Financial Commitment Update

Mozambique will use the budget line for family planning in the Ministry of Health budget to procure contraceptive supplies, and will cover 5 percent (2012), 10 percent (2015), and 15 percent (2020) of contraceptive needs in the federal budget. The Government plans to secure additional funding needed to implement the national Family Planning and Contraceptives Strategy by 2015 through partnerships with the private sector and donors to cover the current funding gap of $15 million.

• After the London Summit on Family Planning in 2012, Mozambique planned the purchase of contraceptives via the Central de Medicamentos e Artigos Médicos for 2013, and covered 25 percent of the budget necessary for contraceptives.

• The Government of Mozambique is striving to establish new partnerships with the private sector and donors in the SRH/FP area. [For this purpose] and in collaboration with UNFPA [Fundo das Nações Unidas para a População (United Nations Population Fund)], financing was received from the Government of the Netherlands in November 2013 to promote and offer SRH services using m-Health.

• Resources from the Government of Korea were mobilized to support the National Integrated Plan to reach the Millennium Development Goals [Objetivos de Desenvolvimento do Milênio ] 4 and 5, and the UK Department for International Development for community distribution of contraceptives.

Policy & Political Commitments

The Government of Mozambique will revitalize the National Partnership to Promote Maternal Health to implement and monitor multi-sector interventions for Millennium Development Goals (MDGs) 4 and 5. They will continue to provide cost-free integrated sexual and reproductive health services (SRH) and commodities in all health facilities, and ensure that existing laws pertaining to SRH are known and implemented at all levels.

Mozambique will also work to strengthen existing coordination mechanisms between partners, private sector and government to accelerate the implementation of the national Family Planning and Contraceptives strategy.

• Mozambique continues to offer integrated sexual and reproductive health services in all health facilities in the country, as an approach to increase access to these services. This commitment is evident in the Health Sector Strategic Plan 2014-2019, recently approved at the highest government level.

• Under the scope of the implementation of the family planning (FP) strategy, the offer of providing counseling in FP in all sexual and reproductive health services (SRH) was introduced, including the bureaus of HIV counseling, testing and Care and Treatment Services. Providers of other services (not just maternal and child health) were also included in ongoing training as a means of ensuring service provision to women in a "one stop" approach, where a package of SRH/FP services are offered, including at the pre-natal, postpartum, child at risk, and child vaccination visit.

• The implementation of offering long-term methods (IUD) immediately [following] postpartum are underway. The integration of offering modern contraceptive methods in the HIV program is also in the discussion phase.

• In the context of integrating SRH services, the capacity of screening Breast and Cervical Cancer (BCC) expanded from 31 US [Unidades de Saúde (Healthcare Centers)] in 2012 to 83 US at the moment, via training more than 670 healthcare professionals (530 - SMI [Saúde Materno-Infantil (Maternal and Child Healthcare)] nurses, 113 - general physicians, and 27 - gynecologists-obstetricians) and the allocation of the respective screening kits. During this period (2012 to July 2014), 203,110 women took the screening exam for cervical cancer. To accommodate these structural changes , all the registration instruments for Maternal and Child Health were reviewed, involving several sectors and institutions linked to the program, for the purpose of harmonizing said registration. The implementation of these instruments is set forth for January 2015, and they are being reproduced at this time.

• The government has focused on establishing a legal framework that permits the upholding of individual sexual and reproductive rights, with a particular emphasis on risk groups. The Assembly of the Republic approved the Law of Decriminalizing Abortion, the implementation of which is awaiting promulgation. In addition to laws, the Government approved strategies such as the Prevention and Treatment of Obstetric Fistula in 2012, as a means of increasing access to the treatment of fistula that affect women in low income families. With this action, a basic right is given back to these women that enables their social and familial re-insertion.

• To improve coordination, a family planning technical sub-group [has been] established; [its] mission is to review the policies, strategies, norms, and plans set forth in SRH/FP, as well as monitor family planning on a national level and mobilize human resources and materials for the implementation of activities. This working sub-group is lead by the Ministry of Health [Ministério da Saúde] and currently co-lead by UNFPA and meets regularly once a month and extraordinarily whenever necessary. As a result of this group's work, the following instruments were established:
  • The family planning consultation norms
  • The family planning acceleration plan
  • Emergency contraception norms
  • The quality standards of RH/FP consultations
  • The criteria for family planning in the mobile brigades and National Healthcare Week.

• The family planning sub-group, in coordination with other areas, will be performing various research/evaluations, namely:
  • The evaluation of availability of modern contraceptive methods at Healthcare Centers;
  • The evaluation of Elementary Multi-Task Agents' follow-up in the community of women using DEPO as a method of contraception; and
  • The evaluation of the integration of SRH and HIV services.

• To further improve coordination and ensure better logistical management, a technical sub-group for materials and products for RH/FP lead by MISAU (FP Program and Central de Medicamentos e Artigos Médicos - CMAM) exists, with the support and contribution of Cooperation and Implementation Partners. This sub-group, among other activities, is responsible for analyzing and revising requirements on a provincial level to avoid errors, given that one of the weaknesses is the rigor in accounting for needs at all levels.

Objective Update

Mozambique's target is to increase access to long-acting and permanent methods (LAPMs) from 1 percent to 5 percent of women by 2015 and to increase the contraceptive prevalence rate (CPR) from 12 percent in 2008 to 26 percent in 2015 and 34 percent in 2020.

Program & Service Delivery Commitments

Mozambique will revitalize family planning information, services, and outreach for youth, build public-private partnerships to improve the distribution of contraceptive commodities, and increase the number of health facilities offering at least three contraceptive methods from one-third to 50 percent by 2015. Efforts will be put forth to train at least 500 health providers to provide post-partum and post-abortion counseling on family planning and contraception by 2015.

Additionally, the Government of Mozambique will stimulate an increase in demand of family planning services, by expanding the provision of information and family planning services in rural and peri-urban communities. It will do this by promoting community based distribution of contraceptives and the participation and involvement of communities, health agents, traditional midwives, non-governmental organizations, and mobile clinics. Mozambique, in particular, will intensify community involvement at local levels through engaging religious leaders and community leaders in educating and advocating for various methods of family planning.

• The National Partnership to Promote Maternal-Child Healthcare is being revitalized, whereby its launch is scheduled for November 2014. The government, via the Ministry of Health, is working with its partners to make this event a moment of mobilization for everyone to speed up the actions that contribute to reaching MDG 4 and 5. An internal working group led by the public healthcare sector was established and involves senior sector levels, whose goal is to monitor all the acceleration processes involved in the reduction of maternal and infant mortality.

• With the approval in 2010 of the integrated package of services offered to adolescents and youth by the National Healthcare Service (SRH/STD/HIV/AIDS, Mental Health, Nutrition and Hygiene/Sanitation of the area), a space opened to discuss adolescent and youth issues in a holistic manner, which has contributed to the improvement in access to information, especially family planning, among the various services.

• In 2013, a National Adolescent and Youth Meeting was held, where participants from different sectors in the government and partners discussed the situation of adolescent healthcare and the means of improving access to information by that specific group. This meeting defined the guidelines for the adolescent and youth healthcare strategy which is being drafted. On the other hand, the revitalization of areas in public schools where a student has access to healthcare information and education is underway.

• In collaboration with UNFPA, a partnership was established with DKT International, focused on training healthcare providers in the public and private sector. Since 2012, 511 public sector and 28 private sector providers were trained in this partnership.

• Considering the primary network, the current coverage of healthcare centers offering at least 3 methods of contraception in the country is 89 percent. The country is focused on increasing that coverage, however, the lack of human resources has been the main limitation.

• The number of technicians trained in postpartum counseling, family planning, and contraception for 2012/2013 was 3,633, listed in the table below:

Area of Training	No trained
IUD postpartum	89
Implant	74
All methods (including Interval IUD and except for Implant) involving contraceptive management	208
All methods (except for Implant and Interval IUD and in Postpartum) without contraceptive management	530
All methods (including Postpartum IUD and except for Implant) without contraceptive management	114
All methods (including Implant an Interval IUD) with contraceptive management	344
All methods (including Implant and IUD) without contraceptive management	461
All methods (except for implant) with contraceptive management	1813

• In order to increase community access to FP, the following interventions are underway, namely:
  1. District-level training of community healthcare agents in promoting and offering contraceptives (birth-control pills and condoms), in partnership with non-governmental organizations (NGOs). By 2013, 3,323 community healthcare agents were active promoting FP and distributing birth control pills in communities.
  2. Offering complete family planning services (with exception of IUD insertion) in communities via Mobile Brigades and National Healthcare Weeks.

The process of revising the curriculum for training Elementary Multi-Task Agents is underway to ensure that the latter are the permanent agents offering information, education, and anti-conception methods at the community level.

• The intensification of community involvement ... in education activities related to family planning will be invigorated by the healthcare and co-management committees, respectively. Between 2012 and 2013, 1,283 new healthcare committees and 302 new co-management committees were created.

• The healthcare committee members are the community reference agents, that is, religious leaders, community leaders, traditional midwives, traditional medicine practitioners, healthcare providers, among others. They are the beneficiaries of a holistic training package in community healthcare, so they can support healthcare-promoting activities, specifically in relation to the disclosure of services, community education via lectures, the identification of healthcare problems in the community and their reference. These groups have played a fundamental role in family planning education and the need for an institutionalized delivery.