Mozambique

Q2/2010: Mobile Clinic Update

August 13, 2010

Dr. Martina Fuchs

Photos by Rui Esmael and Dr. Martina Fuchs

Additional information provided by Chiqui Arregui, Teresa Mendoza and Dr. Monica Carvalho

Zambézia is one of Mozambique’s poorest and the second most populous province, with 3,892,854 inhabitants (2007 Census), and an estimated HIV prevalence of 19% (2007 sentinel data). Zambézia is located in the central coastal region south of Nampula and north of Sofala. It has a population of 3,794,509 (2006). The provincial capital is Quelimane on the Bons Sinais River. Zambézia has a total area of 103,127 km², much of it drained by the Zambezi River.

A large proportion of Mozambique’s population is very poor (Mozambique ranks 175 of 179 in the 2008/2009 UNDP Human Development Index) – 70% of the population lives below the national poverty line – and has limited access to health care, as approximately 40% walk more than 20 km to reach a primary care facility. In addition, the country has one of the worst healthcare worker to population ratios in the world: There are 600 trained physicians and 6,000 nurses for a country of almost 21 million people. Since most of the healthcare professionals are in the major cities of Maputo and Pemba, this equates to 1 doctor for every 100,000 people in many of the remote rural are

The major infectious diseases prevalent in Mozambique are food or water borne diseases: bacterial and protozoal diarrhea, hepatitis A, and typhoid fever; vector borne diseases: malaria and plague; water contact: schistosomiasis. The Infant Mortality Rate is 103.82/1,000 live births, the 6th highest in the world (comparison: Germany – 3.95 deaths/1,000 live births; US – 6.14 deaths/1,000 live births)

RMF’s partner in Mozambique is Friends in Global Health, FGH (www.globalhealth.vanderbilt.edu/fgh). With funding from the CDC (PEPFAR), FGH is strengthening all the HIV&AIDS care and treatment services at district level health facilities in 12 districts in Mozambique, comprising approximately 2,500,000 people: Alto Molócuè, Chinde, Gilé, Ile, Inhassunge, Lugela, Maganja da Costa, Morrumbala, Mopeia, Namacurra, Namarroi and Pebane. FGH, in close coordination with the DPS and DDSs (Provincial and District Health Directorates), focuses our Mobile Clinic activities in the locations of Macuse and Mexixine in Namacurra district.

In a meeting on Friday, May 27, 2010, FGH’s Country Director, Chiqui Arregui , introduced me to Dr. Abdul Hamid Mussa with DNAM (Direcção Nacional de Assistência Médica). A brief background of FGH´s program in Mozambique was provided to Dr. Mussa. This was followed by the chronological description of MISAU´s (Ministério de Saúde), FGH´s and RMF´s efforts aiming to develop a coherent program for a Mobile Clinic taking healthcare to the neediest populations in a target district. Dr. Mussa was made aware of the fact that viability and sustainability issues were important for FGH and RMF. Dr. Mussa expressed that our Mobile Clinic intervention has MISAU/DNAM support. Potential of the intervention is recognized as much as the need to think creatively on sustainable strategies. Expressed by Dr. Mussa was an increasing concern of abandonment of HIV care and treatment. Provinces have been asked to inquire and understand the causes. It was acknowledged that data collection could be one of the factors hindering the comprehension of the real number of people adhering (or not) to care and treatment. Emphasis should be on the need for data to be harmonized throughout the country (how do we know that when a person leaves point A and goes to point B the person is not continuing care and treatment at point B). This is seen as highly relevant in a country with internal mobility. A focus also needs to be on HIV patients getting TB tests. Dr. Mussa also encouraged us to speak to Dr. Mouzinho at the Direcção de Saúde Pública. Linkages to Mobile Brigades should be sought as experience has proven that with small support these Mobile Brigades can substantially improve their indicators. He absolutely agreed that bringing health to communities is the best strategy as Health Facilities only reach 50% of the people in the Mozambique. Concluding, he ensured DNAM’s commitment in engaging in working in the identification of sustainable strategies for the Mobile Clinic.

Mobile Clinic Outreach

We departed early on May 31st for Mexixine in Namacurra District, one of 17 districts in Zambézia Province, a 95km drive. Mexixine has a population of 20,000 people. For this target population – without our Mobile Clinic – 1 nurse and 1 doctor are available.

The Mobile Clinic was brought to the location before we arrived. Dozens of patients were already waiting. The clinic day started with a very well received theater presentation about the importance of protection and prevention; edutainment has been proven to be very successful connected with our Mobile Clinic operations.

Following the theater presentation, our medical team supported by medical personnel from the District Ministry of Health saw a total of 300 patients in about 3 hours. To reach our medical services at the Mobile Clinic, patients walked an average of 7km; many walked more than 10km.

We provided:
• Maternal and Child Healthcare
• Antenatal care
• Clinical consultation & Blood Pressure control
• Promotion of Cervical, Ovarian and Breast Cancer Prevention & Treatment
• Malaria testing and treatment
• HIV counseling & testing
• STD testing and counseling, especially for our male patients
• Biscuits distribution for children (Mozambican Child Day on June 1)

54 adult consultations were performed, 20 children were seen, and 62 women were educated on cervical cancer prevention. 89 patients were tested for HIV, 26 of them were found to be HIV positive. 126 patients received medication. By policy, medicines are provided through the Ministry of Health. Since May 31st was the last day of the month, the MoH experienced a shortage of available supplies. Numerous patients received a voucher to receive their medicines in the first days of June. Our day was concluded by a meeting with the District Administrator and District Health Director.