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Tackling Brain Drain and Regional Inequities in Health Service Coverage in Mozambique

July 29, 2011

  • More that 70 percent of Mozambique’s specialized physicians are clustered in Maputo
  • Many of these health care providers leave their communities for better-paid jobs
  • Mozambique’s Human Resources Development Plan 2010-15 outlines a strategy to increase numbers and improve geographic distribution of human resources

MAPUTO, July 29, 2011— Attracting and retaining skilled professionals in the health sector is a well-known challenge in most countries, but especially in Sub-Saharan Africa where insufficient production of health human resources, inadequate working conditions, remuneration, and poor incentives constitute a major headache for governments and policy makers.

In Mozambique, more than 75 percent of Mozambican specialized medical doctors are based in the capital city of Maputo, leaving a wide service gap in rural areas. Moreover, in the last five years, more than half (56.5 percent) of medical doctors with degrees in public health (Master’s and PhDs) have left the sector for better-paid jobs in international organizations and NGOs across the country.

“While it’s true that we have made significant strides in securing that each one of the country’s 128 districts has a medical doctor, with only 65 health personnel per 100 thousand inhabitants, the country is far from reaching the World Health Organization’s target of at least 230 per 100 thousand inhabitants,” H.E. Alexandre Manguele, Mozambique Minister of Health, said during a recent speech.

To address the personnel issues, the Ministry of Health has developed a Human Resources Development Plan 2010-15 to significantly increase the number of health professionals and improve geographical distribution as a critical component of strengthening the health system in order to reach health MDGs.

“I’m happy that the World Bank is once again associated with such a major development topic, one whose ramifications are numerous for the bigger development agenda and the fight against poverty,” said Laurence Clarke, World Bank Country Director for Mozambique, Angola, and Sao-Tomé and Principe.

Some of the features of the current human resources shortcoming include low wages, lack of incentives, inadequate socio-economic conditions in the provinces, inadequate recruitment practices and lack of career development systems, among others.

According to health experts, evidence and sound analytical work are critical to uncovering the underpinning factors that are plaguing the health HR sector. This was the topic of a two-and-a-half day event, held July 19-21, 2011, that gathered health planners, international specialists, and ministerial delegates from Ghana, Zambia, Malawi, Sierra-Leone, and Brazil, alongside their Mozambican counterparts, in a south-south initiative aimed at discussing and exchanging health human resource insights.

The event was organized by the Ministry of Health, with technical and financial support from the World Bank, the U.S. Centers for Disease Control, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and international non-profit organization Jhpiego.

 “This is the first event of its kind in Mozambique where multiple countries have gathered to discuss experiences in managing the crisis of human resources in the health sector,” said Laura Rose, World Bank Task Team Leader and the event’s coordinator“The workforce is a key element in the health sector:  it does not make sense to invest in other parts of the sector if there is no staff to provide the services.”

A public recognition of HR issues affecting the sector, as well as recognition by the government of its own shortcomings in helping to address those issues, were among the top gains of the conference. The Ministry of Health issued a synthesis report gathering participants’ comments, which they have agreed to further analyze as part of an effort to find sustainable solutions.