2006年-世界发展银行全球_Mozambique___Health_Sector_Recovery_Program_2页_238kb

Mozambique: Health Sector Recovery Program Summary

Core Content

The Health Sector Recovery Program (HSRP), implemented from 1996 to 2003, was the first World Bank-assisted initiative in Mozambique to adopt a sector-wide approach (SWA). The program aimed to improve the overall health status of the population, with a specific focus on reducing infant and child mortality. It was a collaborative effort involving the Ministry of Health (MOH) and 16 other donors, and was funded by IDA with a total contribution of US$98.7 million over five years.

Key Achievements

• Health Outcomes Improvement:

  • Infant mortality decreased from 162 per 1,000 in the early 1990s to 101 in 2003.
  • The intra-hospital maternal mortality rate dropped from 186 per 100,000 live births in 1995 to 160 in 2002.

• Infrastructure Development:

  • One rural hospital (Muxungue) and two rehabilitated/expanded rural hospitals (Gurue and Mueda) were constructed.
  • These hospitals represented 25% of the rural hospitals built by the government during the period.
  • The distance to reach a hospital for critically ill patients was reduced by up to 200 km in some areas.
  • 94% of planned health centers were completed and deemed satisfactory, a 74% increase from 1995 baseline.

• Human Resources Development:

  • 2,543 professionals were trained through 84 health professional courses, surpassing the target of 48 courses.
  • 3 high-level training institutes and 2 medium-level training centers were rehabilitated and expanded.
  • The program contributed to the training of 14% of the current clinical staff, significantly improving the quantity and quality of health professionals in the country.

• Operational Efficiency:

  • The National Maintenance Program enhanced the MOH’s ability to manage equipment through the establishment of a national maintenance policy, a standard equipment list, and an equipment inventory and maintenance information system.
  • A Local Area Network (LAN) with internet access was installed, improving communication with the provinces and tracking inventory.
  • Maintenance was decentralized, with the creation of provincial and rural hospital maintenance services.
  • Mid-level engineers and equipment technicians were added to support local repair capabilities, reducing equipment downtime.

• Drug Supply Management:

  • A common fund using international tendering improved the adequacy and predictability of medical supplies.
  • The country experienced no stock-out of chloroquine for 5 years and no stock-out of Fancidar for 3 years.
  • A network of warehouses for drugs and pharmaceuticals was improved, with computers linked to a countrywide tracking system.

• Program Management:

  • The Program Management Unit (GACOPI) resolved financial management issues and established 2 regional offices for better contract monitoring.
  • It outsourced procurement and supported 9 other projects across 7 financiers, achieving economies of scale.
  • GACOPI’s operating costs represented 4.75% of total investment costs, a highly efficient performance.

Main Views and Lessons Learned

• Government Ownership in Post-Conflict Contexts:
  In post-conflict settings, ensuring government ownership of health programs is challenging, especially with multiple donor involvement. It is essential to allocate sufficient time and resources during project preparation to address this.

• Sector-Wide Approaches (SWA):
  SWA improves efficiency and speed of implementation by harmonizing procurement, supervision, and reporting procedures. This approach allows for more coordinated and effective use of resources.

• Monitoring and Evaluation (M&E):
  Transitioning from project-based to SWA requires new M&E requirements. It is important to design robust M&E systems, including:

  • Choosing appropriate indicators.
  • Establishing a baseline for comparison.
  • Balancing routine data collection with periodic surveys.
  • Including M&E specialists in the program management team.

Conclusion

The HSRP played a pivotal role in strengthening Mozambique’s health sector through infrastructure development, human resource training, and improved operational efficiency. It demonstrated the effectiveness of a sector-wide approach in post-conflict environments and highlighted the importance of government ownership, coordinated donor support, and strong M&E systems in achieving sustainable health outcomes.