Mozambique’s health system expands coverage with more frontline community workers

“I used to walk for about two hours to reach the nearest healthcare unit or spend a substantial amount of money on transport every time a family member needed assistance. Now, unless it is a severe condition, the community health worker comes to our house and provides the care we need,” says Matola Mourana, 38, a resident of Moamba District, Maputo Province. She has learned how to prepare her children’s food in a more nutritious way with the help of a community health worker. “I now know how to make cassava more nutritious by combining it with green leaves or coconut milk.”

Matola also described how the community health worker helped her with family planning. “Thanks to the healthcare worker, I received contraceptives and am now settled with two children.”

Challenge

Mozambique has made great strides in reducing mortality rates and improving access to primary healthcare in the past two decades. However, the country’s health outcomes and expenditure efficiency have not kept pace. For those in rural areas and the extremely poor, women, adolescent girls, and children, quality healthcare is still unsatisfactory and hard to reach, exposing health system inequalities between genders and geographic regions.

In addition, health infrastructure is limited, and the training and supervision of frontline community health workers needs improvement. In 2015, over half of deaths were associated with communicable, maternal, neonatal, and nutritional diseases. Malaria still contributes to over one-third of deaths among children. Stunting is prevalent, affecting over one in three children under five years of age, and lack of access to clean water and sanitation is widespread.

Approach

To increase the coverage and quality of primary healthcare across Mozambique, the World Bank and partners have supported the country’s Ministry of Health over the last two decades to expand and strengthen the community health worker network. The World Bank Primary Health Care Strengthening Program contributed to this long-term effort, focusing on mass training of community health workers to assist communities living in urban and rural areas in 10 of the country’s 11 provinces.

These frontline health workers are the first point of contact for families and communities with the National Health System. They provide primary healthcare through home visits and community gatherings in urban and hard-to-reach areas in rural Mozambique, saving families from traveling long distances when they need assistance. They are also crucial in promoting health and providing critical information through workshops they deliver in the communities on nutrition, contraception, and the prevention of common diseases such as malaria, diarrhea, and pneumonia. They work part-time and receive a stipend.

Training of new health workers has been evolving to meet communities’ needs and includes integrating COVID-19 prevention measures and a Nutrition Intervention Package.

Results

Through this program, Mozambique has greatly expanded health care coverage.

• Mozambique has increased the number of trained and active community health workers, from 1,000 in 2018 to 8,300 in 2022.
• Community access to health services expanded four-fold, from nearly 240,000 households in 2018 to an estimated two million in 2022. The increase in trained and active community health workers translates into more home visits and community gatherings on critical health topics, leading to better health outcomes.
• Among the 8,300 trained community health workers, 5,300 also received training on a package of nutrition interventions, benefiting over 134,000 children 0 to 24 months and older.

Bank Group Contribution

The project was financed by an International Development Association (IDA) grant of $80 million, with an added $25 million in co-financing from the Global Financing Facility (GFF), $82.5 million from Canada and the Netherlands, $8.7 million from the UK’s Foreign Commonwealth & Development Office (FCDO), and $7 million from the US Agency for International Development (USAID).

Partners

The Primary Health Care Strengthening Program operationalizes the Government of Mozambique's Health Strategic Plan, which the Ministry of Health leads. Since program implementation started, the World Bank and co-financiers have conducted joint support missions to monitor its progress and improve its timely and participatory implementation.

Looking Ahead

A new program under preparation will leverage the achievements of the program, which ends in December 2023. It will continue expanding Mozambique’s community health worker network and improving the services delivered to communities through the mass training of community health workers.