normal operation of the sectorsuch as tuberculosis, malaria and other diseases.The increase in AIDS cases is a dramatic humanitariansituation in terms of public and individualhealth within the National Health Service. In healthunits, such as, for example, the Maputo and BeiraCentral hospitals, and the Tete and Manica provincialhospitals, in the medical wards, 60%-80% of thepatients have diseases related to AIDS.In this phase, without adequate drugs, increasinglylengthy absences from work begin, as do successiveand also increasingly lengthy periods in hospital.From the hospital’s point of view there is agrowing overload of work, due to the increase in thenumber of people seeking health care. This fact inturn means increased expenditure due to the longand repeated treatments that these patients need, onthe one hand, and to the increased consumption ofmore expensive drugs on the other, because thesepatients need special drugs to fight off infections.These situations are experienced today in most of thecountry’s health units.It is estimated that the general cost of caring foran AIDS patient is about US$30 (thirty dollars) ayear, without including treatment with anti-retroviral.The per capita budget for health in 2004 was US$12.If we take into account that the cost of treatment withantiretroviral varies from around US$200 toUSD$3,000 US$ per person per year, it can be clearlyunderstood that AIDS, given the costs it represents,could monopolise all extra funding in health.Since the budget is limited, other activities with aless visible but equally strong impact on publichealth in general, such as vaccinations, control ofmalaria and of other chronic and childhood diseases,may be compromised.With the increase of availability of antiretroviraltreatment and ARV prophylaxis for prevention ofmother-to-child transmission, the impact of the epidemicon the health sector is shifting from an acuteillness to a chronic disease. At present, the country isfacing these two situations simultaneously. The availabilityof antiretroviral has increased the need fortraining and refresher training of large numbers ofstaff and has created the need for the rehabilitationof health services to be able to ensure confidentialityand quality treatment for the eligible patients.Until a few years ago, the typical epidemiologicalpicture of Mozambique was characterised by a predominanceof acute infectious and contagious diseasessuch as malaria, diarrhoeal diseases and othersthat could be resolved immediately. The advent ofHIV and AIDS and the increase in tuberculosis andother chronic diseases bring other needs to the systemin structural and organizational terms, and interms of adequate resources that can allow appropriateand sustained response to the new demands.Impact on agricultureLike the other sectors documented above, the agriculturalsector is showing some instability in itshuman resources deriving from the impact that HIVand AIDS is beginning to cause. However, preliminaryconclusions, although they suggest that the additionalcosts due to HIV and AIDS might be significant,do not forecast a catastrophic decline in services,because there is a response capacity on the part ofthe institutions concerned – the study infers(MADER/Verde Azul Consult Lda, 2005).This scenario, however, has to be seen andanalysed in the context of the human resource managementof an institution that facilitates the developmentof services among the producers. It is thus notindicative of the context and environment that HIVand AIDS engenders among producers of the family,semi-commercial or industrial sectors.In a projection from 2004 to 2010, theAgriculture Sector (the Agriculture Ministry and itsProvincial and District Directorates) may lose28
The Demographic Impact of HIV and AIDS in Mozambiquethrough death around 1,700 staff at various levels.AIDS will account for about 84% of these deaths.Thus, in a time span of seven years, the sector maylose 25% of its total work force. Of the 1,700 it isestimated that about 881 deaths may occur amongbasic, mid-level and high technical staff. Of these,between 175 and 184 may be from the agriculturalextension area (MADER, Verde Azul Consultant,2005).ConclusionFrom the data presented, it is clear that all sectorsshow that they will, over time, suffer serous reductionsin their labour force, including skilled andexperienced technical staff of various levels and specialisations,which will have various implications forproduction and productivity. The conclusions thatcan be drawn are the following:• Without strong and sustained HIV and AIDSprevention programmes at the workplace,labour costs may increase significantly;• A significant part of the revenue or income fromundertakings may be used to pay for theexpenses arising from the above scenario, whichmay be expressed in reduced productivity orchanges in policies on social benefits and staffmanagement;• Many of these costs will be associated with healthcare, absenteeism and training;• The sectors that make intensive use of highlyskilled labour tend to be strongly affected, whilethose that make intensive use of unskilled labourtend to have less severe impacts;• The sectors that provide capital goods, such asconstruction and manufacturing are those thatwill suffer most from the effects of the epidemic;• To mitigate these impacts and sustain theeconomy as a whole, strong policies and strategiesin the areas of prevention, care and treatment,as well as at the level of impact mitigation,will have to be considered.29