Public health risks of humanitarian crises in Mozambique

Journal of Global Health, Volume 11, Year 2021

Interpretation

Mozambique has been experiencing various humanitarian crises with important public health implications over the last years. These crises compound underlying disease burden dominated by human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS), neonatal disorders, tuberculosis, and malaria [1]. Despite important health gains over the last two decades, the number of deaths and disability-adjusted life-years due to HIV/AIDS per 100 000 population increased by 1201.6% and 1034.4% from 1990 to 2019 in the country [1]. Currently, as coronavirus disease 2019 (COVID-19) responses disrupt the livelihoods of populations throughout the country, by limiting business and access to health care, thousands are being displaced due to armed conflicts in the northern and central provinces of the country, as the country heals from the consequences of recent natural disasters. Between October 2017 and October 2020, >424 200 people, mostly women and children, are estimated to have been internally displaced because of the worsening armed conflict in the northern province of Cabo Delgado [2]. Many medical staff have fled the region, leaving health facilities deserted [3]. This compounds the health risks raised by cyclones Idai and Kenneth, which on 14 March 2019 and 25 April 2019 hit the central and northern regions of the country, displacing >2.2 million people (>7.0% of country’s population) [4,5]. In the central province of Sofala, 28 out of 157 health facilities were entirely or partially destroyed [6]. The country’s health system is already fragile and underfunded: in 2015, government health spending per general government spending was 2.8% – well below the 15% mandated by Abuja Declaration (2001) [7,8]. Therefore, under these circumstances, access to essential maternal and child health products, services, and resources, including sanitation, nutrition, bed nets, antenatal care, skilled birth attendants, and childhood immunizations, becomes unattainable, risking the re-emergence of diseases that had so far been controlled, and compromising the effectiveness of efforts towards global targets. Subnationally, investment policies and provision of public services have focused more on the southern region of the country [9], resulting in important within-country geographical inequalities in the accessibility and quality of essential health products, services, and resources, further compounding the public health risks in the central and northern provinces, which account for 78.5% of country’s population [5].

AI Digest

Study Justification:

The study focuses on the public health risks of humanitarian crises in Mozambique. Mozambique has been facing various crises, including armed conflicts, natural disasters, and the ongoing COVID-19 pandemic. These crises have exacerbated the existing disease burden in the country, particularly HIV/AIDS, neonatal disorders, tuberculosis, and malaria. The study aims to highlight the impact of these crises on public health and the potential re-emergence of diseases that were previously under control.

Highlights:

1. Mozambique has experienced a significant increase in deaths and disability-adjusted life-years due to HIV/AIDS over the past few decades.
2. The ongoing armed conflicts in the northern and central provinces have led to the displacement of thousands of people, including women and children.
3. Health facilities in conflict-affected areas have been deserted as medical staff flee the region.
4. Cyclones Idai and Kenneth in 2019 displaced over 2.2 million people and destroyed a significant number of health facilities.
5. The country’s health system is already fragile and underfunded, with low government health spending.
6. Access to essential maternal and child health products, services, and resources has become unattainable, risking the re-emergence of diseases and compromising global health targets.
7. Geographical inequalities in the accessibility and quality of essential health services further compound the public health risks in the central and northern provinces.

Recommendations:

1. Increase investment in the health system, particularly in conflict-affected areas, to rebuild and strengthen health facilities and attract medical staff.
2. Improve access to essential maternal and child health products, services, and resources, including sanitation, nutrition, antenatal care, skilled birth attendants, and childhood immunizations.
3. Address geographical inequalities in the provision of public services by prioritizing the central and northern provinces and ensuring equitable distribution of resources.
4. Strengthen disease surveillance and response systems to effectively monitor and control the re-emergence of diseases.
5. Increase government health spending to meet the Abuja Declaration target of 15% of general government spending.

Key Role Players:

1. Government of Mozambique
2. Ministry of Health
3. International humanitarian organizations
4. Non-governmental organizations (NGOs)
5. United Nations agencies (e.g., WHO, UNICEF)
6. Donor agencies and development partners

Cost Items for Planning Recommendations:

1. Reconstruction and rehabilitation of health facilities
2. Recruitment and retention of medical staff in conflict-affected areas
3. Procurement and distribution of essential maternal and child health products
4. Training and capacity building for healthcare providers
5. Disease surveillance and response systems
6. Public awareness campaigns and community engagement initiatives
7. Strengthening of health information systems
8. Research and evaluation of interventions
9. Advocacy and policy development initiatives

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. It provides specific statistics and references to support the claims made about the public health risks in Mozambique. However, the abstract could be improved by including more recent data and additional sources to further strengthen the evidence. Additionally, providing specific examples or case studies of the impact of the humanitarian crises on public health would enhance the overall strength of the evidence.

Abstract

Materials

N/A

Innovations

Innovations for improving access to maternal health in Mozambique could include:

1. Mobile health clinics: Utilizing mobile clinics equipped with medical staff and necessary equipment to reach remote areas and provide essential maternal health services.

2. Telemedicine: Implementing telemedicine platforms to connect pregnant women in remote areas with healthcare professionals, allowing for virtual consultations and guidance.

3. Community health workers: Training and deploying community health workers who can provide basic maternal health services, education, and referrals in underserved areas.

4. Maternal health vouchers: Introducing voucher programs that provide pregnant women with access to essential maternal health services, including antenatal care, skilled birth attendants, and postnatal care.

5. Supply chain management: Developing efficient supply chain systems to ensure the availability and timely delivery of essential maternal health products, such as sanitation supplies, nutrition supplements, and bed nets.

6. Public-private partnerships: Collaborating with private sector organizations to improve access to maternal health services, leveraging their resources and expertise.

7. Health information systems: Implementing robust health information systems to collect and analyze data on maternal health outcomes, enabling evidence-based decision-making and targeted interventions.

8. Maternal health education: Promoting maternal health education and awareness campaigns to empower women with knowledge about pregnancy, childbirth, and postnatal care.

9. Infrastructure development: Investing in the construction and renovation of health facilities, particularly in areas affected by humanitarian crises, to ensure adequate infrastructure for maternal health services.

10. Policy and funding support: Advocating for increased government funding and policy support for maternal health, including meeting the Abuja Declaration target of allocating 15% of general government spending to the health sector.

These innovations can help address the challenges faced in accessing maternal health services in Mozambique, particularly in areas affected by humanitarian crises and geographical inequalities.

AI Innovations Description

Based on the information provided, a recommendation to improve access to maternal health in Mozambique would be to develop and implement a comprehensive mobile health (mHealth) program. This innovation would leverage the widespread use of mobile phones in the country to provide essential maternal and child health information, services, and resources to women in remote and underserved areas.

The mHealth program could include the following components:

1. Mobile health education: Develop and disseminate educational content via SMS or mobile apps to provide information on prenatal care, nutrition, hygiene practices, and the importance of skilled birth attendants. This would help improve knowledge and awareness among pregnant women and their families.

2. Teleconsultations: Establish a teleconsultation service where pregnant women can remotely connect with healthcare professionals for antenatal check-ups, advice, and guidance. This would help address the shortage of medical staff in certain regions and ensure that women receive necessary care and support.

3. Appointment reminders: Send automated SMS reminders to pregnant women for their prenatal care appointments, vaccinations, and other important healthcare visits. This would help reduce missed appointments and ensure timely access to essential services.

4. Supply chain management: Utilize mobile technology to track and manage the distribution of maternal health products, such as bed nets, medications, and vaccines. This would help ensure that these resources reach the areas most in need and reduce stockouts.

5. Data collection and monitoring: Implement a system to collect and analyze data on maternal health indicators, such as maternal mortality rates, birth outcomes, and access to services. This would enable policymakers to make informed decisions and allocate resources effectively.

By implementing a comprehensive mHealth program, Mozambique can overcome geographical barriers, improve access to essential maternal health services, and reduce maternal and child mortality rates. It would also contribute to strengthening the overall healthcare system in the country, making it more resilient to future humanitarian crises.

AI Innovations Methodology

To improve access to maternal health in Mozambique, here are some potential recommendations:

1. Mobile Health Clinics: Implementing mobile health clinics that can reach remote and underserved areas, providing essential maternal health services such as antenatal care, skilled birth attendants, and childhood immunizations.

2. Telemedicine: Introducing telemedicine services to connect pregnant women in remote areas with healthcare professionals, allowing them to receive medical advice and consultations without the need for physical travel.

3. Community Health Workers: Expanding the network of trained community health workers who can provide basic maternal health services, educate women about pregnancy and childbirth, and refer them to appropriate healthcare facilities when necessary.

4. Strengthening Health Facilities: Investing in the renovation and construction of health facilities in areas affected by humanitarian crises, ensuring they are equipped with necessary resources and skilled staff to provide quality maternal healthcare.

5. Public Awareness Campaigns: Launching public awareness campaigns to educate communities about the importance of maternal health, encouraging women to seek timely care during pregnancy and childbirth, and addressing cultural barriers that may hinder access to maternal healthcare.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Data Collection: Gather data on the current state of maternal health in Mozambique, including indicators such as maternal mortality rates, access to antenatal care, skilled birth attendants, and immunizations.

2. Baseline Assessment: Assess the current level of access to maternal health services in different regions of the country, identifying areas with the greatest gaps and disparities.

3. Modeling: Use mathematical modeling techniques to simulate the potential impact of the recommended interventions on improving access to maternal health. This could involve estimating the number of additional women who would have access to services, the reduction in maternal mortality rates, and the improvement in key indicators.

4. Sensitivity Analysis: Conduct sensitivity analysis to assess the robustness of the model and explore different scenarios, taking into account factors such as population growth, funding availability, and the effectiveness of the interventions.

5. Policy Recommendations: Based on the simulation results, provide policy recommendations on the most effective interventions to prioritize and allocate resources for improving access to maternal health in Mozambique.

6. Monitoring and Evaluation: Continuously monitor and evaluate the implementation of the recommended interventions, tracking progress towards the desired outcomes and making adjustments as needed to ensure their effectiveness.

Author

Dima Health

Statistics:

Citations: 2

Identifiers:

DOI: 10.7189/jogh.11.03054

ISSN: 20472978

Research Areas:

COVID, Disability, Disparities, Environmental, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Workforce

Study Countries:

Mozambique

Study Design:

Cross Sectional Study

Participants Gender:

Female