Mozambique's health problems

Ebola has focused attention on the inability of local health systems to contain a major disease outbreak. But even in African nations untouched by the epidemic, health systems are struggling with insufficient financing and poor organization. That holds back progress against malaria, HIV/AIDS and basic health problems such as infant mortality.

Children in Mozambique are 15 times more likely to die before turning 5 than an American child.

Despite rapid economic growth, countries including Mozambique are spending on things other than health care, leaving much of Africa with too few clinics, hospital beds, doctors and health workers, and with inadequate systems for linking them together.

“It seems like health care is always at the end of the queue,” said Dr. Inacio Chichango, 31, director of the Chokwe hospital.

“We don’t have any politicians talking about health. There are no champions,” said Jorge Martin, an activist for CIP, a local advocacy group that has highlighted Mozambique’s underinvestment in health and its reluctance to sufficiently tax foreign companies.

Over the past decade, more than half of sub-Saharan countries have either cut the share of government spending devoted to health care, or barely increased it, according to World Health Organization data. In Mozambique, health care dropped from 15 percent of the government budget in 2001 to 9 percent in 2012. Many industrialized nations, including the United States, are under pressure to scale back foreign assistance during their own economic struggles. After nearly tripling between 2000 and 2010, global health aid has hit a plateau over the past four years, according to data compiled by the Institute for Health Metrics and Evaluation at the University of Washington.

“The need here is still huge,” said Jean-Luc Anglade, chief of mission in Mozambique for Doctors Without Borders.

Where one doctor can have responsibility for tens of thousands of patients, the health workers are a first line of defense against malaria, pneumonia and diarrhea, three of the deadliest threats to young children. Many global health experts believe that such programs can make a huge difference if implemented correctly. There are about 3,000 such health workers in Mozambique, eventually to expand to 12,000. Each worker is given basic medical training and outfitted with a green bag with basic diagnostic kits, antibiotics and other drugs to treat the three illnesses. Ethiopia has deployed nearly 40,000 community health workers in the past decade.

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