Africa Transforming (Vol. 2) : Scaled Up Financing for Scaled Up Ambition

Mozambique’s medical sector was in trouble: inadequate
planning, procurement, warehousing, and distribution
of medicines had led to recurrent stock outs. Reports
of stolen or damaged medicines were frequent. Lack of
medicines at service delivery points impacted care and
treatment outcomes.
The education system was also in crisis. Weak school
governance, limited community participation, ineffective
supervision, high absenteeism, and delays or the diversion
of school funds contributed to low student retention, low
completion rates, and poor learning outcomes.
In 2014, Mozambique launched its Public Financial
Management for Results Program for Health and
Education to bring more transparency and efficiency
to spending and management in these two key
sectors. It featured the World Bank’s new Program for
Results instrument.
Untested at the time, this IDA instrument disburses
funding in a phased manner and based on the achievement
of pre-agreed targets. This pioneering project paved the
way for sectors to create specific incentives to drive
behavior change at the sub-national level and across
stakeholder groups.
Progress is significant
“Medicines only have value when they reach the right
patient at the right time,” says João Grachane, a senior
officer at Mozambique’s Ministry of Health. He has seen
the project shift practitioners’ attention from inputs to
results, decisively improving the medicines supply chain.
Key progress includes a substantial increase in the
availability of essential maternal health medicines at
the facility level, from 79 percent in 2013 to 86 percent
in 2015, as well as a sharp decrease in the number of
treatment sites with stock outs of antiretroviral drugs,
from 27 percent in 2013 to 5 percent in 2015.
The education system is also faring better under the
project. Matilde Xilume, primary school director at EP1.2
of 3 de Fevereiro, explains that before the project, the
Medicines only have value when they
reach the right patient at the right
time.
João Grachane, senior officer at Mozambique’s
Ministry of Health
school’s functioning was constantly disrupted by delays
in grant allocations meant to procure basic learning
materials and support the most vulnerable children.
“We now receive our grant allocations at the beginning
of the school year, a major improvement as it allows us
to plan better at the beginning of the year,” says Xilume.
All 1,300 primary schools under the project are benefiting
from more reliably delivered funding.
Working together to find solutions
The project, which is in its final stages of implementation,
has provided a unique support structure to create a
network of reinforcing incentives. A capacity building
window has ensured that sector stakeholders collaborate
more with public financial management agencies to get
the resources they need to deliver services and improve
institutional know-how.
“The project adopted an innovative problem-driven and
iterative approach,” says Humberto Cossa, World Bank
senior health specialist. “Frontline implementers focused
on identifying bottlenecks to the achievement of results
in their sectors, bringing people out of their silos to craft
integrated solutions.”
Building on this successful approach, Mozambique has
launched a new Primary Health Care Strengthening
Program for Results. It is benefiting from additional
results-based grant financing of $105 million, including
$80 million from IDA18, to improve reproductive,
maternal, child, and adolescent health and nutrition
services in underserved areas.
TRANSFORMING AFRICA | BUILDING HUMAN CAPITAL 23