New Internationalist

Health by the People

Issue 085

One of Africa’s poorest nations, Mozambique, is leading the way for the Third World in its commonsense approach to the health-care of its citizens. Perhaps this is because President Samora Macliel is a former assistant nurse.

The priorities of the Portuguese colonialists were dismal. In the last year of their rule, a third of the government’s health budget was spent on the capital’s main hospital, within reach of perhaps eight percent of the population. Two-thirds of the country’s 550 doctors were also working in the capital. Whilst the settler community in the towns received privileged and segregated care, 70 per cent of the people lived beyond the reach of any modern health care at all.

When the Frelimo liberation movement came to power in 1975, a mass medical exodus had left only 85 doctors in the country. But the movement already had years of experience in health work in the zones it liberated during the war.

Swift action followed independence. Within a month all health institutions were nationalised and private medical practice was banned. For the new government this was an essential first step towards the goal of making the country’s health resources available to everyone. Soon afterwards the number of pharmaceutical products licensed for importation was cut drastically from 13,000 to 2,600: this saved valuable foreign exchange being wasted on unnecessarily sophisticated and expensive drugs so it was possible to buy more of the basic medicines so badly needed. Later the number of pharmaceuticals for use in the health service was cut from 1,100 to 640 for the same reason.

Still in the first year of independence, a national environmental health campaign was launched in which the rural population was mobilised to dig pit-latrines. The latrines were not always well built and they are not always well utilised, but a great many were dug and sanitation, one of the corner-stones of disease prevention, is gradually improving. The following year, with the technical help of UNICEF and the World Health Organisation, a second mass campaign was launched - this time to immunise the entire population. Starting in the north and moving systematically southwards, mobile brigades immunised children against tuberculosis and measles, women of child-bearing age against tetanus, and everyone against smallpox. The population was so well mobilised that after two-and-a-half years, ahead of schedule, more than 90 per cent of Mozambique’s I 1-or-so million people had been immunised.

Already over 1,200 primary health care workers have graduated from the country’s five health institutes.

In the country’s communal villages, Mozambique’s equivalent of China’s ‘barefoot doctor’ acts as a link between these health centre workers and the organised village population. The main role of these village health workers is to involve the people themselves in promoting their own health, but they also provide simple treatments. They are chosen by the villages from those among their members who have at least four years of primary schooling. And the village guarantees them subsistence living to the extent that they take time off farming to do health work. The government provides the six months’ training in one of the eight rural schools. To date some 450 communal village health workers have graduated.

Countless problems remain as the new health structures creak painfully into operation. But some hard facts suggest the shape of things to come. In the last colonial year the government spent 3.7 per cent of its budget on health - an average of $1.50 per person in Mozambique. By 1978 the Frelimo government had increased the health allocation to 11.2 per cent or an average of about $4.00 per head.

In the same period the proportion of doctors working in Maputo fell from more than two-thirds to about two-fifths and the proportion of the drug budget allocated to Maputo Central Hospital dropped from 47 per cent to 10 per cent. The government is putting its money where its mouth is and making an impressive start in getting health care to where it is most needed.

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