Mozambique's Struggle for Wellness

Premier Pascoal Manuel Mocumbi on the progress his nation is making in basic health care -- and how much yet needs to be done

Mozambique has made enormous economic strides since it abandoned socialism in the '80s and its long, bloody civil war ended in 1992. Growth reached nearly 14% last year, and its economy has expanded 7.5% on average for the past decade. But it also has one of the world's worst health-care crises: Thousands die each year of malaria, 13% of the population is infected with HIV or has AIDS, and some 20% of adults suffer from hepatitis B.

Still, among nations in sub-Saharan Africa, Mozambique is regarded as the country that's working the hardest to fight domestic poverty. It also has good relationships with the International Monetary Fund and World Bank, which have forgiven much of the nation's foreign debts, freeing funds for more spending on education and health care.

In part because of Mozambique's efforts to achieve self-sufficiency, the Global Alliance for Vaccines & Immunization (GAVI) picked it as one of the nations in which it will roll out an aggressive immunization effort. GAVI obtains vaccines for six preventable diseases, including measles, polio, and tetanus, and has just started distributing a hepatitis B vaccine (see BW, 4/17/01, "Health: Power of the Needle").

In an interview with BusinessWeek Senior News Editor Pete Engardio, Mozambique Prime Minister Pascoal Manuel Mocumbi discussed his country's efforts to reduce poverty and GAVI's contribution. Edited excerpts of their conversation follow:

Q: How has GAVI made an impact in your country?


GAVI is making a very, very important contribution. For example, it brought us a hepatitis B vaccine, HEP B. The vaccine was available on the market for a long time, but we couldn't afford to import it. Many children contracted hepatitis B that could have been prevented.

For our present immunization campaign, we're also using autodisposal syringes provided through GAVI. They can only be used once, and you don't have to sterilize them. This helps avoid any recontamination, which spreads disease.

With the help of programs such as this, we're also getting the technical assistance to increase the capacity of our health-care system. Aside from the current vaccines, we're getting a functional health-care infrastructure to deliver new vaccines for malaria, which is the No. 1 killer in Mozambique. For example, we're purchasing cold-storage equipment for our clinics. If clinics aren't equipped with cold storage, we don't have the conditions to keep medications stable.

Q: What has Mozambique been doing on its own to upgrade its health-care system?


We have been able to rebuild the clinics that were destroyed by the war that ended in 1992. But then we had floods in 2000, which obliged us to renew the reconstruction program. At the same time, we want to expand health services...especially at the primary level, so that there are health centers as close as possible to rural communities.

The goal is to have a center within five kilometers of every village. We're providing both curative and preventive care in these centers, as well as information on things such as sanitation and nutrition.

Q: Do you regard GAVI as a new way of managing foreign aid?


GAVI is an alliance of the public and private sectors, [allowing them to] join efforts to promote a public good. It's allowing us to expand and maintain a program in a sustained way (see BW Online, 10/9/02, "Bill Gates Battles Deadlier Bugs").

I see this as a model that can help...redress the declines we've observed in development assistance. This is a program that's delivering. A donor can say to his peers that this money is being used well.

It also helps us to think about how we can use similar coalitions to address other issues, like HIV. There's a group now for HIV, and another team is being established to build a global fund for malaria. I hope these funds draw lessons from the efficient manner in which GAVI is being managed.

Q: What's Mozambique doing to improve the economy and reduce poverty?


A few years ago, we were eating maize from donations. Now, we have a surplus and are exporting. We're moving to self-sufficiency for rice. We were dependent on imports of sugar. Our needs are for 100,000 tons a year. This year, we will produce 200,000 tons. We've been able to rehabilitate factories. We now produce soft drinks and beer inside the country -- we used to have to import these products.

We've also benefited from access to debt-reduction programs of the IMF and World Bank. The process has been smooth for us. We have shown our commitment -- we can implement what we promise [in meeting vaccination targets. GAVI will cut funds to countries that don't meet the targets].

Q: What are some of the major problems Mozambique still has to address?


[One area] where we have to step up is education. We're building more schools so that all children can have access to education. Many adults need literacy courses. We still have people who have no access to water. There are women who have to walk 5, 10, or 15 kilometers to get water.

Q: Are you optimistic about Mozambique's future?


Ten years from now, we will have sharply reduced poverty. Perhaps it can be eradicated in 25 years, as long as we invest in education, health, and good governance. If we maintain peace and stability, we will attract foreign investment. We will really be able to change the situation in which we live.

Edited by Patricia O'Connell