African Health Initiative

Publications

Effects of health-system strengthening on under-5, infant, and neonatal mortality: 11-year provincial-level time-series analyses in Mozambique

Fernandes QF, Wagenaar BH, Anselme L, et al. Lancet Glob Health 2014;2:e468-77

In the present study, we examine subnational trends in child mortality and their relation to key variables related to health-system strength between 2000 and 2010, a period during which Mozambique saw large reductions in child mortality. Our findings show that national success in under-5, infant, and neonatal mortality masks continued inequalities at the subnational level. Some of the improvements in child mortality seem to be attributable to the expansion of the national health system, particularly improvements in public-sector human resources for health, increased institutional birth coverage, and increased government health expenditures.

 

Systems analysis and improvement to optimize pMTCT (SAIA): a cluster randomized trial

Sherr K, Gimbel S, Rustagi A, et al. Implementation Science 2014;9:55.

A facility-level systems analysis and improvement intervention (SAIA) was designed to maximize effectiveness of prevention of mother-to-child HIV transmission (pMTCT) service provision by improving understanding of inefficiencies, guiding identification and prioritization of low-cost workflow modifications, and iteratively testing and redesigning these modifications. A total of 36 health facilities are part of the trial, including 18 intervention and 18 comparison facilities across Côte d' Ivoire, Kenya and Mozambique. Through improved pMTCT services, the SAIA intervention aims to improve outcomes for pregnant and postpartum mothers and their infants.

 

Stock-outs of essential health products in Mozambique - longitudinal analyses from 2011 to 2013

Wagenaar BH, Gimbel S, Hoek R, et al. Tropical Medicine & International Health 2014; DOI: 10.1111/tmi.12314.

Facility-level stock-outs of essential health products (EHPs) in Mozambique are common and appear to disproportionately affect those living far from district capitals and near facilities with few health staff. The majority of facility-level EHP stock-outs in Mozambique occur when stock exists at the district distribution centre. Innovative methods are urgently needed to improve EHP supply chains, requesting and ordering of drugs, facility and district communication, and forecasting of future EHP needs in Mozambique. Increased investments in public-sector human resources for health could potentially decrease the occurences of EHP stock-outs.

 

Strengthening integrated primary health care in Sofala, Mozambique

Sherr K, Cuembelo F, Michel C, et al. BMC Health Services Research 2013;13(Suppl 2):S4.

Over the past decade, the government of Mozambique has continued to decentralize the management of public sector resources to the district level, including in the health sector, with the aim of bringing decision-making and resources closer to service beneficiaries. Weak district level management capacity has hindered the decentralization process, and building this capacity is an important link to ensure that resources translate to improved service delivery and further improvements in population health.

 

Brain drain and health workforce distortions in Mozambique

Sherr K, Mussa A, Chilundo B, et al. PLoS ONE 2012;7(4):e35840.

Trained human resources are fundamental for well-functioning health systems, and the lack of health workers undermines public sector capacity to meet population health needs. While external brain drain, the migration of trained health workers to work in wealthier countries for higher salaries, is well described, there is little understanding of the degree of internal brain drain, the movement of health workers from the public sector to work for other entities within the same country including non-governmental organizations (NGOs), the private sector, and multi-lateral and bi-lateral donor agencies. Research shows that internal migration is an important contributor to capital flight from the public sector, accounting for more cases of physician loss than external migration in Mozambique.

 

An assessment of the accuracy and availability of data in electronic patient tracking systems for patients receiving HIV treatment in central Mozambique

Lambdin BH, Micek MA, Koepsell TD, et al. BMC Health Services Research 2012;12:30.

Since the rapid scale-up of antiretroviral therapy programs in sub-Saharan Africa, electronic patient tracking systems (EPTS) have been deployed to respond to the growing demand for program monitoring, evaluation and reporting to governments and donors. In our cross-sectional study of 16 HIV care and treatment clinics in the Manica and Sofala provinces of Mozambique, we found high levels of completeness and reliability for key variables indicating that these electronic databases provided adequate data not only for monitoring and evaluation but also for research. Routine evaluations of the completeness and reliability of these databases need to occur to ensure high quality data are being used for reporting and research.