Mozambique has one of the fastest growing economies in sub-Saharan Africa. Since the end of a 17-year civil war in 1992, leaders have worked hard to leverage country resources to build infrastructure and improve the quality of life for Mozambican citizens. However, despite this promising growth, many public-sector programs remain weak. Outside major city centers, much of the population still has limited access to quality health care.
With a population of 24 million, Mozambique has less than 4 doctors for every 100,000 people. According to USAID, more than 1.4 million people in the country are infected with HIV. Mozambique also suffers high rates of tuberculosis and other respiratory diseases, malaria, and diarrheal diseases including endemic cholera, all of which exacerbate the impact of HIV and AIDS.
Drawing on expertise from I-TECH’s global network, including the University of Washington and the University of California, San Francisco, I-TECH began working in Mozambique in December 2005. Since then, its main objectives have been to provide technical support to the Ministry of Health (MISAU) to address the shortage of health care providers in the country and improve the quality of HIV care and treatment services. Ongoing monitoring and evaluation measures the effectiveness of such programs so that I-TECH and MISAU can continue to improve existing programs and assess the need for new programs to strengthen the health system in Mozambique, and transition to local ownership.
CURRENT PROGRAM PRIORITIES
- Quality Improvement of HIV care and treatment:
- Provide assistance to MISAU in expanding (beyond the pilot stage) the national Quality Improvement and Humanization Strategy (QIHS). This project seeks to improve HIV clinical care indicators through the training of clinicians in quality improvement cycles (Plan-Do-Study-Act) and through clinical mentoring.
- Distance learning: in addition to on-site clinical mentoring, provide clinicians, particularly in remote areas, with access to clinical consultation by telephone (“warmline”) as well as online resources for self-study and group courses.
- ART Therapeutic Committees: support the creation, initial training, and continuing education for provincial committees that handle complicated HIV cases, including drug regimen changes.
- Quality Assurance of Voluntary Medical Male Circumcision for HIV prevention: assist MISAU to improve the quality, safety and performance of the VMMC sites through external quality assurance visits and mentoring.
- Partner Services: expand a pilot project for an integrated partner services intervention that increases partner testing among persons with newly diagnosed HIV infection, increases HIV patient’s engagement in care, and improves uptake of HIV-related medical therapies.
- Electronic Medical Record (EMR): support the development and implementation of standards for EMRs at antiretroviral treatment (ART) sites.
PAST Program Highlights
- Support MISAU in the expansion of integrated health services to provide antiretroviral treatment and quality health care to people living with HIV at primary care facilities.
- Strengthen pre-service (undergraduate) training for mid-level clinicians (técnicos de medicina geral, TMGs) by providing technical assistance in curriculum design and development to the Ministry’s training department and Health Training Institutes (IdF.)
- Assisted MISAU to revise the pre-service “bridging” course for low-level clinicians (agentes de medicina) to become mid-level TMGs.
- Provided in-service training to Health Training Institute faculty in lesson planning and participatory learning methods, through faculty development courses and ongoing professional development.
- Responded to the training and support needs of Mozambican nurses and agentes de medicina to prepare them for new roles in HIV care (task-shifting), including the identification of opportunistic infections, and signs and symptoms of treatment failure.
- Integrated Positive Prevention messaging into patient encounters and referral systems within health facilities and health provider training.
- Developed a cadre of clinical trainers who can implement effective positive prevention training to ensure that people living with HIV or AIDS are linked with both facility and community-based services and resources.
- Implemented Biological and Behavioral Surveys among high risk populations, including men having sex with men, mine workers, long distance truck drivers, female sex workers and IV drug users to measure HIV prevalence, syphilis prevalence, related risk behaviors, and access to prevention and care services.
- Supported prevention of mother-to-child transmission of HIV through innovative programming, such as the development of Mães para Mães (Mothers for Mothers, or MpM), a community support program for HIV-positive mothers.