IMPLICAÇÕES DE SUPORTE DE INICIATIVAS DE SAÚDE GLOBAIS NO SISTEMA DE SAÚDE DE MOÇAMBIQUE

Abstract

Over 70% of financial support to the health system in Mozambique comes from international health partners. During the last decade, substantial support was allocated through the Global Health Initiatives, however, the concrete implications of these Global Health Initiatives on national health system are not known. Drawing upon qualitative methods, between March 2007 to May 2011, 26 senior managers from the national level, 66 health managers and providers from Gaza, Zambézia and Nampula provinces were interviewed. We also conducted an extensive review of the documents that report the context of national health policy, degree of implementation and the role of international aid. As results, during the last years, Health Programs have been boosted by funds from the Global Health Initiatives and thus the volume of interventions to control selected diseases has increased markedly. Despite this increase, the National Health System remains poor in many aspects (infrastructure, personnel, monitoring and evaluation, health information systems, etc). Many Non-Governamental Organizations supported by these Global Initiatives continue to attract qualified public health personnel, helping to weaken the system and induce geo-discrepancies and inequities while rendering ineffective monitoring and evaluation systems. The Ministry of Health still plays a marginal role in terms of management and control of funds and therefore the implementation of existing strategic plans is full of uncertainties. The unpredictability of promised disbursements mainly due to the weak capacity of the Ministry of Health accountability system aggravates the situation. Very recently, some Global Health Initiatives started to strengthen the national health system, but the impact of these efforts will only be visible in the long term. The exaggerated emphasis on supporting disease specific interventions limits the integration approach to the health of the population. Global Health Initiatives should be based on a long-term commitment and support approaches that are consistent with the Compact of the International Health Partnership, which focuses on strengthening the National Health System as a whole.