Speeches Shim
- Agriculture and Food Security
- Democracy, Human Rights, and Governance
- Economic Growth & trade
- Education
- Gender Equality and Women's Empowerment
- Global Health
- Working in Crises and Conflict
Agriculture and Food Security
Borlaug Higher Education for Agricultural Research and Development (BHEARD)
Agriculture is the backbone of Mozambique’s economy - employing 80% of the active workforce; 90% of the female labor force and 70% of the male working population. Accelerating agricultural growth is a key means of eradicating poverty and increasing food security in rural areas where poverty is widespread. BHEARD aims to help improve agricultural productivity and growth, integrate agriculture and nutrition and contribute to a more robust policy development process in areas such as trade and agribusiness. Progress in these areas requires attention to critical shortages of agricultural policy analysts, research scientists, nutritionists, and agribusiness professionals who are trained at the postgraduate level (M.S. or PhD).
Feed the Future Mozambique Climate Smart Agriculture Activity – Beira Corridor (FTF CSA-BC)
Climate-smart agriculture (CSA) offers a promising pathway to sustainable intensification of agriculture and increased farm productivity, income and resilience for smallholder farming families. CSA is not new to Mozambique, but uptake has been slow due to various demand- and supply-side challenges. Limited awareness and trust in new technologies and a lack of access to markets and finance constrain demand. Further, even where demand exists, low-capacity and poorly functioning systems fail to deliver a supply of high-quality inputs and services to the rural farmer.
Feed the Future Mozambique Innovations (FTF INOVA)
USAID has worked closely for years with partners such as private sector companies and associations, civil society organizations, and the Government of the Republic of Mozambique (GRM) to increase investment and incomes in the agriculture sector. The GRM has set forth an ambitious agenda to increase equitable, pro-poor agricultural growth and sustainably reduce poverty and hunger. Aligned with GRM’s vision, USAID’s FTF Inova provides the framework for ensuring that successes in Mozambique’s agricultural sector are enduring, that market actors are resilient, and that women benefit from growth in the agricultural sector.
Mozambique Smallholder Farmer Production and Productivity Activity (MSFPPA)
Agriculture is the backbone of Mozambique’s economy with more than 80% of the population employed in this sector, 90% of those being women. However, the sector’s performance is characterized by low levels of production and productivity due to numerous challenges. These include the adverse impacts of climate change and climate variability (droughts, floods, emergent crop and livestock pests/diseases); lack of availability and access to quality inputs and technologies; soil degradation and low fertility; poor capacity for disease surveillance and control; inadequate veterinary services; insufficient extension services and poor linkages between extension and research. As a result, the Mozambican Ministry of Agriculture and Food security (MASA), in partnership with FAO, would like to build its capacity to improve service delivery to farmers to counter the climatic and pest/disease challenges facing them.
Partnering for Innovation (P4I)
Despite Mozambique’s recent economic growth and its strategic location in southern Africa, the country still faces challenges in developing its agriculture sector and reducing hunger. The most common is the lack of access to quality inputs and markets. The Mozambican agricultural market has an undeveloped agro-inputs distribution system, with very few agriculture supply shops in rural areas. The few inputs that are commercially available are found in distant urban centers, inaccessible to most farmers.
Resilient Agricultural Markets Activity (RAMA) - NACALA
Rural livelihoods in Mozambique are primarily agriculturally based and climate dependent. Climate shocks will likely increase poverty and malnutrition for rural households, which are not currently resilient enough to withstand the effects of a changing climate. According to the Feed the Future Resilient Agricultural Markets Activity (RAMA) Framework, “Resilient Agricultural Markets Activity encompasses how agriculture affects and is affected by climate change and aligns this integration with food security objectives
Feed the Future Improved Seeds for Better Agriculture (SEMEAR)
Agriculture is the backbone of Mozambique’s economy. More than 80% of Mozambicans are employed in the agricultural sector with 90% of those being women. Therefore, accelerating agricultural growth is a key means of eradicating poverty and increasing food security in rural areas where poverty is widespread. The crops targeted by this activity (common bean, cowpea, groundnuts, pigeon pea and soybean) are the foundation of Mozambique’s food and nutrition security and a source of income for many smallholder farmers. Nevertheless, the competitiveness and profitability of most smallholder legume and sesame farmers are constrained by low productivity due to limited access to improved varieties and outdated agronomic practices.
Integrated Land and Resource Governance (ILRG) GLOBAL
An estimated 70 percent of land in developing countries is not documented, and hundreds of millions of households in rural and urban areas lack secure rights to the land and resource they live and rely on. This limits access to capital and the ability to make long-term investments. As a result, these individuals are particularly vulnerable in the event of conflict or natural disaster. Countries where property rights are perceived as insecure are less attractive for investors and more reliant on donor funding. USAID recognizes that strengthening rights to land and natural resources is central to achieving a broad range of development goals on the journey to self-reliance including: conflict prevention and mitigation; countering violent extremism; realizing inclusive economic growth, managing biodiversity and natural resources sustainably; enhancing agricultural productivity; generating own source revenue; and empowering women and vulnerable populations.
Integrated Land and Resource Governance (ILRG) Mozambique
In the 1990s, the government of Mozambique created a legal framework for land which recognized traditional community rights while encouraging investment. While the resulting legislation is progressive – land is owned by the state, and communities and good faith occupants have perpetual use rights – it has been unevenly implemented. The majority of rural residents are unaware of their communal and individual land rights, or, if aware, lack the political, financial, and technical means to effectively assert those rights in key situations.
Water Sanitation and Hygiene (WASH) in Health Centers
The 29 million Mozambicans are served by approximately 1,640 primary level health facilities. Due to inadequate investment in routine maintenance and upgrades many of these facilities are in a poor condition and lacking essentials such as water, functioning sanitation systems, safe medical waste disposal and electricity. A lack of access to safe water and adequate sanitation, and poor hygiene practices creates the environment for an alarmingly high prevalence of diarrhea throughout the country. Furthermore, 16 percent of all deaths in Mozambique can be attributed to inadequate WASH practices.
Viable Sweet Potato Technologies in Africa (VISTA)
While Mozambique’s economy has had consistent growth rates for several years, progress has been much slower in rural areas. Food insecurity in these rural areas remains a significant challenge. At least 25% of the rural population consistently suffers from food insecurity, 43% of children under the age of five suffer from chronic malnutrition (stunting), and more than 65% of children under five have deficiencies of essential micronutrients, such as vitamin A – which compromises the immune system and can lead to blindness.
Democracy, Human Rights, and Governance
Building Social Cohesion in Cabo Delgado
Despite having significant economic potential in terms of natural resources and tourism, Cabo Delgado is one of the poorest regions in Mozambique and is a hub for wildlife, human and drug trafficking; it also has the highest illiteracy rate in the country (67%), a history of economic marginalization and high unemployment rates. Since October 2017, the province has seen an increase in violent attacks, creating a climate of fear and distrust in communities. The insecurity has forced families out of their homes and into host communities, overstretching resilience capacities. The devastation caused by Cyclone Kenneth in April 2019 destroyed over 45,000 homes in Cabo Delgado and Nampula as well as farmland, livestock and fisheries. This has further compounded the economic difficulties in the region and tension within communities.
Civic Partnership for Good Governance (PCBG)
For more than twenty years since the end of the civil war, Mozambicans have worked diligently to build a more prosperous, peaceful, and democratic country which has included the development of civil society. However the ecosystem for civil society overall is weak and most organizations have difficulty effectively mobilizing and influencing governance processes. In recent assessments of civil society in Mozambique, civil society organizations (CSOs) mention the closing off of the spaces for policy dialogue, the difficulty of accessing information and a great deal of political pressure on CSOs, particularly those devoted to policy debate at district and provincial level. Against this backdrop, support to CSOs in carving a tolerant and representative space for policy dialogue is critical for the country’s democratic and economic development.
Media Strengthening Program (MSP)
Developing an effective media is a significant challenge and opportunity for developing democracy in Mozambique. There is a great need to increase the amount and quality of information that is available to the public. Under the Media Strengthening Program (MSP), USAID is promoting a more diverse, independent and effective media environment by building the capacity of media professionals and outlets, strengthening key institutions to analyze and advocate for policy reforms, increasing the quality and sustainability of community radio stations, and improving access to information for people with disabilities.
Wildlife Crime Prosecution Support Program – Attorney General’s Office (AGO)
In recent years, transnational organized criminal syndicates have used Mozambique as a major source and hub for illicit wildlife products, which has resulted in a precipitous decline in the country’s wildlife population. Effective programs to improve environmental governance are essential to secure the future of Mozambique’s wildlife. To ensure long-term success of conservation efforts, investments must extend beyond the boundaries of Mozambique’s many national parks. In response, the Government of the Republic of Mozambique (GRM) has recently strengthened its Biodiversity Conservation Law to expand the GRM’s authority to prosecute a wider range of crimes associated with wildlife poaching and trafficking cases.
Strengthening School Councils Capacity for Sustainable Organizational Development
School councils (SCs) are the school bodies charged with monitoring quality of services, improved school management and accountability. SC members are elected and typically include representatives from the community. SCs are partially composed by parents and local leaders who are often adults who typically have limited access to information on how school councils should operate. SC members also lack the capacity to hold school staff accountable for providing quality education, starting with the effective use of available instruction time for improved learning outcomes. In addition, there is a great diversity amongst teachers and directors of schools, in terms of their levels of training and experience which contributes to significant differences in student performance.
Local Capacity Development (Indefinite Quantity Contract)
USAID/Mozambique aims to substantially increase direct funding to local partners to implement development projects. Such potential partners, however, lack the institutional capacity in areas such as organizational governance, financial management, and monitoring and evaluation (M&E); which are required in order to ensure that United States Government (USG) funds are well-used and that current development efforts are sustainable into the future. As a result, USAID/Mozambique is investing resources in strengthening the processes and resources targeted local organizations need to be effective stewards of development assistance resources. With such capacity building assistance, future development funds will be channeled through local partners (government and non-government) using direct awards.
TV Surdo: Improving Inclusive Information and Advocacy
In Mozambique people with disabilities (PWD) are routinely marginalized and discriminated against, particularly in rural areas. They often lack full access to education, health care, information and employment. In addition to practical barriers, prejudice and stigmatization make it even more difficult for Mozambicans with disabilities to maximize their contribution to society. TV Surdo, a local NGO promoting the inclusion of PWD and expansion of advocacy for their rights, focuses on using inclusive media content to accomplish this.
USAID Office of Transition Initiatives (OTI)
Strengthen communities in Cabo Delgado to better manage conflict and change. Program will address emerging issues and empower local partners to leverage timely and locally driven activities that enhance engagement between government and citizens and promote democratic processes.
Economic Growth and Trade
Institutional Capacity for Mozambique Private Sector (CTA DGP)
Despite strong and sustained economic growth over the past decade, the Mozambican economy has undergone minimal structural transformation. Specifically, growth has not translated into increased employment opportunities. The latest estimate of the unemployment rate is 23% overall, with more than a third of youth between 20-25 years of age unemployed.
Loan Portfolio Guarantee – Development Credit Authority
Mozambique’s agricultural sector comprises an overwhelming majority of smallholder farmers. About 70 percent of the population is engaged in agriculture, which serves as the main economic sector in Mozambique (24 percent of GDP). Only 16 percent of the country’s 36 million hectares of arable land is currently under cultivation. In addition, due to obstacles such as lack of access to financing, markets and quality inputs, productivity of small-holder, family-based agriculture is very low. Agricultural development is the key to reducing poverty. USAID agriculture focused programs use a value chain approach to strengthen the agribusiness sector through improved linkages between smallholder farmers and large commercial agribusinesses, processors, and traders. Productivity, processing, and marketing of staple agricultural commodities are expanded by enhancing access to finance, forging public-private partnerships, providing business development services, and improving the business-enabling environment.
Supporting the Policy Environment for Economic Development (SPEED+)
USAID has worked closely for years with partners such as private sector companies and associations, civil society organizations, and the Government of Mozambique to make it easier to do business across sectors, put the country in a stronger competitive position, and increase trade and investment. Recent work has focused on reforming agricultural trade and investment policies with an eye on improving livelihoods of smallholder farmers as well as enabling agribusiness to flourish.
Mozambique Monitoring and Evaluation Mechanism and Services (MMEMS)
Over the past several years, USAID/Mozambique has managed development assistance activities designed to achieve a wide-ranging set of results in the areas of health; agriculture, environment, and business; education; and democracy, human rights, and governance. Disaster assistance is a growing focus area. USAID provides development assistance in the form of grants, cooperative agreements, and contracts to a wide range of implementing partners (IPs), including: the Government of the Republic of Mozambique; international and local non-governmental organizations; other donors; other U.S. Government agencies; and public international organizations through more than 70 separate mechanisms. This complex portfolio, implemented over a large geographic area, requires strong management for results based on high-quality data and robust evaluations. USAID/Mozambique designed MMEMS to provide capacity building and technological solutions to USAID’s IPs and our own staff and to assist us with transforming our data into learning and adapting.
Education
Education is a fundamental human right. In 2016, 94% of school-age children were enrolled in primary school, compared to 72% in 2003. Despite the increase in enrollment, education quality in Mozambique still remains a challenge, with low levels of competency in reading and writing at the end of the 1st and 2nd grades of primary education. As a result, less than five percent of students demonstrate grade-level reading proficiency by 3rd grade.
Poverty and HIV/AIDS in Mozambique’s Zambézia Province have kept many children from staying in school. About 75% live in absolute poverty where the HIV prevalence rate of women and men aged 15-49 is 15.1%. Poor teaching quality, long distances to schools, early pregnancy and marriage, gender-based violence, child labor and negative attitudes towards girls’ schooling are major challenges to the education of girls in Zambézia. Girls’ average completion rates in Zambézia are 23% percent at the upper primary level and 4% at the secondary level.
Engaging Communities to Improve Early Grade Reading
Overall in Mozambique, the primary school net completion rate is an alarmingly low 15% through grade 7 (30% urban versus 7% rural); with a literacy rate for Mozambicans, 15 years of age or older, of 58% overall, and 45% for females. Completion rates have stagnated within the last 3 years due to inadequate infrastructure, poor teaching methodologies, limited instruction and time in school and high absenteeism among students, teachers and school administrators. As a result, less than 5% of students demonstrate the desired grade-level reading proficiency by grade 3. To address the challenge of poor education quality, Peace Corps Volunteers (PCVs) who live in local communities, often speak the local language, and have extensive community networks which extend to education personnel and community leaders, help to mobilize communities around improving early grade reading. PCVs also help provide supplemental education services in the communities where they serve.
Since the end of the civil war in 1992, the Government of the Republic of Mozambique (GRM) has been rebuilding its education system with the goal of providing universal access. Under the policy of free and compulsory primary education, the primary education net enrollment ratio has expanded from 52% in 1999 to 94% in 2016. This expansion has placed pressure on school management, teaching personnel, and the overall quality of classroom instruction, resulting in overcrowded multi-shift schools, high student/teacher ratios, and plummeting reading and math test scores.
School councils (SCs) are the school bodies charged with monitoring quality of services, improved school management and accountability. SC members are elected and typically include representatives from the community. SCs are partially composed by parents and local leaders who are often adults who typically have limited access to information on how school councils should operate. SC members also lack the capacity to hold school staff accountable for providing quality education, starting with the effective use of available instruction time for improved learning outcomes.
Gender Equality and Women's Empowerment
Gender Equality & Female Empowerment
Mozambique ranked 181st out of 188 countries in the 2015 UNDP Human Development Index, and 139th out of 159 countries in the UNDP Gender Inequality Index. Extreme poverty and the HIV/AIDS epidemic have contributed to the precarious status of women and girls in the country. Low levels of education, high maternal health risks, pressure to marry at a young age, limited economic prospects, gender-based violence, and accepted cultural norms place women at a high disadvantage. Few girls finish primary school (46%), even fewer finish secondary school (22%), and 56% of women are illiterate (upwards of 70% in rural areas).
Environment
Support To Conservation Partners in Natural Resource and Fire Management
Mozambique’s rich biodiversity and natural resources have the potential to drive economic growth through increasing the tourism and extractive industries. Historically though the government has lacked the capacity and political will to effectively protect these resources from illegal activities and corruption. To expand both sectors responsibly, the Mozambican government is now working to curb corruption, enact conservation laws and policies and enforce meaningful legal penalties. Better coordination between relevant government agencies and improved systems and tools for stopping illegal wildlife and timber trafficking, illegal fishing, and uncontrolled forest fire are necessary for the government to succeed in its efforts.
ECOSMART: The Alliance for Ecosystem Conservation Systems, Markets, and Tourism
Covering 42,300 km2, the Niassa National Reserve (NNR) in northern Mozambique is larger than Switzerland and is home to the country’s greatest concentrations of wildlife, including 70% of Mozambique’s elephants and a third of the lion population. The NNR is also home to 40,000 people, who depend critically on the Reserve’s fish, water, timber, soil, meat, and tourism revenue for their livelihoods. Yet despite the Reserve’s size and importance, the area is still little known internationally, and conservation is under significant threat from poaching, commercial logging, unmanaged use of natural resources, and relatively weak management capacity.
Gorongosa National Park and the surrounding landscape provides ecosystem services of food, freshwater and fuelwood to communities who have experienced conflict, food insecurity, and Cyclone Idai of 2019. The abundance and diversity of wildlife, decimated by decades of civil strife and poaching, has been restored alongside ecotourism and community infrastructure. Since 2008, USAID has invested $17 million, matched 2:1 by American philanthropist Greg Carr, in the conservation and development of Gorongosa National Park. With reintroductions of key species lost during the civil war, increased protection, and improved local livelihood options, the Gorongosa Project has restored ecosystem services and provided agriculture, education, and health services to communities in the buffer zone. This progress is notable, but tenuous unless further efforts succeed.
KHETHA – Protecting Wildlife, Benefiting Communities
Wildlife crime is threatening both the black and white rhino and elephant populations in the Greater Limpopo Transfrontier Conservation area (GLTFCA), a transboundary area bordering Mozambique, South Africa and Zimbabwe. Poaching and illegal wildlife trade remains an alarming threat to the survival of rhino and elephant species, particularly in the Kruger National Park in South Africa where populations have rapidly declined as the region has become a lucrative rhino poaching hotspot.
Global Health
Alcançar
The government of Mozambique has committed to improving maternal, neonatal, and child health (MNCH) and there has been progress in expanding the network of health facilities. This has resulted in increased coverage and provision of lifesaving MNCH services. However, the expansion in network and coverage has not consistently yielded improvements in actual health outcomes. Nampula, Mozambique’s largest and most populous province, has some of the worst statistics surrounding maternal, neonatal and child mortality.
Construction of Three Warehouses in Zambezia
Male circumcision reduces female to male sexual transmission of HIV by 60% and is a highly cost-effective means of reducing infection rates. Voluntary medical male circumcision (VMMC) has historically been a priority for the Mozambique Ministry of Health (MOH), however the VMMC program has consistently not met goals particularly among males 15-29. Manica and Tete were the lowest-performing provinces across all age groups, but particularly among this priority population.
Central Contraceptives Procurement (CCP)
USAID’s family planning and reproductive health (FP/RH) program aims to: 1) increase access to a wide range of modern contraceptive methods and high quality services for postpartum women, HIV positive women and adolescents, high parity women, and post-abortion care women at both community and facility levels; 2) increase demand for modern contraceptive methods and high quality FP/RH services; 3) strengthen social behavior change communication interventions; and, 4) strengthen FP/RH systems in strategic planning, human resources, financial systems, commodities, and supply chain management. Improving civil society engagement regarding family planning and sexual reproductive health/safety plays an invaluable role in USAID’s support to the health sector in Mozambique. As the largest bilateral donor of family planning assistance in the world, USAID continues to support safe, effective, and acceptable contraceptive technologies designed for provision and use in low-resource settings. Increased use of modern contraceptives by Mozambicans who specifically want to avoid pregnancy saves lives and improves health.
Clinical & Community HIV/AIDS Services Strengthening (CHASS 3.0)
USAID is proud to support Mozambique’s leadership in the global HIV/AIDS response. Through PEPFAR, USAID improves service delivery and provides technical assistance to maximize the quality, coverage, and impact of the national HIV/AIDS response. PEPFAR aligns investments to scale up evidence-based interventions in the geographic areas and populations with the highest burden of HIV/AIDS. USAID also supports improvements in the health workforce, financing, management, information systems, supply chain, and service delivery. Health systems strengthening will ensure sufficient and sustainable revenues for health from domestic sources and ensure that they are allocated and used efficiently. Assistance in constructing and repairing health facilities and sites is increasing the availability of quality health services in rural areas.
Communication for Improved Health Outcomes - CIHO
Indicators for family planning, HIV/AIDS, orphans and vulnerable children (OVC), malaria, and nutrition demonstrate the urgent need for national multi-channel social and behavior change (SBC) campaigns to promote healthy behavior and use of health products and services across Mozambique. Mozambique currently has one of the lowest modern contraceptive prevalence rates, with rates as low as 17.8% percent in some provinces. Regarding HIV/AIDS, Mozambique’s prevalence rose to 13.2% in 2015. Twelve percent of children under 18 are orphans, with a 29% HIV prevalence among orphans aged 15-17. Malaria remains the leading public health problem with a national average of 40.2% prevalence among children under five. Furthermore, 43% of children under 5 years of age suffer from chronic malnutrition – 46% in rural areas and 35% in urban areas. By understanding how and why people act as they do, they can create and implement actions and approaches that will remove barriers to behavior and subsequently improve nationwide health indicators.
The government of Mozambique has made progress in its efforts to combat malaria and address issues pertaining to Maternal, Newborn and Child Health (MNCH). However, malaria is still endemic throughout Mozambique, and its entire population of 26.4 million (2016) is at risk. Malaria is considered the most important public health problem in Mozambique and accounts for 29% of all deaths. Among children under five years of age, malaria accounts for 42% of deaths. Regarding MNCH, despite substantial improvements, preventable maternal and child deaths continue to be unacceptably high. Child mortality fell 37% between 2003 and 2011 and gains have continued. Infant mortality has fallen even further, by 50 percent between 2003 and 2011. Maternal mortality rates stagnated between 2003 and 2011; and in 2015, the percentage of institutional births increased from 63% to 70%. Using data to track and sharpen implementation, advancing quality, respectful care, strengthening health systems, and continuous learning are key to combating malaria and improving MNCH.
Service Delivery and Support for Orphans and Vulnerable Children (COVIDA)
Nearly 12 million children in Sub-Saharan Africa have lost one or both parents to AIDS. Many more children have been made vulnerable because of family illness and the widespread impact of HIV/AIDS on their communities. OVCs are more vulnerable to abuse and exploitation and are also more likely to engage in unsafe behaviors, increasing the risk of HIV infection. Targeted OVC interventions, linked with broader development efforts around education, food and nutrition, and livelihood assistance, contribute to reducing the risk and impact of HIV/AIDS on the most vulnerable population in Mozambique.
Design-Build of Manica, Tete, and Sofala HIV Viral Load Laboratories
Demand for HIV viral load (VL) testing in Mozambique outweighs current capacity. The increasing demand results in backlogs of VL samples throughout the country- this problem will become more acute as demand continues to grow. Backlogs of VL samples result in long delays in the delivery of VL test results to clinicians and patients, negatively impacting patient care. These delays also slow the expansion of differentiated models of care, specifically 3-month drug distribution and rapid patient flow, interventions known to greatly increase retention in HIV care. Thus, it is imperative that the current HIV VL testing network be expanded as quickly as possible.
Design-Build of Zimpeto Warehouse Extension
In 2008, the Government of Mozambique (GRM) through the Ministry of Health (MoH) conducted a Warehousing and Distribution Needs Assessment. The assessment found that the MoH was spending substantial funds annually to rent warehouse space nationwide and recommended the MoH adopt a regional/district distribution model in place of the present national/provincial/district structure. The assessment proposed three main warehouses located in the northern (Nampula), southern (Zimpeto - Maputo), and central (Beira) regions. Based on this assessment, in 2013, the MoH issued the Pharmaceutical Logistics Strategic Plan (PELF), which covers the policy, infrastructure, and supply-chain needs to achieve lasting improvements in commodity security. USAID aligns support in the pharmaceutical sector to this plan. Given the poor state of warehouse infrastructure and the large investments that USAID and other US Government (USG) agencies are making in commodities, supporting the construction of warehouses will provide support to the planned distribution system, while simultaneously safeguarding USG and GRM commodity investments. Furthermore, investing in regional warehouses, such as Zimpeto, will enable long term cost-savings by eliminating rental costs currently paid by the USG and GRM.
Efficiencies for Clinical HIV Outcomes (ECHO)
Mozambique has the eighth highest HIV prevalence in the world, and according to UNAIDS, 12.6% of the adult population is living with HIV. While the country has made strides in testing people for HIV and providing treatment, systemic challenges, such as the need to travel long distances to access care, long wait times in facilities, stigma, poor quality healthcare, and inadequate communication about the importance of staying on treatment have resulted in a high proportion of HIV-positive individuals discontinuing their treatment. As a consequence, Mozambique has among the highest HIV mortality rates in the world.
The high prevalence of early pregnancy and high fertility, combined with the poor quality of obstetric services, increases risks related to prolonged or obstructed labor in Mozambique. Complications may lead to obstetric fistula, resulting in lifelong disability and social stigma. An estimated 2,300 women suffer from new cases of fistula each year in Mozambique, yet access to fistula repair services remains limited across the country. The Mozambican health system’s capacity to provide fistula repair services is hampered by a lack of trained staff and basic equipment. In response, USAID supports Fistula Care Plus (FC+) to increase access to and quality of fistula repair services in Mozambique.
In Mozambique, all Ministry of Health interventions carried out at the provincial level are overseen by the provincial Directorates of Health (DPS). Therefore, in the area of HIV/AIDS response, the DPS implements and supervises all activities related to the care and treatment of the national strategy of HIV/AIDS fight under the guidance of the Ministry of Health. Yet DPS capacity throughout the provinces is generally not high enough to fully implement the necessary health interventions. This project intends to address the problem of capacity and, if successful, will be used to develop other direct agreements with provincial directorates in the remaining provinces where USAID is the leader in the implementation of PEPFAR programs. Efforts like this are part of USAID’s strategy to help Mozambique on its Journey to Self-Reliance.
Health Policy Plus: Mozambique
The health sector in Mozambique is faced with multiple financing challenges, limited domestic resources, plateauing donor support and increasing absolute level of out-of-pocket expenditures. This contributes to limiting access to care for people in need. Palladium and its partners support Mozambican partners and stakeholders to improve the enabling environment for HIV, Family Planning and Reproductive Health (FP/RH), and maternal, newborn, and child health (MNCH) and the Palladium/Health Policy Project (HPP), 2010 –2015 collaborated with USAID and the Mozambican Ministry of Health (MISAU) on a program that supported costing of Reproductive, Maternal, Neonatal, Child, and Adolescent Health (RMNCAH) programs.
ICF Macro Demographic and Health Surveys 7/8
The Demographic and Health Surveys (DHS) Program has collected, analyzed, and disseminated accurate and representative data on population, health, HIV, and nutrition through more than 400 surveys in over 90 countries. Data generated by these surveys enables countries to identify and prioritize development targets, monitor progress towards Sustainable Development Goals (SDGs), and measure the impact of programming at the population level. In Mozambique, the DHS program has worked with the Instituto Nacional de Estatítica (INE) and Instituto Nacional de Saúde (INS) to complete the following surveys:
• HIV/AIDS indicator surveys in 2009 and 2015
• Malaria indicator surveys in 2015 and 2018
• Standard Demographic and Health surveys in 2003 and 2011
During this current phase of the DHS program, there are plans to complete the next iteration of a standard Demographic and Health survey to update key maternal and child health indicators in 2020/21.
Integrated Family Planning Program (IFPP)
High fertility rates present a serious health threat in Mozambique, with the total fertility rate varying from 4 to 8 with an average of 6 children per woman (DHS 2011). According to the National Malaria and HIV Indicator Survey 2015 (IMASIDA), the modern contraceptive prevalence rate (mCPR) is 25% (34% urban and 22% rural) with a high demand for modern methods of 50% and unmet need of 23%. A total of 46% of adolescent girls are pregnant for the first time or already have one child, and in this group only 14% are using any contraception method. There is also a high unmet need for family planning (FP) with 46% of women that express a desire to limit or space pregnancy not using any form of contraception. There is a high unmet need for FP especially among HIV positive women. However, few programs targeting HIV-positive women provide counseling and services for FP. IFPP will focus on young people and smart integration of FP into other services.
Mozambique Integrated Malaria Program
The Mozambique Integrated Malaria Program (IMaP) is a five-year USAID-funded project implemented by Chemonics International that will contribute to reducing malaria mortality, morbidity, and parasitemia in four high malaria burden provinces (Cabo Delgado, Nampula, Tete, and Zambézia). Mozambicans, especially in the high-transmission north and center, continue to be stricken with malaria. The disease accounts for nearly 30 percent of all deaths and is especially lethal for children under five. Despite significant investments by the Government of Mozambique, USAID, and other donors, cases continue to increase, even accounting for improved reporting. The causes are complex– the country’s ability to address health challenges is hindered by such issues as health system weaknesses, low uptake of preventive and treatment services, and broader climatic and environmental factors that compromise progress. As the flagship activity for the President’s Malaria Initiative (PMI) in Mozambique, IMaP leads technical assistance for improved malaria case management, malaria in pregnancy activities, social and behavior change communication, surveillance, monitoring and evaluation, including routine data quality, and strengthened health systems at the national and subnational levels. In addition to addressing systemic and facility-level constraints to improve quality of facility- and community-based malaria services, IMaP implements community-based social and behavior change communications interventions to increase demand and uptake of these same services. IMaP also works to strengthen data flow and quality for improved decision-making and planning within these systems.
Food Security Innovation Lab – Impact Evaluation of FCC - SFCS Project
Força a Criança e Comunidade (FCC) is a five-year cooperative agreement implemented by World Education and designed to provide education, social and economic strengthening to orphans and vulnerable children (OVC) in Manica, Sofala and Zambezia. Food Security Innovations Lab, part of the BASIS-AMA consortium implemented by UC Davis in conjunction with other US-based universities, is completing a prospective independent impact evaluation of the FCC activity.
In 2013, the Mozambique Ministry of Health (MISAU) adopted the Pharmaceutical Logistics Strategic Plan (PELF) prompting several reforms to improve the distribution of critical health products to health facilities. It also expanded the use of electronic logistics management information systems (LMIS) to help ensure end-to-end visibility and quality of key logistic information throughout the supply chain. In its efforts to provide quality health services to its citizens, the Government of Mozambique and USAID are partnering with VillageReach to design and implement a streamlined and effective last mile supply chain system. The primary objective is to improve the availability of medical commodities and diagnostics at the last mile. The Last Mile Supply Chain (LMSC) program is aligned with long-term national strategies and efforts, while taking short-term steps to address chronic logistics and transport challenges at the sub-national level. The program initially is being implemented in Zambézia province, with plans to expand in the future. Strategic partnerships are core to the program, helping ensure effective implementation, results maximization and sustainability. The Ministry of Health, CMAM (Center for Drugs and Medical Supplies), and the Provincial Health Directorate (DPS) in Zambezia are central to the work. Other technical partners include Bolloré Transport & Logistics, ThinkWell and Nichols Group LLC. Trucks loading medicines at a provincial warehouse site.
Medicines, Technologies and Pharmaceutical Services (MTAPS)
Mozambique has made important progress in strengthening its pharmaceutical systems and improving access to life-saving medicines including antiretroviral therapy in recent years. A new medicines law, enacted by Parliament in 2017, created the National Directorate of Pharmacy (DNF), which is the National Medicines Regulatory Authority (NMRA). The number of people living with HIV receiving antiretroviral therapy (ART) has increased from the 308,000 in 2012 to approximately 914,000 in 2016, and new policies to strengthen the human resource capacity in the health sector, including shifting HIV care and treatment functions to clinical officers and nurses, were introduced. Still, there are still gaps in the DNF’s immediate capabilities and long-term regulatory planning.
Community-based HIV Services for The Southern Region - N'WETI
The prevalence of HIV in Mozambique is 12% among adults 15 to 49 years old with substantial variation in regional prevalence rates ranging from 25% to 3.7%. Mozambique’s HIV epidemic is driven by a complex combination of structural and social and behavioral factors that vary among sub-populations, including: low literacy rates (59%); poverty; low levels of male circumcision; insufficient access to HIV prevention, care, and treatment services; sexually transmitted infections; sexual violence; transactional sex; multiple concurrent partners; cultural practices, such as rites of passage; and gender imbalances. Despite gains made in scaling up access to Anti-Retroviral Treatment (ART), Mozambique has not yet achieved epidemic control. Although ART is now being provided in every district, national coverage has reached only 74% for adults and 46% for children as of 2014.
Integrated HIV Prevention and Health Services for Key and Priority Populations (PASSOS)
According to UNAIDS (2014), as many as 30 percent of newly HIV-infected people in Mozambique are female sex workers (FSW), their customers, or their regular partners. A 2010/2012 Integrated Bio-Behavioral Surveillance (IBBS) study of FSW in the urban areas of Maputo, Beira and Nampula showed HIV incidence rates around 20 percent, with regional variation. A 2011 IBBS study of men who have sex with men (MSM) in the same urban areas showed approximately eight percent HIV prevalence among this group.
Oversight Services for the Construction of 16 Type II Rural Health Centers
Mozambique is one of fourteen priority countries targeted by the President’s Emergency Plan for AIDS Relief (PEPFAR). USAID/Mozambique, in collaboration with the Government of Mozambique’s (GRM) Ministry of Health (MoH), created the Health Infrastructure Development Program (HIDP) to support GRM’s efforts to improve and expand health care services for the people of Mozambique. The HIDP was designed for construction and rehabilitation of health facilities, medical staff housing, training establishments, laboratories, and warehouses. The construction oversight services are intended to support USAID/Mozambique’s small infrastructure team by providing access to specialist A&E services and technical expertise required to undertake oversight activities. Under this mechanism, and upon USAID’s request, a contractor may be solicited to provide technical and financial proposals to oversee other infrastructure projects still under consideration.
Promoting the Quality of Medicines (PQM)
Since 2003, USAID/Mozambique has been providing technical assistance and support to the Government of Mozambique (GRM) and the Central Warehouse for Medicines and Medical Supplies (CMAM) in logistics and supply chain management for health, malaria, and HIV commodities, as well as providing in-kind donations of medicines and other supplies for malaria, HIV, and other health programs. However, until recently, USAID has provided very limited technical support to the Ministry of Health (MOH) to strengthen the medicines quality assurance and quality control systems. Initially, the National Quality Control Laboratory (LNCQM) had inadequate infrastructure, equipment and staff to provide full-fledged quality control services that meet internationally recognized pharmacopeial requirements. Laboratory infrastructure did not allow microbiological tests to be performed due to the inability to create sterile testing areas; which subsequently limits the ability of laboratories to perform common tests for injectables and other medicines requiring microbiological tests, of which there is great public health concern. Besides infrastructure shortages, there is a lack in human resources capability to execute full technical competence and quality management.
Procurement and Supply Management Project (PSM)
Mozambique’s civil war led to an erosion of funding and support for the nation’s health system. Since its end in 1992, the health system has been improving, but the gains are not enough to effectively manage the significant health challenges facing the country. People are still dying due to lack of access to health services and low-quality care. In 2015, 40,000 deaths were reported from HIV/AIDS; and according to the Ministry of Health (MISAU), with a population of 26 million, Mozambique recorded over six million cases of malaria in 2015. Furthermore, 43% of children suffer from malnutrition and the 2015 maternal mortality ratio was a staggering 480 deaths per 100,000 live births. The Central Medical Stores (CMAM) is tasked with managing Mozambique’s medical commodities supply chain and alleviating some of these issues, but it has limited resources to effectively implement all the necessary supply chain functions. CMAM is tasked with managing warehousing, distribution, commodity quantification, stock procurement, logistics management, monitoring and evaluation, and staff training, on its own.
Reducing Aflatoxin Exposure: Nutrition Innovation Lab
Aflatoxins are pervasive in the value chains of key staple crops such as maize and groundnuts in many developing countries where agriculture is a significant contributor to Gross Domestic Product (GDP). Mozambique is one such country, where agriculture constitutes 24% of the GDP, with 80% of the population dependent on it as a source of income. Some of the most commonly cultivated crops in Mozambique, such as maize, cassava, and groundnuts, are easily contaminated by aflatoxins and widely consumed by the population. Aflatoxin exposure and its association with growth impairment in children may contribute to a significant public health burden, especially in less developed countries like Mozambique. Many studies have found strong associations between aflatoxin exposure and stunted fetal, infant, and child growth, thus providing evidence for the first criterion for causality. Mozambique is a country with high rates of chronic malnutrition (stunting), particularly in rural areas and the provinces where USAID activities linked to the Feed the Future (FTF and Preventing Child and Maternal Deaths (PMCD) initiatives are being implemented. While some data on soil and crops which show high levels of aflatoxin exist in Mozambique, there is no data on levels of aflatoxin in human serum. While the case for aflatoxin mitigation to decrease stunting is slowly being made, there is still lack of data to understand the extent of the problem at the national and sub-national level in Mozambique. Furthermore, there is very little or practically no knowledge of if and how the presence of aflatoxin in the body might interact with other risk factors of stunting, thereby exacerbating the problem.
Support Community Health Interventions to Address Neonatal and Child Health - UNICEF
Mozambique has shown significant improvements in health indicators and progress in maternal and child health over recent decades. However, despite substantial improvements in infant and child mortality rates, preventable maternal and child deaths continue to be unacceptably high in Mozambique. Neonatal complications or infection, malaria, diarrhea, pneumonia and HIV/AIDS account for more than 80 percent of all deaths of children under five in the country, with malnutrition as a contributing factor in 35 percent of children deaths.
With over 60% of Mozambicans living below or just above the poverty line, regular shocks leave most of the population at risk of becoming poor or sinking deeper into poverty. Without adequate care, the consequences of growing up in this environment have life-long implications for the wellbeing and development of orphans and vulnerable children (OVC). To address these concerns, USAID, in collaboration with the Mozambican Government (GRM), civil society, local organizations, and other donors, support the technical areas of HIV/AIDS, malaria, health systems strengthening, maternal and child health, family planning, nutrition, tuberculosis, water and sanitation, and neglected tropical diseases. More specifically, USAID seeks partnerships to implement programs designed to reduce the vulnerability of OVC and the poor in Mozambique, including social protection programs and comprehensive OVC programming, which can contribute to positive wellbeing outcomes.
Strengthening High Impact Interventions for an Aids-free Generation (AIDSFREE) Project
Latest figures indicate that HIV/AIDS prevalence in Mozambique is 13%, with 29% prevalence among orphans aged 15-17, and almost 40,000 AIDS related deaths in 2015. Three randomized clinical trials showed that male circumcision (MC) reduces female to male HIV transmission by approximately 60%. In Mozambique, MC has been practiced by many communities for centuries. In addition to having religious significance, MC often serves as a rite of passage to adulthood and is performed as part of adolescent initiation rites. Approximately 63% of men aged 15-49 are circumcised (up from 51% in 2009), although there is significant variation across the nation’s 11 provinces, with low circumcision rates and high HIV prevalence observed in the southern and central regions of the country.
Mozambique– ranked in the bottom third of countries for health indicators – faces significant challenges in the health sector that impact TB diagnosis, treatment and outcomes. At the community level there is low awareness of TB symptoms, transmission, prevention and treatment. There is also stigma associated with the disease and its common co-infection HIV. Despite some recent progress at the facility level, significant gaps remain in terms of access to quality diagnosis, treatment and care. The four target provinces - Nampula, Zambézia, Tet and Sofala- represent 56% of all new TB notifications in 2018 and the TB treatment coverage of those case was on at 59%. This provides both a challenge in tackling such large numbers and gaps, but also an opportunity to allow the government to take lessons learned here and apply elsewhere in Mozambique.
Mozambique – ranked 170 of 188 countries on the Human Development Index – faces significant development challenges. The country is largely dependent on agriculture (mostly subsistence-based with small family farms) and is vulnerable to drought and natural disasters. 66% of the population live in rural areas, most live below the poverty line, and one-third is chronically food-insecure with high child stunting. The situation is worse in Nampula – Mozambique’s largest, most densely populated province –particularly for pregnant and lactating women, adolescent girls, and children under 2. The most recent surveys show that Nampula has the highest stunting rate for children under 5 at 55%, a full 12% higher than the national average. 51% of adolescent girls are anemic, early marriage and pregnancy rates are among the highest in the country, and women and girls face extreme socio-economic exclusion. The causes of and contributing factors to malnutrition are complex including inadequate food intake; diets low in micronutrients and protein; gender inequity in access to nutritious foods; misconceptions about nutritious diets; poor infant and young child feeding practices; poor sanitation; and low dietary diversity. Transform Nutrition (TN) aims to address these challenges in Nampula Province, particularly for pregnant and lactating women, adolescent girls and children under 2.
Malnutrition is an underlying cause in almost half of child deaths and a persistent barrier to economic growth, with countries in Africa and Asia losing up to 11% of their gross domestic product each year because of malnutrition. Nampula—Mozambique’s largest and most densely populated province—has the highest prevalence of malnutrition with 55% of children with stunted growth, a full 12% higher than the national average. The Government of the Republic of Mozambique (GRM) has made the reduction of malnutrition one of its key economic and health priorities. Yet, despite recent decades of investments in food security and nutrition, the prevalence of malnutrition remains high and its social and economic effects continue to hinder Mozambique’s progress.
U.S. Bureau of the Census Project
The U.S. Bureau of the Census has an existing Interagency Agreement with USAID at the global level to provide technical assistance to National Statistical Organizations in the preparation, implementation, analysis and dissemination of national population and housing censuses.
Malaria is considered the most important public health problem in Mozambique. It accounts for nearly one third of all deaths and 42% of deaths in children less than five years old. Although malaria prevalence has decreased in all provinces, the country continues to face challenges that have slowed the progress of key malaria prevention and treatment interventions.
Almost one-third of Mozambicans suffer from chronic food insecurity, exacerbated by the historic drought of 2015-2016. Nationally, 43 percent of children under 5 are stunted. Micronutrient deficiencies are widespread: 69 percent of children under 5 are anemic, and 74 percent of children under 5 are vitamin A deficient, with negative impacts on growth, immunity and development. The National Nutrition Rehabilitation Program (PRN) was established by the Government of the Republic of Mozambique in 2010. The PRN sets clinical protocols for treating acute malnutrition for two distinct groups: 1) patients below 15 years of age 2) patients aged 15 years of age and older (including pregnant and lactating women). Corn-Soy Blend plus (CSB+) is the supplementary food used for treatment of moderate acute malnutrition (MAM) in the areas of Prevention of Mother-to-Child Transmission (PMTCT) of HIV, support of orphans and vulnerable children (OVC), and support to people living with HIV/AIDS.
Mozambique faces a large youth population with high unemployment, low levels of secondary education, and limited support to help young people transition from adolescence to adulthood. There is insufficient attention and understanding on youth development and on adolescence in particular, and addressing the needs of youth during this phase of life has not been a high priority in Mozambique. For youths without one or both parents, obtaining education is very difficult. Many young orphans are obligated to live with distant family members, work to generate income and, sometimes, abandon their studies. Without the financial or emotional support of a respected adult and living in an unstable emotional state as a result of traumatic experiences, they remain exposed to conditions of risk. Early trauma may have impacted cognitive development and the ability to develop positive “non-cognitive behaviors” such as social and relationship skills, positive self-concept and communication skills. While all youth need to develop key skills and behaviors to help them transition successfully into adulthood, youth who have experienced trauma and who lack supportive parenting to help them transition into productive, healthy and engaged adults benefit from additional supports such as having positive relationships and adult role models.
Crisis Response
Mozambique is the third most vulnerable country in Africa to disaster risks (according to the UN’s Global Assessment Report on Disaster Risk Reduction). Frequent natural disasters disrupt livelihoods and food production of the most vulnerable people, undermining the fight against extreme poverty. During the last 35 years there were 75 declared disasters in Mozambique consisting of 13 drought events, 25 floods, 14 tropical cyclones and 23 epidemics (Instituto Nacional de Gestao de Calamidades, 2016). The regional El Niño-induced drought emergency of 2015-2016 was the worst in 35 years.
Southern Africa - Tropical Cyclones
Mozambique is the third most vulnerable country in Africa to disaster risks (according to the UN’s Global Assessment Report on Disaster Risk Reduction). Frequent natural disasters disrupt livelihoods and food production of the most vulnerable people, undermining the fight against extreme poverty. During the last 35 years there were 75 declared disasters in Mozambique consisting of 13 drought events, 25 floods, 14 tropical cyclones and 23 epidemics (Instituto Nacional de Gestao de Calamidades, 2016). The regional El Niño-induced drought emergency of 2015-2016 was the worst in 35 years.
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