CHAPTERS 1 2 3 4 5 6 PREVIOUS HOME CONTENTS NEXT PRINT CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010
YOUTUBE United Nations Mozambique ACKNOWLEDGEMENTS
The 2010 Study on Child Poverty and Committee composed of Government (MPD, Disparities in Mozambique is a joint MISAU, MINED, MMAS, MINJUS, INE and undertaking of the United Nations in CNCS); Civil Society (Fórum Mulher, FDC, Mozambique. Many organisations and Save the Children Alliance, Rede da Criança individuals contributed throughout the and Grupo 20); Bi-lateral and Multi-lateral process of researching and writing this Organisations (DfID, World Bank and Swiss report. While they are too numerous to all be Embassy) and United Nations (UNAIDS and mentioned individually, we are grateful for UNICEF). their fierce commitment and dedication to the children of Mozambique. For their useful comments and inputs, a special thanks are due to the following The main responsibility for coordination individuals: Carlo Azzari (World Bank), and drafting of the report fell with the team Gabriel Dava (UNDP), Baiba Gaile (UNDP), at the Social Policy, Planning, Information Isabel Kreisler (UNDP), Pierre Martel, Wim and Monitoring (SPPIM) Section within the Ulens (EU), Bridget Walker (Irish Aid), Karin UNICEF Mozambique Country Office. The Metell (Swedish Embassy), Antonio Nucifora research was carried out by Brendan Kelly, (World Bank) and Zainul Sajan Virgi (McGill in close collaboration with the sections of University). the UNICEF Mozambique Country Office that prepared the preliminary background papers For her leadership and vision through the for the thematic chapters of the report. development of the report, special thanks are also due to Leila Gharagozloo-Pakkala, The report has benefited immensely from who served as Representative of the UNICEF the generous contributions and intellectual Mozambique Country Office during critical guidance of a multi-sectoral Steering stages of this study’s preparation.
Permission to reproduce any part of this publication is not required, except for commercial pruposes. Acknowledgement of source requested.
© UNICEF, Maputo, Mozambique, 2011 Foreword
The 2010 Study on Child Poverty and This does not mean that no progress has Disparities in Mozambique provides an been observed over recent years. Absolute opportunity to take stock of the progress poverty, measured by deprivation of basic made towards the realisation of the rights of needs and services, has fallen significantly the country’s ten million children since the in Mozambique, with more children having 2006 Childhood Poverty Study: A Situation access to essential services such as health and Trends Analysis, and to assess the and education, as a direct result of the immense challenges that remain for the Government’s dedication to increasing coming years. access to essential services. The importance of education cannot be overstated, as an The Government of Mozambique has shown educated mother is a key determinant in the its commitment to the realisation of the health and welfare of her children. Eliminating rights of all Mozambican children by ratifying geographic disparity is equally vital, as the the Convention on the Rights of the Child children of central and northern provinces, in 1994. The rights and needs of children such as Zambezia, are being left behind with are distinctive from those of adults, in that lower budget allocations and an equivalent poverty and deprivation faced as a child have lack of access to the very services they need life-long impacts on health, productivity and to catch up to their peers in the south. the ability to raise a family and live a happy life. This means that investment is needed There are only four years left until the today to ensure a productive, healthy and target year of the Millennium Development fulfilled next generation of Mozambicans. Goals (MDG), 2015. While it is becoming increasingly evident that Mozambique is Poverty in Mozambique has stagnated over unlikely to achieve all of these goals, the the past six years. More than half of the upcoming four years are an opportunity to population continue to live on less than 50 scale up interventions to reduce the burden cents a day, a number that includes more caused by poverty, hunger, child mortality, children than adults. A staggering number of gender inequality and diseases that too many children are stunted – suffering from chronic children continue to face. Each MDG target malnutrition – the effects of which cannot that is obtained will be due to the concerted, be reversed. The number of children with collaborative efforts of the Government access to safe water is declining and even of Mozambique, the UN family, the donor fewer have access to safe sanitation. These community, civil society and the people of gaps in children’s basic needs make it all the Mozambique. easier to fall victim to the four leading causes of child mortality: malaria, neonatal causes, Recent years have proven that investments acute respiratory infections, and AIDS. Girls, can be made to better the lives of children orphans, children with disabilities and living in Mozambique. It is now time to redouble in rural areas and the poorest households, these efforts so that each and every are even more vulnerable as they face great Mozambican child can look forward to a inequity of access to already scarce services. long, healthy, happy and fulfilling life.
UN Resident Coordinator
Jennifer Topping Contents
List of Figures ...... XIII
List of Tables ...... XVII
Acronyms ...... XIX
Map of Mozambique ...... XXII
Executive Summary ...... XXIII
CHAPTER 1: POVERTY IN MOZAMBIQUE
1. Introduction ...... 3
2. Measuring Poverty ...... 4
2.1. Consumption-based poverty ...... 4
2.2. Deprivations-based poverty ...... 9
2.3. Comparison of consumption- and deprivations-based poverty ...... 14
3. Analysis by deprivation ...... 15
3.1. Severe education deprivation ...... 15
3.2. Severe nutrition deprivation ...... 16
3.3. Severe water deprivation ...... 17
3.4. Severe sanitation deprivation ...... 18
3.5. Severe health deprivation ...... 19
3.6. Severe shelter deprivation ...... 19
3.7. Severe information deprivation ...... 20
4. Conclusions ...... 21
References ...... 23
CHAPTER 2: THE DEVELOPMENT CONTEXT
1. Introduction ...... 27
2. Transition to peace, democracy and market economy ...... 28
2.1. Demographic trends ...... 28
2.2. Economic growth and macroeconomic stability ...... 29
2.3. Millennium Development Goals ...... 30
2.4. Decentralisation ...... 32
3. Policy and institutional analysis ...... 34
3.1. Policy and planning mechanisms ...... 34
3.2. Monitoring and evaluation ...... 36
3.3. Legal framework ...... 38
VII 4. External development assistance ...... 39 CHAPTER 4: EDUCATION AND CHILDREN’S RIGHT TO DEVELOPMENT 4.1. Aid coordination ...... 39 1. Introduction ...... 103
4.2. Implications for children ...... 40 2. The current situation and recent trends in education ...... 104
5. Conclusions ...... 42 2.1. The education system in Mozambique ...... 104
References ...... 43 2.2. Children in school ...... 105
2.3. Children out of school ...... 107
CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT 2.4. Delays in starting education ...... 107
1. Introduction ...... 47 2.5. Primary school completion and transition to secondary education ...... 108 2. Health and nutrition ...... 49 2.6. Progression through grades ...... 109 2.1. Child survival ...... 49 2.7. Equity in education ...... 110 2.2. Child nutrition ...... 53 2.8. Literacy ...... 111 2.3. Maternal survival, health and nutrition ...... 63 2.9. Tertiary education ...... 112 2.4. Childhood illnesses ...... 70 3. Barriers to participation in education ...... 113 2.5. Malaria ...... 70 3.1. Direct costs in education ...... 113 2.6. Acute respiratory infection ...... 72 3.2. Opportunity costs to communities ...... 113 2.7. Diarrhoeal diseases ...... 74 3.3. Impact of traditions and culture on the right to education ...... 113 2.8. Cholera ...... 74 3.4. Impact of violence and abuse in schools ...... 114 2.9. Vaccine-preventable diseases and immunisation ...... 76 3.5. Educational quality ...... 114 2.10. HIV and AIDS ...... 78 3.6. School infrastructure ...... 117 2.11. Sector financing and budget allocations ...... 78 3.7. Availability of teachers ...... 117 3. Water and sanitation ...... 82 3.8. Pre-service and in-service teacher training ...... 119 3.1. Institutional framework ...... 82 3.9. School management ...... 121 3.2. The National Rural Water Supply and Sanitation Programme ...... 83 3.10. Lack of focus on school health ...... 122 3.3. Water supply ...... 85 3.11. Impact of language on educational outcomes ...... 122 3.4. Sanitation ...... 88 4. Further issues in the education sector ...... 123 3.5. Sustainability of WASH infrastructures ...... 89 4.1. Life skills strategy to combat AIDS ...... 123 3.6. Water and sanitation in schools ...... 92 4.2. Children’s participation ...... 123 3.7. Sector financing and budget allocations ...... 93 4.3. Education for children with special needs ...... 124 4. Conclusions ...... 95 4.4. Sector financing and budget allocations ...... 124 References ...... 96 4.5. External financing ...... 125
4.6. Direct Support to Schools Programme ...... 125
5. Conclusions ...... 127
References ...... 129
VIII IX CHAPTER 5: CHILD PROTECTION 3. Geographical disparities ...... 180 1. Introduction ...... 135 3.1. Disparities in budgetary allocations ...... 182
2. Legislative and policy reform ...... 137 3.2. Disparities in health ...... 183
3. Violence, abuse and exploitation ...... 140 3.3. Disparities in access to education ...... 186
3.1. Violence and sexual abuse in schools ...... 140 3.4. Disparities in relation to child protection ...... 188
3.2. Domestic violence ...... 141 3.5. Conclusions ...... 189
3.3. Commercial sexual exploitation and abuse ...... 144 4. HIV and AIDS ...... 190
3.4. Child trafficking and migration ...... 144 4.1. Profile of the HIV epidemic in Mozambique ...... 190
3.5. Child labour ...... 145 4.2. Priority actions for children in relation to HIV and AIDS ...... 194
3.6. Child marriage ...... 147 4.3. P1 – Primary prevention ...... 194
4. Children and the justice sector ...... 149 4.4. P2 – Prevention of mother-to-child transmission of HIV ...... 196
4.1. Children’s access to property and inheritance ...... 150 4.5. P3 – Paediatric AIDS ...... 203
4.2. Birth registration ...... 150 4.6. P4 – Protecting orphans and vulnerable children affected by AIDS ...... 205
4.3. Children with disabilities ...... 152 4.7. Nutrition and HIV ...... 205
4.4. Alternative care mechanisms ...... 153 4.8. Conclusions ...... 206
4.5. Orphaned, vulnerable and other marginalised children ...... 154 5. Environmental issues and climate change ...... 207
4.6. Basic social protection ...... 157 5.1. Environmental issues in Mozambique ...... 207
4.7. Poverty certificates ...... 159 5.2. Sustainable development in Mozambique ...... 208 4.8. Capacity analysis ...... 159 5.3. Impact of environmental degradation and emergencies on children in Mozambique ...... 209 4.9. Civil society partnerships ...... 161 5.4. The institutional context ...... 214 4.10. Sector financing and budget allocations ...... 162 5.5. Conclusions ...... 215 5. Conclusions ...... 163
References ...... 165 6. Communication for Development ...... 216 6.1. Mass media development in Mozambique ...... 216 CHAPTER 6: CROSS-CUTTING ISSUES 6.2. The changing role of the media: communication for development and community mobilisation ...... 218 1. Introduction ...... 171 ...... 2. Gender ...... 172 6.3. Promising initiatives in Mozambican media 218
2.1. Gender aspects of poverty in Mozambique ...... 173 6.4. Child-friendly networks and partnerships ...... 219
2.2. Gender development and gender empowerment ...... 174 6.5. Information deprivation ...... 220
2.3. Gender disparities ...... 175 6.6. Conclusions ...... 220
2.4. Gender issues in education ...... 176 References ...... 221
2.5. Violence, abuse and exploitation ...... 176 BIBLIOGRAPHY ...... 229 2.6. Lineage systems ...... 177
2.7. HIV and gender ...... 178
2.8. Conclusions ...... 179
X XI List of Figures
Figure 1.1: Proportion of children experiencing two or more severe deprivations, by geographical location, 2003 and 2008 ...... 12
Figure 1.2: Proportion of children experiencing deprivations, 2003 and 2008...... 13
Figure 1.3: Percentage of children experiencing two or more severe deprivations by province, 2003 and 2008 ...... 13
Figure1.4: Deprivations-based poverty compared to consumption-based poverty for children, 2008 ...... 14
Figure 1.5: Severe education deprivation among children by province, 2003 and 2008...... 15
Figure 1.6: Severe nutritional deprivation among children by province, 2003 and 2008...... 16
Figure 1.7: Severe water deprivation among children by wealth quintile, 2008 ...... 18
Figure 1.8: Severe sanitation deprivation among children by province, 2008 ...... 18
Figure 1.9: Severe health deprivation among children by province, 2003 and 2008 ...... 19
Figure 1.10: Severe shelter deprivation among children by wealth quintile, 2008 ...... 20
Figure 2.1: Planning instruments in Mozambique ...... 36
Figure 3.1: Mortality rates in Mozambique per 1,000 live births, 2003 and 2008 ...... 49
Figure 3.2: Infant mortality rates in Mozambique per 1,000 live births 1997, 2003 and 2008 (five-year average preceding the survey)...... 50
Figure 3.3: Share of households with less than 45 minutes walk to nearest primary health facility, 2002/03 and 2008/09 ...... 51
Figure 3.4: Probability of child (age 0–17) survival in the last 12 months by education level of the head of household, 2008 ...... 52
Figure 3.5: Causes of under-five mortality in Mozambique, 2008 ...... 52
Figure 3.6: Chronic undernutrition rates by country, 2009 ...... 53
Figure 3.7: Undernutrition rates (moderate) in children under five, 2003 and 2008...... 54
Figure 3.8: Percentage of wasting in children under five by province, 2008...... 55
Figure 3.9: Percentage of underweight in children under five by province, 2008...... 55
Figure 3.10: Percentage of chronic undernutrition (stunting) in children under five by province, 2008 ...... 56
Figure 3.11: The conceptual framework for undernutrition ...... 58
Figure 3.12: Percentage of children of different age groups who are exclusively breastfed: 1997, 2003 and 2008 ...... 59
Figure 3.13: Exclusive breastfeeding in children under 12 months, 1997, 2003 and 2008 ...... 59 Figure 3.14: Feeding patterns for children less than one year old, 2008 ...... 60 Figure 4.7: Primary school net attendance ratios by wealth quintile, 2003 and 2008 ...... 110
Figure 3.15: Children 6–11 months old who received breastmilk and complementary food at least Figure 4.8: Secondary school net attendance ratios by wealth quintile, 2003 and 2008 ...... 111 three times per day, by province, 2008 ...... 61 Figure 4.9: Literacy rates for women aged 15–24 by wealth quintile, 2008 ...... 112 Figure 3.16: Use of iodised salt by province, 2008 ...... 62 Figure 4.10: Child marriage and girls out of secondary school by province, 2008 ...... 114 Figure 3.17: Use of iodised salt by wealth quintile, 2008 ...... 63 Figure 4.11: Pupil reading results, 2000 and 2007 ...... 115 Figure 3.18: Vitamin A supplementation coverage, 2003 and 2008 ...... 64 Figure 4.12: Pupil mathematics results, 2000 and 2007 ...... 115 Figure 3.19: The continuum of care for maternal and newborn health ...... 65 Figure 4.13: Pupil-teacher ratio, 2004–2009 ...... 119 Figure 3.20: Women attended at least once by skilled health personnel during pregnancy, Figure 4.14: Education budget allocation in millions of MTN, 2009 and 2010 ...... 124 1997, 2003 and 2008 ...... 68
Figure 3.21: Proportion of women receiving antenatal care and delivering in a health facility Figure 5.1: Percentage of women aged 15–49 who think that a husband can beat his spouse, by specific reason, 2008 ...... 142 by wealth quintile, 2008 ...... 69
Figure 3.22: Proportion of children receiving appropriate treatment for malaria, 2003 and 2008 ...... 71 Figure 5.2: Proportion of women aged 15-49 who believe that wife-beating is justified under certain circumstances, 2008 ...... 143 Figure 3.23: Prevalence of acute respiratory infection, by province, 2008 ...... 73 Figure 5.3: Probability of women aged 15-49 accepting domestic violence, by socio-economic Figure 3.24: Proportion of children under five receiving appropriate treatment for acute respiratory background, 2008 ...... 143 infection by province, 2008 ...... 73 Figure 5.4: Percentage of children aged 5–14 who are involved in child labour by province and Figure 3.25: Immunisation of children aged 12–23 months by antigen, 1997, 2003 and 2008 ...... 76 gender, 2008 ...... 145
Figure 3.26: Per capita health allocations by province (Meticais), 2009...... 79 Figure 5.5: Prevalence of child labour by level of mother’s education, 2008 ...... 146
Figure 3.27: Allocations to health sector (Millions of Meticais), MTEF 2010–2012 ...... 80 Figure 5.6: Child labour and school attendance by geographic area, 2008 ...... 146
Figure 3.28: Proportion of households with access to safe water, by geographic location 2004 Figure 5.7: Women aged 20–24 who were married before ages 15 and 18, by geographic location, and 2008 ...... 85 2008 ...... 147
Figure 3.29: Use of improved water source by province, 2008 ...... 86 Figure 5.8: Reasons for not registering births, 2008 ...... 151
Figure 3.30: Mean time to water source (minutes), 2008 ...... 86 Figure 5.9: Percentage of children under five whose birth was registered by province, 2008...... 152
Figure 3.31: Probability of access to improved water source, by wealth score 2008 ...... 87 Figure 5.10: Percentage of children aged 2–9 with at least one reported disability, 2008 ...... 153
Figure 3.32: Access to safe sanitation, by geographic location 2004 and 2008 ...... 88 Figure 5.11: Percentage of orphans and vulnerable children due to AIDS by province, 2008 ...... 156
Figure 3.33: Access to improved sanitation facilities, by province 2008 ...... 89 Figure 6.1: Proportion of male-headed households by wealth quintile, 2002, 2005 and 2008 ...... 173
Figure 3.34: Probability of access to improved sanitation source, by wealth score 2008 ...... 89 Figure 6.2: GDI based on different methods of determining salary gap, 2009 ...... 175
Figure 4.1: Net attendance rates, 2003 and 2008 ...... 105 Figure 6.3: Combined per capita expenditure for health, education and justice, 2005, 2006 and 2008 ...... 182 Figure 4.2: Probability of children aged 6-12 not attending primary school, 2008 ...... 106 Figure 6.4: Health expenditure per capita, percentage of national average, 2008 ...... 183 Figure 4.3: Percentages of children aged 6–12 and 13–17 out of school, by sex, place of residence and socioeconomic background, 2008 ...... 107 Figure 6.5: Per capita expenditure for health (2008) and child survival (1998-2008) ...... 184
Figure 4.4: Distribution of population according to the age they started school, 2008 ...... 108 Figure 6.6: HIV prevalence by province, 2009 ...... 184
Figure 4.5: Primary school completion rates and transition to secondary education, 2008 ...... 109 Figure 6.7: Proportion of women receiving HIV information and testing during antenatal consultation visit, 2008 ...... 186 Figure 4.6: Percentage of children entering first grade who reach the last grade of primary school by selected characteristics, 2008 ...... 110 Figure 6.8: Expenditure per capita on education by province, percentage of national average, 2008 ...... 186
XIV XV Figure 6.9: Education expenditure per capita and literacy rates, 2008 ...... 187 List of Tables Figure 6.10: Net enrolment ratio primary (EP1 and EP2) by province, 2008 ...... 187
Figure 6.11: Percentage of women aged 15-49 in marriage or union before their 15th birthday, 2008...... 188 Table 1.1: Deprivation in Mozambique, 2008 ...... 9
Figure 6.12: Distribution of new infections by mode of exposure in Mozambique, 2008 ...... 191 Table 2.1: Economic indicators, 2003–2009 ...... 28 Figure 6.13: Estimated HIV incidence and prevalence by region in Mozambique, 1998–2010 ...... 192 Table 2.2: Progress towards the Millenniun Development Goals ...... 31 Figure 6.14: Identifying misconceptions about HIV, women 15-49 years, 2008 ...... 195
Figure 6.15: Probability of not using condom in sexual relationship among women aged Table 2.3: Internal and external funding in the State Budget, 2009 – 2012 ...... 40 15-24, 2008 ...... 196
Figure 6.16: Trends in PMTCT coverage between 2002 and 2009 ...... 197 Table 3.1: Multivariable linear regression on the height‑for-age Z-score in children under five, 2008 ...... 57 Figure 6.17: Testing and counselling during antenatal visits, 2003 and 2008 ...... 198
Figure 6.18: HIV test and counselling during antenatal visits, by wealth quintile, 2008 ...... 199 Table 3.2: Cholera cases in Mozambique, 2007–2010 ...... 75
Figure 6.19: Attended deliveries, 1997, 2003 and 2008 ...... 201 Table 3.3: Comparative analysis of health allocations, 2007 and 2008 ...... 80 Figure 6.20: PMTCT antenatal and post-natal cascade, 2009 ...... 202 Table 3.4: Number of pupils enrolled, by sex, in five Child-Friendly School Figure 6.21: Estimated number of children under 15 living with HIV, under 5 living with HIV, number districts, 2006–2008 ...... 93 of new infections in children under 15, and numbers of children under 15 in need of treatment/antiretroviral therapy, 2006–2010 ...... 203 Table 3.5: Financing of the water sector as a proportion of state budget, selected years Figure 6.22: Cost of environmental degradation per year, 2009 ...... 208 2003–2010 ...... 94
Table 4.1: Pupil-teacher ratio by province, 2008 ...... 118
Table 5.1: Projected cash transfers to households headed by elderly people, people living with deficiencies and the chronically ill, 2010-2014 ...... 157
Table 5.2: Cash transfers to families with orphans and vulnerable children, 2010-2014 ...... 158
Table 6.1: Scorecard for Government of Mozambique’s gender response to AIDS ...... 178
Table 6.2: Proportion of children experiencing two or more severe deprivations, 2003 and 2008 ...... 181
Table 6.3: Paediatric HIV targets, 2009 ...... 205
Table 6.4: Coping strategies used in rural Mozambique during the lean season each year, 2009, percentage ...... 211
XVI XVII Acronyms
ADE Apoio Directo às Escolas (Direct Support to Schools) Apoio Directo à Escola – Crianças Orfãs e Vulneráveis (Direct Support to Schools ADE–COV – Orphans and Vulnerable Children) Ajuda de Desenvolvimento de Povo para Povo (Development Aid from People to ADPP People) AMCOW African Ministers’ Council on Water AIM Agência de Informação de Moçambique (Mozambique News Agency) APE Agente Polivalente Elementar (Community Health Workers) ARI Acute Respiratory Infection AZT Zidovudine C4D Communication for Development CEDAW Convention on the Elimination of All Forms of Discrimination against Women CIMCI Community-Integrated Management of Childhood Illness C-IMNCI Community-Integrated Management of Neonatal and Childhood Illness CLTS Community Led Total Sanitation CMC Community Multimedia Centre CWIQ Core Welfare Indicator Questionnaire DHS Demographic and Health Survey DNA Direcção Nacional de Águas (National Water Directorate) DPT Diptheria-Pertussis-Tetanus Direcção Nacional dos Registos e Notariado (National Directorate for Registry DRN and Notary) ECD Early Childhood Development EFA-FTI Education for All – Fast Track Initiative EP1 Ensino Primário do Primeiro Grau (lower level primary education) EP2 Ensino Primário do Segundo Grau (upper level primary education) EPC Ensino Primário Completo (primary education) EPE Escolas Primárias Expandidas (expanded primary schools) ESG1 Escola Secundária Geral do Primeiro Grau (lower level secondary education) ESG2 Escola Secundária Geral do Segundo Grau (upper level secondary education) EPF Escola de Professores do Futuro (Training College for Teachers of the Future) FASE Fundo de Apoio ao Sector da Educação (Education Sector Common Fund) FORCOM Forum Nacional das Rádios Comunitárias (National Forum of Community Radios) FRELIMO Frente de Libertação de Moçambique (Liberation Front of Mozambique) GABINFO Gabinete de Informação (Information Office)
XIX GDI Gender Development Index NVP Nevirapine GDP Gross Domestic Product OVC Orphans and Vulnerable Children GEM Gender Empowerment Measure Plan de Acção para as Crianças Órfãs e Vulneráveis (Action Plan for Orphaned PACOV and Vulnerable Children) GPI Gender Parity Index PAP Parceiros de Apoio Programático (Programme Aid Partners) HAART Highly Active Antiretroviral Therapy Plano de Acção para a Redução da Pobreza (Plan of Action for the Reduction of HIV Human Immunodeficiency Virus PARP Poverty, 2010 – 2014) IAF Inquérito aos Agregados Familiares (Living Conditions Household Surveys) Plano de Acção para a Redução da Pobreza Absoluta (Action Plan for the PARPA I ICS Instituto de Comunicação Social (Institute of Social Communication) Reduction of Absolute Poverty, 2002-2006) ICT Information and Communication Technology Plano de Acção para a Redução da Pobreza Absoluta (Action Plan for the PARPA II Reduction of Absolute Poverty, 2010-2014) IFP Instituto de Formação dos Professores (Teacher Training Institute) PASD Programa de Apoio Social Directo (In-kind Social Transfer Program) IFTRAB Inquérito Integrado à Força de Trabalho (Labour Force Survey) IMCI Integrated Management of Childhood Illness PCR Polymerase Chain Reaction IMNCI Integrated Management of Neonatal and Childhood Illness PES Plano Económico e Social (Economic and Social Plan) Instituto Nacional das Comunicações de Moçambique (National Institute for Plano Estratégico de Abastecimento de Água e Saneamento Rural (Strategic Plan INCM PESA-ASR Communications in Mozambique) for Rural Water Supply and Sanitation) Instituto Nacional de Gestão de Calamidades (National Institute for Disaster PMTCT Prevention of Mother-to-Child Transmission INGC Management) Programa Nacional de Abastecimento de Água e Saneamento Rural (National PRONASAR Inquérito Nacional de Prevalência, Riscos Comportamentais e Informação sobre Rural Water Supply and Sanitation Programme) INSIDA o HIV e SIDA em Moçambique (National Survey on HIV/AIDS) PSA Programa de Subsídio de Alimentos (Food Subsidy Programme) IOF Inquérito ao Orçamento Familiar (Household Budget Survey) RED Reaching Every District IOM International Organisation on Migration RENAMO Resistência Nacional Moçambicana (National Resistance of Mozambique) IPAJ Instituto do Patrocínio e Assistência Jurídica (Legal Aid Institute) RM Rádio Moçambique (Radio Mozambique) IRS Indoor Residual Spraying SACMEQ Southern and Eastern Africa Consortium for Monitoring Education Quality LOLE Lei dos Órgãos Locais do Estado (Law on Local State Organs) Secretariado Técnico de Segurança Alimetar e Nutricional (Technical Secretariat SETSAN MDG Millennium Development Goal for Food Security and Nutrition) Sistema de Administração Financeira do Estado (State Financial Administration MICS Multiple Indicator Cluster Survey SISTAFE System) Ministério para a Coordenaçãoda Acção Ambiental (Ministry for the Coordination MICOA of Environmental Affairs) TVM Televisão de Moçambique (Television of Mozambique) MINED Ministério da Educação (Ministry of Education) UEM Universidade Eduardo Mondlane (Eduardo Mondlane University) MMAS Ministério da Mulher e da Acção Social (Ministry of Women and Social Action) UP Universidade Pedagógica (Pedagogical University) MMR Maternal Mortality Ratio WASH Water, Sanitation and Hygiene MTEF Medium-Term Expenditure Framework WHO World Health Organisation ZIP Zona de Influência Pedagógica (School Cluster)
XX XXI Map of Mozambique Executive Summary
Childhood poverty has immediate and from 59 per cent in 2008. The reduction was long-term effects on children. Chronic driven by significant improvements in the TANZANIA Palma malnutrition, for example, in the first two health and education sectors. Children are Nangade years of life can permanently impact a child’s particularly vulnerable to water, sanitation Mocimboa MALAWI Mueda da praia growth, resulting in stunting and reduced and information deprivations. Muidumbe Mecula Cabo mental development. The impact of inter- Macomia Sanga Mavago Lago Delgado generational childhood poverty and its Meluco Quissanga Child survival and development Montepuez Muembe Niassa Pemba cyclical nature is also evidenced by poverty’s Ancuabe Marrupa proven role as a barrier to accessing social Poverty and child survival are intrinsically ZAMBIA Mecuti Lichinga Majune Balama Chiure services. Poor households have more linked. Low levels of child survival and Namuno N‘gauma Maua Erati Memba Nipepe difficulty accessing good-quality health health status are both a cause and a Nacaroa Mandimba Metarica Lalaua Mecuburi care, are less likely to have their children in symptom of poverty. The principal indicator Nacala-a-Velha Chifunde Muecate Angonia Cuamba Malema Monapo school and are less likely to have access to used to measure the level of child well- Macanga Ribaue Nampula Ilha Nampula Maravia Mecanhelas Mossuril safe drinking water and adequate sanitation being and its rate of change in a country Zumbu Tsangano Gurue Morrupula Chiuta Alto Mogincual facilities. Poor children have an elevated risk is the under-five mortality rate. The under- Tete Molocue Mogovolas Namarroi five mortality rate reduced from 153 deaths Magoe Cahora Moatize of growing up to become poor adults and in Bassa Gile Angoche Tete Milange Ile Lugela turn, have poor children. per 1,000 live births in 2003 to 141 in 2008. Changara Moma Mutarara The under-five mortality rate is the result Tambara Zambezia Pebane Mocuba In 2008/2009, out of Mozambique‘s almost Guro Chemba Morrumbala Maganja of a wide variety of factors including: the da costa 21.5 million people, nearly 12 million, or Namacurra nutritional status and the health knowledge Caia Macossa Maringue Quelimane – Cap 55 per cent of the population, live below Mopeia Nicuadala of mothers, caring practices, the availability, Báruè Inhassunge the poverty line of 18.4 Meticais (around use and quality of maternal and child health Marromeu Chinde Manica Gorongosa Cheringoma $US 0.50) per day. Compared to 2002/03, services, income and food availability in the ZIMBABWE Manica Sofala poverty rates have stagnated. Other Muanza family, the availability of clean water and Gondola Nhamatanda consumption-based measures include the safe sanitation, and the overall safety of the Dondo Sussundenga amount of calories consumed a day. More Beira Mozambique child’s environment. Although a disparity Buzi than half of Mozambican children consume remains, improvements in the under-five Chibabava Channel
Mossurize fewer calories daily than is considered mortality rate were driven by rural areas. Machanga adequate by the World Health Organisation. Machaze Govuro Consumption-based poverty rates have Malaria, neonatal causes and acute
Inhassoro stagnated between 2002 and 2008, respiratory infections and AIDS are the Massangena Mabote Vilankulo principally due to a lack of progress in the four major immediate causes of mortality agricultural sector. among young children in Mozambique. Inhambane Chicualacuala Chigubo Undernutrition is the main underlying Massinga
Mabalane Funhalouro Mozambique has made great strides in cause of child mortality. Stunting (or chronic recent years in reducing deprivation-based Gaza Morrumbene undernutrition) remains very high - 44 per Massingir Maxixe childhood poverty and in increasing access Homoine cent of children less than 5 years old are Panda Guijá Chibuto Jangamo to essential services. The level of a family’s stunted, a decrease of only 4 percentage Inharrime SOUTH AFRICA Chokwe Magude Mandlakazi Zavala income does not create a full picture of points since 2003. Stunting affects individual Xai-Xai Xai-Xai – Cap the health and well-being of a child. The children but is also closely linked to the Maputo Bilene Moamba deprivations-based approach focuses on overall development of a country, as stunting Manhiça Marracuene the basic needs and key public services affects cognitive development and is related Maputo City Boane of which a child is deprived, allowing for to future educational outcomes. Namaacha a more multidimensional understanding SWAZILAND Matutuíne of poverty. Using this measure, 48 per Prevalence of malaria (the cause of a third cent of Mozambican children are living in of deaths in children under five-years- absolute poverty - as measured using a old) has changed little in recent years. In deprivations-based methodology - a fall 2007, the overall prevalence was 51 per
XXII XXIII CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 EXECUTIVE SUMMARY
cent of the population. Despite significant Long-standing disparities have been Violence against women and children has experienced early sexual debut and are more improvements, access to anti-malarial reduced in the sector. While urban and devastating short and long-term mental likely than non-orphans to marry young. medicine remains low; just over a third of wealthier children are still more likely and physical health consequences. Physical children with a fever receive treatment, to participate in the education system and sexual violence is common, as many Although the capacity of justice systems reflecting both low awareness and demand than their rural and poorer counterparts, as 54 per cent of women have been beaten in preventing and responding to different among care-givers for treatment and low improvement have been more significant and 23 per cent subjected to some form of forms of violence, abuse and exploitation access to health facilities. for the latter groups. sexual abuse. Sexual abuse of female pupils has been strengthened, the overall response in schools is also prevalent. A low level of continues to be fragmented, reactive, weak Acute respiratory infections (ARI) are Being ‘over-age’ in school is a widespread knowledge of victims with regards to their and under-funded. Improvements are also another leading cause of morbidity phenomenon in Mozambique. While rights combined with a culture of silence and needed in terms of improved data collection, and mortality among young children in children have tended to start their acceptance of violence are the key barrier to monitoring and reporting mechanisms at all Mozambique, with pneumonia being the schooling earlier in recent years, those addressing the problem. levels. most serious infection. There is a wide aged 13-17 years are still more likely to be disparity in the proportion of children found attending primary than secondary Child labour is another common and Cross-cutting issues receiving treatment for ARI. Children living in schools. The ‘over-age’ phenomenon serious form of abuse and exploitation in urban areas, children from better off families in primary education has significant Mozambique. Child workers are often further Women are more likely than men to and children with educated mothers are implications for children’s learning exploited by poor working conditions, experience poverty in Mozambique. In 2007, much more likely to receive treatment for outcomes, as the same curriculum is taught including verbal and sexual abuse, and Mozambique ranked 145 of 155 countries ARI symptoms. to learners of different ages and levels of wages paid late or not at all. Reducing the on the gender development index based cognitive development. burden of work on children depends both on life expectancy, education, literacy and Unsafe water, poor sanitation and on enforcing effective anti-child labour per capita GDP. This reflects the social, inadequate hygiene also contribute to child The phenomenon of ‘access shock’ is legislation and on ensuring those children economic and cultural challenges faced by mortality and morbidity. Water, sanitation pervasive. The massive increase in student and their families, particularly the poorest women. Women are more likely than men and hygiene are closely linked to childhood numbers has put enormous pressure and most vulnerable, benefit from poverty to participate in the work force, but have malnutrition. Access to safe water also on the education system, resulting in reduction. lower access to education, less opportunity has a significant effect on poverty rates by deleterious effects in terms of the quality for formal employment, lower income and increasing the time households (particularly of education. Recent data indicate the Early marriage may have serious health less opportunity to diversify their incomes. women and girls) can spend on more reading and numeric skills of Mozambican implications for girls. Adolescent pregnancy Female students face barriers to accessing productive activities. Access to safe water children have deteriorated in recent years. and childbirth are associated with poor education including sexual abuse in schools and sanitation remains low, at 43 and 19 Improvements are needed in terms of the health and nutritional outcomes both for and early marriage. per cent of households respectively. There number and quality of teachers; school the mother and her children. Over half of is a high level of geographical disparities infrastructure; and the protection of Mozambican girls are married before the age Provincial disparities exist across the in relation to access to safe water and children from physical and sexual violence of 18. Child marriage is more common in the board, with children in northern and central sanitation. to further increase access and quality, northern region of Mozambique. provinces having lower access to health and to translate access into development services, education, water, sanitation and Birth registration impacts on poverty Education outcomes. protection. Provinces such as Zambezia through providing children with increased have lower budget allocation, fewer services A well-educated population is one of the access to social services. Mozambique and lower human development outcomes fundamental requirements for broad-based Child protection has significantly increased access to birth in terms of child survival and mortality. poverty reduction. Historically, Mozambique Effective child protection ensures that the registration services across the country, Southern provinces have higher HIV/AIDS has had an extremely limited education most vulnerable children are protected from although it remains low. The proportion of prevalence along with correspondingly system. Significant improvements have been harmful practices and not marginalised children under the age of five years who higher health services and treatment. achieved but massive challenges remain from poverty reduction. Child protection have had their birth registered from eight per in the sector. Approximately 3.3 million of issues in Mozambique include sexual abuse cent in 2003 to 31 per cent in 2008. HIV and AIDS affect household poverty Mozambique’s 4.1 million children in the and exploitation; trafficking; child labour; through incapacitating breadwinners and There are an estimated 1.8 million orphans age group 6–12 are now attending primary violence; disabilities; child marriage, among raising the level of dependence across in Mozambique, 510,000 of whom have school. Net enrolment rates in primary have others. Effective national child protection the population. Through its effects on the been orphaned due to AIDS. This figure increased dramatically. Improvements were systems begin with the existence of laws, numbers of trained teachers, health workers is expected to grow in the coming years. also achieved in terms of gender parity, but policies, and regulations designed to uphold and other providers, AIDS also impacts Orphaned children may face a wide range a continued focus on this area is warranted, a child’s rights. Important progress has been on the future generation of human capital. of child protection threats. Female orphans as more girls remain out of the education made in these areas in recent years but The 2009 National Survey on Prevalence, are more likely than non-orphans to have system as compared to boys. many challenges remain. Behavioral Risks and Information about HIV
XXIV XXV CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 EXECUTIVE SUMMARY
and AIDS (INSIDA) shows a national HIV increases the occurrence of cyclones in prevalence among 15–49 year olds of 11.5 Mozambique. per cent. The results disaggregated by region confirmed the highest prevalence in the Environmental factors are also linked to south followed by the centre. HIV prevalence leading causes of child mortality such as is significantly higher in urban than rural malaria and acute respiratory infections. areas across all regions, and among Environmental degradation means increased women, particularly young women. There is pollution, water stress, deforestation and soil however some evidence that HIV incidence degradation that put pressure on children’s is decreasing. Data also show an overall basic health and food security needs. positive trend in knowledge and awareness Communication and a robust media are of HIV transmission and prevention. essential for all citizens, including children, Emergency situations such as droughts to have a say in the issues that affect and floods have severe impacts on the their lives. They are also a way to transmit well-being of a child. The vulnerability of vital information to parents on health, children increases in emergency situations education and protection issues such as as they have less access to health facilities; how to protect their children from malaria at the same time they increase water-borne or on the damaging effects of child abuse. diseases such as cholera. Education and Innovative communication for development routine are disrupted and children have strategies, including Child-to-Child Radio and less protection from exploitation such as Multimedia Mobile Units, have a tremendous sexual abuse and survival sex. Emergencies, potential to engage more people, particularly along with the vulnerabilities they increase, youth, in educational activities, public are likely to intensify as climate change dialogue and debate.
XXVI XXVII CHAPTER CHAPTER
Poverty in Mozambique
1 1. Introduction 1 The national five-year plan or Programa situation of children have become available, Quinquenal do Governo 2010–2014 establishes primarily through the 2007 Census,2 the 2008 Mozambique’s national governmental priorities. Multiple Indicator Cluster Survey (MICS),3 This plan and its accompanying operational the 2008/09 Household Budget Survey (IOF),4 plan and monitoring and evaluation framework the 2008 National Child Mortality Study,5 the – the Plan of Action for the Reduction of Poverty, Concluding Observations of the Committee for or PARP – in turn guides the contributions the Convention on the Rights of the Child6 and of the United Nations (UN), donors and civil the 2009 joint evaluation of progress towards society partners in support of those priorities. the goals and targets of the Government of The UN System in Mozambique will prepare a Mozambique’s PARPA II (2006–2009).7 new Development Assistance Framework for 2012–2015, and individual agencies and partners Childhood poverty has immediate and will develop their own Country Programmes long-term effects on children. Chronic of Cooperation in support of, and aligned with, undernutrition, for example, which is developed national priorities and planning processes. in the period covering pregnancy up to the first two years of life can permanently impact In 2006, the UN System in Mozambique a child’s growth, resulting in stunting and published the Childhood Poverty in reduced mental development. The impact of Mozambique: A Situation and Trends Analysis1 inter-generational childhood poverty and its that described how poverty affects the lives cyclical nature is also evidenced by poverty’s of children and their ability to realise their proven role as a barrier to accessing social rights. The primary focus of this 2010 Study is services. Poor households have more difficulty to assess childhood poverty in Mozambique accessing good-quality health care, are less and to identify barriers to the realisation of likely to have their children in school and are child rights. This 2010 update provides a less likely to have access to safe drinking water comprehensive description of the situation in and adequate sanitation facilities. Poor children which the ten million children of Mozambique have an elevated risk of growing up to become live. It also describes the public policy, financing poor adults and in turn, have poor children. and service delivery environments for children, and will act as a source of quantitative and This chapter analyses childhood poverty, first qualitative data to inform evidence-based policy by examining historical trends in consumption- decisions on national development priorities based poverty and second by analysing and associated interventions. deprivations-based poverty. This is followed by a comparison of the two measures and in- Since the publication of the 2006 Childhood depth analysis by deprivation. Finally, a number Poverty in Mozambique: A Situation and Trends of conclusions with regard to child poverty are Analysis, additional data and analyses of the drawn. POVERTY IN MOZAMBIQUE 3 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 1: POVERTY IN MOZAMBIQUE
is used. This index is an average percentage Households in Mozambique are vulnerable 2. Measuring Poverty distance measure that examines how far the to shocks which can push them below average poor household is from escaping the poverty line. Poverty levels among poverty and rising above the poverty line. households have varied significantly over 2.1. Consumption-based depends upon the demographic composition In order to measure inequality amongst the last decade, especially at the provincial the poor, the ‘squared poverty gap index’ level. This underscores the vulnerability poverty of the region, but averages approximately 2,150 calories per day). The cost of this is used. This index averages the square of of a large proportion of the population. Following the signing of the 1992 Peace basket represents the food poverty line. the poverty gaps, thereby giving weight to Mozambican households are extremely Agreement, Mozambique made impressive A non-food poverty line is obtained by gains made by the poorest of the poor. The vulnerable to shocks such as the loss of an progress in reducing the poverty headcount examining the share of total expenditure Third National Poverty Assessment found income or crop failure due to droughts or from 69 per cent in 1996 to 54 per cent in allocated to non-food by households living no change in the poverty-gap or poverty- floods. Seasonal fluctuations can temporarily 2002, exceeding the PARPA I target of a near the food poverty line. The overall squared gap measures between 2002/03 and push households above and below the poverty headcount of 60 per cent by the poverty line is then calculated as the sum of 2008/09, implying that the real income of the poverty line. poor relative to the poverty line has been year 2005.8 This trend did not continue the food and non-food poverty lines. It must The factors identified by the Ministry of relatively constant between 2002 and 2008.11 between 2002 and 2008. According to the be stressed that the poverty line represents Planning and Development as primarily 2008/2009 IOF, 55 per cent of Mozambicans an extremely basic standard of living.i Levels of equality have remained reasonably behind poverty stagnation between 2002 and are living below the national poverty line constant between 2002 and 2008. The Gini 2008 include:15 of 18.4 Meticais (around $US 0.50) per day. The indicator measuring the percentage coefficient,ii a measure of income inequality, Consumption and incomes increased and of people living below the poverty line is ll Very slow growth rates in agricultural as calculated from the IOF surveys, did not poverty fell for a majority of Mozambicans known as the ‘poverty headcount’. Although productivity, especially with respect to significantly change between 1997 and between 1996 and 2002, followed by the poverty headcount at a national level 2008. Inequality is significantly higher in food crops, observed since 2002; stagnation between 2002 and 2008.9 remained reasonably constant between 2003 and 2008, large disparities, in both poverty urban compared to rural areas.12 There is ll Weather shocks that impacted the Official national poverty estimates for levels and variation in levels, were estimated some evidence to suggest that inequality is harvest of 2008, particularly in the Central Mozambique measure a household’s at a provincial level. The largest reduction bigger within provinces and districts rather provinces; ability to satisfy its most basic needs in poverty rates was found in Cabo Delgado than between them. One study found that ll Declining terms of trade due to large by measuring its consumption. The (-26 percentage points) and Inhambane (-23 between 83 per cent and 86 per cent of the increases in international food and fuel consumption-based poverty headcount is percentage points). In contrast, Zambezia total inequality in Mozambique occurs within 13 prices. Fuel prices, in particular, rose based on the Household Budget Survey (+26 percentage points) and Sofala (+22 districts rather than between districts. (Inquérito ao Orçamento Familiar, IOF), percentage points) stand out as the two substantially over the period 2002/03 to Poverty reduction in Mozambique between which is conducted by the National Institute provinces showing the largest increases 2008/09. 1996/97 and 2002/03 did not equally benefit of Statistics and the Ministry of Planning in poverty incidence since 2002/03. The all segments of the population. Poverty The consumption measure used in and Development every six years. The third stagnation in the overall poverty rate since was reduced much more significantly Mozambique is a per capita measure, with and most recent survey was conducted in 2002/03 is principally due to substantial among male-headed households than no allowance for differences between child 2008/09. increases in measured poverty in Zambezia female-headed households, which represent and adult in the requirements of calories per and Sofala, which offset the large declines about 30 per cent of all households in day to satisfy minimum needs. At first sight, “Consumption” includes both food and non- in poverty observed in five provinces. Mozambique.14 While poverty was reduced this implies that the poverty situation for food items and is adjusted for seasonality Zambezia province was estimated to have by 26 per cent in male-headed households (it children may be a little better than portrayed, of the former, but omits public services and the highest poverty headcount in 2008/09: declined from about 70 per cent in 1996/97 as a working adult requires more calories per home produced services. A Cost of Basic 70.5 per cent.10 to 52 per cent in 2002/03), it only went down day, and hence greater expenditure, than a Needs methodology is then applied. This non-working child. However, since children The headcount does not convey information by 6 per cent in female-headed households approach consists of the development of a require a higher intake of micronutrients about levels of well-being among those (down from about 67 to 63 per cent between basket of food items consumed by the poor than adults, maintaining the adult caloric below the poverty line. In order to measure 1996/97 and 2002/03).iii that is judged sufficient for basic caloric requirement may be a reasonable proxy needs (the calorie content of each basket the depth of poverty, the ‘poverty gap index’
ii The Gini coefficient is a measure of statistical dispersion commonly used as a measure of inequality of income or wealth. The Gini coefficient can range from 0 to 1. A low Gini coefficient indicates a more equal distribution, with i For a full description of the methodology used to estimate Mozambique’s poverty rate see: Ministry of Planning and 0 corresponding to perfect equality, while higher Gini coefficients indicate a more unequal distribution, with 1 Development. ‘Poverty and Wellbeing in Mozambique: Third National Poverty Assessment.’ Government of Mozambique, corresponding to perfect inequality. The Gini coefficient was 0.41 in both 2002, and 2008. Maputo, September 2010. iii See Chapter 6, Cross-cutting issues, for a more detailed discussion of the feminisation of poverty in Mozambique.
4 5 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 1: POVERTY IN MOZAMBIQUE
for formulating a consumption-based services is excluded. There is no attempt to Box 1.1. Methodology and Sources of Information child poverty line.16 Also, the proportion of value consumption of public services such children who work is high, the 2008 MICS as education, healthcare, and economic Research Methodology reports that 22 per cent of children aged 5–14 infrastructure.19 Given the significant The methodology employed in producing this Study on Child Poverty and Disparities in Mozambique consists years were engaged in some form of work investment in public services in recent primarily of a desk review of pre-existing publications, survey data and reports. Contributions to the analysis outside the home (28 or more hours per years, the consumption of public goods had were solicited from Government, donor partners, UN agencies and a range of other stakeholders, and the week).17 a significant impact on the well-being of process was managed through a steering committee chaired by UNICEF. The structure and content of the 2010 children in Mozambique. Study are based on that used in the original 2006 Childhood Poverty in Mozambique: A Situation and Trends All measures of poverty have their limitations Analysis in order to ensure consistency, facilitate comparisons and assess progress. A new chapter dealing with and the consumption-based approach is no Children experience poverty, deprivation cross-cutting issues has been added. exception. One important limitation is that the and rights violations differently from their consumption measure applies to households parents and other adults, in terms of both The desk-based review of documentation was supplemented by consultations with civil society and other and not individuals. It is not possible with the type of deprivation experienced and the stakeholders. These consultations were instrumental in developing the causality, role/pattern and capacity IOF data to estimate the consumption of each relative degree of deprivation. Children are analyses described below. Like the 2006 report, this update uses a deprivations-based measure of childhood person within a household. The measure does proportionally more vulnerable to extreme poverty to complement the official consumption-based measure of poverty. Deprivations-based poverty analysis not, therefore, capture variations in allocation poverty than adults, and it is therefore vital to examines children’s access to seven key aspects of development: water, sanitation, shelter, education, health, among household members, including determine if the poverty situation described nutrition and information.20 differences between adults and children. This from a predominantly adult perspective is Sources of data and information could mean that some members of a non- equally applicable to children.24 This section poor household may in fact be consumption- presents estimates of childhood poverty The 2010 Study on Child Poverty and Disparities in Mozambique draws on three important surveys, namely poor, and vice versa. There is evidence in using the Bristol Indicators for a deprivations- the 2008 Multiple Indicator Cluster Survey (MICS)21, the Household Budget Survey (IOF) 2008/09 and the 2009 Mozambique that discrimination in terms based measure, adapted for Mozambique. National Child Mortality Study.22 The MICS was conducted and published by the National Institute of Statistics, of resource allocation does occur within with technical and financial support from UNICEF. The IOF 2008/09 was conducted and published by the National Consumption-based child poverty headcount households. For example, a 2005 study Statistics Institute and the Ministry of Planning and Development. The National Child Mortality Study was estimates, based on the 2003 Living found that non-biological descendants of the conducted by the Mozambican National Institute of Health in collaboration with the London School of Hygiene Conditions Household Survey (IAF), indicated household head are discriminated against in and Tropical Medicine and UNICEF. The data obtained from these sources were used to update information that the level of poverty among children was the intra-household allocation of resources presented in the 2006 Childhood Poverty in Mozambique: A Situation and Trends Analysis. An important source 18 significantly higher than among adults. In in poor households. It is not possible to of additional information and analysis was the joint Impact Evaluation of PARPA II, including the in-depth studies 2002/2003, 58 per cent of children living in measure this discrimination through the commissioned as part of the PARPA II evaluation process.23 IOF data. Further, consumption of all public poverty compared to 49 per cent of adults. Through the eyes of a childiv
A methodology known as photo-voice was used to better understand the ideas, perspectives and realities as projected by the girls. Photo-voice involves posing questions to children about the issues they face and having them respond through photographs taken followed by group debate and dialogue.
Through this process the girls seemed to undergo a transformation. At the beginning of the research, the girls were shy and timid. When one girl responded to a question in a very quiet voice, the other girls would mimic the response by changing the words slightly. If a follow-up question was asked, they would respond quietly using one or two words only. The girls confided that no one had ever asked them for their ideas. This was a new experience for them. Within a short span of time, through the use of participatory methodology, the girls were eagerly sharing their unique ideas. In fact, they were debating with one another and confidently voicing their thoughts. They were no longer passive recipients of knowledge, but were now active contributors to new knowledge, ideas and solutions. The girls shared practical solutions towards the challenges faced in their daily lives. Through the community interviews they conducted and the photos they took, they began to see for the first time the similarities in the lives of their grandmothers, mothers and aunties and how much they wanted their lives to be different.
The group produced more than 100 photographs and expressed their views on a wide variety of issues including poverty, health, water and sanitation and gender issues. Some of the pictures they took and the stories they told are included in this report.
iv Zainul Sajan Virgi, PhD Candidate at McGill University, undertook participatory research to uncover issues faced by children in Machava in the environs of Maputo city. The research involved the on-going consultation of a group of pre-adolescent girls over a period of 6 months.
6 7 CHILD POVERTYT ANDhrough DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 1: POVERTY IN MOZAMBIQUE the eyes
Consumption-based child poverty did, While reporting on the consumption-based of a child however, decrease significantly between measure in its poverty analysis, PARPA the 1997 and 2003 surveys. But the gap II adopted a new definition of poverty: between children and adults did not close “Impossibility, due to incapacity or through between 1996/97 and 2002/03, with both lack of opportunity, for individuals, families groups witnessing a decrease of 22 per cent and communities to have access to in poverty level. The decrease in child poverty minimum conditions, in accordance with the levels was more pronounced in rural areas norms of society.” PARPA II also explicitly (24 per cent) than in urban areas (16 per cent). recognises that it is important not to be over- reliant on any one poverty measure, stating 2.2. Deprivations-based poverty that,“ For purposes of policy decisions, poverty was initially considered as the lack Mozambique’s first Poverty Reduction of income – money or negotiable goods Strategy Paper, PARPA I (2001–2005), – necessary to satisfy basic needs. Because defined absolute poverty as “the inability this monetary definition did not cover all the of individuals to ensure for themselves and manifestations of poverty, the definition was their dependants a set of basic minimum broadened over time to cover such aspects conditions necessary for their subsistence as a lack of access to education, health care, and well-being in accordance with the water and sanitation, etc.”27 norms of society.”25 Many observers subsequently proposed that this definition UNICEF, along with a growing number of of poverty should be supported by more academics and policymakers, has chosen to multidimensional measures in order to adopt an increasingly multidimensional view present a broader, more pluralistic and of what it means to be living in poverty. rights-based analysis.26 This view was Poverty has traditionally been measured formally adopted by the Government in the using a narrow focus on household country’s second Poverty Reduction Strategy consumption. However, the level of a Paper, PARPA II (2006–2010). family’s income does not create a full picture
Table 1.1: Deprivation in Mozambique, 2008 “I remember clearly that in this picture I had eaten food that day.” Deprivation Proportion of children experiencing severe deprivation
”We never have enough food to eat. We “We remember the days that we have eaten. Nutrition 20 per cent of children under five years of age are experiencing severe malnutrition.v normally have black tea and bread for Often, when we wake up in the middle of Water 39 per cent of children do not have access to safe drinking water within 30 minutes breakfast. Whether or not we have a second the night, we see our mothers worried about of their home. meal depends on the adults in our lives. If what they will feed us the next day. Even Sanitation 43 per cent of children have no access to a toilet of any kind in the vicinity of their home. our mothers and grandmothers have made though our mothers and grandmothers Health 12 per cent of children under five years of age are not immunised or have suffered money that day or have money left over work every day, they often come home with from an acute respiratory infection that was not treated. from their monthly salary, then we eat. If it very little money. It makes us sad to see the Shelter 5 per cent of children live in a house with more than five people per room. is towards the end of the month, we have difficult life our mothers and grandmothers probably run out of money and food, so we lead. When we grow up, we will work hard to Education 12 per cent of children have never been to school. go to bed hungry. Often, we haven’t eaten take care of our mothers and grandmothers.” Information 40 per cent of children without a radio, television or newspaper at home.
anything for one or sometimes even two Source: UNICEF, Child Poverty in Mozambique: A deprivations-based approach. Maputo, 2009. days. We often cry, not just because we are —Lina, age 14 hungry, but because we feel all alone when we don’t have food to eat, like no one cares Source: Sajan Virgi, Zainul, 2010. v Proportion of children under five years of age whose nutritional index (weight-for-height, weight-for-age, height-for-age) about us. is equal to or below -3 standard deviations from the median of the 2006 WHO standard.
8 9 CHILD POVERTYT ANDhrough DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 1: POVERTY IN MOZAMBIQUE the eyes
of the health and well-being of a child. A An inherent strength of the deprivations- of a child child’s parents may earn a decent wage but based approach is its inclusion of the live too far from a school for their child to consumption of key public services. This attend class. Education, along with other is particularly evident when contrasting basic services like health, sanitation and results of deprivations- and consumption- clean water are all necessary investments based measures of poverty for rural and for a child to grow up to be a productive urban children. In 2003, 22 per cent of urban adult. Focusing on the basic needs and key children were living in absolute poverty public services of which a child is deprived as measured by the deprivations-based allows for a multidimensional understanding approach versus 55 per cent as measured by of poverty. With the deprivations-based the consumption-based approach, reflecting approach, the link between resource the increased access to social services in allocation, policy choices and the resulting urban areas. With the deprivations-based changes in childhood poverty becomes approach, the link between resource much more explicit. allocation, policy actions and the resulting changes in childhood poverty is made much The analysis presented here uses a more explicit. For example, the increased deprivations-based measure of childhood allocation of funds to expand immunisation absolute poverty. The indicators used programmes would have an immediate to quantify this measure were originally and direct impact on child poverty under developed by a team at the University of the deprivations-based measure (by Bristol, and are often referred to as the demonstrating an increased number of Bristol Indicators.28 They are based on the children who had been immunised), but deprivations approach to poverty, drawing would show the effect more slowly under the upon the definition of absolute poverty consumption-based measure. agreed at the World Summit for Social Development: “a condition characterised by Using the deprivations-based approach, severe deprivation of basic human needs.”29 focused on a child’s ability to access essential services, the proportion of children The indicators comprise seven measures of living in absolute poverty in Mozambique severe deprivation: nutrition, safe drinking fell from 59 per cent in 2003 to 48 per cent in water, sanitation facilities, health, shelter, vi, 30 “My great-grandmother worked on the field. 2008. The proportion of children in rural education and information. The Bristol areas living in absolute poverty decreased My grandmother works on the field. I do not Indicator approach defines the proportion of significantly, from 72 per cent to 60 per cent know what my mother does since she lives children living in absolute poverty as those (Figure 1.1). In 2008, 22 per cent of urban in South Africa. My aunties have food stalls. children facing two or more types of severe children were poor, versus 60 per cent of Now that I see the lives of my family, I hope I deprivation. The indicators constitute both rural children. will do something different.” causes and symptoms of poverty. Access to safe water, for example, is a symptom of The reduction in children’s absolute — Aida, age 12 poverty in that poor households are far less poverty levels was driven by significant likely to enjoy safe water. It is also a cause improvements in the health and education of poverty in that individuals that do not sectors. The proportion of children \ have access to safe water are more likely to experiencing severe education deprivation suffer from water-borne illnesses leading to was halved between 2003 and 2008 (24 to an inability to engage in activities to provide 12 per cent). Severe health deprivation was income for their families. reduced by one-third (18 to 12 per cent).31
vi The figure quoted in 2006 Childhood Poverty in Mozambique: A Situation and Trends Analysis for the proportion of children living in absolute poverty in 2003 (49 per cent) differs from that used here due to improvements in the methodology used to calculate several deprivations in the areas of water, health and nutrition. The 2003 data were therefore recalculated to reflect these improvements.
10 11 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 1: POVERTY IN MOZAMBIQUE
Figure 1.1: Proportion of children experiencing two or more severe deprivations, 2003 and 2008 as the level of education of the mother that are linked to the disadvantaged status of or caretaker, the dependency ratio at rural populations. 80% household level, the area of residence and the survival status of the parents of the Outside of improving material wealth, the 70% 72% child. The area of residence is likely to be a model suggests that the most important, and proxy for a number of unmeasured variables possibly the most straightforward, way to 60% 60% 59% 50% 48% Figure 1.2: Proportion of children experiencing deprivations, 2003 and 2008 40% 50% 30% 47% 30% 45% 20% 22% 40% 43% 39% 39% 40% 10% 35%
0% 30% 31% Overall Urban Rural 25% 27% 24% 2003 2008 20% 20% 18% Source: UNICEF, Child Poverty in Mozambique: A deprivations-based approach, Ministry of Planning and Development, Maputo, 2009. 15%
10% 12% 12% The proportion of children experiencing relatively high level of access to essential 5% 6% nutrition and sanitation deprivations services in the Capital. The second largest 5% 0% registered moderate improvement between reduction in deprivation occurred in Niassa Nutrition Water Sanitation Health Shelter Education Information 2003 and 2008, but the proportion of children province, where the proportion fell from experiencing severe water deprivation 58 per cent in 2003 to 35 per cent in 2008. 2003 2008 increased. The most frequently experienced Interestingly, both Maputo City and Niassa Source: UNICEF, Child Poverty in Mozambique: A deprivations-based approach, Ministry of Planning and Development, Maputo, 2009. severe deprivations are water, sanitation, and also experienced large reductions in the information, which affect 39 per cent, 43 per consumption-based poverty measure cent, and 40 per cent of children, respectively. between 2002/03 and 2008/09.32 Only five per cent of children experience Figure 1.3: Percentage of children experiencing two or more severe deprivations by province, 2003 and 2008 severe shelter deprivation (Figure 1.2). A multivariate analysis, using as outcome the 90% number of severe deprivations in children 0 to 80% At the provincial level, there has been a 17 years old, was conducted to obtain a better 80% reduction in child poverty between 2003 and understanding of the relationship between 70% 2008 in Niassa, Cabo Delgado, Zambezia, a deprivations-based measure of poverty, 68% 66% 65% Sofala and Inhambane provinces and Maputo the Bristol Indicators, and other relevant 60% 62% 64% 60% City. Figure 1.3 shows the proportion of individual and household level variables 58% 59% 58% 50% 52% 53% 53% children experiencing two or more severe available in the MICS 2008 dataset. 48% deprivations by province in 2003 and 2008. 40% 45% Asset-based wealth is a crucial explanatory 39% 35% 37% Significant disparities exist in relation to variable in predicating deprivation. The 30% provincial poverty rates. The proportion of model suggests that asset-based wealth 20% 24% children experiencing two or more severe is strongly (and inversely) related to the 18% 10% deprivations was highest in Zambezia number of deprivations; as would be 11% province in both 2003 and 2008 (80 and 64 expected, children in wealthier households 0% 4% per cent respectively). Maputo City has the are far less likely to be deprived. Niassa Cabo Nampula Zambezia Tete Manica Sofala Inham- Gaza Maputo Maputo lowest levels of absolute child poverty, with Delgado bane Prov. City only 4 per cent of children experiencing two However, the analysis suggests that other 2003 2008 or more severe deprivations, reflecting the factors also play an important role, such Source: UNICEF, Child Poverty in Mozambique: A deprivations-based approach, Ministry of Planning and Development, Maputo, 2009.
12 13 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 1: POVERTY IN MOZAMBIQUE
reduce child poverty might be to improve the and the north of the country but diverge education of future mothers. sharply in the south. In the case of Maputo 3. Analysis by deprivation City, this is explained by the fact that 2.3. Comparison of consumption– the consumption-based approach does not directly take into account access to The following section presents an analysis of severe education deprivation than children in and deprivations-based social services such as health, education, each of the seven Bristol Indicators. the best-off households. poverty water and sanitation, which are likely to be concentrated in urban areas. By both Severe education deprivation has been In 2008, poverty levels were significantly measures, Zambezia is estimated to have 3.1. Severe education reduced in all provinces, as shown in Figure lower as measured by the deprivations- the highest proportion of people living in 1.5 below. Niassa, Zambezia, Inhambane based approach, as compared to the deprivation absolute poverty. As discussed in chapter 6, and Gaza provinces experienced large consumption-based measure. This is Zambezia is allocated considerably less funds Between 2003 and 2008, severe education reductions. All four provinces saw a relative explained by the fact that there were per capita than average and has is amongst deprivation has halved (24 versus 12 per decline of over 60 per cent in the proportion significant improvements in non-monetary the worst performing province in terms of cent). The education deprivation indicator of children experiencing severe education poverty measures of poverty between human development indicators. The re-dress is the proportion of children between 7 and deprivation. Only three per cent of children 2002 and 2008 but not accompanying of this inequitable allocation of resources 18 years old who have never been to school in Gaza are experiencing severe educational improvements in terms of increased should be prioritised by the Government and and are not currently attending school. The deprivation. Despite these improvements, consumption. Poverty rates were relatively its development partners. levels of severe education deprivation are education deprivation still remains high similar (by both measures) in the centre three times higher for rural children (15 in Niassa and Zambezia (15 and 12 per per cent) than urban children (5 per cent), cent, respectively). It is highest in Tete (22 Figure1.4: Deprivations-based poverty compared to consumption-based poverty for children, 2008 although both groups experienced large per cent), where children have the lowest improvements. Severe education deprivation primary school completion rate (5 per cent) is highly correlated with the wealth of and among the lowest levels of family 80% the household. Children in the poorest support for children’s educationvii and the 70% households, based on a wealth index, are lowest access to pedagogical materials in almost ten times more likely to experience the home.33 This suggests that the poor 60% 50% Figure 1.5: Severe education deprivation among children by province, 2003 and 2008 40% 40% 30% 35% 37% 20% 34% 30% 33% 31% 10% 30% 25% 26% 0% 24% 24% 20% Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Urban Rural Total 22% Delgado pula bezia bane Prov. City 18% 15% 17% 15% 14% 15% 10% 12% 12% 11% 12% 12% 12% Severe Deprivation 2008 Consumption-based poverty 2008/09 9% 3% 5% 5% 4% 4% 3% Source: UNICEF, Child poverty in Mozambique: A deprivations-based approach, Ministry of Planning and Development, Maputo, 2009 0% 2% 2% and Ministry of Planning and Development, ‘Poverty and wellbeing in Mozambique: Third national poverty assessment, Government Niassa Cabo Nampula Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Urban Rural Overall of Mozambique, September 2010. Delgado bezia bane Prov. City 2003 2008 Source: UNICEF, Child Poverty in Mozambique: A deprivations-based approach, Ministry of Planning and Development, Maputo, 2009.
vii The MICS survey calculates a family’s support for a child’s education through five indicators: a) Children whose household members are involved in four or more activities that promote learning and facilitate education; b) Average number of activities in which adult members participate with the child; c) Children whose father is involved in one or more activities that promote learning and facilitate education; d) Average number of activities in which the father is involved; and e) Children living in a household without their biological father.
14 15 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 1: POVERTY IN MOZAMBIQUE
educational outcomes in Tete are more impacts is child mortality. Undernutrition is for urban children (15 per cent). The higher among children living with HIV or AIDS. In complex than simply a lack of educational the main underlying cause contributing to the rate for rural children is largely explained Mozambique, a lack of access to safe water opportunities. The problem may also be high level of child mortality in Mozambique. by differences in food availability, a lack of is directly responsible for regular outbreaks related to the value parents there put on Proper nutrition is also important in its own variation in diet and lower access to health of cholera. The water deprivation indicator children’s learning. right, since undernutrition (in particular services,37 safe drinking water and sanitation is the proportion of children under 18 years chronic undernutrition or stunting) affects facilities. Rural children may also be more of age who only have access to surface Girls are more likely to experience severe a child’s physical and mental development likely to experience a reasonably prolonged water (e.g. rivers) for drinking or who live education deprivation than boys (13 and and is closely linked to the ability to succeed food deficit at some point in time. in household where the nearest sources of 10 per cent respectively).34 Sofala province in school and become a productive adult. water is 30 minutes away or more. has the largest gender disparity in primary The nutritional deprivation indicator is the The reduction in the proportion of children education attendance rates, with 87 per cent proportion of children under five whose experiencing severe nutritional deprivation Severe water deprivation among children of boys and 77 per cent of girls attending nutritional index (based on an equally was driven by improvements for rural has increased in Mozambique between 2003 primary school. Tete has the largest gender weighted weight-for-height, weight-for-age, children. Thirty-one per cent of rural children and 2008 (31 versus 39 per cent).ix There is disparity in secondary level education: 12 per height-for-age composite) is equal to or were experiencing severe nutritional a large disparity between urban and rural cent of boys are attending secondary school below minus 3 standard deviations from the deprivation in 2003 compared to 22 per children; rural children are more than two compared to 6.5 per cent of girls. Nationally, median of the WHO standard population, i.e., cent in 2008. The reduction in the level of and a half times more likely to experience the education gender gap has been closing, severe anthropometric failure. nutritional deprivation for urban children severe water deprivation than urban as have disparities between provinces.35 was not statistically significant. The gap children (14 and 40 per cent respectively). There has been a reduction in the percentage between the rural and urban areas has thus Rural children experienced an increase in 3.2. Severe nutrition deprivation of children in Mozambique experiencing narrowed from 2003 to 2008, although a severe water deprivation between 2003 and severe nutritional deprivation,viii from 27 disparity persists. 2008, while for urban children the level of Undernutrition has wide ranging impacts per cent of children in 2003 to 20 per cent deprivation remained reasonably constant.39 on the lives of mothers and children in in 2008.36 Severe nutrition deprivation is There is considerable inequity in terms of Mozambique. The most drastic of these higher for rural children (22 per cent) than severe nutritional deprivation. Children In Gaza province, more than half of children in the in the poorest households (25 are experiencing severe water deprivation per cent) are significantly more likely to (58 per cent). Gaza registered an increase in experience severe nutritional deprivation children’s severe water deprivation between Figure 1.6: Severe nutritional deprivation among children by province, 2003 and 2008 than children in the best-off households (9 2003 and 2008 (39 versus 58 per cent). The
45% per cent). However, poorer households have mean time to walk to a water source in Gaza experienced more significant improvement province in over one and half hours.40 There 40% 39% in the proportion of children experiencing is no evidence of any province achieving a 35% 36% 36% severe nutritional deprivation.38 statistically significant reduction in severe 33% water deprivation among children. 30% 31% 30% 29% 25% 27% 27% 3.3. Severe water deprivation There is considerable inequity in access to 24% 23% safe water. Children from poor households 20% 22% 21% 22% Access to clean, safe water is vital for 20% 20% 20% the survival and healthy development of are at a far greater risk of experiencing 15% 17% 17% 17% 15% severe water deprivation. Severe water 15% 14% children, reducing sickness and death due to 10% diarrhoeal diseases and other major causes deprivation is nearly five times higher for 10% 9% 10% 5% 8% 8% of child mortality. Use of safe water lowers children who live in the poorest households the risk of water-borne diseases among than for those who live in the best-off 0% households (54 versus 11 per cent) (see Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Urban Rural Overall children weakened by malnutrition and Delgado pula bezia bane Prov. City reduces the risk of opportunistic infections Figure 1.7). 2003 2008
Source: UNICEF, Child Poverty in Mozambique: A deprivations-based approach, Ministry of Planning and Development, Maputo, 2009.
viii The difference between this figure and the figure reported in the 2006 Child Poverty in Mozambique: A Situation and Trend Analysis is due to the change in WHO standards for components of the nutritional indicator. The estimates in the DHS 2003 report were based on the NCHS reference population, developed in 1975. The estimates based on data ix Previous calculations of severe water deprivation among children used “time to go to and return from a water source is from the 2003 DHS were recalculated using as base the 2006 WHO standard population. Please refer to WHO, Growth more than 30 minutes” as the indicator. The correct indicator, as per Gordon et al., 2003, refers to children who live more Standards, Methods and Development: http://who.int/childgrowth/standards/en. than 30 minutes away from a water source. The data from 2003 were recalculated to reflect this change.
16 17 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 1: POVERTY IN MOZAMBIQUE
Figure 1.7: Severe water deprivation among children by wealth quintile, 2008 3.5. Severe health deprivation In all three provinces, mothers/guardians are less likely to recognise the symptoms 60% Severe health deprivation among children of pneumonia than the national average, fell significantly between 2003 and 2008, 50% 54% suggesting that severe health deprivation from 18 per cent* to 12 per cent. The severe may be linked to the level of knowledge 40% 46% health deprivation indicator is the proportion guardians have about diseases. Notably, 30% 40% 38% of children under five who have never been only three per cent of children in Zambezia 20% immunised or who have suffered from a suspected of having pneumonia received 10% severe episode of acute respiratory infection 43 11% antibiotics. 0% that was not treated. As can be seen Lowest Second Middle Fourth Highest from Figure 1.9 below, there is a disparity between rural and urban children, with rural 3.6. Severe shelter deprivation Source: UNICEF, Child Poverty in Mozambique: A deprivations-based approach, Ministry of Planning and Development, Maputo, 2009. children twice as likely to experience severe Five per cent of children are experiencing health deprivation (14 per cent versus 7 severe shelter deprivation in Mozambique. per cent). Deprivation levels did however This level has remained fairly constant 3.4. Severe sanitation deprivation sanitation deprivation, compared to 15 per decrease significantly for rural children while between 2003 and 2008. The shelter indicator cent of urban children.42 remaining fairly constant for urban children. is the proportion of children under 18 living Poor sanitation and inadequate hygiene There are also disparities between provinces, in dwellings with more than five people per contribute to child mortality and morbidity. Besides urban/rural disparities, there are ranging from five per cent in Maputo City to room (severe overcrowding). Cabo Delgado Water, sanitation and hygiene are also also large disparities between provinces. 19 per cent in Zambezia and Nampula. has experienced a large fall in severe shelter closely linked to childhood malnutrition.41 In Zambezia, 73 per cent of children are deprivation among children. Almost no The sanitation deprivation indicator is the experiencing severe sanitation deprivation Breaking down the indicator into its children (0.2 per cent) in the province are proportion of children under 18 years of age compared to less than one per cent in Maputo components (acute respiratory infection and now experiencing severe shelter deprivation, who have no access to a toilet of any kind City. A higher proportion of children in the immunisation) reveals some of the causes compared to 3 per cent in 2003. Severe in the vicinity of their dwelling, including central and northern provinces experience behind the severe health deprivation in shelter deprivation has increased in Gaza communal toilets or latrines. severe sanitation deprivation than in the Zambezia, Nampula and Tete. southern provinces (see Figure 1.8). The proportion of severely deprived children in terms of sanitation remained reasonably There is also a large disparity depending constant between 2003 and 2008. In 2008, on the wealth of the family. Data show Figure 1.9: Severe health deprivation among children by province, 2003 and 2008 that 92 per cent of children in the poorest 43 per cent of children were experiencing 40% severe sanitation deprivation. The urban/ households experience severe sanitation 35% rural disparity is large. Fifty-six per cent deprivation, compared to 3 per cent in the 35% of rural children are experiencing severe best-off households. 30% 32%
25%
22% Figure 1.8: Severe sanitation deprivation among children by province, 2008 20% 21% 19% 19% 18% 18% 15% 80% 14% 10% 13% 13% 12% 11% 12% 12% 11% 11% 73% 9% 10% 9% 8% 5% 7% 7% 7% 7% 60% 5% 6% 59% 4% 58% 56% 0% 52% Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Urban Rural Overall Delgado pula bezia bane Prov. City 40% 45% 43% 2003 2008 30% 30% 20% Source: UNICEF, Child Poverty in Mozambique: A deprivations-based approach, Ministry of Planning and Development, Maputo, 2009. 23% 20% 15% 13% 0% 0% Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Urban Rural Overall * Delgado pula bezia bane Province City The small difference between the value reported here for 2003 and the value reported in UNICEF 2006 is explained by the treatment of children without any information on health. In line with the established Bristol Indicator methodology, Source: UNICEF, Child Poverty in Mozambique: A deprivations-based approach, Ministry of Planning and Development, Maputo, 2009. children without information on the components of the health indicator were excluded from the calculation.
18 19 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 1: POVERTY IN MOZAMBIQUE
and Inhambane. No other provinces show deprivation indicator is the proportion evidence of a statistically significant change of children between 5 and 18 with no 4. Conclusions in the proportion of children experiencing possession of or access to a radio, television severe shelter deprivation. or newspaper at home. There have been significant improvements Poverty rates have stagnated as measured Severe shelter deprivation is strongly The information deprivation indicator in levels of absolute poverty among children by the consumption-based approach with correlated with wealth. Thirteen per cent does not take into account mobile phone as measured by the deprivations-based nearly 12 million Mozambicans living on 18.4 of children in the poorest quintile are ownership. It is likely that if access to mobile approach. Advances observed in deprivation- Meticais (around $US 0.50) per day. This is experiencing severe shelter deprivation phones were included in the calculation based poverty are associated in part with the principally due to the poor performance of the compared to only one per cent of children in of information deprivation, it would have large efforts made by the Government in the agricultural sector, on which the majority of the best-off households. caused a reduction in the proportion of provision of social services. The Government Mozambicans rely for their livelihoods. There children experiencing severe information has invested strongly in education and is an unambiguous relationship between the deprivation, given the large increase in 3.7. Severe information health, and this has resulted in significant wealth and the well-being of children. While mobile phone ownership in Mozambique improvements in the proportion of children continued investments in the social sectors deprivation over the last decade (see Chapter 6, Cross- experiencing severe education and health are necessary to reduce deprivation levels, it cutting issues). It is also possible that the There was no statistically significant change deprivations. Although the proportion of is vital that the Government and its partners rapid expansion of mobile phone ownership in the proportion of children experiencing children experiencing severe deprivation re-examine their approach to stimulating the is actually reducing the demand for severe information deprivation between has decreased in recent years, almost half agricultural sector. 2003 and 2008. Forty per cent of children radios and televisions among the poorest of Mozambican children remain severely were experiencing severe information households as they prioritise mobile phones deprived. Children are most often deprived Both the consumption- and deprivation- deprivation in 2008. The information over other communication assets. of access to safe water, sanitation and based measures underline the high levels of information. Continued investment in vulnerability of the Mozambican population, essential services means a continued as evidenced by the fluctuating provincial investment in the future of Mozambique’s Figure 1.10: Severe shelter deprivation among children by wealth quintile, 2008 poverty rates. These disparities are linked children. to inequitable allocation of Government 14% resources. Provinces with the lowest human The urban/rural divide is particularly evident development indicators tend to receive a 12% 13% through deprivations-based analysis. It lower allocation of resources. The ability 10% is also clear from the results that levels of households to withstand internal or 8% of deprivations are significantly higher in external shocks is extremely limited. The 6% the central and northern provinces than most common shocks experienced are the 6% 4% in the southern provinces. However, if we death of a family member or weather related 4% exclude Maputo City, the northern provinces 2% 3% shocks such as drought or flood.44 These experienced the largest reduction in levels 0% 1% shocks can push children and their families Lowest Second Middle Fourth Highest of deprivation among children. Similarly, into severe deprivation and absolute poverty consumption-poverty estimates indicate a and have life-long impacts on the well-being positive trend in northern Mozambique. Source: UNICEF, Child Poverty in Mozambique: A deprivations-based approach, Ministry of Planning and Development, Maputo, 2009. of children.
20 21 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 1: POVERTY IN MOZAMBIQUE
References
1 United Nations Children’s Fund, Childhood 12 Ibid. Poverty in Mozambique: A situation and 13 Simler, Kenneth R., and Virgulino Nhate, trends analysis, UNICEF, Maputo, 2006. V., ‘Poverty, Inequality, and Geographic 2 National Institute of Statistics, ‘Statistics of Targeting: Evidence from Small-Area Mozambique’, Government of Mozambique, Estimates in Mozambique,’ Government of Maputo, retrieved from http://www.ine.gov. Mozambique, Maputo, March 2005. mz, accessed 30 October 2010. 14 National Institute of Statistics, ‘Inquérito 3 National Institute of Statistics, ‘MICS 2008, Integrado à Força de Trabalho (IFTRAB) Relatório Final,’ Government of Mozambique, 2004/05,’ Government of Mozambique, Maputo, 2010. Maputo, 2006.
4 Ministry of Planning and Development, 15 Ministry of Planning and Development, ‘Poverty and Wellbeing in Mozambique: Third ‘Poverty and Wellbeing in National Poverty Assessment’, Government of Mozambique: Third National Poverty Mozambique, Maputo, September 2010. Assessment,’Government of Mozambique, Maputo, September 2010. 5 Mozambique National Institute of Health, London School of Hygiene and Tropical 16 United Nations Children’s Fund, Childhood Medicine and UNICEF, Mozambique National Poverty in Mozambique: A situation and Childhood Mortality Study 2009, Government trends analysis, UNICEF, Maputo, 2006. of Mozambique, Maputo, 2009. 17 National Institute of Statistics,‘MICS 6 United Nations Committee on the Rights of 2008,Relatório Final,’ Government of the Child, Consideration of Reports Submitted Mozambique, Maputo, 2010. by States Parties Under Article 44 of the 18 Virgulino, Nhate, et al. Orphans and Convention: Concluding observations of Discrimination in Mozambique: An Outlay the Committee on the Rights of the Child Equivalence Analysis. Ministério da – Mozambique, CRC/C/MOZ/CO/2, Office of Planificação e Desenvolvimento, Maputo, the High Commissioner on Human Rights, October 2005. Geneva, October 2009. 19 Ministry of Planning and Development, 7 Ministry of Planning and Development, ‘Poverty and Wellbeing in Mozambique: ‘Relatório de Avaliação de Impacto do PARPA Third National Poverty Assessment,’ II’, Government of Mozambique, Maputo, 30 Government of Mozambique, Maputo, October 2009. September 2010.
8 Ministry of Planning and Finance, 20 Gordon, David, et al., ‘The Distribution of International Food Policy Research Institute, Child Poverty in the Developing World,’ and Purdue University, Poverty and Well- Centre for International Poverty Research, Being in Mozambique: The second national University of Bristol, and UNICEF, Bristol, July assessment, 2002–2003, Government of 2003. Mozambique, Maputo, 2004. 21 National Institute of Statistics, ‘Inquérito 9 Ministry of Planning and Development, de Indicadores Múltiplos 2008, Sumário,’ ‘Poverty and Wellbeing in Mozambique: Government of Mozambique, Maputo, Third National Poverty Assessment,’ retreived from: http://www.ine.gov.mz, Government of Mozambique, Maputo, accessed 30 October 2010. September 2010. 22 Mozambique National Institute of Health, 10 Ibid. London School of Hygiene and Tropical 11 Ibid. Medicine, and United Nations Children’s
22 23 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 1: POVERTY IN MOZAMBIQUE
Fund, Mozambique National Childhood 34 United Nations Children’s Fund, ‘Trends in Mortality Study 2009, Government of Child Poverty in Mozambique: A deprivations- Mozambique, Maputo, 2009. based approach,’ Ministry of Planning and Development, Government of Mozambique, 23 Ministry of Planing and Development, and UNICEF Mozambique, Maputo, 2009. ‘Relatório de Avaliação de Impacto do PARPA II,’ Government of Mozambique, Maputo, 30 35 National Institute of Statistics, ‘MICS 2008, October 2009. Relatório Final,’ Government of Mozambique, Maputo, 2010. 24 United Nations Children’s Fund, Childhood Poverty in Mozambique: A situation and 36 United Nations Children’s Fund, ‘Trends in trends analysis, UNICEF, Maputo, 2006. Child Poverty in Mozambique: A deprivations- based approach,’Ministry of Planning and 25 Government of Mozambique, ‘Action Plan for Development, Government of Mozambique, the Reduction of Absolute Poverty (2001- and UNICEF Mozambique, Maputo, 2009 2005),’ Government of Mozambique, Maputo, 2001. 37 United Nations Children’s Fund, Childhood Poverty in Mozambique: A situation and 26 Grupo 20, ‘Annual Poverty Report 2004,’ trends analysis, UNICEF, Maputo, 2006. Grupo 20, Maputo, 2004. 38 United Nations Children’s Fund, ‘Trends in 27 Government of Mozambique, ‘Plan of Action Child Poverty in Mozambique: A deprivations- for the Reduction of Absolute Poverty 2006- based approach,’ Ministry of Planning and 2009,’ Republic of Mozambique, Maputo, Development, Government of Mozambique, 2006. and UNICEF Mozambique, Maputo, 2009. 28 Gordon, David, et al., The Distribution of Child 39 Ibid Poverty in the Developing World, report to UNICEF, July 2003. 40 National Institute of Statistics, ‘MICS 2008, Relatório Final,’ Government of Mozambique, 29 United Nations, Report of the World Summit Maputo, 2010. for Social Development, United Nations, Copenhagen, 1995. 41 World Health Organisation, ‘Turning the tide of malnutrition: responding to the challenge 30 United Nations Children’s Fund, ‘Trends of the 21st century,’ WHO, Geneva, 2000. in Child Poverty in Mozambique: A deprivations-based approach,’ Ministry of 42 United Nations Children’s Fund, ‘Trends in Planning and Development, Government Child Poverty in Mozambique: A deprivations- of Mozambique, and UNICEF Mozambique, based approach,’ Ministry of Planning and Maputo, 2009. Development, Government of Mozambique, and UNICEF Mozambique, Maputo, 2009. 31 Ibid. 43 National Institute of Statistics, ‘MICS 2008, 32 Ministry of Planning and Development, Relatório Final,’ Government of Mozambique, ‘Poverty and Wellbeing in Mozambique: Third Maputo, 2010. National Poverty Assessment,’ Government of Mozambique, September 2010. 44 Austral Cowi, Revisão de Literatura sobre os Determinantes da Vulnerabilidade e 33 National Institute of Statistics, ‘MICS 2008, Tendências, United Kingdom Department for Relatório Final,’ Government of Mozambique, International Development, 2009. Maputo, 2010.
24 25 CHAPTER CHAPTER
The development 2 context 1. Introduction 2
This chapter describes the political, weakening of the role of domestic institutions social and economic context for human in governance. Budgetary and administrative development in Mozambique. Since the decentralisation is ongoing has and the signing of the Peace Agreement in 1992, potential to ensure that resources are Mozambique has experienced a period of equitably allocated to the provinces, strong, economic growth. Mozambique has taking human development indicators into a strong legal and policy framework that account. But this reallocation has not yet is rights-based and focused on economic been achieved. Provinces with the worst growth and poverty reduction. However, development indicators generally receive Mozambique is heavily dependent on lower budget allocations than provinces international cooperation and Official with better indicators. This chapter reviews Development Assistance, and the influence the recent history of Mozambique and gives of donors has raised concerns regarding brief economic and political overviews of the public accountability and potential current development context in Mozambique.
THE DEVELOPMENT CONTEXT 27 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 2: THE DEVELOPMENT CONTEXT
census data.6 The most recent census was since 2000 has been underpinned by strong 2. Transition to peace, democracy conducted in 2007, and results reveal that the investment in large projects, particularly in total population of Mozambique increased the minerals and mining sectors. Economic and market economy by 28 per cent between 1997 and 2007, growth has been accompanied by the equivalent to an annual rate of increase of development of a reasonably stable and 2.4 per cent. Maputo province recorded the predictable macroeconomic environment. In largest population increase in the period spite of the recent global financial crises, and Mozambique gained independence from President Armando Guebuza, who secured between the 1997 and 2007 censuses, the corresponding fuel and food costs crises, Portugal in 1975, but almost immediately an estimated 75 per cent of votes cast. The increasing by 52 per cent. The population Mozambique continued to have relatively entered a 16-year period of unrest newly formed Mozambique Democratic of Maputo City increased only slightly, as strong economic growth and a robust characterised by armed conflict between Movement, led by Daviz Simango, Mayor of much of the migration was to the developing macroeconomic structure. The growth of the Government, led by the Liberation Beira, won the most votes in the city of Beira. suburbs surrounding the city, rather than to the GDP in each one of the last five years Front of Mozambique (FRELIMO), and the The Election Observer Mission from the the city itself. The majority of the population was above 6.5 per cent. Per capita GDP has, Mozambican National Resistance (RENAMO). Southern African Development Community of Mozambique (almost 40 per cent) is however, fallen between 2008 and 200913 The social effects of the war were dramatic, Parliamentary Forum concluded that the concentrated in the two northern provinces with as many as one million people killed, 2009 elections “were a true reflection of the of Nampula (approximately 4 million Mega-projects are currently estimated to including an estimated 600,000 children. will of the people of Mozambique.”2 While inhabitants) and Zambezia (3.9 million).7 contribute more than 70 per cent of exports, More than one third of the population voter registration is consistently high, at compared to virtually none in the late was forced to abandon their homes, and around 80 per cent, voter turnout has fallen The population of Mozambique is 1990s. However, as a result of tax breaks, much public infrastructure was destroyed, from 88 per cent in the first national election overwhelmingly young. In 2007, of a the foreign-owned mega-projects still do particularly schools. Thousands of citizens to an estimated 42 per cent in 2009.3 total population of 20.5 million, half were not contribute significantly to Government were left disabled, and many suffered the children under the age of eighteen years revenue, limiting public finances and At the time the Peace Agreement was effects of starvation as well as psychological (10 million). Slightly more than half of the shifting the tax burden to small and medium 1 signed in 1992, Mozambique was ranked trauma. The two parties signed a General population are women, with a ratio of men businesses.14 The reliance on mega-projects among the poorest countries in the world, Peace Agreement in October 1992. The to women of 91:100. Population density in has also raised concerns among some according to both the United Nations country’s first presidential and legislative Mozambique is low, at around 26 inhabitants observers of a possible two-tiered economy Human Development Index and World Bank elections were held in October 1994, per square kilometre,8 and the population is in which “capital-intensive export sectors estimates of per capita Gross National resulting in the election of Joaquim predominantly rural (69 per cent). The size of continue to prosper without sufficient trickle- Product.4 Despite nearly two decades of Chissano as President of the Republic and an average household is estimated in urban down to the rest of the private sector and peace, political stability and strong economic the establishment of Mozambique’s first areas at 4.7 members and in rural areas at with little impact on poverty reduction.”15 growth, Mozambique remains one of the multi-party parliament, the Assembly of the 4.2 members, giving a national average of poorest countries in the world, ranking 165 Republic. 4.3.9,10 Dependency ratiosi were estimated in Mozambique has encouraged foreign of 169 countries in the terms of the Human 2006 at 72 per cent and 92 per cent for urban investment by adopting open-market Four successive rounds of general and Development Index.5 and rural areas respectively, with an overall policies, and it has created an investment presidential elections have now been held, national ratio of 85 per cent.11 environment more accommodating to large in which FRELIMO won both presidential and 2.1. Demographic trends investors than have many other African parliamentary majorities and RENAMO led countries. However, rigid labour laws an electoral union of opposition parties. The Official population figures and projections 2.2. Economic growth and and governance issues continue to affect fourth presidential election, held in October are produced by the National Institute macroeconomic stability Mozambique’s attractiveness to investors. 2009, resulted in victory for incumbent of Statistics, and are based on national Mozambique is a low-income economy, with This is reflected in the World Bank’s 2011 per capita Gross Domestic Product (GDP) ‘Doing Business’ report, which places Mozambique 126th out of 183 economies estimated at $US 453 million in 2009.12 GDP for ease of doing business.16 The African Table 2.1: Economic indicators, 2003–2009 growth averaged an impressive eight per cent annually during the period 1993–2009 Development Bank also comments on the (see Figure 2.1). Strong real GDP growth difficult business environment in the country, Indicator 2003 2004 2005 2006 2007 2008 2009 Real GDP growth (%) 6.5 7.9 8.4 8.7 7.3 6.8 6.4 Inflation (%) 13.5 12.6 6.4 13.2 8.2 10.3 3.3 GDP per capita (USD) 256.9 301.6 334.5 352.8 398.7 476.9 453.9 i Dependency ratios for households are estimated by adding the number of children aged 0–14 and the number of older Source: Republic of Mozambique, Report on the Millennium Development Goals, Government of Mozambique, Maputo, 2010. people aged 65 and above, and dividing this sum by the number of “active” people aged 15–64.
28 29 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 2: THE DEVELOPMENT CONTEXT
noting that domestic investors are faced with 2.3. Millennium Development Table 2.2: Progress towards the Millenniun Development Goals stifling regulation, corruption and poorly Goals functioning public monopolies.17 OBJECTIVES/TARGETS WILL THE GOAL/TARGET BE MET? In its fourth and most recent national EXTREME POVERTY AND HUNGER Probably Potentially Unlikely Without data Mozambique is Africa’s largest recipient of Millennium Development Goal (MDG) Reduce to half, by 2015, the proportion of people living under extreme poverty Potentially grants in terms of percentage of GDP, at progress report, in 2010, the Government more than 9 per cent of GDP in 2007. The of Mozambique reasserted its commitment Ensure, by 2015, decent work for all, including women and young people Without data Government of Mozambique, in its Medium- to achieving the targets.ii The Government Reduce by half, by 2015, the proportion of people who suffer from hunger Potentially Term Expenditure Framework (MTEF 2010- noted that the country has “continued to UNIVERSAL PRIMARY EDUCATION 1012), estimates that external resources record significant progress,” highlighting Ensure that, by 2015, all boys and girls will be able to complete a full comprised 47 per cent of the state budget in the “expansion of health and education Potentially 18 course of primary schooling 2010. To reduce this dependency on Official services.”20 Overall, Mozambique is GENDER EQUALITY Development Assistance, the country has considered likely to achieve four of the 21 begun reforming its tax policy, expanding its Eliminate, preferably by 2005, gender disparity in primary and secondary targets, has potential to reach an additional Probably education, and by 2015 in all levels of education. fiscal base and improving the collection of nine targets and is unlikely to reach one customs duties. Tax revenue accounted for target. Progress towards seven targets could CHILD MORTALITY 17.8 per cent of GDP in 2009, up from 13.0 not be assessed due to lack of data. Progress Reduce by two thirds, by 2015, the under-five mortality rate. Probably per cent in 2003.19 is summarised in Table 2.2. MATERNAL HEALTH Reduce by three quarters, by 2015, the maternal mortality ratio Without data Achieve, by 2015, universal access to reproductive health. Potentially HIV/AIDS, MALARIA AND OTHER DISEASES Have halted, by 2015, and begun to reverse the spread of HIV/AIDS Potentially Achieve, by 2010, universal access to HIV/AIDS treatment for all those who Unlikely need it Have halted, by 2016, and begun to reverse the incidence of malaria and Probably other major diseases ENIVRONMENTAL SUSTAINABILITY Integrate the principles of sustainable development into national policies and Potentially programmes and reverse the loss of environmental resources Reduce the loss of biodiversity, achieving, by 2010, a significant level Without data Reduce to half, by 2015, the number of people without access to safe Potentially drinking water and sanitation By 2020, to have achieved a significant improvement in the standard of Potentially living of the slum dwellers GLOBAL PARTNERSHIP FOR DEVELOPMENT Develop further an open, rule-based, predictable, non-discriminatory trading and financial system. This includes a commitment to good governance, Potentially development and poverty reduction – both nationally and internationally Address the special needs of the least developed countries Without data Address the special needs of landlocked developing countries and small island developing States and the outcome of the twenty-second special Without data session of the General Assembly of the UN Deal comprehensively with the debt problems of developing countries through nation and international measures in order to make debt Without data sustainable in the long term ii At the 55th Session of the United Nations General Assembly in 2000, 189 of the world’s countries and many leading In cooperation with pharmaceutical companies, provide access to Without data development institutions committed to The Millennium Declaration, a reaffirmation by world leaders of their collective affordable essential drugs in developing countries. responsibility to support the principles of human dignity, equality and equity at a global level. The Millennium Declaration established a new global partnership to reduce extreme poverty and defined a series of time-bound targets In cooperation with the private sector, make available the benefits of new Probably with a deadline of 2015. These targets have subsequently become known as the eight MDGs. Twenty-one targets and 60 technologies, especially information and communications indicators are associated with the eight MDGs. Source: Republic of Mozambique, Report on the Millennium Development Goals, Government of Mozambique, Maputo, 2010.
30 31 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 2: THE DEVELOPMENT CONTEXT
2.4. Decentralisation establishes the district as a budgetary unit study also revealed significant differences Much of the local government reform that with power to plan and define its priorities. between the decentralisation processes has taken place to date has focused on Decentralisation is considered to be a driver The district development plan is legally in the two provinces visited (Nampula decentralising administrative functions for poverty reduction, as it encourages recognised as the principal instrument and Gaza). Differences were observed in (often termed ‘deconcentration’), some fiscal democracy, popular participation, for planning and budgeting. Community relation to planning criteria, definition elements of the public sector, and most responsiveness, accountability and equity consultation and participation is encouraged of priorities, allocation of resources and notably planning and budgeting processes. at the local level. Decentralisation can through district consultative councils, which financial flows. These differences could Democratic decentralisation remains a distant give a voice to poor citizens and enhance are given a role in the preparation, approval at least partly be explained by differences prospect, and district participatory planning their access to Government structures. In and implementation of the plans at district in the level of experience in managing apart, accountability in the district tends to addition, it is assumed that local authorities level. The district consultative councils offer decentralisation processes between the two flow upwards to provincial and national level better understand their situation and a potential avenue through which the voices provinces.39 rather than downwards to local people. populace than central authorities, and so of children can be heard and their rights can more effectively target poverty-reducing realised. investments. Decentralisation is a priority within the Five-Year Plan 2010-14. Since 2006 the Government has allocated approximately seven million Meticais to The decentralisation process in each district for investments in job creation Mozambique dates back to the adoption of and promotion of the private sector. This the constitution in 1990, which establishes has provided a strong incentive to improve State Local Bodies. Law 2/1997 establishes systems to ensure that these monies are municipalities as territorial units with their effectively spent on local development own representative bodies (municipal projects. At its 17th Ordinary Session in assemblies) and executive organs (the 2007, the council of ministers decided municipal council). The municipal assembly to decentralise funding for roads, water, is composed of directly elected members. agriculture, and health and education The municipal council comprises the mayor infrastructures as a step towards effective and town councillors. Decree 15/2000 implementation of Law 8/2003 and recognises community authorities as the achievement of the strategic objectives of link between civil society and Local State PARPA II and the Five-Year Plan. Bodies and describes several duties of the recognised community authorities, A study commissioned for the PARPA II including: (i) disseminating Government evaluation concluded, “(1) decentralisation laws and policies to community members; of sectoral funds has not yet been effective; (ii) collecting taxes; (iii) registering the (2) involvement of planning institutions population; (iv) enforcing justice; and (v) and community consultation is effective; mobilising and organising communities for (3) the accounting systems are complex, local development activities. Community slow and counterproductive; (4) the authorities receive a monetary incentive for monitoring and evaluation system at the the taxes they collect. National guidelines district level would benefit from further for district development plans (adopted improvement; (5) maintenance capacity in 2003) reinforce the role of the districts at district level requires strengthening; (6) as units for planning and budgeting and the private sector is only weakly involved allow for the creation of local consultative in provision of services; (7) institutional councils to act as an interface between civil divergence exists in relation to application society and the district authorities in the of legislation; (8) the criteria for allocation planning process. of sectoral funds are inconsistent and not well known; and (9) at district level, Law 8/2003iii defines the structure and a multisectoral perspective is lacking, as organisation of State Local Bodies and is a systematic planning process.” The
iii Lei dos Órgãos Locais do Estado (LOLE).
32 33 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 2: THE DEVELOPMENT CONTEXT
3. Policy and institutional analysis Box 2.1. Planning and budgeting instruments in Mozambique 1. The PRSP (PARPA or PARP) is based on the Government’s Five-Year Plan (Programa Quinquenal do Governo) and the Sectoral Strategic Plans (Planos Estratégicos Sectoriais) and 3.1. Policy and planning and human capital. Cross-cutting issues, presents the policies, objectives, goals and expected results towards the reduction of absolute mechanisms including gender, HIV and AIDS, environment, poverty in the country over a five-year period. food and nutritional security, and natural National-level planning in Mozambique disasters, were mainstreamed throughout 2. The Strategic Sectoral Plans are medium-term planning instruments designed to harmonise is guided by the Government’s Five-Year the document. PARPA II was considerably global government policies with sectoral policies. They are aligned with the Programa Programme. A Five-Year Plan (Programa more child-friendly than PARPA I, setting Quinquenal and detail the strategies that will drive achievement of the Government’s objectives. time-bound and quantifiable targets for the Quinquenal do Governo) is produced by 3. The Medium-Term Expenditure Framework (Cenário Fiscal de Médio Praso) is a medium-term further realisation of child rights, many of each new Government upon entering planning instrument used to allocate available financial resources according to the priorities iv which contribute directly towards attaining office and establishes the Government’s outlined in PARPA and the Sectoral Strategic Plans. priorities and operational agenda until the the MDGs. next general election. The Five-Year Plan is 4. The Economic and Social Plan (Plano Económico e Social) is the annual planning instrument in the central long-term planning instrument PARPA II focused on key sectors and which the principal economic and social objectives and goals for the fiscal year are set out. that sets out the central priorities and strategies for economic growth and objectives of the Government and describes poverty reduction and gave greater detail 5. The State Budget (Orçamento do Estado) is the financial expression of the Economic and Social the specific strategies for achieving them. on resource allocation and the setting of Plan. The current Five-Year Plan 2010–2014 has time-bound targets for monitoring and evaluating performance. PARPA II reaffirmed 6. The Provincial Strategic Plan (Plano Estratégico Provincial) is a medium-term planning instrument the central objective of reducing absolute that describes the strategies for development at the provincial level, and takes its lead from poverty to improve the living conditions of the Government’s commitment to providing social services, but also prioritised the the national objectives contained in the Programa Quinquenal. The Provincial Strategic Plan is the Mozambican people in an environment translated into an annual provincial Economic and Social Plan and a Provincial Budget, both of of peace, harmony and tranquillity. The promotion of private sector development as a means of sustaining economic growth, which are submitted to the Ministry of Planning and Development for final approval. The Provincial Five-Year Plan addresses: human and social Budget is then incorporated into the State Budget. development, good governance, economic reducing poverty and, in the long term, development, and strengthening national generating domestic sources of foreign 7. The District Development Strategic Plan (Plano Estratégico de Desenvolvimento Distrital) is a sovereignty and international cooperation, exchange, increasing revenues and reducing medium-term planning instrument that describes district-level development strategies. These plans as well as the cross-cutting issues of de- aid dependency. PARPA II was subjected to a are developed by the district governments with technical support from the provinces and with the mining, environment, vulnerability, HIV and joint impact evaluation by Government and participation of local communities. District Development Strategic Plans are implemented through AIDS, gender, food and nutritional security, partners in October 2009,23 which concluded annual Social and Economic Plans and Budgets (Plano Económico e Social e Orçamento Distrital). and rural development. that while there had been significant progress in implementing the objectives of the 8. The District Economic and Social Plan and Budget is the annual planning instrument that puts into The PARP is the key instrument for putting human capital pillar, especially in terms of operation the District Strategic Development Plan (Plano Estratégico Distrital de Desenvolvimento) the Government’s Five-Year Plan into expanding access to basic services, not all and includes an estimate of expected district revenues and expenditures for the year. operation. Mozambique has to date produced established targets were met. Areas in which two Plans of Action for the Reduction of insufficient progress was registered included: Absolute Poverty or PARPAs (PARPA I 2001– health service coverage, ensuring quality of sets out the financial resources necessary national planning framework. Preparation 2005 21 and PARPA II 2006–2009).22 PARPA II education services, improving use of water for the implementation of the objectives of of Sectoral Strategic Plans is not subject to reflected the goals and objectives of regional, and sanitation services, and reaching the the Five-Year Plan and PARPA. The Medium- a prescribed methodology, and different African and international agreements, poor with social protection programmes. It is Term Expenditure Framework (MTEF) sectors use different approaches. including the MDGs, the New Partnership for expected that Mozambique’s third generation also contributes to ensuring fiscal and the Development of Africa and the Southern Poverty Reduction Strategy Paper (the PARP) budgetary aggregate discipline. Together, The annual planning cycle commences with African Development Community. It was will be finalised in early 2011. PARP and MTEF are the planning and the preparation of the MTEF in February. A developed within the overall structure of the budgetary instruments that jointly support final version of the MTEF is made available by national vision document “Agenda 2025,” and The Medium-Term Expenditure Framework harmonisation of national policies and April/May as a contribution to the next phase comprised four pillars: macro economy and (Cenário Fiscal de Médio Prazo)24 is a priorities and set out the resources necessary of the cycle: budget preparation. Sectoral, poverty, governance, economic development medium-term planning instrument that for their implementation over the medium provincial and district plans and budget term. National plans are complemented by proposals have to be submitted by end of July. sectoral, provincial and district plans (see These plans are consolidated into the national Figure 2.1), which together with PARPA Economic and Social Plan and State Budget iv Article 198 of the Constitution mandates that parliament should develop the Five-Year Plan at the initiation of the legislature. and the MTEF constitute the medium-term for submission to the Council of Ministers by
34 35 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 2: THE DEVELOPMENT CONTEXT
15 September, then passed to the Assembly The State Budget is the financial expression PARPA II Monitoring and Evaluation Strategy à Força de Trabalho [IFTRAB]) are used to of the Republic by 30 September, for final of the Economic and Social Plan and is aimed to develop an integrated national quantify output and outcomes. The irregularity approval by 15 December. approved by the Assembly of the Republic. monitoring and evaluation system, operating of surveys and lack of coordination between The SISTAFE Law (No. 9/2002, 12 February) as a routine component of the planning the medium-term planning cycle and relevant The State Budget and the Economic and requires that information on the execution of process. It established a matrix of strategic surveys have constrained the effective Social Plan translate PARP into annual the Economic and Social Plan be presented indicators that is more extensive than the monitoring of PARPA. plans.25 The Economic and Social Plan is the to the Assembly of the Republic twice yearly. Performance Assessment Framework matrix annual embodiment of the Government’s and is reported on in the Economic and Social Despite enormous progress in monitoring Five-Year Plan and PARPA. A system of monitoring and evaluation Plan and its associated review report. PARPA and evaluation in Mozambique in recent exists for the State Budget, with reports II also introduced a distinction between years, weaknesses remain as a consequence 3.2. Monitoring and Evaluation published quarterly and annually. The medium-term, results-based indicators and of the lack of consolidation of a multitude State Budget is monitored internally by the annually measured, product-based indicators. of processes and methodologies, according No single explicit source of normative Ministry of Finance through the State Budget The Monitoring and Evaluation Framework to a study commissioned by the Ministry of guidance on planning, monitoring and Execution Report (Relatório de Execução of the Five-Year Plan 2010-14, the PARP, is Planning and Development in 2008.26 At the evaluation processes exists in Mozambique. do Orçamento do Estado) and externally currently under development. central level, three distinct systems exist for Rather, this guidance can be found dispersed via an audit of the Consolidated State monitoring and evaluating the Economic and across the constitution, in the law relating Accounts (Conta Geral do Estado) by the PARPA is also evaluated by means of Social Plan, PARPA and the Sectoral Strategic to SISTAFE (Financial Administration Administrative Tribunal. mid-year and annual joint donor reviews Plans. These national systems are in turn System of the State) and in the statute and a final impact evaluation (Relatório supported by a multitude of sectoral and that created the Ministry of Planning and The need to monitor implementation de Avaliação de Impacto) that assesses provincial systems that have not benefited from Development. Mozambique’s constitution and impact of PARPA I necessitated the progress in each of the pillars and in the a consistent methodology or standardisation. establishes the Economic and Social Plan as development of a Monitoring and Evaluation cross-cutting thematic areas across the There are multiple demands for monitoring the principal planning instrument, and this framework. A concise version of this lifetime of PARPA. The Joint Review (Revisão and evaluation information from a variety of is aligned with the Government’s Five-Year framework, known as the Performance Conjunta) is the mechanism through which sources, both internal and external, and this Programme. The constitution requires that Assessment Framework, was adopted as an Government, donors and civil society places a significant burden on the systems. the Economic and Social Plan be developed annual monitoring and evaluation tool for evaluate implementation of PARPA, with a District planning instruments and processes using a decentralised planning process. General Budget Support (see below). The focus on the Economic and Social Plan, the including the District Economic and Social State Budget and their associated monitoring Plan, district budgets and adoption of the Law instruments (the Balanço do PES and the on Local State Organs (Lei dos Órgãos Locais Figure 2.1: Planning instruments in Mozambique Relatório de Execução do Orçamento do do Estado [LOLE]) have been developing at Estado). The joint review of Government pace, in line with decentralisation strategies; Goverment Five-Year Plan and donor performance takes place in April however, there has not been a concomitant each year and reviews performance over development of instruments and processes for the previous year. The Mid-Year Review (or monitoring and evaluating implementation of planning meeting) takes place in September these plans. The use of participatory processes Medium Term Instruments Harmonisation and focuses on setting targets for the in monitoring and evaluation in Mozambique is of Sectoral and following year and indicating whether key relatively new and somewhat underdeveloped. PARPA Sectoral & Provincial Social and Economic Plan targets in the Performance Assessment Provincial Targets Much of the monitoring and evaluation Strategic Framework are likely to be achieved. The Plans joint review meeting also evaluates the activity carried out in Mozambique contributions of the Programme Aid Partners appears to be in response to requests for Annual in achieving results in accordance with the information from external partners or higher Resource Priorisation of administrative centres rather than providing Instructions allocation to Policies-Actions principles of the 2005 Paris Declaration on Harmonisation input for policy making. Making General on how priorities and Measures Aid Effectiveness. PARPA monitoring data between to affect are primarily collected through sectoral Budget Support disbursement conditional Policies, resources to contributions that quantify the input of the on performance against the Performance Strategies and priorities sectors. Surveys, including the Demographic Assessment Framework indicators may Objectives and Health Survey, MICS, Inquérito aos have created incentives for sectors to set conservative, easily attainable targets and to MTEF State Budget Agregados Familiares, the Core Welfare Indicators Questionnaire (Questionário de prioritise actions that respond to the narrow Source: Government of Mozambique, ‘Plan of Action for the Reduction of Absolute Poverty 2006-2009,’ Republic of Mozambique, Indicadores Básicos de Bem-Estar), and the scope of these indicators in order to maintain Maputo, 2006. Labour Force Survey (Inquérito Integrado external funding.
36 37 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 2: THE DEVELOPMENT CONTEXT
3.3. Legal framework incompatibilities existed between the Convention and the domestic legal order. At 4. External development assistance The constitution of Mozambique was the same time, the need to improve internal approved and enacted in November 1990 regulations relating to the rights of the child Mozambique is Africa’s single biggest emphasis is now on sector Common Funds and revised in 2004. The constitution acts was recognised. recipient of international development and General Budget Support mechanisms as the fundamental law for all political and assistance. The United Kingdom is the that give increased flexibility to the The Government has also acceded to the social organisations in the country. Under single largest bilateral source of aid to Government in terms of how it allocates the two Optional Protocols to the Convention Article 62 of the constitution, Mozambique Mozambique.27 Increases in the amounts of money received. General Budget Support on the Rights of the Child on the sale accepts, observes and applies the principles Official Development Assistance committed should also reduce the Government’s burden of children, child prostitution and child of the Charter of the United Nations and by developed countries are generally of monitoring, evaluating and reporting for pornography and on the involvement of the Charter of the Organisation of African considered to be positive, and the United multiple external funding sources. PARPA 36 children in armed conflict, in 2003 and 2004 Unity. Nations advocates an allocation of 0.7 per II supports the use of more flexible funding respectively. In addition to the Convention cent of GDP from developed countries. modes, and of General Budget Support in Mozambique ratified the United Nations on the Rights of the Child, Mozambique However, concentration of large amounts of particular, and states, “although the ideal Convention on the Rights of the Child has also ratified the African Charter on the overseas aid in certain countries raises the balance between aid modalities will probably without reservation, and the Convention Rights and Welfare of the Child and other issue of aid dependency. The Committee contain a mixture of them, the Government was incorporated into the country’s internal international legal instruments dealing with on the Rights of the Child, in its concluding wishes that the proportion of funds legal structure following its publication in the development and welfare of children. observations on Mozambique’s Second channelled through the Public Treasury the Government Gazette on 23 October Immediately after national independence Periodic Report,28 notes with concern that Accounts, principally through General 1990.37 Prior to its ratification, the Convention and before the Convention on the Rights despite the commendable economic growth Budget Support …be increased.”32 was studied by national institutions, of the Child, Mozambique adopted its own sustained over the last decade, the State including the Supreme Court, the Attorney Declaration on the Rights of the Mozambican Party continues to be heavily dependent The move towards harmonisation, General’s Office, the Ministries of Justice, Child, containing a set of 12 basic rights.38 on international cooperation, noting that a alignment and the use of increasingly Education and Health and other relevant Domestic legislation concerning the rights of significant proportion of the national budget flexible aid modalities has been led in sectors, and it was concluded that no major children is discussed in Chapter 5. came from development cooperation. Mozambique by the Programme Aid The International Poverty Centre argues Partners (Parceiros de Apoio Programático) that a large and sustained flow of Official group. The Programme Aid Partners (PAPs), Development Assistance into a country can otherwise known as the Group of 19 or shift the focus of accountability away from ‘G19’, comprises 19 bilateral and multilateral state and society and onto the relationship donorsv that provide General Budget between the Government and the aid Support. The Government of Mozambique donors, thereby weakening the role of and PAPs first signed a Memorandum domestic institutions in governance.29 Other of Understanding in 2004, in which the commentators have taken a more extreme principles for the partnership were defined view, asserting that because of the budget and commitments to improving the quality support process, donor representatives of Programme Aid were established. A are now at the heart of decision-making second Memorandum of Understanding was processes within Government.30 signed in March 2009. The overall objective of PAPs’ Budget Support to Mozambique is to contribute to poverty reduction in all its 4.1. Aid coordination dimensions. Furthermore, the Memorandum Within the context of heavy aid dependency, of Understanding states, “The PAPs’ Budget there have been moves towards increased Support should help attain the mutual harmonisation and alignment of external objectives of poverty reduction and the assistance in recent years, particularly MDGs in Mozambique by providing budget following PARPA II and the 2005 Paris financing to the public sector for poverty Declaration on Aid Effectiveness.31 The reduction, aligned with Mozambican
v The 19 partners are: the African Development Bank, Belgium, Canada, Denmark, the European Commission, Finland, France, Germany, the Netherlands, Ireland, Italy, Norway, Portugal, Spain, Sweden, Switzerland, the United Kingdom, the World Bank, and Austria. The United States of America and the United Nations joined as Associate Members in 2009.
38 39 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 2: THE DEVELOPMENT CONTEXT
systems and clearly and transparently process, lead to costly and unnecessary ll Continued and accelerated expansion ll Campaigns to expand school construction linked to performance.”33 Direct Budget duplication of reporting, and ultimately of access to, and quality of, paediatric in all districts, using both community– Support also provides an important avenue weaken the executive’s accountability to treatment, voluntary counselling based or local labour and outsourced for coordinated and harmonised dialogue Parliament. The problem of off-budget and testing as part of antenatal contractors. between Government and donors on funding is most severe in the social services care programmes, and drugs for The longer-term benefits of reforming how development policies and public spending and infrastructure sectors since they are the the prevention of mother-to-child choices. largest recipients of external aid. external development assistance is delivered transmission of HIV; are widely accepted by Governments of PAPs pledges for General Budget Support The Committee on the Rights of the Child, in ll Use of funding targeted to AIDS developed and developing countries, as in 2009 amounted to $US 485 million, and its concluding observations on Mozambique, programmes as an entry point for evidenced by the 2005 Paris Declaration pledges for 2010 total $US 472 million.34 recommends to the State Party that when allocating resources to the wider health on Aid Effectiveness and the 2008 Accra According to the MTEF 2010–2012, external negotiating development cooperation, and sector, strengthening expansion of Agenda for Action. However, both processes, funding accounts for approximately 44 per particularly any increases, funding should be facilities and improving quality of care; both moving away from existing bilateral cent of the total State Budget, rising to 47 targeted to programmes that can deliver the arrangements, which have substantial ll Large-scale social protection schemes and per cent in 2010 and 48 per cent in 2011 and quickest or highest impact in implementing components of ‘off budget’ and project- cash transfer programmes; 2012 (see Table 2.3). the rights of the child.35 In particular, priority based funding, and developing the capacity should be given to: ll Expanded rural and peri-urban water and of national governments, are likely to take sanitation programmes, building on rural several years for full implementation. 4.2. Implications for children ll Large-scale programmes that deliver water and sanitation initiatives such as the Capacity development is a key area that clear benefits for children, such as ‘One Million Initiative’; and has been neglected in harmonisation and Knowledge of the full extent of the available comprehensive distribution of long- resource envelope is vital to ensuring alignment reforms. lasting, insecticide-treated nets; policy-driven allocation of public funds for children. Off-budget funding, or funding ll Large-scale health outreach programmes, that is fully or partially outside the formal including structured use of national Child budget process, undermines Government Health Weeks to increase vaccination efforts to prioritise, plan, budget, monitor coverage, micronutrient supplementation and evaluate effectively. Off-budget funds and preventive care at the community also damage the credibility of the budget level;
Table 2.3: Internal and external funding in the State Budget, 2009 – 2012 (in Millions of Meticais, assuming GDP growth of 6.1 per cent)
2009 (adjusted) 2010 2011 2012 Internal resources State receipts 43,100 49,981 56,826 64,230 Privatisation 1,044 Internal credit 5,721 2,449 -1,595 -2,923 Total Internal 49,865 52,430 55,231 61,307 External resources Donations 31,991 34,770 37,488 40,368 Credits 7,148 11,673 14,171 17,304 Total External 39,139 46,443 51,659 57,672 Total Internal + External 89,004 98,873 106,890 118,979 Internal resources as % of total 0.56 0.53 0.52 0.52 External resources as % of total 0.44 0.47 0.48 0.48
Source: Ministry of Planning and Development and Ministry of Finance, Cenário Fiscal de Médio Prazo 2010–2012, Government of Mozambique, Maputo, September 2009.
40 41 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 2: THE DEVELOPMENT CONTEXT
5. Conclusions References
1 United Nations Committee on the Rights of Economic Co-operation and Development, the Child, Consideration of Reports Submitted African Economic Outlook 2009, retrieved Despite a successful transition to peace, of heavy aid dependency, there have been by States Parties Under Article 44 of the from http://africaneconomicoutlook.org, 2009. years of steady economic growth and a moves towards increased harmonisation Convention, Initial report of States Parties 15 set of institutional processes focused on and alignment of external assistance in due in 1996, Mozambique, CRC/C/41/Add.11, Standard & Poor’s, Ratings Direct, development, Mozambique continues to be recent years, particularly following PARPA United Nations, Geneva, 14 May 2001. Mozambique, 4 February 2009, retrieved one of the poorest countries in the world, II and the 2005 Paris Declaration on Aid from: http://www.standardandpoors.com/ 2 Mozambique News Agency, ‘Guebuza and ranking 165 of 169 on the 2010 Human ratingsdirect, 2009. Effectiveness. An over reliance on aid may Frelimo win landslide victory,’ retrieved 16 Development Index. Since the signing of shift Government accountability away from from: http://www.poptel.org.uk/mozambique- The International Bank for Reconstruction the Peace Agreement in 1992, Mozambique state and society to focus instead on aid news/newsletter/aim389.html, accessed 9 and Development, Doing Business 2011, has made progress against a number of donors, weakening the role of domestic November 2009. Mozambique: Making a difference for indicators relating to child well-being in institutions such as Parliament. Entrepreneurs, World Bank and the 3 Mozambique. Further investment is needed Hanlon, Joseph, ‘Mozambique: ‘the war International Finance Corporation, 2010. ended 17 years ago, but we are still poor,’ if the country is to reach many of the MDGs. The Government’s Five-Year Plan and its 17 Conflict, Security & Development, 10:1, 2010, African Development Bank Group and the Mozambique is currently considered likely to operational plan, the PARP, focus national pp. 77-102. Development Centre of the Organisation for achieve only four of the 21 targets, with the development priorities on human and Economic Co-operation and Development, potential to reach another nine. social development along with other areas 4 World Bank, World Development Report 1997: African Economic Outlook 2009, retrieved of economic and political development. In The state in a changing world, World Bank, from http://africaneconomicoutlook.org, 2009. The fiscal environment is one of heavy order to best make progresses towards the Washington, D.C., 1997. 18 Ministry of Planning and Development aid dependence. According to the MTEF goals laid out in the Government’s planning 5 United Nations Development Programme, and Ministry of Finance, Cenário Fiscal de 2010–2012, external funding accounts for and budgeting instruments, further efforts ‘International Human Development Médio Prazo 2010–2012, Government of approximately 44 per cent of the total State are needed towards consolidating national Indicators,’ retrieved from: http://hdr.undp. Mozambique, Maputo, September 2009. Budget, rising to 47 per cent in 2010 and 48 planning, monitoring and evaluation org/en/statistics, accessed 21 November 2010. per cent in 2011 and 2012. Within the context frameworks. 19 USAID, PARPA II review. The tax system in 6 National Institute of Statistics, ‘Statistics of Mozambique, Maputo, September, 2009. Mozambique,’ Government of Mozambique, 20 Maputo, retrieved from http://www.ine.gov. Government of Mozambique, Report on the mz, accessed 30 October 2010. Millennium Development Goals, Government of Mozambique, Maputo, 2010. 7 Ibid. 21 Government of Mozambique, Plano de Acção 8 Ibid. para a Redução da Pobreza Absoluta (2001– 9 National Institute of Statistics, ‘Inquérito 2005), Government of Mozambique, Maputo, Integrado à Força de Trabalho (IFTRAB) 2001. 2004/05,’ Government of Mozambique, 22 Government of Mozambique, Plano de Acção Maputo, 2006. para a Redução da Pobreza Absoluta (2006– 10 National Institute of Statistics, ‘Statistics of 2009), Government of Mozambique, Maputo, Mozambique’, Government of Mozambique, 2006. Maputo, retrieved from http://www.ine.gov. 23 Ministry of Planning and Development, mz, accessed 30 October 2010. Relatório de Avaliação de Impacto do PARPA 11 National Institute of Statistics, Mozambique II, Government of Mozambique, Maputo, 30 Third Population and Housing Census, October 2009. Government of Mozambique, Maputo, 2007. 24 Ministry of Planning and Development 12 Government of Mozambique. Report on the and Ministry of Finance, Cenário Fiscal de Millennium Development Goals, Government Médio Prazo 2010–2012, Government of of Mozambique, Maputo, 2010. Mozambique, Maputo, September 2009.
13 Ibid. 25 Government of Mozambique, Orçamento do 14 African Development Bank Group and the Estado, Government of Mozambique, Maputo, Development Centre of the Organisation for 2009.
42 43 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 2: THE DEVELOPMENT CONTEXT
26 Ministry of Planning and Development Provision of General Budget Support’, and USEC Inc., Estudo sobre o Ciclo de Government of Mozambique, Maputo, March Planeamento, Monitoria e Avaliação, 2009. Government of Mozambique, Maputo, 2008. 34 Programme and Partnership Mozambique, 27 Economist Intelligence Unit, Country Report ‘Financial Contributions’, retrieved Mozambique, Economist Intelligence Unit, from: http://www.pap.org.mz/financial_ London, May 2009. contributions.html, 2010.
28 United Nations Committee on the Rights of 35 United Nations Committee on the Rights of the Child, Consideration of Reports Submitted the Child, Consideration of Reports Submitted by States Parties Under Article 44 of the by States Parties Under Article 44 of the Convention: Concluding observations of Convention: Concluding observations of the Committee on the Rights of the Child the Committee on the Rights of the Child – Mozambique, CRC/C/MOZ/CO/2, Office of – Mozambique, CRC/C/MOZ/CO/2, Office of the High Commissioner on Human Rights, the High Commissioner on Human Rights, Geneva, October 2009. Geneva, October 2009.
29 Virtanen, Pekka, and Dag Ehrenpreis, ‘Growth, 36 Government of Mozambique, Constituição Poverty and Inequality in Mozambique’, da República, Government of Mozambique, Country Study No. 10, International Poverty Maputo, 19 November 2004. Centre, New York, September 2007. 37 United Nations Committee on the Rights of 30 Hanlon, Joseph, ‘Mozambique: ‘the war the Child, Consideration of Reports Submitted ended 17 years ago, but we are still poor’’, by States Parties Under Article 44 of the Conflict, Security & Development, 10: 1, 2010, Convention: Initial report of States Parties pp. 77-102. due in 1996 – Mozambique, CRC/C/41/Add.11, Office of the High Commissioner on Human 31 ‘High Level Forum on Aid Effectiveness, Rights, Geneva, 2001. ‘Paris Declaration on Aid Effectiveness,’ Organisation for Economic Cooperation and 38 Ibid. Development, Paris, 2005. 39 Kulipossa, Fidelx Pius, and Eduardo Jossias 32 Government of Mozambique, Plano de Acção Nguenha, Relatório Final da Pesquisa sobre para a Redução da Pobreza Absoluta (2006– o Impacto da Descentralisação dos Fundos 2009), Government of Mozambique, Maputo, Sectoriais de Estradas, Águas e de Construção 2006. Acelerada de Salas de Aulas nas Províncias, nos Distritos e nas Autarquias Locais, 33 ‘Memorandum of Understanding between the Government of Mozambique, Maputo, 2009. Government of the Republic of Mozambique and the Programme Aid Partners on the
44 45 CHAPTER CHAPTER Child survival and development
3 1. Introduction 3
The rights of every child to life, survival and Child survival is a major development development are enshrined in the United priority, both internationally and Nations Convention on the Rights of the within individual countries. Millennium Child. Despite the commitments of nations Development Goal Four has as its target throughout the world, almost 10 million a two-thirds reduction in the under- children continue to die every year, with the five mortality rate between 1990 and majority of child deaths occurring in just 60 2015. Beyond the desirability of meeting developing countries.1 Around 40 per cent international development targets, of child deaths occur during the child’s first improving child survival and health is a month of life, usually in the child’s home and crucial investment for future development often because there is no access to health and prosperity of nations. Well-nourished, services and basic health commodities.2 well-cared-for, healthy children are more Many children die as a result of contracting likely to survive and develop into healthy easily preventable or treatable illnesses and and productive adults able to make a conditions, including diarrhoeal infections, meaningful contribution to the social and measles, malaria and pneumonia, among economic development of their families, others. In up to half of deaths of children communities and nations. Investing in the under five, undernutrition is an underlying survival and good health of children is cause.3 Unsafe water, poor sanitation and also cost-effective. The interventions with inadequate hygiene also contribute to child the strongest impact on the prevention of mortality and morbidity. Water, sanitation child death are appropriate infant feeding and hygiene are closely linked to childhood practices (preventing 19 per cent of deaths) undernutrition.4 Research dating back to and the use of insecticide-treated materials 1968 has confirmed the deleterious effect (preventing 7 per cent). The most effective of diarrhoea on children’s nutritional status. treatment interventions are the use of oral Eighty-eight per cent of all cases of diarrhoea rehydration therapy (resulting in a 15 per globally are attributable to water, sanitation cent reduction in child mortality if applied and hygiene.5 Ascaris (roundworm), Trichuris universally), and the use of antibiotics for (whipworm) and hookworm infestation are sepsis and pneumonia (each preventing 6 attributable to inadequate sanitation and per cent).8 hygiene.6 More recent evidence has provided guidelines to prevent and treat these Cost-effective solutions are available illnesses (e.g. promotion of breastfeeding, that could bring rapid improvements, but supplementation of micronutrients).7 urgency and commitment are required CHILD SURVIVAL AND DEVELOPMENT 47 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
to implement them and to meet the safe motherhood; newborn care; and child Millennium Development Goals (MDGs) survival, growth and development, all 2. Health and nutrition related to maternal and child health.10 delivered within a legal, institutional, and Maternal mortalityi has generally received community and family environment that less attention from national governments upholds and respects women’s rights. 2.1. Child survival the 22nd highest under-five mortality rate in and the international community than child the world.13 Furthermore, the improvement The emerging trends in under-five mortality, mortality, and as a result successes have The principal indicator used to measure the in child survival rates has been unevenly as in other indicators of children’s well- been more elusive. However, a growing level of child well-being in a country is the distributed across the country; children and being in Mozambique, show persistent body of research evidence shows that the under-five mortality rate. The under-five women in some provinces have benefited geographical disparities. The northern part necessary tools to make an impact in this mortality rate results from many factors: the less than those living in other provinces. of the country and rural areas are still far previously neglected area are available. It is nutritional status and health knowledge of The AIDS pandemic is increasingly taking its behind the southern parts of the country and estimated that 80 per cent of maternal deaths mothers; childcare practices; the availability, toll on children’s lives and could negatively urban areas (despite marked improvements could be averted if women had access to use and quality of maternal and child health affect the recent encouraging trend. essential maternity services and basic health in both urban and rural areas). Though there services; income and food availability in care.11 There is a growing consensus that have been improvements in all segments the family; the availability of clean water In addition to the under-five mortality rate, maternal and newborn health and survival of the population, there has been little and safe sanitation; and the overall safety measuring the rates of neonatal (less than can best be improved by establishing a reduction in the gaps between the poorest of the child’s environment. The under-five one month) and infant (under one year) ‘continuum of care’ for mothers, newborns and the best-off. mortality rate can be taken as a proxy of the mortality are also critical, as these rates acknowledge the particular vulnerability of and children that integrates programmes This chapter is divided into two sections: health status of Mozambican children and of newborns and children in their first year of and interventions for reproductive health; health and nutrition, and water and sanitation. Mozambican society as a whole. life. Neonatal mortality in particular indicates Results from the 2008 Multiple Indicator the circumstances of the entire pregnancy Cluster Survey indicate a reduction in the period and the birth of the child, such as the under-five mortality rate from 153 deaths mother’s health, the circumstances in which per 1,000 live births in 2003 to 141 in 2008 the child was delivered and the care the (see Figure 3.1). This is significant progress newborn received in the first few days of life. in improving child and maternal health and survival in Mozambique, although the rate Children face a barrage of diseases, all of decrease in the under-five mortality rate rendered more dangerous by undernutrition. has slowed in recent years and will need to The majority of deaths in children under accelerate if the country is to achieve MDG five are due to a small number of common, 4.12 Despite this progress, Mozambique has preventable and treatable conditions, such
Figure 3.1: Mortality rates in Mozambique per 1,000 live births, 2003 and 2008 (five-year average preceding the survey) 250 201 200 153 150 135 141
101 95 100
50
0 1997 2003 2008
i Maternal mortality is defined by the WHO as the death of a woman while pregnant or within 42 days of termination of Under 5 Under 1 pregnancy, regardless of the site or duration of pregnancy, from any cause related to or aggravated by the pregnancy or its management. Source: DHS 1997, DHS 2003, MICS 2008
48 49 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
as malaria, neonatal conditions, acute 3.2), which also fell much more rapidly in There is a significant difference in under-five children (0–17 years) in the household, the lower respiratory infections, HIV infection, rural areas. mortality between the central and northern dependent variable in the model taken as a infectious intestinal diseases, meningitis provinces and the southern provinces. The proxy for child health. and undernutrition, occurring alone or in The marked improvement in child mortality highest rates were recorded in Zambezia combination. A child’s risk of dying is very rates in rural areas may be associated, at (206 deaths per 1,000 live births) and Cabo Households where the head has secondary- high in the first month of his or her life (the least in part, with increased access to health Delgado (181 deaths per 1,000 live births). level education or higher are less likely neonatal period); almost a quarter of all services in those areas. Rural areas saw a Tete province has the third highest under- to experience a child death, as Figure 3.4 under-five deaths occur during this period large improvement in terms of distance to five mortality rate, 174 per 1,000 live births. confirms. The observed relationship to the (38 per 1,000 live births in 2008).14 the nearest primary health facility. In 2008/09 Maputo province and Maputo City report the age of the head of household simply reflects in the rural North, for example, 69.7 per cent lowest under-five mortality rates (103 and the biological relationship between parent’s The observed reduction in mortality in of households are now able to access such a 109, respectively).16, ii and child’s age. However, the gender of Mozambique has been more pronounced in facility within a 45 minute walk compared to the head of household does not appear to rural areas. The average mortality rate from only 31.5 per cent in 2002/03. Access in the A household-level multivariate regression be statistically correlated to child survival. 1987 to 1997, 237 deaths per 1,000 live births, rural Centre and South has also improved, analysis was conducted to further explore Anti-mosquito spraying appears to reduce was reduced to 164 deaths for the 1998–2008 but not quite so quickly. which factors were related to the survival of household child mortality by one per cent.17 period, equivalent to a 32 per cent reduction. In urban areas, the under-five mortality rate Access in urban areas to primary health decreased from 150 in 1987–1997 to 138 in facilities appears to have worsened, as a 1998–2008, a reduction of around 10 per slightly smaller share of households report Figure 3.3: Share of households with less than 45 minutes walk to nearest primary health facility, 2002/03 and cent. The marked improvement in rural areas they are able to reach a facility on foot within 2008/09 (percentage) is likely to be linked to improved access to 45 minutes. This may be due to a number health facilities and services. Geographical of factors such as urbanisation, with higher IAF02 86.3 North - urban disparities remain acute, with a child in Cabo population growth in the periphery of cities IOF08 75.4 Delgado province being almost three times where access to public facilities is lower; more likely to die before reaching age five and a greater reliance on hospitals and IAF02 88.8 than a child in Maputo City. A similar trend other medical facilities in urban areas, thus Center - urban IOF08 76.3 was observed in infant mortality (see Figure reducing demand for basic primary facilities.15
IAF02 92.0 South - urban Figure 3.2: Infant mortality rates in Mozambique per 1,000 live births 1997, 2003 and 2008 IOF08 78.7 (five-year average preceding the survey) IAF02 31.5 180 North - rural IOF08 69.7 160 160 IAF02 35.0 140 Center - rural 135 IOF08 47.6 120 111 IAF02 48.8 100 101 South - rural 95 95 IOF08 53.6 80 0% 20% 40% 60% 80% 100% 60 Households 40 Source: Ministry of Planning and Development. ‘Poverty and Wellbeing in Mozambique: Third National Poverty Assessment, Government of Mozambique, September 2010. 20
0 1997 2003 2008
Urban Rural ii Average of ten years preceding the survey. Source: DHS 1997, DHS 2003, MICS 2008
50 51 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
Malaria, neonatal causes and acute it. Undernutrition is a major underlying The 2010 National Millennium Development 2.2. Child nutrition respiratory infections are the three major cause of child mortality, as are diarrhoeal Goal Progress Report found that if trends immediate causes of mortality among illnesses. Many of the causes of child in reducing child mortality continue, the Undernutrition is the main underlying young children in Mozambique.18 iii AIDS mortality are preventable by either country has the potential to reach the MDG cause contributing to the high level is also emerging as a major killer, with 10 vaccination or other simple prophylactic relating to child mortality by 2015. However, of child mortality in Mozambique. It is per cent of under-five deaths attributed to measures. to reach the target for under-five mortality, also important in its own right, since equivalent to a mortality rate of 108 per undernutrition (in particular, chronic 1,000 live births in 2015, the required annual undernutrition or stunting) affects Figure 3.4: Probability of child (age 0–17) survival in the last 12 months by education level of the head of reduction in the number of deaths is 4.3 per cognitive development and is closely household, 2008 cent for the under-five mortality rate and linked to future educational outcomes. The major manifestations of undernutrition
1 3.7 per cent for the infant mortality rate. are underweight (low weight for age),
l This would represent an acceleration of a 9
v wasting (low weight for height), stunting i
9 the reduction rates recorded in the last five . v r (low height for age), and micronutrient u years, which are three per cent and slightly s
8 d deficiencies. l
9 less than two per cent per year, respectively. i . h c
f 7 o
9 y . t i l i b 6 a 9 b . Figure 3.6: Chronic undernutrition rates by country, 2009 o r P 5
9 Stunting . Number of children who are stunted Ranking Country prevalence 18 28 38 48 58 68 (thousands, 2008) (%) Age of household head 1 India 48 60,788 primary secondary higher 2 China 15 12,685 3 Nigeria 41 10,158 Source: UNICEF calculations based on MICS 2008 4 Pakistan 42 9,868 5 Indonesia 37 7,688 Figure 3.5: Causes of under-five mortality in Mozambique, 2008 6 Bangladesh 43 7,219 7 Ethiopia 51 6,768 Meningitis 8 Democratic Republic of Congo 46 5,382 2% Other infectious diseases 9 Philippines 34 3,617 5% Malnutrition 10 United Republic of Tanzania 44 3,359 4% Intestinal 11 Afghanistan 59 2,910 infectious diseases 12 Egypt 29 2,730 Acute Lower Other Respiratory Infections 7% causes 13 Viet Nam 36 2,619 13% Birth 10% asphyxia 14 Uganda 38 2,355 5% Sepsis of 15 Sudan 40 2,305 Neonatal the newborn 16 Kenya 35 2,269 HIV/AIDS 16% 3% 10% Prematurity 17 Yemen 58 2,154 Malaria 8% 18 Mynmar 41 1,880 33% 19 Nepal 49 1,743 20 Mozambique 44 1,670
Source: National Institute of Health, London School of Hygiene and Tropical Medicine and UNICEF, Mozambique National Child 21 Madagascar 53 1,622 Mortality Study 2009, Maputo, 2009. 22 Mexico 16 1,594 23 Niger 47 1,473
iii These findings are derived from the Ministry of Health and UNICEF’s 2008 child mortality study. The aim of the study 24 South Africa 51 1,425 was to measure neonatal, infant and under-five mortality rates in Mozambique for all programme-relevant causes using data collected at community level. Verbal autopsies, i.e., interviews with family members or caregivers about the Source: UNICEF, Tracking Progress on Child and Maternal Nutrition: A survival and development priority, UNICEF, November 2009. circumstances of death after the event has taken place, were used to determine the causes of child mortality.
52 53 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
Children’s nutritional status Acute undernutrition (wasting) Underweight poorest households, in which prevalence of underweight children fell from 29 per cent in Using World Health Organisation (WHO) No significant difference was observed The prevalence of underweight among 2003 to 23 per cent in 2008.25 classifications, stunting prevalence among between the 2003iv and 2008 rates of acute children under five reduced from 20 per Mozambican children is very high (44 per undernutrition for children under five, which cent in 200323 to 18 per cent in 2008.24 A higher proportion of boys are underweight cent), underweight prevalence is medium were five and four per cent, respectively.21 Underweight, which is defined as low than girls (20 per cent against 15 per cent). (18 per cent), and wasting prevalence Wasting or acute undernutrition, which is weight for age, is a function of deficiencies Underweight levels by age group are is low (4 per cent), according to MICS defined on the basis of weight for height, is in both current and past nutrition, health, highest at ages 6–11 months (22 per cent), 2008 data (See Figure 3.6).19 A slowly a type of undernutrition that results from a and other care experienced by a child. The decreasing slightly as children get older, but declining trend is observed across all recent excessive loss of weight due to severe greatest improvements occurred in rural still remaining close to 15 per cent as children undernutrition indicators from 1996/97 to illness and/or lack of food. It should be noted areas, where the prevalence decreased from approach their fifth birthdays. Provincial 2008. Mozambique has one of the highest that the temporal and seasonal instability of 25 per cent in 2003 to 19 per cent in 2008; disparities are particularly acute, with more rates of stunting world-wide, with over 1.6 this indicator makes meaningful comparisons during the same time period, prevalence in than one in four children underweight in million children experiencing stunting. between years challenging. urban areas remained static at 13 per cent Nampula province, compared with one in Larger improvements were seen among the fifteen in Maputo City (see Figure 3.9).26 The IOF 20008/09 survey indicates slightly Although wasting at a national level is low different levels of undernutrition to MICS (less than 5 per cent is considered low by 2008 – for example, chronic undernutrition the WHO classification), provincial variations Figure 3.8: Percentage of wasting in children under five by province, 2008 is 46 per cent according to IOF 2008/09 are significant, ranging from nine per cent in 10% versus 44 per cent in MICS 2008. Analysis Nampula to one per cent in Gaza (see Figure 9% conducted by the MPD restricted the 3.8). Wasting prevalence is linked to wealth, 9% analysis of MICS 2008 and IOF 2008 to with children in the poorest households 8% households surveyed during the same over three times more likely to suffer acute 7% period of 2008 (the MICS was conducted undernutrition (six per cent) than those 6% between September and November 2008 in the richest households (two per cent). 5% while IOF ran from September 2008 to Wasting rates are highest at six months of 5% 5% August 2009). This analysis indicated no 4% age (eight per cent) and then progressively 4% 4% 4% statistical differences between the national decline. Wasting prevalence is similar in rural 3% averages for the three indicators.20 3% 3% and urban areas (five and three per cent, 2% respectively).22 2% 2% 1% 1% 0% Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Figure 3.7: Undernutrition rates (moderate) in children under five, 2003 and 2008 Delgado pula bezia bane Province City 50% Source: MICS 2008. 48% 40% 44% Figure 3.9: Percentage of underweight in children under five by province, 2008 30% 30%
20% 20% 25% 26% 18% 20% 22% 10% 21% 18% 18% 19% 15% 5% 4% 16% 0% Stunting Underweight Wasting 10% 12%
2003 2008 5% 7% 7% 7% Source: DHS 1997, MICS 2008. 0% Niassa Cabo Nam - Zam - Tete Manica Sofala Inham - Gaza Maputo Maputo Delgado pula bezia bane Province City iv The anthropometric data from DHS 2003 were recalculated based on the 2006 WHO standard population. Source: MICS 2008.
54 55 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
The 2010 National Millennium Development regained, even if nutrition conditions improve is highest in the provinces of Cabo Delgado The p-value tests the probability of the Goals Report considers that is “potential” and a child gains weight. (56 per cent) and Nampula (51 per cent), and regression coefficient taking the same that the MDG target of reducing underweight in Zambezia, Niassa, Tete, Sofala and Manica value or a more extreme one if there is no prevalence by half will be met.27 While this is The proportion of children with severe prevalence also exceeds 40 per cent.32 association between the explanatory variable an important achievement, there is no room stunting decreased from 23 per cent in and height-for-age Z-score in children 0–59 for complacency, since levels of stunting 2003 to 18 per cent in 2008. The observed Male sex, age (in months), a low education months, using the same sampling and (low height for age) are more than twice the reduction appears to have occurred level in the mother, use of unsafe water, use analysis methods repeatedly. levels of underweight. Even if Mozambique predominantly in rural areas, where the of precarious sanitation, and living in central meets the underweight MDG, urgent action proportion decreased from 52 per cent to or northern provinces all have a negative These high stunting rates have received is needed to address the very high levels of 47 per cent.29 In urban areas, where the effect on children’s height for age. These increased attention since 2009. The nutrition stunting. prevalence of chronic undernutrition is lower, results were derived by analysing some of component of the PARPA II impact evaluation the reduction was less marked, with only the factors related to chronic undernutrition highlighted this issue and recommended an annual 0.2 percentage points reduction through multivariate regression (see Table that it be addressed with a sense of urgency Chronic undernutrition (stunting) achieved between 2003 (36 per cent) and 2008 3.1) using data from MICS 2008. The effect and that a multi-sectoral plan of action The proportion of five-year-old children (35 per cent).30 of the province of residence remains, even be developed to address it. A high-level that are stunted has decreased from 48 when other variables, such as poverty national seminar held in March 2010, with In Mozambique, stunting is observed among per cent in 2003 to 44 per cent in 2008.28 and access to safe water and improved participation of the Prime Minister, the Mozambique’s stunting prevalence is still children at a very early age, even before six sanitation, are considered. Ministers of Health and Agriculture and other months, and increases up to 24–36 months. high-level Government representatives, classified as “very high” by the WHO. v Stunting, or chronic undernutrition, defined The high prevalence (slightly above 20 per The introduction of the variable ‘wealth’ served to craft inputs for this plan and as low height for age, shows undernutrition cent) of stunting recorded among children reduces the impact of the mother’s education the Multi-sectoral Plan of Action for the resulting from cumulative inadequacies in less than six months old reported in the 2008 and the quality of water and sanitation, Reduction of Chronic Undernutrition 2011- the nutritional and health status of a mother MICS is a cause for concern, as one would not making these factors not significant. This 2015 (2020) was approved by the Council of before and during pregnancy and of a normally expect to see such a high prevalence demonstrates that the variable ‘wealth’ is the Ministers in September 2010. The plan aims child in the first two years of life. Stunting at this early age. Stunting rates increase with most important underlying cause of chronic to reduce stunting to 20 per cent in 2010. is a good indicator of the well-being of age from birth up to 24–36 months, reaching undernutrition. a population, as it reflects the structural a peak of around 54 per cent, after which it 31 context surrounding undernutrition. Children decreases slightly. who are stunted have compromised physical Provincial disparities in relation to stunting Table 3.1: Multivariable linear regression on the height‑for-age Z-score in children under five, 2008 and mental development, and this growth are particularly striking (see Figure 3.10). opportunity is irreversibly lost. It cannot be Stunting prevalence among children under five Height-for-age of children 0–59 months Linear regression 95% confidence P-value1 Explanatory variables coefficient (b) interval of (b) a) Male sex -0.188 -0.253 to -0.122 <0.001 Figure 3.10: Percentage of chronic undernutrition (stunting) in children under five by province, 2008 b) Residence in Manica or northward 0.819 0.37 to 1.269 <0.001 c) Natural log of age in days -0.132 -0.191 to -0.073 <0.001 60% d) Interaction factor: residence x age -0.176 -0.246 to -0.106 <0.001 56% 50% e) Mother’s successful years at school 0.032 0.019 to 0.045 <0.001 51% 48% 48% f) Unsafe source of drinking water -0.160 -0.255 to -0.064 0.001 46% 40% 45% g) Unimproved sanitation facilities -0.191 -0.297 to -0.085 <0.001 40% constant -0.266 30% 34% 34% Source: UNICEF calculations based on MICS 2008. 28% 20% 25%
10%
v The wealth variable is based on a wealth index. the Wealth Index is constructed based on information on household’s 0% possession of durable goods such as a television, a bicycle, a car as well as the characteristics of accommodation Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo including electricity, source of drinking water, type of sanitation facility and material used for roofing. It is an indicator of Delgado pula bezia bane Province City the level of wealth that has been shown to be correlated with measures of expenses and incomes. For a full discussion of the methodology and its limitations see Gwatkins et al, Socio-economic differences in Health, Nutrition and Population in Source: MICS 2008. Mozambique, The World Bank, 2000.
56 57 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
Causes of chronic undernutrition in sanitation services. Basic causes include undernutrition is an intergenerational In 2008, 63 per cent of newborns were put Mozambique poverty, insufficient education (particularly phenomenon, since the child of a woman to the breast within one hour after birth. of mothers) and gender inequities. The most with a suboptimal nutritional status before This compares with a figure of 65 per cent The causes of undernutrition amongst visible examples of the latter are teenage and during pregnancy will have a lower in 2003. Eighty-eight per cent of newborns children are interrelated. They are depicted pregnancies, which have a direct impact on potential height. Whether or not a child were put to the breast within one day of in graphic form in the conceptual framework both the mother’s and her child’s height. reaches its full growth potential depends on birth in 2008.36 Exclusive breastfeeding (see Figure 3.11) and can be grouped An analysis of the IOF 2008-9 data showed the food, health and other care it receives in rates in children under six months old in across three levels. The immediate causes a significant difference in stunting levels the first two years of its life. The period before Mozambique increased significantly between are inadequate dietary intake (in quantity between children whose mothers were pregnancy up to two years of age is therefore 2003 and 2008 (from 30 to 37 per cent), but and quality) and diseases. The interaction younger that 19 when the children were born referred to as “the window of opportunity.” the level remains low in absolute terms between these two factors leads to increased (54 per cent) and children whose mothers Even when a child survives her or his early (see Figure 3.12). Exclusive breastfeeding morbidity and mortality. HIV infection were older than 19 when they gave birth (46 years, undernutrition and repeated infections decreases rapidly with age; from 57 per cent is also a major cause of failure to grow per cent).33 can lead to lifelong developmental delays. for the zero-to-one-month age group to 17 and of undernutrition among children. per cent in the four-to-five-month age group Inadequate dietary intake and diseases in Across the world, stunting starts to manifest (see Figure 3.13).37 turn are caused by insufficient access to itself immediately after birth (unlike wasting Infant and young child feeding food, inadequate maternal and childcare and underweight, which start from about Appropriate infant feeding practices are The main items given to newborns that practices (particularly poor breastfeeding three months of age), and continues to crucial for child survival and development. interfere with exclusive breastfeeding are and other feeding practices) and insufficient increase in the first two or three years of Exclusive breastfeeding is recommended for water and solid, semi-solid or soft foods38 access to health care, safe water and life, after which it remains stable.34 Chronic the first six months of life. After this, children (see Figure 3.14). A qualitative study in should receive solid, semi-solid and soft Maputo City and the provinces of Gaza, foods in increasing frequency, along with Tete, Zambezia and Nampula39 showed that Figure 3.11: The conceptual framework for undernutrition continued breastfeeding. Breastfeeding can mothers have heard of the recommendation be continued to two years of age or beyond.35 to breastfeed exclusively, but they feel The WHO recommends that breastfeeding they are not able to put their knowledge Child undernutrition, be initiated immediately after birth, when into practice, since other family members death and disability the newborn’s suckling reflex is strong. The insist that they should give their baby Ministry of Health approved in early 2009 a water, traditional medicines and/or solid, comprehensive five-year communication and semi-solid or soft foods. This suggests that Inadequate dietary intake Disease Immediate communication efforts should focus on causes social mobilisation plan to promote, protect and support breastfeeding. eliminating these items from the diet and
Inadequate Poor water/sanitation Underlying causes Insufficient access maternal and child and inadequate health at household/ Figure 3.12: Percentage of children of different age Figure 3.13: Exclusive breastfeeding in children to food care practicies services family level groups who are exclusively breastfed: 1997, 2003 under 12 months, 1997, 2003 and 2008 and 2008
100% 100%
80% 80% Quantity and quality of actual Basic 60% 57.3 resources-Human, economic and causes 48.4 60% 53.1 organisational, and the way they 37.6 38.3 40% are controlled 40% 49.8 36.8 20% 30 20%
Inadequate and/or inappropriate Political, cultural, religious, 0% 0% knowledge and discriminatory Potential resources; economic and social systems, 1997 (DHS) 2003 (DHS) 2008(MICS) 0-1 2-3 4-5 6-7 8-9 10-11 1997 2003 2008 attitudes limit household access to environment, technology, including women´s status, limit the 0-3 months 0-6 months actual resources people utilisation of potential resources
Source: DHS 1997, DHS 2003 and MICS 2008.
Source: UNICEF, Strategy for Improved Nutrition of Children and Women in Developing Countries, UNICEF, New York, 1990.
58 59 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
include family members and communities months, it is three times per day in addition the risk of breastfed children being infected Micronutrient deficiencies: in efforts to communicate that breastmilk to breastmilk. On average, only half of with HIV. The so-called HIV-free survival Iodine deficiency contains sufficient water and nutrients children aged six to eleven months received rate at 18 months or two years of age is for children less than six months old, and the minimum recommended number of similar for both groups. The earlier guidance Iodine deficiency is the single largest cause that mothers need practical and emotional meals, as seen in Figure 3.15. There is for mothers living with HIV recommended of preventable brain damage and mental support for breastfeeding. considerable variability among provinces. exclusive breastfeeding, unless replacement retardation in the world.45 Iodine deficiency Seventy-one per cent of children in this age feeding was ‘acceptable, feasible, affordable, also reduces child survival, growth and The median duration of breastfeeding in group are being appropriately fed in Niassa, sustainable and safe.’43 development. When pregnant women are 2008 was reduced to 18 months, from 22 compared with 32 per cent in Inhambane.42 iodine-deficient, they risk miscarriage, months in 2003.40 This is a cause for concern, WHO updated its guidelines at the end of stillbirths and other complications. The since breastmilk still provides key nutrients 2009 to recommend the use of antiretroviral Infant feeding and HIV transmission visible and most severe consequences of and protects against disease for children drugs (for either the mother or the child) iodine deficiency are goitre (an enlarged between 12 and 23 months of age. Continued One of the ways in which HIV can be during breastfeeding.44 In this way, the child thyroid gland) and cretinism. The milder breastfeeding is most important when transmitted from a mother to her child receives the benefit of breastmilk as well forms of iodine deficiency cause reduced children are sick and lose their appetite for (in addition to during pregnancy and as protection against HIV transmission. The mental development. other foods but continue to be breastfed.41 childbirth) is via breastfeeding. It has been Ministry of Health of Mozambique, within determined that the total risk of mother-to- the context of the Prevention of Mother-to- The most cost-effective strategy for After six months, solid, semi-solid or soft child transmission of HIV is about 30–45 per Child Transmission programme, adopted preventing iodine deficiency is universal salt foods need to be introduced into children’s cent. Numerous studies have documented the latest WHO recommendations in mid- iodisation. Salt iodisation is the fortification diet, with an adequate frequency. For that the risk of non-breastfed children 2010. This means that HIV-positive mothers of salt destined for human and animal children between six and eight months of dying from causes that can be prevented will be advised to breastfeed exclusively for consumption with iodine. In addition, iodised age, this is two to three times per day for by breastfeeding, including diarrhoea, the first six months of their child’s life and oil capsules can be distributed in areas with a and for children between nine and eleven undernutrition and infections, is similar to to continue breastfeeding with adequate high prevalence of iodine deficiency. complementary feeding up to 12 months longer. After this, breastfeeding can be In January 2000, the Ministry of Health and stopped. Throughout the breastfeeding the Ministry of Industry and Commerce issued the joint Ministerial Diploma No. Figure 3.14: Feeding patterns for children less than one year old, 2008 period and up to one week after that, children should receive a daily dose of the 7/2000, which requires all locally produced or imported salt for human and animal Weaned antiretroviral drug nevirapine. The new (not breastfed) guidance are expected to be introduced in a consumption to be iodised. Enforcement, 2% fashion starting in 2011. however, has been relatively weak to date.
Figure 3.15: Children 6–11 months old who received breastmilk and complementary food at least three times per Exclusively day, by province, 2008 breastfed Breastfed and solid, semi-solid or soft food 20% 80% 70% 56% 71% 60% 63% Breastfed and 50% 53% 53% plain water only 51% 51% 51% 48% 49% 16% 40% 46% 45% 30% 32% 20% 10% 2% 0% Breastfed and 4% Breastfed and Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Total other milk/formula non-milk/formula Delgado pula bezia bane Province City Source: MICS 2008. Source: MICS 2008.
60 61 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
The Ministry of Industry and Commerce because unprocessed, non-iodised salt is Iron deficiency and anaemia A comparison of vitamin A supplementation has invested in training salt producers and more easily available in areas where salt is coverage in 2003 and in 2008 shows a marked providing salt iodisation and monitoring extracted and can more easily make its way Anaemia can be caused by various factors: increase: from 50 per cent to 72 per cent.50 equipment, while the Ministry of Health onto the local market. iron deficiency, diarrhoea, malaria, worm This increase is probably related to the supports promotional activities. The NGO infections, tuberculosis and HIV infection. introduction in 2008 of biannual Child Health PSI is also supporting the Government in Households in the wealthier quintiles more Iron deficiency is the main cause of Weeks, in which children receive vitamin A creating increased demand for iodised salt. often use iodised salt and also more often anaemia. Children with anaemia have supplements and deworming medicines, and use adequately iodised salt. This is probably lower physical and mental development often also immunizations and other pretentive The use of iodised salt increased slightly because wealthier households can better and school performance, often have little interventions. The coverage rates of these from 54 per cent in 2003 to 58 per cent in afford iodised salt, which is often two or energy and have a reduced appetite. campaigns have increased to over 95 per 2008.46 The increase came from greater more times more expensive than non- Anaemia in pregnant women and mothers cent. iodised salt use in urban areas. In rural areas iodised salt, and to the fact that households is a major contributory factor for maternal there was a slight decrease. Differences in the higher wealth quintiles may be better mortality. Women who are anaemic before The 2008 MICS data show that children from between provinces in use of iodised salt and equipped to store the salt appropriately. and during pregnancy have a higher risk of wealthier families are more likely to have levels of adequately iodised salt are large. In bearing children with low birth weight (less received vitamin A supplements: 81 per 2008, only 25 per cent of households were In 2007, the Ministry of Health started than 2,500 grams), and anaemia in early cent of children in the wealthiest quintile using adequately iodised salt (more than distributing iodised oil capsules in the pregnancy affects a child’s potential height. had received them, compared with 62 per 15 parts per million). This low percentage provinces with the highest rates of iodine A national study showed that 74 per cent of cent of children in the poorest quintile. In could be due to inappropriate iodisation and deficiency, namely Niassa, Nampula, children under five were anaemic in 2002.48 rural areas, 69 per cent of children received packaging practices in the factory and/or to Zambezia and Tete. The target group for vitamin A supplements compared with 78 inappropriate storage practices. this intervention was pregnant women per cent in urban areas.51 and children 7–24 months old. In 2008, Vitamin A deficiency Notably, the salt–producing provinces of iodine capsules were distributed during the Vitamin A is a crucial nutrient for the Cabo Delgado, Nampula and Zambezia have Child Health Weeks, achieving 89 per cent prevention of disease and deaths. The 2002 2.3. Maternal survival, health the lowest levels of salt iodisation. Levels of coverage. The intervention was discontinued national survey referred to above found and nutrition iodisation decreased in all three provinces in 2009.47 that 69 per cent of children 6–59 months It is estimated that approximately 80 per between 2003 and 2008. This could be old had vitamin A deficiency (low serum cent of maternal deaths could be averted if 49 retinol). The Ministry of Health provides women had access to essential maternity supplementation with high-dose vitamin and basic health services.52 There is a A capsules to new mothers in the first six growing consensus that improving maternal Figure 3.16: Use of iodised salt by province, 2008 weeks after delivery and to children 6–59 and newborn health and survival can be months old to prevent vitamin A deficiency. 100% 90% 52% 21% 80% 52% 46% 26% 29% 70% 29% 49% 71% Figure 3.17: Use of iodised salt by wealth quintile, 2008 60% 58% 33% 100 50% 48% 48% 46% 38% 26% 19% 40% 45% 80 32% 29% 30% 35% 36% 60 35% 22% 25% 29% 25% 36% 20% 40 33% 32% 49% 18% 34% 10% 20 8% 9% 5% 15% 20% 0% 12% Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Total 0 Delgado pula bezia bane Province City Lowest Second Middle Fourth Highest 15 + PPM 0 < 15 PPM Salt not iodised 0 < 15 PPM 15 + PPM Source: MICS 2008. Source: MICS 2008.
62 63 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
achieved through establishing a ‘continuum from an estimated 1,000 maternal deaths services, particularly family planning, Mozambique has real potential to achieve of care’ that integrates programmes and per 100,000 live births in the early 1990s emergency obstetric and neonatal care the 2015 MDG 5 targets: a Maternal interventions for reproductive health, to 408 per 100,000 live births in 2003.vii and antenatal care, and improvements in Mortality Ratio of 250/100,000 live births, safe motherhood, newborn care and child By comparison, the estimated maternal equipment, communications material and and skilled birth attendance coverage of survival, growth and development, delivered mortality ratio for all of sub-Saharan Africa transport since 2007. Health staff have 66 per cent. Achievement of these targets within a legal, institutional and community was 920 in 2005.53, viii been trained in Integrated Management of will require: improved quality and coverage and family environment that upholds and Neonatal and Childhood Illnesses with a of reproductive health services; expansion respects women’s rights (see Figure 3.19). The Institutional Maternal Mortality Ratio focus on neonatal care, and 90 per cent of and maintenance of quality emergency (IMMR), that is, the maternal mortality health facilities now implement Integrated obstetric and neonatal care; timely vi Estimates of maternal mortality ratios in rate recorded in health facilities, has also Management of Neonatal and Childhood diagnosis, treatment and referral of obstetric ix Mozambique indicate that maternal mortality declined, in Mozambique. This reduction Illnesses services, compared with 50 per cent complications; improvement in the structure has decreased substantially in recent years, is largely due to improved access to health in 2005.54 and functioning of the referral system; !
Figure 3.18: Vitamin A supplementation coverage, 2003 and 2008 Figure 3.19: The continuum of care for maternal and newborn health
90% Connecting care during the lifecycle (A) and at places of caregiving (B). Adapted from paternship for Maternal, 80% 78% Newborn and Child Healh, with permission. 70% 72% 65% 69% 60%
50% 50%
40% 43%
30%
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10% Neo cy nata an l p n er eg io 0% Pr d
Birth In fa 2003 2008 28 years n c y urban rural total Death Ageing 1 year
Source: DHS 2003, MICS 2008. P
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l A o d vi Maternal health is usually assessed by measuring the maternal mortality ratio (MMR), which is an estimate of the annual number of deaths among women from pregnancy-related causes per 100,000 live births. Adolescence and Post-natal (mother) Post-natal health vii Using the sisterhood method, the 2003 DHS estimates that the MMR during the 10-year period prior to the survey was before pregnancy Pregnancy Birth 408 maternal deaths per 100,000 live births. The sisterhood method has wide margins of error, with the result that the Post-natal (newborn) Infancy ‘real’ MMR lies somewhere between 200 and 600 maternal deaths per 100,000 live births. Childhood viii Periodically, UNICEF, WHO, UNFPA and the World Bank evaluate reported maternal mortality data from countries and Ap make adjustments to account for the well-documented problems of under-reporting and misclassification of maternal pr op Hospitals and health facilities r ia deaths, and to develop estimates for countries with no data. The estimated adjusted MMR for Mozambique was 520 per t e
r e 100,000 live births in 2005. f e
r r
ix Outpatient and outreach services a
l
The IMMR declined from 230 per 100,000 live births in 1993 to 177 per 100,000 live births in 2003, although significant a
n
d
Source: Kevbes, Kate. J., et al., “Continuum of Care for Maternal, Newborn and Child Health: From slogan to service delivery,” The
B f
disparities between provinces exist, with the 2003 IMMR estimated at 291 per 100,000 live births in Cabo Delgado and o
l
l o
Lancet, vol. 370, no. 9595, 13 Cctober 2007, p.1360. w -
26.5 per 100,000 live births in Maputo province. u Family and community care p
64 65 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
Box 3.1: Child Health Weeks improvement of the Health Information pregnant women and 48 per cent of non- System to better monitor emergency obstetric pregnant women according to a 2002 study.57 The delivery of an integrated package of relatively cheap preventive and curative interventions, and neonatal care; ensuring reproductive Despite the prevalence of anaemia, 39 per when delivered at scale, can reduce under-five mortality by up to 63 per cent. Unfortunately, in many health commodity security; and increased cent of pregnant women do not receive countries the children that are most in need of these interventions do not have easy access to quality involvement of the community, particularly iron and folic acid supplementation during services at health facilities. Child Health Weeks are designed as a mostly temporary measure to men, in reproductive health decisions. pregnancy.58 improve access by delivering a package of cost-effective health and nutrition interventions to children There are five direct causes of maternal The coverage of antenatal care in under-five years of age, using a campaign approach that reaches even the remotest areas of a country. mortality: haemorrhage (usually occurring Mozambique has improved significantly in Use of a campaign approach not only expands the reach of health services, but it can also strengthen post-partum), sepsis, eclampsia, obstructed recent years, with the proportion of women routine and outreach service delivery as health staff often receive additional training and families labour and complications of abortion. Most attended at least once by skilled health receive additional information about services. Availability of an integrated package of effective, quality of the direct causes of maternal mortality personnel during pregnancy increasing from health services delivered at a single point in time and at a single location saves caregivers from making can be readily addressed if skilled health 85 per cent in 2003 to 92 per cent in 2008 multiple (and costly) trips to health facilities with their children, and also creates demand for other personnel are on hand and key medicines, (see Figure 3.20).59 The largest gains were routine health services, especially when effective social mobilisation has been carried out. equipment and referral facilities are recorded in rural areas, where the proportion Child Health Weeks usually comprise at least two complementary health or nutrition interventions and available. Indirect obstetric deaths occur as a of pregnant women who reported receiving may include a few more. Services and interventions that are delivered in Mozambique include: result of either previously existing conditions antenatal care at least once increased from or conditions arising in pregnancy that are 79 per cent in 2003 to 90 per cent in 2008. Core Interventions: not related to direct obstetric causes but may This increase is the result of expansion of be aggravated by the physiological effects of health services into rural areas. Antenatal ll Vitamin A supplementation of children aged 6 months to 5 years; pregnancy. These include such conditions as care coverage in urban areas remained ll Routine or catch-up immunisation against measles, polio, tetanus, diphtheria and whooping cough, AIDS, malaria, anaemia and cardiovascular almost universal, with a slight increase from and tuberculosis; diseases. Teenage pregnancies also increase 97 per cent in 2003 to 99 per cent in 2008. ll De-worming of children aged 1-4 years. the risk of maternal deaths.55 Antenatal care coverage exceeded 80 per Other Interventions that have been added in Mozambique include: One of the most important factors affecting cent in all provinces of the country, ranging women’s health is good nutrition. In from 81 per cent in Zambezia to almost ll Screening for undernutrition (with the use of Mid Upper Arm Circumference tapes and referrals for Mozambique, about nine per cent of women universal coverage in Gaza and Maputo City. management of acute undernutrition); of reproductive age are undernourished Antenatal care coverage varies according to ll Promotion and distribution of long-lasting, insecticide-treated nets; (as indicated by a low body mass index), the socio-economic status of women, with according to data from the 2003 Demographic 86 per cent of women in the poorest quintile l l Promotion of healthy family and child-care practices, such as exclusive breast-feeding; and Health Survey.x In 2003, the prevalence reporting having attended at least one ll Immunisation of women of reproductive age against tetanus; of undernutrition was greater among women antenatal visit, compared with 99 per cent ll Vitamin A supplements for lactating mothers during first 8 weeks after delivery. in rural areas than in urban areas and was in the wealthiest quintile. Coverage among twice as high among the poorest women women in the poorest quintile has risen from Key to the success of a Child Health Week is a well-integrated social mobilisation strategy that targets (10 per cent) as amongst the wealthiest 67 per cent in 2003 to 85 per cent in 2008. the universal participation of eligible families covered by the campaign. Designed and implemented at women (5 per cent).56 Anaemia, which can national, provincial and district levels under the coordination of the Ministry of Health, the strategy is be related to insufficient consumption of Data from the 2008 MICS reveal that 58 per twofold. First—and beginning well ahead of the Child Health Week—the strategy works to raise public iron-rich foods, worm infestations, malaria cent of births took place in health facilities. awareness about the week. The strategy’s second component works hand-in-hand with service delivery to or other infections, affected 70 per cent of In rural areas the coverage reached 49 ensure the promotion of critical messages on complementary health behaviours and hygiene practices. Social mobilisation for Child Health Weeks exploits mass and local media for the dissemination of public service announcements and—especially through community-based radio—the generation of discussion and participation through community dialogue and debates. Local activists penetrate media dark areas to disseminate information, using communication materials specifically produced for the campaigns, using local languages to reach the communities. Throughout the week, strategic use is made of local and national influencers—opinion leaders and decision makers who have the trust and respect of their constituents—to reinforce messaging and maximise participation. Through community meetings and interpersonal communication at the household level, local leaders play a crucial role in rallying participation for these child health campaigns. x When the ratio of the height and weight of a woman, used to derive the body mass index, is less than 18.5, a woman is regarded as being malnourished.
66 67 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
per cent. The proportion of institutional while the majority of pregnant women during birth and institutional births is Ministry of Health in collaboration with its deliveries in rural areas has increased since receiving antenatal care were weighed correlated with wealth. Ninety per cent of partners has developed training manuals 1997 (33 per cent) and 2003 (34 per cent). during consultation, only 52 per cent women in the highest wealth quintile gave to implement an appropriate model of The proportion of institutional births in were informed about the symptoms of birth in a health facility compared to 38 per comprehensive, community-based newborn urban areas remained stable at 81 per cent. pregnancy-related health complications, cent of women in the lowest quintile (Figure care, with provision for home visits to be The relatively high proportion of births that only 48 per cent had their height measured, 3.21).62 made on key days during the first month take place outside of formal maternity or only 36 per cent were asked to provide a of life (days 3, 7, 14 and 28) to identify other health facilities is important, both in urine sample and only 47 per cent had their Post-partum care also remains low. About 60 danger signs and provide early referrals. relation to women’s access to emergency blood taken for HIV testing. In addition, per cent of women who had non-institutional Training of trainers was conducted in all obstetric and neonatal care services, but only just above half of the women (59 per births do not receive any kind of post- three regions of the country in 2008, and also to their use of prevention of mother-to- cent) were counselled about HIV and AIDS. partum care. Only 12 per cent of women training of community health workers in the child transmission interventions, which are These findings indicate the overall poor who had non-institutional births attend implementation of community IMNCI was delivered through health facilities. Outside of quality of the primary health care services some form of health facility up to two days initiated in some Reaching Every District formal health facilities, there is no system in in Mozambique and show the urgent need after delivery.63 Community interventions (RED) districts of the country. In 2009, close place to ensure that those who do not have for training of mid-level and basic staff, are needed to reach these mothers. Since to 450 community health workers were institutional deliveries comply with, and in order to maintain acceptable levels of 2008, a neonatal component has been trained in C-IMNCI. As a result, over four therefore benefit from, this intervention. maternal health services. included in the Integrated Management of thousand newborns (3 per cent of expected Childhood Illness (IMCI) and Community- deliveries) in 21 districts of 7 provinces The norms established in the national In 2003, only 48 per cent of births were Integrated Management of Childhood Illness were visited at home in the first month of antenatal care programme recommend that attended by skilled health personnel.60 (CIMCI) packages, changing the acronyms life. Among them, over 1,100 (28 per cent) all pregnant women receive information on This increased to 55 per cent in 2008.61 The to Integrated Management of Neonatal and were referred to health centres in 2009.64 possible health problems during pregnancy, provinces with the lowest proportion of Childhood Illness (IMNCI) and Community- The ongoing revitalisation of the community including HIV infection and the risk of births attended by skilled personnel were Integrated Management of Neonatal and health worker programme with paid workers HIV transmission from mother to child. In Manica (33 per cent) and Zambezia (38 per Childhood Illness (C-IMNCI), respectively. will further strengthen and expand these addition, they should be weighed, have their cent). The vast majority of antenatal care is In order to scale up community-based interventions with comprehensive Home- height measured, have their blood pressure provided by nurses and midwives (53 per preventive and curative health services, the Based Maternal, Child and Newborn Care. taken and be tested for syphilis. However, cent in 2008), with doctors accounting for there appears to be little compliance with only 2 per cent of antenatal care provided these norms. According to MICS 2008, overall. Access to skilled health personnel Figure 3.21: Proportion of women receiving antenatal care and delivering in a health facility by wealth quintile, 2008
100% 98% Figure 3.20: Women attended at least once by skilled health personnel during pregnancy, 1997, 2003 and 2008 95% 89% 90% 89% 80% 85% 82% 100%
90% 60% 68% 80% 85% 86% 57% 58% 48% 70% 40% 60% 70% 38% 50% 20% 40% 0% 30% Lowest Second Middle Fourth Highest Total 20% Receive antenatal care from skilled personnel Delivered in health facility 10%
0% Source: MICS 2008. 1997 2003 2008
Source: DHS 1997 & 2003, MICS 2008.
68 69 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
Anaemia and vitamin A deficiency are childhood illness in Mozambique in the Figure 3.22: Proportion of children receiving appropriate treatment for malaria, 2003 and 2008 among the major nutritional problems areas of malaria, acute respiratory infection, affecting women, particularly those who diarrhoea and vaccine-preventable diseases 40% are pregnant and lactating. The 2002 are presented below in more detail. national survey on vitamin A deficiency 35% 37% 36% and anaemia and malaria in children under 2.5. Malaria 30% five and their mothers indicated that 70 per cent of pregnant women suffered from The 2008 National Child Mortality study 25% anaemia, against 48 per cent among non- confirms malaria as the leading killer of pregnant women.65 Only 61 per cent of 68 children in Mozambique. Thirty-three per 20% pregnant women received iron and folic acid cent of deaths among children under five 66 supplementation during pregnancy. These are attributed to malaria. Among children 15% findings illustrate low levels of compliance aged one to five, deaths attributed to malaria 15% with existing national policy on iron and folic reach 46 per cent. As well as being the 10% acid supplementation for pregnant women. major cause of death among young children, malaria also accounts for 40 per cent of all 5% 8% 2.4. Childhood illnesses out-patient consultations, and up to 60 per cent of in-patients in paediatric wards require 0% A major public health intervention to treatment for severe malaria, placing a 2003 2008 address childhood illness has been the significant burden on health resources. Children with fever given antimalarials Children with fever given antimalarials (within 24 hours) development of the IMCI programme, which has three components: building the capacity Prevalence of malaria has changed little of health professionals, strengthening during the period between a 2002 national Source: DHS 2003, MICS 2008. the health system and improving family survey and the 2007 Malaria Indicator and community health practices. IMCI Survey,69 which recorded an overall was introduced to Mozambique in 1998, prevalence of 51 per cent (27 per cent in urban areas and 58 per cent in rural areas).xi when the Ministry of Health began gradual according to the 2007 Malaria Indicator Spraying (IRS) of the interior surfaces implementation, starting in 29 districts. Since Thirty-six per cent of children with a fever Survey), and on the other hand low access of houses with long-lasting insecticides, then IMCI coverage has increased. According were given antimalarial medicines in 2008, to health facilities. Outside the formal health and long-lasting insecticidal nets. The to the 2008 Annual Joint Evaluation of compared to 15 per cent in 2003 (see system, only registered pharmacies and a Government identified IRS as a key strategy health system performance, about 90 per Figure 3.22).70 While this still falls short of few specially registered shops can supply for malaria control and prevention in PARPA cent of health services nationwide were the revised Roll Back Malaria targetsxii, 71 it antimalarial medicines, making access to II, establishing a target of 50 per cent IRS implementing Integrated Management of does demonstrate significant improvement. prompt treatment difficult, especially in coverage by the year 2009, compared with Neonatal and Childhood Illnesses, compared Major reductions in infection were observed underserved rural areas. Malaria treatment is about 18 per cent in 2005. This PARPA target with about 50 per cent in 2005.67 in areas of the country where scaling-up of also available at community level in selected has already been achieved, with over 50 per parts of the country, where it is administered cent of the population being covered with IMNCI is one of the key pillars of the malaria prevention and control interventions by community health workers known as IRS, although questions remain as to the Accelerated Child Survival and Development have occurred, for example in Maputo APEs (Agente Polivalente Elementar). Village quality of the spraying carried out and the strategy, with the potential, if implemented province, where malaria prevalence has health workers, known as Socorristas and accuracy of the coverage data. fully and including a community component, dropped dramatically. trained by World Relief, are also authorized to prevent up to one third of all child deaths. The low reported rates of appropriate to treat malaria at community level in Gaza. In 2000, two major insecticide-treated net programmes were initiated in Zambezia While important progress was made in treatment indicate, on the one hand, low It is hoped that ongoing revitalization of the and Gaza, and insecticide-treated nets were reducing childhood illnesses, the overall awareness and demand among caregivers APE programme by the Government will introduced into the public health system for situation remains daunting. Particular for treatment (only 60 per cent of children improve the situation. the first time. By mid-2009, there were long- successes and challenges in combating with fever were taken to a health facility, The situation regarding prevention and lasting insecticidal net programmes in all control of malaria is more positive than that ten provinces and Maputo City. Long-lasting for prompt and effective treatment. The insecticidal nets are distributed to pregnant xi The Malaria Indicator Survey used the recently developed Rapid Diagnostic Tests to test for the presence of malaria Government of Mozambique promotes the women through antenatal services and to parasites. use of two equally effective tools for malaria children under five through campaigns, xii The 2000 Abuja Roll Back Malaria summit set a target that by 2005, 60 per cent of those suffering from malaria should be able to access and use correct, affordable and appropriate medicines within 24 hours. control and prevention: Indoor Residual including Child Health Weeks. Since 2009, the
70 71 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
Government introduced a policy of universal and HIV.76 Both malaria and HIV infection than among those living in rural areas (12 There is a wide disparity in the proportion access to long-lasting insecticidal nets. in pregnancy are associated with maternal per cent and 9 per cent respectively). The of children receiving treatment for ARI (see Coverage of children under five following anaemia, low birthweight, and maternal percentage of children with symptoms in Figure 3.24). Children from better-off families campaign activities in 2009 is estimated at and infant mortality, with HIV infection Maputo City was five times higher than and children whose mothers had at least a around 93 per cent in unsprayed districts and presenting an increased risk of malaria. In in Tete (see Figure 3.23).79 This could be primary-level education were much more about 54 per cent nationally.72 the presence of co-infection, the prevalence explained by the higher population density in likely to receive treatment for ARI symptoms of anaemia and low birthweight may exceed Maputo City, as ARI is likely to be spread or than those from rural areas, those from poor Mosquito-net ownership on a national scale 35 per cent.77 The WHO now recommends aggravated by overcrowded housing, poor- families and those whose mothers had no has risen from 18 per cent of households the use of intermittent preventive treatmentxv quality living environments or pollution. education. No relationship was observed owning at least one mosquito net in 2003 to and insecticide-treated nets for all pregnant The lower prevalence among children from between a mother’s level of education 65 per cent in 2008.73 However, only 31 per women living in a high-risk malaria area. poorer or less well-educated families could and her ability to recognise symptoms of cent of households reported owning a net Accordingly, the Ministry of Health in be explained by the fact that the majority of pneumonia, suggesting that the education xiii that was treated with an insecticide. The Mozambique also strengthened preventive more highly educated people live in urban system should have a stronger focus on proportion of children who reported sleeping treatment and introduced intermittent areas. family health issues.80 under a net the night before the survey rose preventive treatment in 2006. MICS 2008 from 10 per cent in 2003 to 42 per cent in recorded that 67 per cent of pregnant 2008. Of the 42 per cent of children who women had received intermittent preventive slept under a net, 23 per cent slept under a treatment, which is not far short of the 2010 Figure 3.23: Prevalence of acute respiratory infection, by province, 2008 74 treated net. In 2008, 74 per cent of pregnant target. 12% women throughout the country had received a long-lasting insecticidal net, up from only 10% 10% 75 2.6. Acute respiratory infection 46 per cent in 2007. 8% Like malaria, acute respiratory infection Due to the expansion of insecticide-treated 6% 7% (ARI) is a leading cause of morbidity 6% 6% 6% net coverage and indoor residual spraying, and mortality among young children in 4% 5% 5% the 2010 Roll Back Malaria targets for Mozambique, with pneumonia being the prevention could be met.xiv However, while 2% 3% 3% 3% most serious such infection. The WHO 2% 2% showing encouraging signs of progress, estimates that 60 per cent of ARI deaths 0% coverage with treated nets, which are twice could be prevented by the selective use of Niassa Manica Cabo Tete Sofala Maputo Maputo Zam- Nam- Inham- Gaza Total as effective as untreated nets, remains far antibiotics, but the success of treatment Delgado City Province bezia pula bane below national and international targets. In relies upon early detection and access to Source: MICS, 2008. addition, household ownership of mosquito medical facilities. nets is not translating into effective use of nets by children under five and pregnant The proportion of children under five with women; the two population groups most Figure 3.24: Proportion of children under five receiving appropriate treatment for acute respiratory infection by symptoms of pneumonia reduced from 10 province, 2008 at risk of severe illness and death due to per cent in 2003 to 5 per cent in 2008. In malaria. 2008, around 65 per cent of children with ARI 80% 78% symptoms were taken to a health facility.78 70% 74% As many as one million pregnancies in sub- 71% 70% 71% 69% Saharan Africa every year are thought to be 60% The prevalence of ARI symptoms among 62% 65% complicated by co-infection with malaria 59% children living in urban areas was higher 50% 56% 40% 45% 47% 30% 20%
xiii Prior to the introduction of long-lasting insecticidal nets that do not require treatment during their useful lifespan of three 10% to five years, mosquito nets required re-treatment with insecticide every six months to ensure continuing efficacy. All mosquito nets distributed since 2006 are long-lasting nets. 0% xiv 2010 Roll Back Malaria targets are as follows: 80 per cent of the population protected from malaria by IRS or Long-Lasting Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Total Insecticidal Nets, 80 per cent of people able to receive effective treatment within 24 hours, and 80 per cent of pregnant Delgado pula bezia bane Province City women able to receive Intermittent Preventive Treatment against malaria in pregnancy. xv Defined as the provision of at least two treatment doses of sulphadoxine-pyrimethamine during routine antenatal clinic visits. Source: MICS 2008.
72 73 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
2.7. Diarrhoeal diseases to have diarrhoea more frequently than non- Box 3.2: Child-to-Child radio and school: getting the voice of children across stunted children, with 51 per cent of stunted Diarrhoea is another major cause of child children experiencing diarrhoea in the two Designing effective rights-based messaging for children and young people is a challenge. morbidity and mortality in Mozambique. weeks prior to the survey, compared with 37 Messaging that educates and also stimulates children’s engagement and participation can facilitate It becomes more frequent in children six per cent of non-stunted children.86 their adoption of pro-social and health-seeking behaviours and attitudes. Children and youth are months and older, when they begin to crawl catalysts in creating demand for a rights-based society and can also become agents for community Almost half (47 per cent) of children (aged and to eat complementary food. Recent empowerment. Child-to-child programming is producing strong results as a behaviour development 0-5 years) with diarrhoea received oral global estimates indicate that every year 1.5 and empowerment strategy for young people. million children die from diarrhoea.83 The rehydration therapy and continued with World Health Organisation estimated in 2007 normal breastfeeding. Zinc is not yet being The Child-to-Child Media Network was created in 2000 as a partnership between Radio that 26,900 deaths per year in Mozambique used systematically to treat diarrhoea in Mozambique, Ministry of Education, UNICEF and, more recently, local civil society organisation were attributed to water-, sanitation- and Mozambique. Introduction of zinc and N’weti (2007). Using an entertainment-education approach, the Child-to-Child Media Network hygiene-related diarrhoeal disease.84 community case management by trained actively involves children and young people in developing, producing and presenting radio and TV community health workers will further programmes by and for children, both to ensure their right to participation and to offer them an Data from the 2008 MICS indicate that improve results and accelerate reduction of opportunity to express their opinions and aspirations. Programmes are broadcast in 16 national diarrhoeal disease is the fifth most under-five mortality. languages as well as Portuguese. Child-to-Child has increased opportunities for children and important cause of under-five mortality. adolescents to express themselves, and has also increased their knowledge of child rights and This is supported by the 2009 National health and education issues. Subjects like HIV infection, sexual abuse and child trafficking, usually Child Mortality Study, which reports 2.8. Cholera taboo in Mozambican society, are being openly discussed by the child presenters of radio and that gastrointestinal infectious disease Due to the low levels of sanitation coverage, television programmes for young people. The programmes are increasingly being linked to school contributes almost seven per cent to the a high number of cholera cases have been curricula to reinforce messages and expand the impact of both school and media. total number of deaths.85 Diarrhoeal disease recorded over the years in Mozambique (see causes a relatively higher proportion of Table 3.2). From 1992 to 2004, cholera cases Radio Mozambique presenter Amelia Maisha Tunzine, 15, is one of several presenters who use the total under-five deaths in Inhambane (12 from Mozambique represented between one airwaves to talk frankly with their peers about subjects that matter to them but are often considered per cent) and Cabo Delgado (11 per cent), third and one fifth of all African cases.87 In off-limits by parents. “I don’t feel uncomfortable anymore talking about difficult subjects like HIV. It and a slightly higher proportion of deaths 1997/98, a cholera outbreak registered 50,000 is no longer an adult problem; it also affects children. If the issue is only approached by adults, then in boys than in girls across all age groups, cases and 1,353 deaths, with a case fatality kids will continue to believe it’s something they don’t have to deal with,” she says. from post-neonatal to under five. The 2008 rate of 3.2 per cent.88 The factors contributing MICS also indicates that there has been an to cholera outbreaks in Mozambique are: lack A 2008 audience survey conducted by Radio Mozambique81 in 2008, in which 76 per cent of those increase in diarrhoeal disease prevalence of sanitation and poor hygiene conditions, surveyed were 10–13 years old, indicated that 55 per cent of those interviewed listened to the in children under five, from 14 per cent in scarcity and lack of access to potable water, radio every day. Nearly half listened to Child-to-Child programmes. Among their main reasons for 2003 to 18 per cent in 2008. The highest inadequate waste disposal, poor economic listening were the educational/informative nature of the programmes and the quality of information prevalence of diarrhoea was recorded in conditions of the communities, recurrent received. Nampula (23 per cent) and the lowest in droughts and floods, high population density Niassa (13 per cent). Stunted children appear and poorly planned urbanisation. Larsen Manjate, 17, who has worked on Child-to-Child radio shows since 2006 and has had his own show since 2007, sees Child-to-Child as a way to help children understand not only childhood problems but also the challenges of adulthood. He said, “I think that what we broadcast helps kids grow into adults who know how to make good choices. I think we help make good changes in kids’ lives.” Table 3.2: Cholera cases in Mozambique, 2007–2010
According to a study undertaken by the Community Radio Network, FORCOM, in 200882, Child-to- Number of Number of Case fatality Year Child community radio programmes facilitate easier communication between parents and children. cholera cases deaths rate Listening to the shows makes it easier for parents and caregivers to discuss difficult and sensitive issues with their children or wards, since these issues are often debated on the radio. 2007 1,073 16 1.4% From Week 41 (October–December 2007)
2008 12,306 157 1.3% January–December 2008 For children across Mozambique who do not have access to conventional schooling, the radio programmes can serve as a low-cost means of promoting children’s participation, strengthening 2009 19,088 150 0.8% January–December 2009 their access to life-saving information and promoting healthy behaviours. 2010 4,129 56 1.4% As of 21st epidemiological week
Source: Ministry of Health, Manual de Prevenção e Controlo da Cólera e de Outras Diarreias Agudas, Government of Mozambique, Maputo, 2009.
74 75 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 TCHAPTERhrough 3: CHILD SURVIVAL AND DEVELOPMENT the eyes
Figure 3.25: Immunisation of children aged 12–23 months by antigen, 1997, 2003 and 2008
100% of a child
90% 87% 80% 86% 78% 70% 71% 70% 70% 67% 60% 65% 63% 58% 50% 54% 55% 53% 48% 40% 44%
30%
20% 20% 10% 11% 9% 0% BCG DPT 3 Polio 3 Measles All None 1997 2003 2008
Source: DHS 1997, 2003 & MICS 2008.
To address the poor sanitation situation in urban areas and among provinces and the country, the Government of Mozambique wealth quintiles, the Ministry of Health launched a sanitation campaign in 2008 introduced the Reaching Every District (RED) that focused on hand-washing, constructing approach, which focuses on building the and using latrines, providing safe water and capacity of districts, health workers and waste disposal. A multi-sector, multi-year communities to improve immunisation and cholera prevention plan is being finalised. other maternal and child survival services. “This picture shows where we fetch water. have marks on our arms. We don’t know why The RED approach is currently being used It is full of garbage, mud and dirty water. we have them, but we can’t afford to go to the by the Ministry of Health as a platform for 2.9. Vaccine-preventable This is not good, because we may end up doctor to find out. reaching MDGs 4 and 5. getting cholera and other diseases. Kids end diseases and immunisation “At the hospital, they want money for every In 2008, eighty-seven per cent of children up playing in this water, because we do not small thing. How much can we afford? And The national Expanded Programme of under one had received vaccination have playgrounds and parks. The children when we are sick and they are asking for Immunisation has made substantial against tuberculosis, and 71 and 70 per get sick.” progress in recent years. Mozambique has cent received DPT 3 and Polio 3 vaccines, money, we feel sad and upset. When we increased its immunisation rates for measles respectively. Sixty-four per cent of children “You will receive better care if you have a grow up and if we become doctors, we and diptheria-pertussis-tetanus (DPT) 3 from were vaccinated against measles. Children family member working at a hospital.” will always take care of the poor people around 50 per cent in 1991 to 70–80 per living in urban areas are still more likely first, because we know how it feels when cent in 2007.89 Two new vaccines, hepatitis to be vaccinated than those in rural areas. “The majority of us do not have a hospital someone doesn’t take care of you just B and Haemophilus Influenzae, have been Fifty-five per cent of children 12–23 months inside our community. The closest ones are because you don’t have money.” introduced, and there are plans to introduce old in rural areas received all the vaccines, approximately 3.5–5 km from our home. Most rotavirus and pneumococcus vaccines. as against 74 per cent of children living in of us have to walk to the hospital. Walking — Argentina, age 16 urban areas. Eleven per cent of children in when you are sick is very tiring. Sometimes In order to address low coverage and the rural areas received no vaccines, compared we can afford to go to the hospital, other inequities in coverage between rural and to four per cent in urban areas.90 times, we cannot afford the fees. A lot of us Source: Sajan Virgi, Zainul, 2010.
76 77 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
Measles vaccination coverage in Mozambique 2.11. Sector financing and budget which $US 10.4 was actually spent in 2008 provinces, with the lowest expenditures improved substantially in 2005 following allocations (although vertical funding is not captured in being allocated to the provinces where child implementation of a national immunisation the Budget Execution Report, reducing the well-being indicators, including child poverty, campaign that reached 95 per cent of children The proportion of total financial resources recorded per capita spending, as discussed are among the worst in the country.”100 The aged 9 months to 14 years. A follow-up available to the Government that are below).98 This health allocation is in line with G19 group of donors is also concerned and measles campaign during the second phase allocated to the health sector, including the stated PARPA II objective to increase continues to advocate strongly that the of the 2008 Child Health Weeks reached 99 external funding, has shown a clear health spending to $US 15 per capita by Government introduce a provincial funding per cent of children aged 9–59 months.91 As a decrease over the period 2006–2010, falling 2009.99 Despite showing improvement over allocation formula or mechanism that takes result of these campaigns and strengthened from 13.4 per cent in 200693 to 8.4 per cent time, per capita health spending remains into account the varying levels of social routine services using the RED approach, in 2010.94 This level of funding is below the below the recommended minimum to meet development indicators.101 the number of measles cases reported in the Abuja target of allocating at least 15 per cent basic health needs in low-income countries, country has substantially decreased. Another of the State budget to the health sector.95 The as proposed by the World Bank and WHO, Not all donor financing and internal revenues follow-up campaign is planned for 2011. sector continues to rely heavily on external and also below the sub-Saharan African in the health sector are captured in the funding; the proportion of the sectoral average, which was estimated at $US 31.9 in state budget. A high proportion of funding Since 2008, biannual National Child Health resource envelope funded from external 2002.xvi from some partners is directed towards Weeks have been implemented by the sources decreased from around 65 per cent projects and remains ‘off-budget’. According Government of Mozambique to give every in 2008 to almost 39 per cent in the 2010 In 2010, per capita allocations to the to the 2008 state budget Execution Report eligible child an opportunity to obtain a basic budget proposal.96 An analysis of 2008–2010 provinces varied from 266 Meticais per (Relatório de Execução do Orçamento do package of child survival interventions. The data reveals that both internal and external person in Niassa to 74 meticais per person Estado), around 56 per cent of the 2008 total specific objective of the biannual National funding components of the health budget in Zambezia and 73 in Nampula (see Figure health sector budget consisted of vertical Child Health Weeks is to reach at least decreased in real terms. 3.26). The Committee on the Rights of funding, executed outside of the direct 80 per cent of eligible children under five the Child has raised concerns “about the control of the Government. The high degree with vitamin A supplementation plus other Of the total allocation to the National Health inequitable allocation of resources among of off-budget financing hampers sectoral child survival interventions. Since 2010, System in 2010, 60 per cent was allocated the package has been expanded to include to the Ministry of Health and 40 per cent to elements of maternal health. the Provincial Health Directorates. In terms Figure 3.26: Per capita health allocations by province (Meticais), 2009 of investment funding, the provincial level 1000 2.10. HIV and AIDS of the National Health System received only 22 per cent of the total investment funding 900 902 The vulnerability of a country to the envelope.97 878 800 effects of infectious disease, including AIDS, depends to a large extent on the The disparities in funding between primary 700 764 and tertiary or quaternary levels of the health 711 level of human development attained by 600 677 that country. Individuals and society as a care system are of particular importance 610 599 579 whole are better able to protect themselves for the health and development of children, 500 562 as tertiary- and higher-level care facilities Meticais against the impact of illness and disease 400 in developed countries. This is because tend to be concentrated in urban areas, of constrained financial resources at the while many of the diseases and conditions 300 national and household level in developing that affect children (e.g. malaria, diarrhoeal 200 249 248 countries, and reduced human capital arising diseases) are most prevalent in rural areas from a lack of education opportunities and and are best managed at the primary health 100 access to other basic social services. In care level. In addition, tertiary and higher 0 Mozambique, HIV and AIDS adversely affect levels of the health care system tend to focus Niassa Maputo Maputo Gaza Manica Inham- Tete Cabo Sofala Zam- Nam- development and obstruct the fulfilment of on less cost-effective curative care, rather Province City bane Delgado bezia pula than preventive care. human rights, as reflected in key indicators Source: FDC and UNICEF, O Que Diz a Proposta de Orçamento do Estado 2010 Sobre a Previsão de Recursos no Sector de Saúde?, such as life expectancy at birth, child Budget Brief 3, UNICEF, Maputo, 2010. Funding from the 2009 proposed state mortality, school attendance, literacy and budget equates to around $US 10 per capita. household income, among others.92 If total health funding available to the sector xvi The World Development Report of 1993 recommended a minimum package of $US 12.00 per capita for low-income Because of the cross-cutting nature of AIDS from both the state budget and other off- countries. Other estimates are: $US 9.24 standard under “Better Health in Africa” (World Bank, 1994), and $US 35.00, in Mozambique, it is dealt with in Chapter 6, budget sources is considered, spending prescribed by WHO’s Commission on Macroeconomics and Health (WHO, 2002) to meet basic health needs towards the Cross-cutting issues. increases to around $US 17.7 per person, of year 2007. The figures for sub-Saharan Africa are taken from the World Bank (2005).
78 79 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
Table 3.3: Comparative analysis of health allocations, 2007 and 2008 planning and has prompted the Ministry of ‘vertical’ funds are being channelled through Planning and Development and the Ministry the PROSAÚDE II common fund, and this has Description Annual allocation ($US) Variation of Finance to attempt to improve the extent made quantifying the full resource envelope 2007 2008 to which external assistance is reflected in available to the Government significantly Government public finance management easier. State Budget (internal component) 112,730,067 120,847,887 7% systems. Recurrent 107,166,049 115,039,479 7% The 2009 State Budget Execution Report Investment 5,564,018 5,808,408 4% Within the context of the introduction notes that health sector (minus HIV) budget State Budget (external component) 111,788,250 90,610,103 -19% of a Sector Wide Approach in health in execution has increased in recent years, 2001, common funding mechanisms were from 69 per cent in 2008 to 75 per cent in Global Fund 49,384,580 64,794,092 31% created, culminating in a Memorandum 2009. HIV-related execution fell dramatically of Understanding for the common fund during the same period, from 79 to 55 per Common Fund 96,750,494 93,956,010 -3% PROSAÚDE in 2003. In 2004, this was cent.102 Health budget execution remains PROSAÚDE - Central 24,979,244 30,675,029 23% followed by the creation of the Provincial lower than most other sectors. One reason PROSAÚDE - Medicines 45,000,000 35,890,754 -20% Common Fund and the Pharmaceutical cited for this decrease is that the sector PROSAÚDE - Provincial 26,771,250 27,390,229 20% Common Fund. In 2008, the PROSAÚDE benefits from vertical funding more than Total 370,653,391 370,208,092 0% Memorandum was updated and the three other sectors. Due to lack of information Common Funds were amalgamated under on expenditure of these funds, they are Source: Ministry of Health, Direcção de Administração e Finanças, ‘Financial Reports,’ (unpublished data), 2007, 2008. the single Common Fund PROSAÚDE II. The recorded as zero execution in the budget PROSAÚDE Common Fund is on-budget and reports, thereby reducing overall budget on-treasury. Increasingly, disease-specific execution levels.
Figure 3.27: Allocations to health sector (by millions of Meticais), MTEF 2010–2012 1% 8 2% 2% 7 8% 30% 6 32% 35% 5 36%
4 37% 40% 3 35% 29% Millions of Meticais 2
1 27% 28% 29% 30% 0 2009 2010 2011 2012 Central Provincial PROSAÚDE HIV AIDS
Source: Ministry of Planning and Development and Ministry of Finance, Cenário Fiscal de Médio Prazo 2010–2012, Government of Mozambique, Maputo, September 2009.
80 81 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
ll Improvement of sanitation as an essential ll Development of appropriate technologies 3. Water and sanitation tool for the reduction of water-borne and management models for rural water diseases (such as cholera, malaria and supply and sanitation; diarrhoea) improved quality of life and ll Capacity-building and human resource Mozambique has made significant advances use of basic knowledge of child health and environmental conservation. Separate goals development in the rural water supply and in the water supply and sanitation and nutrition, the advantages of breastfeeding, are set for urban and rural areas. The long- sanitation sub-sector; hygiene (WASH) sector in recent years. hygiene and environmental sanitation and term goal is to contribute to attainment of Improvements have been realised in the the prevention of accidents.” universal access to sanitation services; ll Support to decentralised planning, institutional and policy framework. It has management, monitoring and financing of The primary international framework for the ll Water efficiently used for economic also created a regulatory structure and rural water supply and sanitation activities. that incorporates the Government, the water and sanitation sector is the MDGs, development; specifically Goal 7: to ensure environmental The Rural Water Supply and Sanitation private-sector and consumers. Progress has ll Water used for environmental sustainability. The water and sanitation Programme recognises the necessity for a also been made in the decentralisation of conservation. The Water Policy promotes management. specific target is Target 7c: “halve by 2015 legal framework for community participation the proportion of people without access to conservation of water as part of water to enable community organisations to Most reforms and investment, however, safe drinking water and basic sanitation.” resources management; represent and act on behalf of community have targeted water and sanitation supply The indicators for assessing progress ll Reduction in vulnerability to floods and members in making binding commitments in the larger urban centers.103 Rural and peri- towards this target include: the proportion of droughts through better coordination to public authorities and private entities, urban water services remains fragile and the population using an improved drinking and planning, as well as preparedness of collecting and managing funds, operating sanitation access and hygiene promotion water source, and the proportion of the individuals, communities and institutions a bank account, making purchases and population using an improved sanitation payments and entering into agreements have largely stagnated, particularly in peri- in affected areas; urban areas. Institutional capacity remains facility.106 Improving access to water and with local governments, dealers, suppliers, limited, especially at the local levels. sanitation was a key Government priority ll Joint management of shared river basins contractors and others. Two laws: Law within the human capital pillar of PARPA to promote regional peace and integration. 15/2000 of 20 June 2000 on defining The 2006 Childhood Poverty in Mozambique: II, which recognises the importance of community authorities and their relationship Through the National Water Policy, the A Situation and Trends Analysis noted increasing access to improved water with state entities, and Law 8/91 of 18 July Government has reaffirmed its political that rural water supply coverage had not supplies and sanitation facilities in reducing 1991 which defines conditions for creation commitment to attaining the MDG targets improved, due to the relatively high costs poverty. of legally recognised associations provide relating to water and sanitation, which involved in Mozambique as compared to a legal framework for the operation of 104 imply the provision of improved water and other countries in the region. Since 2006, community-based organisations. These 3.1. Institutional framework sanitation services for more than seven the Government of Mozambique, with laws could be applied separately or jointly million Mozambicans in rural areas and three support from partners, has standardised its The revised National Water Policy focuses on to provide a legal basis for the operation of million in urban areas before the year 2015. procurement and contracting procedures and decentralisation; sustainability; effective user water and sanitation committees. promoted strong private sector participation. participation; the shifting of Government The 2009 National Rural Water Supply and Consequently, costs of construction of rural roles and responsibilities from implementer Sanitation Programme107 is the framework water supplies have been reduced by 36 per 3.2. The National Rural Water to facilitator and increased involvement for putting into operation and implementing cent.105 of the private sector, Non-Governmental the Rural Water Supply Strategic Plan (PESA- Supply and Sanitation Organisations and Community-Based The Convention on the Rights of the ASR) 2006-2015 towards reaching the MDG Programme Organisations. The National Water Policy has target of 70 per cent coverage for rural water Child requires States Parties to take In 2010 a new Sector Wide Approach the following key objectives: supply and 50 per cent coverage of rural appropriate measures to combat disease (PRONASAR-Programa Nacional de sanitation at national level. The programme’s and malnutrition within the framework of l Abastecimento de Água e Saneamento l Satisfaction of basic needs of human development objective is to contribute to the primary health care, through, inter alia, the Rural) for the water and sanitation water consumption. The medium-term satisfaction of basic human needs, improve application of readily available technology sector was created with the objectives of goal is in accordance with the MDG target well-being and contribute to the reduction and the provision of adequate nutritious meeting basic human needs, improving to reduce by half the number of people of rural poverty in Mozambique through foods and clean drinking water. Hygiene and well-being and contributing to poverty without access to a safe and reliable water improved access to water supply and sanitation are also covered: the Convention reduction through the increased use and supply. The long-term goal is to guarantee sanitation services. The programme consists states that States Parties must “ensure access to water supply and sanitation. The universal access to a safe and secure of four components: that all segments of society, in particular PRONASAR provides the framework for the water supply and to increase service parents and children, are informed, have operationalisation and implementation of levels; ll Support to sustainable increase in rural access to education and are supported in the the Strategic Plan of the ARSA (PESA-ASR). water supply and sanitation coverage; It aims to address imbalances in rates of
82 83 CHILD POVERTYT ANDhrough DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT the eyes
access and use within the provinces and in Cabo Delgado. Access to safe water also of a child districts and promote harmonisation of aid varies considerably across household wealth and institutional reform in the subsector quintiles. Only 13 per cent of households with particular focus on capacity building in the poorest quintile have access to at provincial, district and local levels. The safe water, compared with 85 per cent of implementation of PRONASAR began in households in the wealthiest quintile.109 2010 will be implement in two phases Further, only 22 per cent of household namely Phase I (2010-2012) and Phase II without access to safe water use an (2013-2015). A 2008 code of conduct for the appropriate method of treating their drinking “Every morning, I wake up at 5 a.m. to fetch water sector, signed by the Government water (e.g. boiling), thereby increasing the water. I carry at least 20 large containers and nine development partners applies risk of waterborne diseases.110 of water, as shown in the photo. When I’m the principles of the 2005 Paris Declaration finished, I am very tired, very tired.” on Aid Effectiveness to the water sector in There is a large urban/rural disparity as Mozambique. UNICEF currently co-chairs the well: 70 per cent of urban households have “We do not have running water in our PRONASAR Sector Wide Approach. access to safe water, compared to only 30 homes. It is mainly the responsibility of per cent of rural dwellers.111 Despite the children, particularly girls to collect water. 3.3. Water supply improvements in urban areas, a significant Some of us have to make 20 trips a day to number of the population living in the peri- The proportion of households in urban areas are lacking safe drinking water the well. The water sources can be far away, Mozambique with access to safe water and adequate sanitation facilities. Estimates some as far as 60 minutes. The water feels increased from 36 per cent in 2004 to 43 per for water and sanitation coverage in some very heavy on our heads and our arms hurt cent in 2008.108 The most common water peri-urban areas in Mozambique are as from holding 20 litres of water particularly source is an unprotected well. Important low as 10 per cent.112 Due to the lack of when we haven’t eaten anything from the disparities in access to safe water persist proper sanitation, drainage systems, waste night before.“ between urban and rural areas and among management and poor hygiene practices, provinces. Almost all households in peri-urban areas are often an excellent “We start collecting water between 4am Maputo City (98 per cent) have access to breeding ground for gastroenteric diseases and 5am everyday, including weekends. It is safe water, compared to only 26 per cent as well as malaria. People living in peri- difficult carrying water while dodging cars of households in Zambezia and 36 per cent urban areas in Mozambique are often among and trucks as we try to cross busy streets. When we come back from collecting water, we are always very tired. When it is hot Figure 3.28: Proportion of households with access to safe water, by geographic location 2004 and 2008 outside, and we haven’t had enough water to 80% drink, we get very bad headaches.“ 70% 70% 66% “It is not safe for girls to fetch water by 60% themselves. Even when we are together, we have to be careful. A lady who went alone 50% 43% was killed last year when she went to fetch 40% 36% the water at 3am. Another young girl fell into 30% 30% the water well and died instantly. It makes us 23% feel scared, that’s why it is important to go to 20% the water well with a friend.” 10% — Enya, age 12 0% 2003 2008 Urban Rural Total Source: Sajan Virgi, Zainul, 2010.
Source: National Institute of Statistics, ‘Inquérito Integrado à Força de Trabalho (IFTRAB) 2004/05,’ Government of Mozambique, Maputo, 2006 and MICS 2008.
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the poorest and most vulnerable in society, areas are on floodplains, situated below sea It is estimated 5 per cent of the population A multivariate regression analysis was as they do not have stable incomes, nor do level annual floods and stagnant water after receives water supply via a small, piped conducted to further examine the factors they have arable land to provide for their rains are common,” which in combination system.114 No situational assessment that influence whether a household has own food consumption. Population density with the practice of open defecation and has been performed, though it is widely access to an improved water source, is high and often municipal authorities have unimproved latrines leaching content considered that a large number of these defined as taken from a source other than limited funds to provide services for peri- into the environment are main causes of systems are either non-functional or unprotected wells, lakes, rivers or lagoons urban areas. Cholera epidemics and malaria disease. Unlike the rural water supply and deficient, delivering water irregularly to (see Figure 3.31). Unsurprisingly, the results are more common in peri-urban informal sanitation sector, where a Sector Wide only a small proportion of potential users. show that, besides location characteristics, settlements than in any other areas of Approach has been introduced, focus on Most of these systems are managed by local household wealth is the most important Mozambique.113 “Because of geography and sanitation in peri-urban areas has not yet government, and only function if water fees explanatory variable in the model. climatic conditions large parts of peri-urban been prioritised. are subsidised. However, other factors are also found to play an important role. Female-headed For the vast majority of households (95 households are significantly more likely per cent) that do not have any access to to have access to safe water than male- Figure 3.29: Use of improved water source by province, 2008 running water in the home, it is an adult headed households. The presence of a well woman who normally collects water. The educated head-of-household (secondary or 120% mean time to walk to water source is just higher level) is also significantly correlated under one-hour (49 minutes), and multiple with access to safe water.116 100% trips per day are generally necessary. In 98% households where children collect water, it is It is worth noting how location 80% 80% much more likely to be a girl than a boy who characteristics, i.e., local infrastructure, does so. Girls collect water in 11 per cent have the major role in explaining water 60% 69% of households in both Nampula and Gaza, quality. Rural households are significantly spending on average 52 and 96 minutes, less likely than urban households (17 per 40% 49% 46% 50% 46% respectively per trip. Men in the wealthiest cent) to have access to an improved water 36% 36% 37% 20% 26% households are five times more likely source, as are all households living outside to collect water than men in the poorest Maputo City, especially those in northern 0% households.115 provinces. Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Delgado pula bezia bane Province City Source: MICS 2008. Figure 3.31: Probability of access to improved water source, by wealth score 2008 1 e c r u o s
Figure 3.30: Mean time to water source (minutes), 2008 r e 8 t . a w 100 d e 96 v 90 o 6 r . p
80 m i
o t
70
71 s 4 s . 60 65 e c c a 50 52 54 55 53 f o
49 Minutes y 40 2 t . i l i
30 36 37 b
32 a 28 b 20 o 22 r P 10 15 0 0 -1 -.5 0 .5 1 1.5 2 2.5 3 Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Urban Rural Overall Delgado pula bezia bane Province City Wealth score Urban Rural Source: MICS 2008.
Source: UNICEF calculations based on MICS 2008
86 87 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
3.4. Sanitation Open Defecation-Free status in 2009.119 household wealth, head-of-household 3.5. Sustainability of WASH AMCOW was formed in 2002 in Abuja education, and location. Also, living in a Access to improved sanitation facilities Nigeria, primarily to promote cooperation, female-headed household implies higher infrastructures remains low, particularly in rural areas and security, social and economic development likelihood of improved sanitation, although Recent studies by the Water and Sanitation the northern and central provinces. Access and poverty eradication among member the effect is lower than for education (2.5 per Foundation (Fairwater) indicated that there to safe sanitation increased from 12 per states through the management of water cent against 24 per cent for higher education are 50,000 non-functioning water supply cent of households in 2004 to 19 per cent in 120 resources and provision of water supply levels). systems across Africa. This represents a 2008.117 There is a large discrepancy between services. The AMCOW AfricaSan Awards failed investment of $US 215–360 million.121 urban and rural households: 47 per cent and Local infrastructure plays a major role, with are dedicated to recognising outstanding With the increased participation of the 6 per cent, respectively (see Figure 3.32), all the provinces showing a lower probability efforts and achievements in sanitation and private sector and civil society in water point with a much lower rate of improvement for of access than Maputo City, although hygiene in Africa which result in large-scale, and household sanitation construction, the rural households. the effects are lower than in the case of sustainable behaviour changes and tangible Government of Mozambique is shifting its impacts. They aim at raising the profile of improved water source access (see Figure The WHO and UNICEF Joint Monitoring 3.34). focus towards ensuring sustainability and sanitation and hygiene by drawing attention quality of infrastructure. Programme notes that 74 per cent of to successful approaches, promoting the 11.7 million people living in rural excellence in leadership, innovation and areas in Mozambique practiced open sanitation and hygiene improvements in Figure 3.33: Access to improved sanitation facilities, by province 2008 118 defecation. Only 5 per cent had access Africa. to improved sanitation facilities and 21 90% per cent to unimproved facilities However, A regression analysis was conducted 80% 85% improving access to sanitation remains to further examine the factors affecting 70% a key Governmental objective. Reflecting household access to good sanitation 60% this commitment, the ministries of Public facilities, defined as the ownership or use 50% Works and Housing and Health were of a non-traditional water closet. As with 40% 47% 47% awarded an African Ministers’ Council on improved water sources, three factors 30% Water (AMCOW) AfricaSan award for their are found to be positively and statistically 20% 24% leadership in getting 185 villages to attain significant for improved sanitation: 22% 19% 10% 15% 15% 14% 16% 8% 3% 0% 6% 6% Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Urban Rural Total Figure 3.32: Access to safe sanitation, by geographic location 2004 and 2008 Delgado pula bezia bane Province City Source: MICS 2008. 50%
45% 47% Figure 3.34: Probability of access to improved sanitation source, by wealth score 2008 40% e c
34% r u o 35% 1 s
n o i 30% t a t 8 i . n a s
25% d e 6
19% v . o
20% r p m i
4 o . 15% t
12% s s e
10% c c 2 a
6% . f o
5% 4% y t i l i b 0 a
0% b o r -1 -.5 0 .5 1 1.5 2 2.5 3
2003 2008 P
Urban Rural Total Wealth score Urban Rural Source: National Institute of Statistics, ‘Inquérito Integrado à Força de Trabalho (IFTRAB) 2004/05,’ Government of Mozambique, Maputo, 2006 and MICS 2008. Source: UNICEF calculations based on MICS 2008
88 89 CHILD POVERTYT ANDhrough DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT the eyes of a child Box 3.3: Government access data versus household use data on water and sanitation There are two main sources of information on access to and use of water and sanitation: the routine monitoring systems of the National Water Directorate (DNA) and household surveys conducted by the National Institute of Statistics. These two sources use different indicators. Both sources also use different definitions of urban and rural areas.xvii
Water supply
DNA reports that in 2009, 52 per cent of the population in rural areas has access to water from an improved source, compared with 30 per cent reported in the 2008 MICS. The access data was calculated through the assumption that one water point serves, on average, 500 people. Recent Government analyses indicate that the average number of users per improved water point is about 287. This figure was shown to be in broad agreement both with the sustainable capacity of the hand-pumps used in the country, and the norms used by other African countries. In 2010 Government, with the support of development partners, agreed to adopt a new standard for planning of 300 people per water point within one kilometre walking distance providing 20 litres per person per day as the standard for planning. Further, estimation of rural water supply coverage will be based on data from household surveys conducted by the National Institute of Statistics or other national representative surveys, related to access to and use of water supply and sanitation.
Sanitation
Regarding the population with access to improved sanitation in rural areas the figure reported by DNA, is 40 per cent, whereas the figure reported in the 2008 MICS is only 6 per cent. This discrepancy is due to low use of existing facilities by individuals as a result of low levels of sanitation knowledge and ambiguities regarding the classification of sanitation facilities in household surveys. Improved definitions of sanitation facilities are slated to be included in subsequent surveys.
“This picture shows the washroom. The hurt. We sometimes feel scared going to the The sustainability of rural water supplies In 2010, UNICEF undertook the Midterm requires that special attention be paid to Impact Assessment and 2010 Sustainability water leaks from the washroom. As a result, washroom at night and will always try to take quality control throughout the rural water Check of the One Million Initiative in Tete, the area is very smelly. Children play in this someone with us.“ supply project cycle. This includes: during Manica and Sofala Provinces.123 The Mid Term area as there no places for children to play. It the preparation of bidding documents Impact Assessment was a case controlled “When it rains, the water causes a lot of is not healthy for the children to play in areas and technical specifications; during the panel study undertaken in 80 control villages that are not clean.” problems. It attracts flies that can cause construction of water points; during and schools and 80 treatment villages and cholera. The smells are unbearable. The procurement of all materials and equipment; schools. Results from the 1600 household “The washroom leak causes health washrooms become muddy and dirty with and during capacity building of communities. surveys indicated a 27 per cent and a 9 per problems.” the water leaking both inside and outside Recent sustainability checks undertaken cent increase in use of improved water the washroom. As a result, the waste and by external auditors of rural water and sources and sanitation respectively in the “We have washrooms in our yards, but they dirty water leak out into the yard. Children sanitation facilities in Tete, Manica, Sofala programme area (18 districts) between 2008 and Zambezia indicate that up to 30 per and 2010 and 6 per cent reduction in levels of are not very well built. The washrooms are often play close to the washrooms because cent of all rural water supplies are non- self-reported diarrhoeal disease. Furthermore, made of corrugated zinc sheets or reeds. They of limited space for play. As a result, they get don’t have electricity. Most washrooms have operational due to a lack of community the sustainability assessment noted increased sick from the contaminated water mixed into ownership of facilities, a weak spare parts levels of both institutional and infrastructural a capulana (sheet) instead of a door. When the mud.” chain and lack of trained mechanics.122 sustainability in the programme. the wind blows the capulana, everyone can see me inside. I feel so embarrassed. Without — Marta, age 10 electricity inside the washroom, some of us xvii Source: Sajan Virgi, Zainul, 2010. The water sector considers urban areas to include only 13 major cities, while the definition of urban areas used by have fallen into the washbasins and gotten National Institute of Statistics in the 2003 DHS was 13 cities and 68 secondary towns.
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3.6. Water and sanitation in To accelerate progress towards the per cent in the five programme districts. The 3.7. Sector financing and budget MDGs, the Government of Mozambique introduction of CLTS in schools and training allocations schools is promoting a Child-Friendly Schools of key implementing non-governmental In Mozambique, access to safe water and programme, with the aim of providing a organisations and governmental staff has led Approximately 85 per cent of sector sanitation in schools is still not well defined minimum quality package to all schools in to a scale-up of sanitation in schools. investments over the last three years due to a lack of agreed indicators and survey target districts. Amongst other interventions, have come through official development The UNICEF Child-Friendly Schools Annual tools. However, in a recent baseline survey the programme provides safe water and assistance. Actual sector budgets for Field Assessment Report124 shows that undertaken in five districts, it was noted that adequate sanitation facilities in all schools the period 2006-2008 have increased considerable progress has been made in only 28 per cent of schools had access to in the selected districts. By 2008, this effort by 150 per cent as compared with the the enrolment, retention and educational safe water, and fewer than 28 per cent had had resulted in an increase in the proportion period 2003-2005 (from roughly $US 46 performance of children in Mozambique. The access to sanitation. of schools with water from 28 per cent to 80 million to $US 116 million). Similarly, net enrolment ratio at primary level has risen disbursements have increased over this from 69 per cent in 2003 to 95 per cent in 125 Box 3.4: Community Led Total Sanitation same period by 155 per cent, though the 2007. Table 3.4 illustrates progress in raising overall rate of disbursement has remained enrolment in the five school districts where relatively constant at around 60 per cent. The One Million Initiative is a six year programme partnership between the Dutch Government and activities are being implemented. “On-treasury” funding is disbursed at a UNICEF that aims to support the efforts of the Mozambique Government to ensure adequate water supply and sanitation and the adoption of improved hygiene practices for a million rural people in 18 districts, of which 6 are in Tete, 6 in Sofala and 6 in Manica. Table 3.4: Number of pupils enrolled, by sex, in five Child-Friendly School districts, 2006–2008 After the use of the Participatory Hygiene and Sanitation Transformation methodology through non-governmental organisations contracted by the districts failed to bring the desired results 2006 2008 Increase (%) District in the programme’s sanitation and hygiene promotion activities, it was decided to introduce Boys Girls Total Boys Girls Total Total Community Approach for Total Sanitation. In Mozambique, this has taken the form of a combination Maganja da Costa 31,579 18,335 49,914 41,485 26,707 68,192 36,6% of Community Led Total Sanitation (CLTS) with a system of awards/prizes. CLTS is an innovative methodology for mobilising communities to completely eliminate open defecation. Communities Buzi 17,448 13,007 30,455 19,779 16,260 36,039 18.3% are facilitated to conduct their own appraisal and analysis of open defecation and take their own Mossurize 16,226 11,786 28,012 22,987 17,840 40,827 45.7% action to become open defecation free. At the heart of CLTS lies the recognition that merely providing toilets does not guarantee their use, nor result in improved sanitation and hygiene. Earlier Changara 20,706 17,836 38,542 22,240 20,045 42,285 9.7% approaches to sanitation prescribed high initial standards and offered subsidies as an incentive. Chibuto 22,645 22,387 45,032 23,337 23,257 46,594 3.5% But this often led to uneven adoption, problems with long-term sustainability and only partial use. It also created a culture of dependence on subsidies. Open defecation and the cycle of fecal–oral Source: UNICEF, ‘Assessment: Child-Friendly Schools initiative in Mozambique Annual Field Assessment Report’ UNICEF Mozambique, Maputo, 2009. contamination continued to spread disease. In contrast, CLTS focuses on the behavioural change needed to ensure real and sustainable improvements – investing in community mobilisation instead of hardware, and shifting the focus from toilet construction for individual households to the creation of “open defecation-free” villages. By raising awareness that as long as even a minority continues to defecate in the open everyone is at risk of disease, CLTS triggers the community’s desire for change, propels them into action and encourages innovation, mutual support and appropriate local solutions, thus leading to greater ownership and sustainability. WaterAid and UNICEF have become important disseminators and champions of CLTS. Today CLTS is in more than 20 countries in Asia, Africa, Latin America and the Middle East. CLTS has a great potential for contributing towards meeting the MDGs, both directly on water and sanitation (goal 7) and indirectly through the knock-on impacts of improved sanitation on combating major diseases, particularly diarrhoea (goal 6), improving maternal health (goal 5) and reducing child mortality (goal 4). In addition to creating a culture of good sanitation, CLTS can also be an effective point for other livelihoods activities. It mobilises community members towards collective action and empowers them to take further action in the future. CLTS outcomes illustrate what communities can achieve by undertaking further initiatives for their own development.
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rate of 82 per cent, as opposed to donor- required. In urban sanitation approximately managed projects which disburse at an half of the amounts required have been 4. Conclusions average rate of 58 per cent.126 Government committed.129 Given the major funding of Mozambique disbursement rate shortfall, it is unlikely that the MDGs related improvement has been brought about by to water and sanitation will be achieved. There are a number of underlying causes of children, but also shape the behaviour a combination of the elimination of the old Resources for the funding gap are being for the high mortality rates and poor and treatment of their own children later “duodecimal” budget allocation system, mobilised by both establishing a common health status of Mozambican children and in life. Due to low levels of education, the introduction of the new state financial fund and improving coordination of substantial barriers to improving child limited access to information about the management system (SISTAFE), improved programme funds. survival and development in Mozambique. prevention and treatment of illnesses procurement processes, more punctual and the unhealthy environment of many One of the main underlying causes of child donor disbursements, improved estimates In 2010, the Government of Mozambique households, the practices of care-givers are morbidity and mortality in Mozambique is of project start-up dates, and the allowance reported that 7.6 per cent ($US 241 million) often inappropriate or even detrimental to the lack of access to public services, both in by some donors of payment of Government of the total state budget was allocated to the children’s health. 130 terms of physical and economic access and of Mozambique counterpart contributions water sector. This is a significant increase the poor quality of these services. Barriers to or tax payments using the same projects’ over the 2.8 per cent in 2003 (see Table 3.5). Access to safe water and particularly safe accessing and using services are particularly credits or grants. In a move towards decreasing geographical sanitation remain low. Safe water and disparities, the National Rural Water acute for poorer households, for people sanitation are essential to improving the The annual average investment required to Supply and Sanitation programme will be living in rural areas, and for those with less health of children and households due to the meet MDG targets in rural areas has been implemented on a priority basis in provinces education. This directly relates to higher high prevalence of water-borne diseases. Lack estimated at $US 70 million.127 The first and districts meeting agreed criteria, mortality rates among children from these of access to safe water also takes time away phase of the National Rural Water Supply which include present water and sanitation households. from productive activities as the mean time to and Sanitation programme (2009–2011) will coverage, poverty, written commitments and There are significant disparities in the walk to water source is just under one-hour, a require an estimated $US 200 million. adequate staffing, amongst others. allocation of resources from central level to trip taken most often by women and girls. Although planned expenditure for Despite this increase in the proportion of particular provinces and rural areas. This While progress has been made in setting urban water exceeds estimated required the total budget allocated to water and can partly be attributed to insufficient links up an enabling environment (sector investment, there is a shortfall of sanitation, the Government’s contribution between health policy instruments, which institutional framework and related approximately 35 per cent in relation to has declined steeply. In 2006, 66 per cent emphasise poverty reduction and the need implementation guidelines and approaches), to target vulnerable groups, and the sector the rural water sector.128 Current budget of water and sanitation expenditures were the capacity to implement interventions planning and resource allocation systems. commitments for sanitation indicate that covered by external financing.131 Analysis at the required scale and with the required approximately five per cent of funds needed of the total investment in the sector in 2010 Poverty remains a key underlying cause of quality is not always present at sub-national have been committed for rural sanitation, indicates that 85 per cent of funding now child mortality. The mortality rates among levels. Furthermore, sector assessments $US 3 million has been committed per originates from external resources, although children from poorer families are significantly recently undertaken have shown that annum versus an estimated $US 22 million this is a slight decrease from 2009.132,133 higher than those from better off families. despite developments in the urban areas, a Data from the 2008 MICS survey show significant number of the population living in that child mortality levels start decreasing the peri-urban areas are lacking safe drinking significantly only in the fourth wealth quintile. water and adequate sanitation facilities. Table 3.5: Financing of the water sector as a proportion of state budget, selected years 2003–2010 Poverty contributes to the high rates of child Improved sanitation and hygiene practices, 2003 2004 2005 2008 2009 2010 mortality not only through the disadvantages particularly at rural and peri-urban areas, 3% 2% 2.5% 5% 4.5% 8% faced by poorer families, such as lower should be a national priority and requires access to services, lower levels of education a strong multisectoral collaboration to Source: Ministry of Finance 2008, 2010. and less healthy living environments, but address all underlying causes. Although also due to the immediate lack of money to actions are being taken towards to improving pay for services or medication. sanitation conditions (through sanitation campaigns), additional efforts still need to be Care practices, including child feeding made at all levels with a strong community practices, hygiene and sanitation, and approach focus. CLTS is an innovative management of childhood illnesses, play an methodology for mobilising communities to important part in the survival and healthy conduct their own appraisal and analysis of development of children. Care practices their own sanitation and take measures to not only have a direct impact on the health improve their situation in a sustainable way.
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References 30 UNICEF calculations based on: National 44 World Health Organisation, HIV and Institute of Statistics, ‘MICS 2008,Relatório Infant Feeding: Revised principles and 1 Black, Robert E., et al., ‘Child Survival’, The 15 Ministry of Planning and Development, Final,’ Government of Mozambique, Maputo, recommendations – Rapid advice, WHO, Lancet , vol. 362, no. 9387, 13 September Poverty and Wellbeing in Mozambique: Third 2010. Geneva, November 2009. 2003, pp.22-26. National Poverty Assessment,’ Government of 31 National Institute of Statistics,‘MICS 45 World Health Organisation, The World Health Mozambique,Maputo, September 2010. 2 World Health Organisation, ’Children: 2008,Relatório Final,’ Government of Report: Mental and neurological disorders, reducing mortality,’ retrieved from: http:// 16 National Institute of Statistics, ‘MICS Mozambique, Maputo, 2010. WHO, 2001 www.who.int/mediacentre/factsheets/fs178/ 2008,Relatório Final,’ Government of 32 Ibid. 46 National Institute of Statistics, ‘MICS 2008, en/index.html accessed on 9 December 2010. Mozambique, Maputo, 2010. Relatório Final,’ Government of Mozambique, 33 Ministry of Planning and Development, 3 United Nations Children’s Fund, ‘The State of 17 UNICEF calculations based on National Maputo, 2010. ‘Poverty and Wellbeing in Mozambique: Third the World’s Children 2008,’ UNICEF, New York, Institute of Statistics, ‘MICS 2008,Relatório National Poverty Assessment,’ Government of 47 Ministry of Health, Semana Nacional de 2009. Final,’ Government of Mozambique, Maputo, Mozambique, Maputo, September 2010. Saúde da Criança Relatório Final, Government 2010. 4 World Health Organisation, ‘Turning the tide of Mozambique, Maputo, 11 June 2008. 34 Shrimpton, Roger, et al., ‘Worldwide Timing of of malnutrition: responding to the challenge 18 Mozambique National Institute of Health, Growth Faltering: Implications for nutritional 48 Ministry of Health, Direcção Nacional de of the 21st century.’ Geneva, 2000. London School of Hygiene and Tropical interventions’, Pediatrics, vol. 107, no. 5, May Saúde, Inquérito nacional sobre a deficiência Medicine, and UNICEF, Mozambique National 5 World Health Organisation, ‘Environmental 2001. de vitamina A, prevalência de anemia e Childhood Mortality Study 2009, Government burden of disease: Country profiles,’ Geneva, malária em crianças dos 6-59 meses e of Mozambique, Maputo, 2009. 35 World Health Organisation, Global Strategy 2007. respectivas mães, Instituto Nacional de for Infant and Young Child Feeding, WHO, 19 National Institute of Statistics, ‘MICS 2008, Saúde, Maputo, 2003. 6 Prüss-Üstün A, Bos R, Gore F, Bartram J., Geneva, 2003. Relatório Final,’ Government of Mozambique, ‘Safer water, better health : costs, benefits and 49 Ibid. Maputo, 2010. 36 National Institute of Statistics, ‘MICS sustainability of interventions to protect and 2008,Relatório Final,’ Government of 50 National Institute of Statistics, ‘MICS 2008, promote health.’ WHO, Geneva, 2004. 20 Ministry of Planning and Development, Mozambique, Maputo, 2010. Relatório Final,’ Government of Mozambique, ‘Poverty and Wellbeing in Mozambique: Third 7 Brown, K.H., ‘Diarrhoea and malnutrition.’ Maputo, 2010. National Poverty Assessment,’Government of 37 Ibid. Journal of Nutrition, 133, 328-332, 2003. Mozambique, Maputo, September 2010. 51 Ibid. 38 National Institute of Statistics, Multiple 8 Black, Robert E., et al., ‘Child Survival,’The 21 National Institute of Statistics, ‘MICS 2008, Indicator Cluster Survey, Government of 52 United Nations Children’s Fund, The State of Lancet, vol. 362, no. 9387, 13 September 2003, Relatório Final,’ Government of Mozambique, Mozambique, Maputo, 2010. the World’s Children 2009, UNICEF, New York, pp. 915–916. Maputo, 2010. 2009. 39 Pedro, A., et al., Levantamento das Barreiras 9 Authors’ calculations based on: Mozambique 22 Ibid. para o Aleitamento Materno Exclusivo, 53 Ibid. National Institute of Health, London School of Government of Mozambique, Maputo, 2009. Hygiene and Tropical Medicine, and UNICEF, 23 National Institute of Statistics, Inquérito 54 Ministry of Health, Desempenho do Sector da Mozambique National Childhood Mortality Demográfico e de Saúde 2003, Government of 40 National Institute of Statistics, Multiple Saúde Oitava Avaliação Conjunta Annual ACA Study 2009, Government of Mozambique, Mozambique, Maputo, June 2005. Indicator Cluster Survey, Government of VIII, Government of Mozambique, Maputo, Maputo, 2009. Mozambique, Maputo, 2010. 2009. 24 National Institute of Statistics, Inquérito 10 United Nations Children’s Fund, The State of de Indicadores Múltiplos 2008, Sumário, 41 Pan American Health Organisation and World 55 Save the Children, State of the World’s the World’s Children 2009, UNICEF, New York, Government of Mozambique, Maputo, 2008. Health Organisation, Guiding principles of Mothers 2004, Westport, Connecticut, May 2009. complementary feeding of the breastfed 2004. 25 National Institute of Statistics, ‘MICS 2008, child, Pan American Health Organisation, 11 Ibid. Relatório Final,’ Government of Mozambique, 56 National Institute of Statistics, Inquérito Washington, D.C., 2002. Maputo, 2010. Demográfico e de Saúde 2003,Government of 12 Government of Mozambique and United 42 National Institute of Statistics, ‘MICS 2008, Mozambique, Maputo, June 2005. Nations, Report on the Millennium 26 Ibid. Relatório Final,’ Government of Mozambique, Development Goals, Government of 57 Ministry of Health, Inquérito nacional sobre 27 Government of Mozambique, Report on Maputo, 2010. Mozambique, Maputo, 2010. a deficiência de vitamina A, prevalência de the Millennium Development Goals 2010, 43 World Health Organisation, HIV and Infant anemia e malária em crianças dos 6-59 meses 13 United Nations Children’s Fund, The State of Mozambique, Maputo, 2010. Feeding: New evidence and programmatic e respectivas mães, Instituto Nacional de the World’s Children 2009, UNICEF, New York, 28 National Institute of Statistics, ‘MICS 2008, experience – Report of a technical Saúde, Maputo, 2003. 2009. Relatório Final,’ Government of Mozambique, consultation held on behalf of the Inter- 58 National Institute of Statistics, Inquérito 14 National Institute of Statistics, ‘MICS Maputo, 2010. agency Task Team (IATT) on Prevention of HIV Demográfico e de Saúde 2003,Government of 2008,Relatório Final,’ Government of Infections in Pregnant Women, Mothers and 29 Ibid. Mozambique, Maputo, June 2005. Mozambique, Maputo, 2010. their Infants, WHO, Geneva, October 2006.
96 97 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
59 National Institute of Statistics, Inquérito 74 Ibid. 88 Ministry of Health, Manual de Prevenção 100 United Nations Committee on the Rights of de Indicadores Múltiplos 2008, Sumário, e Controlo da Cólera e de Outras Diarreias the Child, Consideration of Reports Submitted 75 Ministry of Health, MISAU Programme Report Government of Mozambique, Maputo, 2008. Agudas, Government of Mozambique, by States Parties Under Article 44 of the (unpublished) Maputo, 2009. Convention: Concluding observations of 60 National Institute of Statistics, Inquérito 76 Feiko O, et al,‘The Burden of Co-Infection with the Committee on the Rights of the Child Demográfico e de Saúde 2003, Government of 89 United Nations Children’s Fund, The State of Human Immunodeficiency Virus Type 1 and – Mozambique, CRC/C/MOZ/CO/2, Office of Mozambique, Maputo, June 2005. the World’s Children 2009, UNICEF, New York, Malaria in Pregnant Women in Sub-Saharan the High Commissioner on Human Rights, 2009. 61 National Institute of Statistics, ‘MICS 2008, Africa,’ American Society of Tropical Medicine Geneva, October 2009. Relatório Final,’ Government of Mozambique, and Hygiene, 2004. 90 National Institute of Statistics, ‘MICS 2008, 101 Fundação para o Desenvolvimento da Maputo, 2010. Relatório Final,’ Government of Mozambique, 77 Brentlinger, Paula E., C.B. Behrens and Comunidade and United Nations Children’s Maputo, 2010. 62 Ibid. M.A. Micek, ‘Challenges in the concurrent Fund, O Que Diz a Proposta de Orçamento do management of malaria and HIV in pregnancy 91 Ministry of Health, Relatório Semana Nacional Estado 2009 Sobre a Previsão de Recursos 63 Ibid. in sub-Saharan Africa,’ Lancet Infectious de Saúde da Criança Segunda Fase, Maputo, no Sector de Saúde?, Budget Brief 3, UNICEF 64 Ministry of Health and Save the Children, Diseases, vol. 6, no. 2, February 2006, pp. 27 Novembro 2008. Mozambique, Maputo, November 2008. ‘Routine annual and semester reports,’ 100–111. 92 Southern African Research and 102 Ministry of Finance, ‘Relatório de Execução do (unpublished data), 2009. 78 National Institute of Statistics, ‘MICS 2008, Documentation Centre, Instituto Superior de Orçamento do Estado 2009,’ Government of 65 Ministry of Health , Inquérito nacional sobre Relatório Final,’ Government of Mozambique, Relações Internacionais, National Institute of Mozambique, 2010 a deficiência de vitamina A, prevalência de Maputo, 2010. Statistics and United Nations Development 103 Water and Sanitation Programme/World Bank, anemia e malária em crianças dos 6-59 meses Programme, Mozambique National 79 Ibid. Water Supply and Sanitation in Mozambique: Human Development Report 2007, UNDP e respectivas mães, Instituto Nacional de turning finance into services for 2015 80 Mozambique, Maputo, 2007. Saúde, Maputo, 2003. Ibid. and beyond. An AMCOW Country Status 66 National Institute of Statistics, Inquérito 81 Radio Mozambique, ’Programas da criança 93 Ministry of Finance, ‘Relatório de Execução do Overview, Water and Sanitation Programme, Demográfico e de Saúde 2003, Government of Pesquisa de opinão aos ouvintes da rádio Orçamento do Estado 2008’ Government of World Bank, 2010 Mozambique, Maputo, June 2005. Mozambqiue,’ Escola Superior de Altos Mozambique, Maputo, 2009. 104 United Nations Children’s Fund, Childhood Estudos e Negócios, Gabinete de Estudos e 67 Ministry of Health, ‘Desempenho do Sector da 94 Fundação para o Desenvolvimento da Poverty in Mozambique: A situation and Projectas, Universidade Politéchnica, 2008. Saúde Oitava Avaliação Conjunta Annual ACA Comunidade and United Nations Children’s trends analysis, UNICEF Mozambique, VIII,’ Ministry of Health, Maputo, 2009. 82 Forum of Community Radio Stations, Fund, O Que Diz a Proposta de Orçamento do Maputo, 2006. ‘Documento Analítico sobre os Programas de Estado 2010 Sobre a Previsão de Recursos 68 Mozambique National Institute of Health, 105 UNICEF, “One Million Initiative” document on Rádio de Criança para Crianças’, FORCOM, no Sector de Saúde?, Budget Brief , UNICEF London School of Hygiene and Tropical cost analysis of boreholes 2008-2010, UNICEF 2008 Mozambique, Maputo, 2010. Medicine, and UNICEF, Mozambique National Mozambique, Maputo, 2010. Childhood Mortality Study 2009, Government 83 United Nations Children’s Fund and World 95 Organisation for African Unity, African 106 United Nations Development Group, Summit on HIV/AIDS, Tuberculosis and of Mozambique, Maputo, 2009. Health Organisation, Diarrhoea: Why children Indicators for Monitoring the Millennium are still dying and what can be done, UNICEF, other Related Infectious Diseases, OAU/SPS/ 69 Development Goals (MDGs): Definitions, Ministry of Health, National Malaria Control ABUJA/3, Organisation for African Unity, New York, and WHO, Geneva, 2009. rationale, concepts and sources, UNDG, New Programme, Malaria Indicator Survey, Abuja, 2001. Mozambique 2007, preliminary report, 84 World Health Organisation, Country profile York, 2003. Government of Mozambique, Maputo, 2008. of environmental burden of disease, WHO, 96 Fundação para o Desenvolvimento da 107 Ministry of Public Works and Housing, Geneva, 2007. Comunidade and United Nations Children’s 70 National Directorate of Water, ‘National National Institute of Statistics,‘MICS Fund, O Que Diz a Proposta de Orçamento 85 Rural Water Supply and Sanitation Program,’ 2008,Relatório Final,’ Government of Mozambique National Institute of Health, do Estado 2010 Sobre sobre os chamados Maputo, March 2009. Mozambique, Maputo, 2010. London School of Hygiene and Tropical Sectores Prioritários?, Budget Brief , UNICEF Medicine, and UNICEF, Mozambique National 71 World Health Organisation and Roll Back Mozambique, Maputo, 2010. 108 National Institute of Statistics, Inquérito Childhood Mortality Study 2009, Government Malaria partnership, Global Malaria Action de Indicadores Múltiplos 2008, Sumário, of Mozambique, Maputo, 2009. 97 Ibid. Plan, WHO, Geneva, 2008, available at www. Government of Mozambique, Maputo, 2008. rollbackmalaria.org/gmap/2-2.html. 86 National Institute of Statistics, ‘MICS 2008, 98 Ministry of Finance, ‘Relatório de Execução do 109 Ibid. Relatório Final,’ Government of Mozambique, Orçamento do Estado 2009,’ Government of 72 Ministry of Health, ‘Provincial campaign Maputo, 2010. Mozambique, 2010 110 Ibid. reports;’ (unpublished), 2009. 87 World Health Organisation Global Task Force 99 Government of Mozambique, Plano de Acção 111 Ibid. 73 National Institute of Statistics, ‘MICS 2008, on Cholera Control, Cholera Country Profile: para a Redução da Pobreza Absoluta (2006- Relatório Final,’ Government of Mozambique, 112 Fundo de Investimento e Património Mozambique, WHO, Geneva, 2006. 2009), Maputo, 2006. Maputo, 2010. de Abastecimento de Água and Beira
98 99 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 3: CHILD SURVIVAL AND DEVELOPMENT
Municipality, (unpublished data), Maputo/ 125 Water and Sanitation Programme/World Bank, Beira. 2009 Water Supply and Sanitation in Mozambique: turning finance into services for 2015 113 Ministry of Health, Informe annual sobre a and beyond. An AMCOW Country Status epidemia de cólera em Moçambique 2008- Overview, Water and Sanitation Programme, 2009, Ministry of Health, Maputo, 2010 World Bank, 2010 114 Water and Sanitation Programme/World Bank, 126 Santos, C., Análise do Relatório de Execução Water Supply and Sanitation in Mozambique: do Orçamento do Estado do 2008 Sector de turning finance into services for 2015 Águas, Maputo, 2009 and beyond. An AMCOW Country Status Overview, Water and Sanitation Programme, 127 Ministry of Public Works and Housing, World Bank, 2010. National Directorate of Water, National Rural Water Supply and Sanitation Programme, 115 Ibid. Government of Mozambique, Maputo, March 116 UNICEF calculations based on: National 2009. Institute of Statistics, ‘MICS 2008, Relatório 128 Water and Sanitation Programme/World Bank, Final,’ Government of Mozambique, Maputo, Water Supply and Sanitation in Mozambique: 2010. turning finance into services for 2015 117 Ibid. and beyond. An AMCOW Country Status Overview, Water and Sanitation Programme, 118 World Health Organisation and United World Bank, 2010 Nations Children’s Fund, Joint Monitoring Programme Report, WHO, Geneva, and 129 Ibid. UNICEF, New York, 2009. 130 Fundação para o Desenvolvimento da 119 WASH News Africa, ‘AMCOW AfricaSan Comunidade and UNICEF, O Que Diz a Awards 2010 Winners: Feliciano dos Proposta de Orçamento do Estado 2010 Santos, Takiso Achame and David Kuria,’ Sobre a Previsão de Recursos no Sector de reterived from: http://washafrica.wordpress. águas e saneamento?, Budget Brief, UNICEF com/2010/11/24/amcow-africasan-awards- Mozambique, Maputo, 2010. 2010-winners-feliciano-dos-santos-takiso- 131 United Nations Children’s Fund, Childhood achame-and-david-kuria, accessed on Poverty in Mozambique: A situation and December , 2010 trends analysis, UNICEF Mozambique, 120 UNICEF calculations based on: National Maputo, 2006. Institute of Statistics, ‘MICS 2008,Relatório 132 Fundação para o Desenvolvimento da Final,’ Government of Mozambique, Maputo, Comunidade and UNICEF, O Que Diz a 2010. Proposta de Orçamento do Estado 2010 121 Skinner, Jamie, and International Institute for Sobre a Previsão de Recursos no Sector de Environment and Development, Where Every águas e saneamento?, Budget Brief, UNICEF Drop Counts: Tackling rural Africa’s water Mozambique, Maputo, 2009. crisis, International Institute for Environment 133 Fundação para o Desenvolvimento da and Development, London, 2009. Comunidade and UNICEF, O Que Diz a 122 Ernst and Young, Sustainability of Rural Water Proposta de Orçamento do Estado 2010 and Sanitation Infrastructure in Tete, Manica Sobre a Previsão de Recursos no Sector de and Sofala Provinces, Maputo, 2008. águas e saneamento?, Budget Brief, UNICEF Mozambique, Maputo, 2010. 123 WE Consult, Data Collection for Mid-term Impact Assessment. UNICEF, Maputo, 2010.
124 UNICEF, ‘Assessment: Child-Friendly Schools initiative in Mozambique Annual Field Assessment Report’ UNICEF Mozambique, Maputo, 2009.
100 101 CHAPTER CHAPTER Education and children’s right 4 to development 4 1. Introduction
Education is a fundamental right of all instruments for advancing economic and children. It is guaranteed by the constitution social development and in reducing poverty, of Mozambique, which states that especially childhood poverty, and inequality. “education constitutes both a right and a As noted in Chapter 3 of this Study on Child responsibility of all citizens.” According Poverty and Disparities in Mozambique to the Convention on the Rights of the - 2010, education also plays an essential Child, the right to education encompasses role in child survival and development. This not only the obligation to provide access is especially the case for girls’ education, to education, but also to eliminate which is highly correlated with reduced discrimination at all levels, to set minimum child mortality and improved child health standards and to improve quality. Education and nutrition for subsequent generations of is also an important global development children. priority. Millennium Development Goals (MDGs) 2 and 3 aim, respectively, at This chapter analyses the education sector achieving universal primary education and in Mozambique. The first section examines promoting gender equality, including parity the current situation and recent trends in in education. participation in the education system. The subsequent section focuses on barriers to As well as being necessary for the fulfilment participation, describes recent trends in sector of civil, political, economic and social rights, financing, and draws some conclusions based education is also one of the most powerful on the analyses presented.
EDUCATION AND CHILDREN’S RIGHT TO DEVELOPMENT 103 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 4: EDUCATION AND CHILDREN’S RIGHT TO DEVELOPMENT
with special needs in the areas of hearing, as measured by the net gender parity index 2. The current situation and recent trends visual, mental or physical disability. (GPI), has narrowed from 0.90 in 2003 to 0.97 in 2008.i In secondary, the GPI improved in education Adult education, which ceased during the from 0.80 in 2003 to 0.97 in 2008. war, has regained momentum in recent years, with new programmes, such as Long-standing discrepancies in children’s distance learning through radio and school attendance between urban and Secondary education consists of five years 2.1. The education system television, introduced to provide basic rural areas and between the poorest and of schooling and is also divided into two in Mozambique education to adults, particularly women in richest households have also been reduced. levels: the first level comprises grades 8 to rural areas. Although gaps remain, rural and poorer 10 (escola secundária geral do primeiro grau, The legal basis for Mozambique’s National children saw a greater increase in net or ESG1) and the second level comprises Education System, which defines the Disparities have been narrowing in primary attendance rates in recent years than urban grades 11 and 12 (escola secundária geral principles, roles and objectives of each education but progress in secondary and better-off children, at both primary and do segundo grãu, or ESG2). The first level sub-system of education, including primary education has been slow. Approximately secondary levels. education, was established by law in should be attended by children aged 13 to 3.3 million of Mozambique’s 4.1 million 1992 (Lei nº6/92). School fees for primary 15 years, while the second level should be children aged 6–12 are now attending education were abolished in 2004, but they attended by children aged 16 and 17 years. primary school2 equivalent to net attendance 2.2. Children in school remain in other levels of education. The curriculum reform process for secondary 3 rate of 81 per cent in 2008. Net attendance More children are attending school today education, introduced in 2007, as well as rate in secondary school remains low; only than five years ago. Primary school net The Ministry of Women and Social Action the Secondary Education Strategy drafted in 20 per cent of children aged 13–17 were attendance rates increased between 2003 has primary responsibility for implementing 2008, intend to make secondary education attending secondary school in 2008. Almost and 2008 from 60 to 81 per cent. Secondary Early Childhood Development (ECD); more accessible and practical, and aim to half of children of that age are still attending however, until now ECD has been provided school net attendance rates also increased develop life skills competencies in pupils. primary school.4 mainly by private operators and some public between 2003 and 2008, from an extremely low base, from 8 to 20 per cent. institutions with a very limited coverage, Technical and professional education within There is no significant difference in primary with only about 61,400 children attending.1 the public education system consists of and secondary school attendance between A regression analysis was conducted to three levels: elementary, basic, and middle. girls and boys. The gender gap in primary, examine the factors that influence primary The general education system in These levels are equivalent to EP2, ESG1 Mozambique is divided into primary and and ESG2 and last for two, three and four secondary education. Primary education years respectively. Within the basic and consists of seven years of schooling middle levels it is possible to specialise in divided into two levels. The lower primary agriculture or industry and commerce. Figure 4.1: Net attendance rates, 2003 and 2008 level comprises grades one to five (ensino 90% primário do primeiro grau, or EP1) and At the tertiary level, there are over 30 80% should be attended by children aged 6 to 10 institutions in Mozambique, of which two 81% 82% 80% years. The upper primary level comprises are main public universities: the Pedagogical 70% grades six and seven (ensino primário University (Universidade Pedagógica or UP) 60% 63% 60% do segundo grau, or EP2) and should and Eduardo Mondlane University (UEM) 50% 57% be attended by children aged 11 and 12 as well as a number of other smaller higher 40% years. In 2004, the Ministry of Education education institutions. The requirements for 30% (MINED) introduced a new curriculum entrance to these institutions are completion 20% for basic education and reformed some of ESG2 (grade 12) and passing entrance 20% 21% 20% critical aspects of the system, including a examinations. 10% 8% 8% requirement for seven years of complete 0% 7% and integrated primary schooling, and Special education is intended to be Total Total Boys Boys Girls Girls Primary Secondary Primary Secondary Primary Secondary semi-automatic promotion. As such, the mainstreamed through inclusive education, according to the objective set out by the two levels of basic education are currently 2003 2008 in the process of being gradually merged Education and Culture Strategic Plan. Special Source: DHS 2003 and MICS 2008. into a single tier (ensino primário completa, education had been mainly provided in a or EPC), comprising a seven year cycle of few special schools, which are managed by primary education. the Ministry of Women and Social Welfare, i The GPI is calculated by dividing the female net enrolment ratio by the male net enrolment ratio for a given level of catering for a limited numbers of children education. A GPI of 0.96 to 1.04 indicates that the percentages of boys and girls in school are roughly equal. A value of less than 0.96 indicates a lower percentage of girls than boys in school.
104 105 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 4: EDUCATION AND CHILDREN’S RIGHT TO DEVELOPMENT
school attendance for children aged 6–12, primary school attendance, although 2.3. Children out of school net attendance rates increased among rural based on the MICS 2008 dataset. Here, the dropouts start from age 10 (see Figure children from 53 per cent in 2003 to 79 per dependent variable is whether the child is 4.2). The model also indicates that a child In 2003, there were 1.5 million children cent in 2008, compared to an increase of attending primary school. Results show that with a disability is 40 per cent less likely to not attending primary school. Five years from 76 per cent to 89 per cent for urban education of the mother seems to be one of be attending primary school than a non- later, that number has halved: 764,000 (see children in the same timeframe.8 the most important factors affecting primary disabled child. The gender of the child Figure 4.3). In absolute numbers, however, school attendance. Household wealthii is does not bear any statistically significant gender disparities persist. More girls are not 2.4. Delays in starting education also positively correlated to attendance. relationship with school attendance, as enjoying their right to primary education: In addition, children in female-headed Figure 4.2 also confirms. 399,000 girls versus 364,000 boys.5 Being over-age in school is a widespread households and those with a father present phenomenon in Mozambique and is Among children of secondary school age are more likely to attend school. Age of the In terms of geographical differences, rural influenced by many factors. Although the who are out of school, a reverse trend can household head and household size do not children have a slightly lower probability Ministry of Education has been promoting be observed. The number of 13- to 17-year- seem to be correlated to attendance. of attending primary school than urban the idea that children should start school at olds out of school appears to have slightly children. Children living in the northern the right age, whether a child actually does increased between 2003 and 2008, from Given the relatively large proportion of provinces show a higher likelihood of so depends on several factors, one of which 31 to 36 per cent.6 More girls than boys (in children who start school late, the age of dropping out of school than children in is the child’s area of residence. Children in both secondary and primary education) are a child has a positive relationship with Maputo City. rural areas enter school later than children out of school. Part of the reason for this is in urban areas. At six years old, 61 per cent that more boys of secondary school age of children in rural areas were attending are found attending primary schools, that primary school in 2008, compared to 73 per PROBABILITY OF NOT ATTENDING PRIMARY SCHOOL is, they are ‘over-age’ (49 per cent of boys Figure 4.2: Probability of children 6-12 not attending primary school, 2008 cent of urban children. Starting school at versus 38 per cent of girls), while more children 6-12 the right time is influenced by the level of
.5 girls are outside of the education system education of the child’s mother and level of altogether (41 per cent of girls versus 30 per wealth of the child’s household. In 2010, 69 cent of boys).7 per cent of girls started school at the correct .4 While urban children fare better than their age, based on statistics from the MINED. rural counterparts, greater overall progress
.3 While progress has been observed over in education indicators was observed in time, more children aged 13–17 are rural areas between 2003 and 2008. Primary attending primary than secondary school. .2
Figure 4.3: Percentages of children aged 6–12 and 13–17 out of school, by sex, place of residence and .1 socioeconomic background, 2008 Probability of not attending primary school 50%
0 49% 45% 6 8 10 12 Age 40% 42% 42% Male Female 35% 30% Source: UNICEF calculations based on MICS 2008. 30% 25% 28% 25% 20% 22% 20% 18% 20% 15% 10% 11% 5% 5% 0% Urban Rural Boys Girls Richest Poorest Primary Secondary
Source: MICS 2008. ii Measured through an asset score index, based on the methodology of Filmer and Pritchett, 2001.
106 107 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 4: EDUCATION AND CHILDREN’S RIGHT TO DEVELOPMENT
In 2008, 44 per cent of the total secondary- 2.5. Primary school completion While there has been a 100 percent increase 2.6. Progression through grades school-age population was in primary and transition to secondary in the number of secondary schools since school, compared to 61 per cent in 2003. 2004, this has occurred mostly in urban and Low primary completion rates are due, at Gender disparities are evident: among 17- education peri-urban areas.12 For the large majority of least in part, to the persistent failure of year-olds, 21 per cent of boys versus 12 per Participation in secondary school depends rural children completing basic education, children to smoothly progress from one cent of girls were attending primary school on completion of primary school. Primary access to secondary education is still a grade to the next. On average, around eight in 2008.9 school completion rates are low, at 15 per challenge. It is interesting to note, however, per cent of children fail to progress from cent. There is a significant disparity between that a reduction in matriculation fees charged one grade to the next every year, and this The age a child starts school clearly affects urban and rural primary completion rates to girls enrolling in secondary schools failure is reasonably constant through the 14 the proportion of over-age children in (30 per cent versus 7 per cent, respectively, has boosted girls’ enrolment in secondary primary cycle. Given that MINED’s semi- school. Children have tended to start their in 2008).10 Although completion rates are schools, although girls enrolment remains automatic promotion policy allows children schooling earlier in recent years. Figure 4.4 increasing in both urban and rural areas, lower than that of boys, in most provinces. to repeat only the second, fifth and seventh shows how younger generations are more the divide between the two has grown, grades, it would be expected that failure to Primary school completion is directly likely to start primary school at age six than with a five-fold increase for urban children progress would be higher from these grades. influenced by a number of factors, including older groups. compared to a two and a half times increase Data from MICS 2008 show that this is not mothers’ education levels, household wealth for rural children. It is possible that recent the case. It should be noted, however, that The over-age phenomenon in primary and province.iii Children whose mothers increases in attendance rates for rural repetition rates have fallen dramatically education has significant implications for have secondary education or more are children will translate into higher completion since 2003. children’s learning outcomes, as the same more likely to complete primary school at rates in the coming years. While a majority curriculum is taught at the same pace to the right age than children whose mothers Only 60 per cent of children reach the last of children (73 per cent) who complete learners of very different ages and levels of have no education (see Figure 4.5). Forty- grade of primary school (see Figure 4.6).15 primary level progress to secondary school, cognitive development. It also poses serious four per cent of children from the richest For some groups of children, the progress completion rates there are even lower. challenges for school-based HIV and AIDS quintile complete primary education at age rate is significantly lower: girls, rural and The Ministry of Education estimates that prevention programmes targeting children 12 compared to 1 per cent from the poorest the poorest children are more likely to fail the gross completion rate for secondary aged 10–14 in grades 5–8 (regarded as the quintile. Rural/urban disparities also persist, to progress through the primary education education was 6.5 per cent in 2009. Males Window of Hope, since most are not yet as children in urban areas are four times system. Children failing to progress may be are more likely to complete secondary sexually active or are only just becoming more likely to complete primary school than either repeating a grade (for grades two, five than females (8 per cent versus 5 per cent sexually active). The more mature over-aged children in rural areas (30 per cent versus 7 and seven) or dropping out of the education respectively).11 Secondary education is not children require a different approach in such per cent).13 system, at least temporarily. free and there are inadequate numbers of programmes. secondary schools, especially in rural areas. Figure 4.5: Primary school completion rates and transition to secondary education, 2008
Figure 4.4: Distribution of population according to the age they started school, 2008 90% 80% 60% 78% 70% 75% 75% 73% 70% 70% 69% 50% 60% 50% 45% 50% 40% 41% 39% 40% 44% 37% 30% 30% 28% 30% 20% 25% 20% 17% 18% 17% 10% 14% 15% 10% 13% 7% 1% 9% 0% Male Female Urban Rural Poorest Richest Total 0% 3% Urban Rural Boys Girls Richest Poorest Net primary school Transition rate to 5-9 years 10-14 years 15-19 years 20-24 years 25-29 years 30-34 years completion rate secondary education
Started school at age 6 Started school at age 10+ Source: MICS 2008.
Source: MICS 2008. iii It should be noted that education of the mother, household wealth and household location (urban/rural) are likely to be correlated with each other.
108 109 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 4: EDUCATION AND CHILDREN’S RIGHT TO DEVELOPMENT
Figure 4.6: Percentage of children entering first grade who reach the last grade of primary school by wealth quintiles did not attend secondary the majority of children, and especially selected characteristics, 2008 school. By 2008, a considerable increase those living in rural areas are compelled was seen in the top two quintiles. Access to stop their education. As a solution to 90% for children in the bottom three quintiles the problem of spaces, Expanded Primary 80% 85% remains extremely low, however (see Schools (or Escolas Primárias Expandidas 70% 71% Figure 4.8). Increases in absolute terms – EPE) have been appearing and providing 60% 64% were significantly higher for richer children. secondary education, however, the teachers 60% Attendance of children in the poorest quintile from the primary school are often the ones 50% 56% 53% 47% increased by only 2 percentage points teaching the General Secondary Education 40% between 2003 and 2008, while attendance classes, despite not having the requisite 30% for children in the richest quintile increased qualifications. In addition, the influx of 20% by 27 percentage points. The gap between secondary students places further pressure 10% the secondary school net attendance ratios on the space available in primary schools.17 0% of the richest and poorest children increased Male Female Urban Rural Poorest Richest Total from 21 percentage points in 2003 to 46 2.8. Literacy percentage points in 2008.16 At independence in 1975, Mozambique had Source: MICS 2008. More pupils graduating from 7th grade have an overall illiteracy rate in excess of 93 per been unable to continue into secondary cent, with even higher rates for women, education or the first cycle of General which posed a tremendous challenge to the Secondary Education (8th grade) due to lack points. The gap between the highest development of the country. Government 2.7. Equity in education of sufficient schools to absorb the surge in and community efforts in the ensuing years and lowest quintiles decreased from 43 demand. The numbers of trained teachers Inequity in primary education has narrowed were successful in decreasing the illiteracy percentage points in 2003 to 23 percentage and equipment are also inadequate, forcing between 2003 and 2008. As can be seen in rate to 72 per cent by 1980. Nevertheless, points in 2008. families to send their children to private Figure 4.7, net primary school attendance this progress was undermined by the onset schools if they have the means. Meanwhile, ratios increased for all wealth quintiles. The Inequity is more pronounced at the of the war and the economic crisis in the increase was larger for poorer children than secondary level and has increased in recent richer children, closing the equity gap. The years. In 2003, the vast majority of children Figure 4.8: Secondary school net attendance ratios by wealth quintile, 2003 and 2008 bottom three wealth quintiles all achieved in secondary school were from the best-off families. Most children in the bottom four absolute increases of around 27 percentage 50% 45% 49% Figure 4.7: Primary school net attendance ratios by wealth quintile, 2003 and 2008 40% 35% 100% 30% 90% 95% 25% 80% 88% 87% 80% 20% 22% 70% 74% 21% 70% 72% 15% 60% 10% 50% 53% 48% 5% 8% 40% 45% 5% 6% 0% 1% 2% 2% 3% 30% 2003 2008 20% Lowest Second Middle Fourth Highest 10% Source: DHS 2003 and MICS 2008. 0% 2003 2008 Lowest Second Middle Fourth Highest
Source: DHS 2003 and MICS 2008.
110 111 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 4: EDUCATION AND CHILDREN’S RIGHT TO DEVELOPMENT
1980s and early 1990s, which virtually 2.9. Tertiary education ceased progress in this area. The efforts 3. Barriers to participation in education resumed after the war, resulting in a The number of tertiary-level educational reduction of the adult illiteracy rate from 61 institutions has expanded from 9 to 38 per cent in 1999 to 54 per cent in 2005.18 between 2000 and 2009. These include the Perceptions of the benefits of education two main public universities: the Pedagogical 3.1. Direct costs in education are also usually associated with other Literacy rates remain low for women. In University (Universidade Pedagógica, or UP) The direct costs of primary education are factors, including: the quality of education 2008, only 47 per cent of women were and Eduardo Mondlane University (UEM). cited as a major barrier to children enrolling children are receiving, post-education literate. However, a greater proportion of The requirements for entrance to these and staying in school.21,22 The abolition job opportunities, distance to the nearest younger women are literate: 41 per cent institutions are completion of ESG2 (grade of school fees, which was introduced in secondary school, availability of places in of 20- to 24 year-olds compared to 53 per 12) and success in entrance examinations. 2004, coupled with the introduction of secondary schools, skills acquired in school cent of 15- to 19 year-olds. There was no a new curriculum and provision of free and the availability of qualified teachers. The significant change in women’s literacy rates Enrolment in tertiary level educational textbooks and some basic school materials large increase in enrolment in Mozambique between 2003 and 2008.19, iv institutions has also been expanding. The number of tertiary institutions increased through the Direct Support to Schools (ADE) suggests that there is a demand for The level of household wealth is strongly from 9 to 38 between 2000 and 2009 and programme, have reduced the direct costs education, certainly at primary level and correlated with the level of literacy, the number of students rose from 13,592 barrier to primary education. However, increasingly at secondary level. Apart especially for women. Among women aged to approximately 80,000 in 2009. 20 There the cost of uniforms and other school from demand-side, supply-side constraints 15–24, only 11 per cent from households in has also been improvement in terms of materials continues to constrain access for exacerbate barriers to education. the poorest quintile were literate, compared geographical equity, with either a fully- the most vulnerable families. Thus, for very with 84 per cent from households in the fledged higher education institution or a poor households, especially in rural areas, 3.3. Impact of traditions and best-off quintile (see Figure 4.9). branch opening in all provinces. the sum of all direct costs still remains a significant factor when deciding whether, culture on the right to who or how many children they can send to education school, particularly at the secondary level.23 Figure 4.9: Literacy rates for women aged 15–24 by wealth quintile, 2008 Cultural traditions can act as barriers to education. Early marriage among girls and 90% 3.2. Opportunity costs to initiation rites among both boys and girls tend 80% 84% communities to have a negative impact on primary school 70% attendance rates. Rites of initiation still occur In the context of poverty, investment in in some, mainly rural, parts of the country. 60% 60% education becomes one of the choices that Child marriage affects access to school, 50% households must make in relation to other retention and completion. Respondents in a 40% priorities affecting their lives and livelihoods. 2007 World Bank study noted child marriage Household poverty often requires children to as a reason why girls do not begin secondary 30% 32% help with household chores or work in order school or later drop out.25 20% 24% to earn money to support the household 10% or to buy school materials. MICS 2008 data There is a strong correlation between the 11% proportion of girls out of secondary school 0% show that 22 per cent of children 5–14 are Lowest Second Middle Fourth Highest involved in child labour.v However, the and the prevalence of child marriage in majority of these children (78 per cent) do a province. Figure 4.10 shows that child Source: 2008 MICS. attend school.24 marriage is more prevalent in the northern and central provinces than in the south of When children do not perform well in the country. Child marriage is also highly school, their parents may not see the correlated with household wealth. Girls benefits of education in terms of getting a from the poorest families are far more likely return on their investment, and as a result to get married than girls from wealthier may withdraw their children from school. backgrounds.
iv Comparisons between literacy data in DHS 2003 and MICS 2008 should be interpreted with caution because the v The definition of child labour includes children who are engaged in paid work, unpaid work, work for a family business or methodologies used in the two surveys are not compatible. household chores for 28 or more hours per week.
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Figure 4.10: Child marriage and girls out of secondary school by province, 2008 Figure 4.11: Pupil reading results, 2000 and 2007 Figure 4.12: Pupil mathematics results, 2000 and 2007 60% 56% 50% 52% 50% 511,8 509,5 46% SACMEQ SACMEQ 42% 42% 45% 500 500 40% 34% 33% 507,7 519,8 30% Zimbabwe Zimbabwe 30% 24% 27% 504,7 22% 21% 21% 19% 19% 19% 533,9 486,2 20% Zanzibar Zanzibar 478,2 478,1 9% 9% 10% 6% 4% 434,4 435,2 Zambia Zambia 0% 440,1 435,2 Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo 478,7 481,9 Delgado pula bezia bane Province City Uganda Uganda Girls out of secondary school Percentage married before age 15 482,4 506,3 577,8 552,7 Source: MICS 2008. Tanzania Tanzania 545,9 522,4
549,4 540,8 Swaziland Swaziland 3.4. Impact of violence and and report cases of sexual abuse in schools. 529,6 516,5 However, follow-up on abuse in schools abuse in schools 494,9 494,8 and strict implementation of the decree South Africa South Africa 492,3 486,1 The prevalence of violence, sexual abuse and zero tolerance policy remain weak. The and harassment in schools affects pupils’ Committee on the Rights of the Child has 575,1 550,7 Seychelles Seychelles attendance, especially girls’, and has been expressed concern at the prevalence of 582 554,3 identified by parents as a factor influencing sexual abuse and harassment in schools. 496,9 471 their decision to withdraw their children Namibia Namibia 448,8 430,9 from school. A study conducted by MINED 3.5. Educational quality in 2008 of children, school council members 476 483,8 Mozambique Mozambique and gender unit members of provincial The quality of education remains an area 516,7 530 education administrations assessed of critical concern in Mozambique. Recent 573,5 623,3 the prevalence of all kinds of violence, data from the Southern and Eastern Africa Mauritius Mauritius harassment and sexual abuse in schools. Consortium for Monitoring Education 536,4 584,6 Seventy percent of girls interviewed Quality (SACMEQ) indicate that between 433,5 447 stated that some teachers require sexual 2000 and 2007 levels Mozambique Malawi Malawi 428,9 432,9 intercourse before promoting students and registered a substantial deterioration that schools do not offer security against in achievement in both reading and 467,9 476,9 Lesotho Lesotho this, as the act is perpetrated with the mathematics.27 SACMEQ concludes that 451,2 447,2 complicit knowledge of school authorities. Mozambique’s decline of over 40 points in 543,1 557 The study also noted that victims and reading and mathematics was linked with Kenya Kenya 563,3 guardians are not aware that sexual abuse is rapid structural changes in the education 546,5 punishable by law. Fear of retaliation often system during the period under analysis 534,6 520,5 Botswana Botswana induces silence amongst the victims.26 that resulted in massive increases in Grade 521,1 512,9 6 enrolments without corresponding In 2003, MINED issued a decree explicitly increases in human and material resources. 0 200 400 600 800 0 200 400 600 800 prohibiting teachers from having sexual relations with students. MINED has also Quality of education can only be achieved 2007 2000 2007 2000 declared a ‘zero tolerance’ policy for sexual when learning environments are child- abuse and in the annual 2010 Economic and friendly and foster a holistic approach Source: Makuwa, D.,‘What are the levels and trends in reading and mathematics achievement?’ Southern and Eastern Africa Social Plan has strengthened the capacity to child development. This means they Consortium for Monitoring Education Quality, 2010. of provincial gender focal points to monitor address children’s multiple rights and
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link school, family and community. Child- children in Mozambique to commence than 1.2 million more people were in the Three types of schooling spaces exist friendly environments ensure that children and continue schooling. A consolidated education system in 2008/09 as compared in Mozambique: conventional schools, have safe and appropriate learning spaces, set of basic and minimum standards can with 2002/03.33 While this is a significant improved schools and thatched schools access to water and sanitation facilities, and act as norms for schools to ensure that increase in access to education, it puts a (Escola Precária). Schools constructed regular health check-ups. Children’s ability children are provided a supportive learning great deal of pressure on the education from bricks with zinc sheets for roofing to learn is adversely affected when learning environment. system. are the conventional type of building environments are not child-centred, gender constructed by the Government. However, sensitive, inclusive, protective and free from Very limited didactic materials are Access shock exacerbates the problem of due to the slow pace of construction, discrimination.28 available for teaching. MINED provides low completion rates, primarily because a large number of schools are built by free textbooks to children in grades 1–7 school construction is incomplete, and communities using locally available To date, the approach to ensuring quality based on projected enrolment figures. In schools are therefore unable to offer places materials; these are basically temporary of education in Mozambique has been 2007, 53 per cent of grade 6 children had to all students eligible to move into the structures, inappropriate for children’s somewhat fragmented, with investments sole use of a reading textbook. Fourteen EP2 level every school year. According learning. All existing secondary schools are primarily directed towards recurrent costs per cent shared a textbook with one to MINED data, approximately 7,000 EP1 of the conventional type, though grossly and at best infrastructure development. classmate while 25 shared a textbook schools were unable to offer EP2 places inadequate in numbers. Focus on improving the school environment with two or more classmates. No reading to all eligible students in 2009 (see School tends to takes a back seat. textbooks were available in 8 per cent of infrastructure). In 2005, an accelerated, low-cost, school grade six classrooms.29 While progress construction programme was launched The environment in Mozambican schools was made in distributing large quantities There is no basic framework of school with community involvement. By June remains insufficiently conducive to of books following the introduction of the quality standards. While a number of 2010, 4,601 primary school classrooms had promoting a rights-based approach to new primary curriculum in 2004, several regulations exist aiming to establish quality been constructed.34 While a new approach education that values children’s views and challenges remain. Textbooks delivered by education, the lack of a consolidated for school construction will be piloted in promotes their critical thinking and creative the Government tend to arrive very late, and system that defines minimum educational 2010, the quality and adequacy of school faculties. Teaching is often conducted in two there are frequent leakages into the informal requirements means that neither teachers infrastructure in Mozambique remains a or more shifts per day. Classes often have market. nor the community are clear on the goals challenge, falling short of planned targets. as many as 75 students (see availability of to be achieved for the schools. There are teachers), mostly seated on the floor with an The average school in Mozambique has no clear reference points or indicators for There is a particular shortage of secondary inadequate supply of textbooks, desks and large numbers of untrained teachers, school monitoring, nor is progress measured schools. According to projections for 2010, learning materials. In many schools, classes and facilities need improvement. Lack or gaps identified to enable appropriate the number of children completing grade are held under trees or in open yards with of professionally strong teacher training planning and systematic prioritising of goals 7 is likely to exceed the estimated intake no access to water or sanitation facilities. programmes and teacher trainers, at decentralised levels. for ESG1 by almost 185,000.35 To cope with Without a quality physical environment, both pre-service and in-service, has the shortage of secondary schools, primary conducive to learning, and child-centred perpetuated low teacher quality. Failure 3.6. School infrastructure schools in some areas are being expanded. classroom teaching-learning processes, to prepare teachers to deliver the new However, secondary classes are sometimes children have little avenue for developing curriculum, and for teachers to prepare School infrastructure is important in taught by primary teachers who do not their potential, life skills or appropriate students to acquire basic learner ensuring the quality of the learning have the required training in secondary attitudes. competencies, is contributing to high environment. Overcrowding is a serious education instruction. New secondary levels of school dropout, low levels of problem in Mozambican schools. The schools are being constructed, but the Mozambique has a strong school performance and school completion, and large increase in the numbers of students pace of construction is not keeping up with curriculum that describes the competencies exclusion of the most vulnerable. in the education system in recent years demand. Cuts in external funding are likely (knowledge, skills, attitudes and has exacerbated overcrowding in schools to exacerbate this problem in the coming appropriate daily life practices) that Few schools in Mozambique currently and classrooms. A lack of adequate school years. students should develop, positioned within provide an optimum teacher-pupil ratio or furniture (desks, chairs, etc.) can affect a rights-based framework. However, the space to deliver and sustain learning.30 The students’ ability to write properly and in 3.7. Availability of teachers type of learning that actually takes place phenomenon of ‘access shock’ is pervasive, the long term may even affect their posture in schools does not always match the in which massive increases in student and physical health. Children thus face Mozambique faces a severe shortage of vision or expectations established in the numbers lead to an overburdened system unhealthy conditions in which learning teachers and the rapid increase in primary curriculum. This has contributed to high that simply cannot keep up.31 In 2008/09, becomes difficult. Furthermore, the lack school enrolment has placed a significant dropout rates, low levels of performance over 40 per cent of all adults and children of water and sanitation facilities adversely strain on the teachers in the system. The and low rates school completion. Other (not counting infants) in urban areas were affects pupils’ attendance, particularly that pupil-teacher ratio deteriorated between factors, such as lack of heath care and engaged in some study, while in rural areas of girls (see Chapter 3, Child survival and 2004 and 2006 due to the significant increase 32 nutrition, further diminish the ability of the share is around 33 per cent. More development).
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of students in the education system (see In 2008, only 37 per cent of EP1 teachers Figure 4.13: Pupil-teacher ratio, 2004–2009 Figure 4.13), but improved between 2006 and 29 per cent of EP2 teachers were and 2009. The number of pupils per teacher women. Significant disparities between 78 in primary education has not improved in provinces also exist: in Cabo Delgado, only 76 response to the numbers of new teachers 17 per cent of teachers at EP2 level were 74 hired, mainly because of delays in replacing women, compared to 38 per cent in Maputo 72 staff who leave the sector (for reasons City.38 Female teachers serve as valuable 70 including death, dismissal and abandoning role models to young girls, while setting a their jobs), reflecting problems in human good example for boys to see women in a 68 resource management.36 In 2009, there professional role. Evidence also shows the 66 was an average of 68 pupils per teacher in presence of female teachers lessens the 64 primary school, up from 65:1 in 2000.37 The likelihood of violence and sexual abuse in 62 international benchmark set by the Fast Track schools. 60 Initiative is 40 pupils per teacher. Significant 2004 2005 2006 2007 2008 2009 disparities in pupil-teacher ratios exist across Absenteeism is common among teachers, partly due to the impact of HIV and AIDS Source: Ministry of Education and Culture, Contribuição do Sector Para a Reunião de Planificação do QAD, Government of Mozambique, provinces, ranging from 55:1 in Gaza to 91:1 Maputo, 2009. in Zambezia. and partly as a result of low morale. Teacher salaries are often paid months late, Despite a considerable increase in the especially for newly recruited teachers, number of female primary school teachers, leading them to abandon their posts or to 3.8. Pre-service and in-service and there is at least one of each type in from 16,922 in 2005 to 25,947 in 2008, the prioritise non-teaching activities. teacher training every province in the country. In order to proportion of female teachers remains low: accelerate the recruitment of trained teachers In 2009, 68 per cent of EP1 teachers and for primary schools, the Government, in 79 per cent of EP2 teachers were trained 2007, reduced the duration of the pre-service and had qualified to teach. However, teacher training course from two years to Table 4.1: Pupil-teacher ratio by province, 2008 nearly 32 per cent of the primary school one year. Both types of colleges now run the Province EP1 Pupil-Teacher Ratio EP2 Pupil-Teacher Ratio teacher training force in Mozambique one-year pre-service training courses. The Maputo City 62 59 has not received pre-service training.39 IFPs also conduct in-service programmes. Cabo Delgado 71 37 There are two major types of primary The requirement for admission to the IFPs/ Gaza 55 44 education teaching training institution in EPFs is a grade 10 completion certificate. Inhambane 56 48 Mozambique: the Institutos de Formação dos Professores (IFPs), administered by Due to the poor quality of secondary Manica 63 45 MINED, and the Escolas de Professores do education in the country, many of the Maputo 56 48 Futuro (EPFs), run by the international non- teacher trainees have poor reading and Nampula 83 45 governmental organization ADPP (Ajuda de writing abilities. A study by the Matola Niassa 68 41 Desenvolvimento de Povo para Povo). training institute in Maputo province showed that nearly 40 per cent of trainees Sofala 75 58 In Zambezia province, only 58 per cent had acquired their grade 10 qualification Tete 75 45 of EP1 teachers were qualified in 2009.40 more than six years before enrolling in the Zambezia 91 44 MINED is training increasing number of programme and consequently had lost most of their basic academic competencies and Best four Middle four Worst four teachers per year, reaching 10,000 teachers in 2009.41 The decrease in the proportion of found it difficult to cope with the heavy, Source: UNICEF calculation from MEC 2008. qualified teachers is particularly challenging knowledge-oriented and highly theoretical at the secondary level, where 30 per cent of course content. all teachers in the first cycle of secondary The change to a one-year programme education were untrained in 2009, compared has given rise to issues of quality and to only eight per cent in 1992.42, 43 The sector management of the courses. The IFP course has effectively eliminated the hiring of is run in a top-down manner, with only a 44 untrained teachers since 2008. week’s time stipulated for teaching practice. The numbers of both types of educational As a result, IFP graduates do not acquire institution have been gradually increasing, the necessary teaching experience and
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classroom management skills. Due to the principally to prepare teacher trainers. The lack of transportation) will need to be is an area not without problems. In the lack of transportation, trainees must utilise course, however, remains theoretical and simultaneously addressed for achieving a first instance, there is no School Directors’ schools close to the training colleges for lacking in practical knowledge and training functional system of supervision and teacher training course in Mozambique and, their teaching practice. This leads to large skills. support at local levels. therefore, all of the School Directors are numbers of trainees attempting to practice simply teachers that were considered able to The main body mandated to provide their skills in a small number of schools, 3.9. School management perform that duty. Many School Directors are further curtailing the time available for pedagogic monitoring and teacher not even trained teachers. Further, all School acquiring teaching experience. EPF colleges, support for in-service training is the Zona The weaknesses in the teacher training Directors are required to undertake teaching which were compelled to shorten their de Influência Pedagógica (ZIP). Schools system and the resultant poor quality of duties as well, often with two shifts or extra two-year course structure to one year in have also been mandated to provide in- teachers in the country makes schools hours (in EP2), reducing the time available to order to conform to national guidelines, are service support to teachers at the cluster management even more important in the them to undertake school management and comparatively better managed, devoting 50 level. There is no structured system or achievement of results, however, this too supervision. per cent of the one-year course to teaching policy on in-service teachers training in practice. Trainees learn through a computer- Mozambique. In-service training is usually aided, self-learning system with tutors run on an ad hoc basis in the IFPs, driven on hand to solve problems. Students are mainly by central requirements rather assigned responsibility in the management than based on local needs assessment. As of certain college functions, thus providing a result, there are several short-term in- them with practical experience in service teacher training interventions being institutional management. supported by partners that run parallel to each other. These interventions remain Few of the IFP teaching faculty have uncoordinated and unsustainable and have a professional background as teacher little institutional impact or sustainable trainers; they are usually recruited from the impact on teachers’ professional administrative stream of MINED. There is development. also a shortage of trainers in the IFP system. The course content of the IFPs has been The ZIP is a sub-district lead school constantly changed over the last three years mandated to provide pedagogic supervision to accommodate new areas. These changes to teachers and school directors. The district have resulted in a very heavy pre-service educational authority also conducts one or course. Often there is insufficient time to two supervision visits per year to a limited cover subjects adequately. The MINED is number of schools. Several elements currently planning a revision of the course limit the effective functioning of the ZIP structure and content of the IFPs. coordinator, who is also the director of the lead school with teaching and administrative In order to orient IFP trainers to the ever- responsibilities, which restrict the time evolving course structure, technical staff available to visit the other schools in the members from the MINED Department of ZIP cluster. There may be as many as 20 Human Resources are deployed to train schools in a cluster, and they can be located the trainers, despite the fact that many of 25 km or more from the lead school. The them are not necessarily professionally excessive non-academic demands placed qualified teacher trainers or equipped on ZIP coordinators have prevented the with teacher training methodologies. In development of a more structured system of addition, allocation of resources to IFPs teacher support at the ZIP level. Experiences remains highly uneven amongst different from other countries show a successful use provinces, and the criteria used in allocation of ZIPs as a channel for holding regular are unclear. All these factors contribute to teacher development sessions for mutual a critical situation in the country’s teacher learning, joint planning of lessons and training system. problem solving.
A two-year course in Basic Education run by The current work conditions of teachers the Universidade Pedagogica is designed (low salaries, lack of housing in rural areas,
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3.10. Lack of focus on school or a mixture of Portuguese and a local health language at home. A child’s first contact 4. Further issues in the education sector with Portuguese often occurs when the child School health and nutrition programmes first attends school. This can negatively provide cost-effective ways to retain affect the learning achievement of children.45 4.1. Life skills strategy to 4.2. Children’s participation children in school and to promote quality Some teachers never become fully skilled at combat AIDS education. Mozambique has a school health teaching in Portuguese, because Portuguese The education system remains teacher- programme that forms part of the national is their second language. The use of Since 2002, MINED has been implementing centred rather than child-centred. integrated programme in the health sector, Portuguese as the predominant medium of educational programmes to combat HIV. Children only speak in response to which commenced in the early 1980s. The instruction can delay the entry into school of These programmes are aligned to the questions posed by teachers and are Ministry of Health and MINED have jointly children who come from cultural sub-groups national HIV and AIDS strategic plan and encouraged to respond in unison. Efforts implemented the school health programme and speak different languages, and can lead are guided by the sector’s strategy on HIV, are being made to encourage children’s under a memorandum of understanding that to lower educational outcomes, such as low 46 which aims to reduce the impact of HIV participation in school. One such initiative defines the roles and responsibilities of both literacy levels in Portuguese. and AIDS on staff through workplace polices is children’s participation in the school sectors and establishes the mechanism for and on students by developing life skills council system. School councils comprise coordination. However, there is a wide gap With education reform, bilingual education programming in schools, integrating HIV student representatives, parents, teachers between the policy and its implementation. has been incorporated into the new and sexual and reproductive health into and other community members. Student curriculum and two alternative approaches the school curriculum, and providing HIV representatives are elected by their peers. Chronic health issues remain a major are currently being piloted in a small and AIDS information kits. With the help of The school councils discuss and promote challenge which could erode the gains number of schools. In the first, Portuguese several partners, the programme Geração Biz, solutions to the problems that affect their made in increased access to education. Poor is the main teaching language, and the supported by the UNFPA and now support by schools. The challenge of this initiative is to health, particularly malaria, malnutrition local language is used as an additional MINED as a national programme, promotes ensure that the children’s participation goes and cholera, are underlying factors for teaching and learning resource; in the life skills education through its basic package beyond mere tokenism and gives them an absenteeism, poor classroom performance second, the local language is used as the for the 15–18 age group. UNICEF promotes active voice in school management. In its and high school dropout. See Chapter 3 for teaching language until the second grade, a life skills programme that combines concluding observations in Mozambique’s more information on the health challenges while Portuguese is studied as a separate, knowledge with communications strategies second periodic report, the Committee on faced by Mozambican children. formal subject. This initiative is still in the for the Window of Hope age group (10-14 the Rights of the Child expressed concern pilot phase and is being implemented in year-olds). The programme, which has been that “the views of the child in Mozambique only a few schools throughout the country. implemented in 86 districts in all provinces are sometimes not solicited or taken into 3.11. Impact of language on Indications are that, while extremely limited, educational outcomes of Mozambique, helps children hone their life account in various settings concerning it is beginning to show positive results. skills and acquire knowledge and information children…including in matters of school Therefore, the Ministry intends to expand it 47 The language of instruction throughout the to protect themselves from risky behaviours. administration and education….” gradually to the rest of the country from 2011 country is Portuguese, the official language The programme also includes the creation of onwards. Production of school materials to Sport and play are a child’s right, as of Mozambique. However, Mozambique a community support system through radio accommodate all the local languages is a prescribed by Article 31 of the Convention has 19 local languages. A majority of programmes. challenge. on the Rights of the Child. While sport is communities speak in their local language The main challenge of these approaches is a vital component of children’s well-being sustainability in developing partnerships and physical education is an integral part with non-governmental organizations, of the primary school curriculum, schools building the capacity of teachers to impart in Mozambique, especially at the primary life skills–based education and allocating level, do not conduct any organised play resources, as these programmes continue to or team activities. Most school teachers be funded with external aid. lack formal training in physical education and sports management. Recreational MINED has adopted a workplace policy equipment or facilities are not always to reduce the impact of HIV and AIDS on available, especially at schools in rural staff. In 2009, the Ministry commenced areas. There is, however, a strong informal implementation of a programme to monitor sporting culture at the community level in and gradually decrease the prevalence of the country, though participation of girls sexually-transmitted infections among staff. and children with disabilities is not very The programme also includes periodic common. health checks of employees.
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4.3. Education for children with (in 2009, the education share was around based on pupil/teacher ratio. Nevertheless, for additional funds under the Fast Track special needs 22 per cent). The PARPA II target is 19 per funds allocated per student in Nampula are Initiative Catalytic Funds (see Box 4.1) cent. The education sector increased its just over a quarter of those allocated per after the expiry of phase I in 2010, and has As per the education sector’s national expenditures by about 68 per cent between student in Niassa province and a third of successfully been awarded $US 90 million strategic plan, special education is 2004 and 2008. In general, the execution funds allocated per capita in Maputo City.54 for the period 2011 to 2013. 55 mainstreamed into inclusive education. rate of the education sector has been fair Special schools managed by the Ministry (90 per cent) compared to other sectors, In spite of the gains in efficiency resulting Internal sector resources have been of Women and Social Action are the which could explain the higher percentage from the existence of a national sector prioritised to: (i) maintain the existing predominant institutions of special share in execution compared to the budget strategic plan, increased investment in the support system; (ii) improve the quality education. In 2009, there were about 62,000 allocation.50 post-primary school system (i.e. secondary of primary education; and (iii) strengthen 56 children with special needs attending normal and technical schools) is needed to keep implementation capacity at district levels. schools. In 2008, only 3,127 teachers were Direct external funding to the sector has been up with the increasing demand for places. The consequence of declining external funds trained to cater to children with special 35–40 per cent of total expenditure (around Investment in secondary and higher for 2010 primarily affects the expansion of needs, and there were only 98 schools $US 230 million in 2009). Around 60 per cent education is also necessary to produce post-primary education. providing inclusive education.48 of external funding is channelled through sufficient numbers of qualified teachers to the education sector common fund. External staff the growing numbers of primary and 4.6. Direct Support to Schools funding finances most of the investment and secondary schools. 4.4. Sector financing and budget non-salary-related recurrent costs.51 Programme allocations Direct Support to Schools (or Apoio Directo Although the current budget structure does 4.5. External financing à Escola [ADE]) transfers funds directly $US 593 million was allocated to the not disaggregate per level of education, it is The global financial crisis and the EU Code to schools according to the number of education sector in 2010. This represents estimated that primary schooling (EP1 and of Conduct on Division of Labour are likely pupils enrolled to overcome cost barriers a 10 per cent increase over 2009 (see EP2) received the major share of resources, to have a negative effect on external funding through a process of decentralization. The Figure 4.14). Total public sector education around 48–54 per cent of total expenditure. for the educational sector in coming years. ADE increased its financial assistance to expenditure has increased substantially Secondary education is estimated to receive For 2010, external commitments were 57, 58 between 2005 and 2009 (20–37 per cent per schools five-fold between 2003 and 2009. around 20 per cent of the budget (ES1 22 per cent less than in 2009. Although year).49 Budget execution in the education 52 According to an evaluation study conducted and ES2). Salaries and remunerations the overall education budget for 2010 sector is often higher than budget allocation, in 2007/08, the general sentiment among accounted for approximately half of total increased by approximately 10 per cent, as ‘top-ups’ to the budget are frequently 53 education stakeholders was that ADE budget in 2010. due to increased internal financing of made during the year. contributes to the reduction of problems in 36 per cent, the loss of external funding Funds are allocated to provinces based on schools (via provision of needed materials has directly affected financing for sector Over the last few years, the education historical trends that are directly related to and improving functioning of schools), programme activities, since the increase in sector has been allocated a steady 18–22 the education structure at provincial level. improves the teaching and learning process internal funding is primarily geared towards per cent of the budget. In terms of actual Some corrective measures are being taken and thus the quality of education, and financing new teacher contracts and salary 59 expenditure, the percentage has consistently to address inequalities between provinces, supports children in need. However, even reform. Mozambique has, however, applied been above the 20 per cent benchmark for example the allocation of new teachers though some school materials are provided
Box 4.1: Education for All – Fast Track Initiative Figure 4.14: Education budget allocation in millions of MTN, 2009 and 2010
The Education for All – Fast Track Initiative (EFA-FTI) was launched in 2002 as a global partnership 25,000 between donor and developing countries to ensure accelerated progress towards the Millennium 20,000 20,771 Development Goal of universal primary education by 2015. All low-income countries that demonstrate serious commitment to achieving universal primary completion can receive support from FTI. 15,000 16,167 10,000 13,720 FTI is built on mutual commitments. Partner countries have put primary education at the 9,433 forefront of their domestic efforts and developed sound national education plans. Donors provide 7,051 5,000 6,734 coordinated and increased financial and technical support in a transparent and predictable manner. 0 The Fast Track Initiative manages two trust funds that can provide financial support for education 2009 2010 goals in low-income countries: the Catalytic Fund for Education, with a total of $US 1.5 billion in Investment Component Recurrent Component commitments (2003–2009), and the Education Program Development Fund, with $US 92 million in Source: FDC and UNICEF, O Que Diz a Proposta de Orçamento do Estado 2010 Sobre a Previsão de RecursosTotal no Sector de Educação?, Budget Brief, UNICEF Mozambique, Maputo, 2010.. commitments (2005–2009).
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through ADE, they are often insufficient provision of materials and reduced the main in quantity, resulting in parents having to barriers to school enrolment and retention 5. Conclusions purchase additional consumables. associated with opportunity costs. In two districts, the pilot was also complemented In March 2006, a pilot programme – Apoio by measures to reduce other barriers both Significant progress has been achieved in strengthen accountability mechanisms. It is Directo à Escola - Crianças Orfãs e inside and outside of school.vii Available expanding participation in primary education also necessary to conduct and implement Vulneráveis (ADE-COV) – was created to dataviii indicate that the number of orphans in recent years. However, primary school a comprehensive salary review and reform support school enrolment and retention and vulnerable children enrolled increased completion rates and secondary school process that prioritises providing adequate of orphaned and vulnerable children in in the target districts of ADE-COV by 56 attendance rates remain low. Although support to “front-line” workers. four districts, increasing to 12.vi It doubled per cent, compared to the national average gaps remain, long-standing discrepancies in the ADE funds available per child for the increase of 21 per cent. children’s school attendance between urban If improvements in educational quality and rural areas and between the poorest and are to be realised it will be necessary to richest households have also been reduced. professionalise the teacher education Disparities between girls and boys net programme, both the in- and pre-service attendance rates at have been eliminated. components, at all levels. An area that calls for serious attention is the development of The quality of education is a key challenge training and teaching methodologies that for the sector with recent SACMEQ data move away from authoritarian, lecture- indicate that the quality of education driven to student-centred and independent has deteriorated in recent years. A learning practices that promote faculties of comprehensive approach is needed to critical thinking and creativity. Streamlining improve quality of education through the (i) the process of selection of pre-service development of school quality standards, trainees will guarantee the quality of human (ii) establishing national framework on resources in the teaching profession. assessment of learning achievement, and (iii) integrating various teacher There is a need for the decentralisation training, motivation and supervision of in-service training programmes that efforts, especially for in-service pedagogic are designed on the basis of needs supervision and teacher support. The assessment of teachers. This will promote implementation of the new textbook policy the development of teacher professionalism, should have a positive impact on educational confidence and motivation. Development of quality. A national policy on the expansion of a structured and non-threatening system of bilingual education should also contribute to teacher support and supervision with ZIPs improving quality. as the local resource centres will ensure the necessary and continuous support that is In the context of reduced external-funding, crucial for teacher development. strategic allocation of funds are needed to avoid losing gains made to date such as A system for the identification of core support for the Direct Support to orphans learner competencies and the tracking of and vulnerable children initiative (ADE-OVC). children’s progress through continuous In order to ensure equity, the usage of ADE assessment is required. Monitoring the for different levels of education needs to be level and acquisition of competencies by reviewed. children is an integral component of the semi-automatic promotion system. This Significant and sustained investment is will require developing teacher training vi The four districts were: Angónia district, Tete province; Búzi district, Sofala province; Chokwé district, Gaza province; required to strengthen the institutional programmes, both pre- and in-service, that and Mocímboa da Praia district, Cabo Delgado province. They were chosen based on HIV prevalence rates, net school capacity of Government at the national and focus on teaching methodologies around enrolment rates, population density, livelihoods and vulnerability, and their governing and administrative context. sub-national levels. Innovative arrangements core competencies and assessment of those vii Namely, provision for birth registration, an outreach programme to identify out-of-school orphans and vulnerable should be piloted that are designed to competencies through non-threatening children and monitor their attendance, and provision of psychosocial support to orphans and vulnerable children as required. The Ministry of Women and Social Action and the National Directorate for Registry and Notary conducted them provide incentives in order to address methods. The development of a national in collaboration with school councils. certain key constraints (including relating to assessment system (which is being pursued viii Sofala province, which included Buzi district, did not have official data on orphans and vulnerable children for 2007. being posted in remote locations) and also by INDE currently) will need to be built
126 127 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 4: EDUCATION AND CHILDREN’S RIGHT TO DEVELOPMENT
through a stakeholder consultative process behaviour change and also supporting the References to ensure ownership and accountability. expansion in access and quality of basic
services. Recognising that many civil society 1 18 Ministério de Educação e Cultura, ‘Plano Gender units at national and decentralised Da Costa, Maria Raquel ‘Relatorio da organisations are based at the community Assistência Técnica na Área de Primeira Estratégica de Educação e Cultura 2006-2011,’ levels should be strengthened to sensitise level, they are also often well placed to Infância,’ (unpublished), 2009. Government of Mozambique, Maputo, 2006. all school authorities and school council ensure that the most vulnerable populations 19 members on the prevention and reporting are reached by development programmes 2 Authors’calculations based on National National Institute of Statistics, ‘MICS 2008, of sexual abuse; that the Ministry in and to advocate for the realisation of Institute of Statistics, ‘MICS 2008, Relatório Relatório Final,’ Government of Mozambique, Maputo, 2010. cooperation with the Ministry of Women human’s rights. Civil society organisation Final,’ Government of Mozambique, Maputo, 2010and Census 2007. and Social Action, revise its Despacho capacities at all levels should be further 20 Ministry of Education and Culture, Balanço 39/GM/2003 to ensure that punitive action strengthened, and coordination mechanisms 3 National Institute of Statistics, ‘MICS 2008, do Plano Quinquenal do Governo Educação is taken against those who commit acts of be put in place to promote coherence and Relatório Final,’ Government of Mozambique, e Cultura, Government of Mozambique, abuse and violence. information-sharing in approaches under the Maputo, 2010. Maputo, 2009. leadership and overall direction of national Civil society will continue to play a critical 4 Ibid. 21 National Institute of Statistics, ‘Inquérito and sub-national government counterparts. aos Agregados Familiares sobre Orçamento role both in creating demand, promoting 5 Authors’ calculations based on National Familiar 2002/3,’ Relatório Final, Government Institute of Statistics, ‘MICS 2008, Relatório of Mozambique, Maputo, 2003. Final,’ Government of Mozambique, Maputo, 2010 and Census 2007. 22 Justiniano, M., et al., ‘Multifaceted Challenges: A study on the barriers to girls´ 6 National Institute of Statistics, ‘MICS 2008, education, Zambezia province’, UNICEF Relatório Final,’ Government of Mozambique, Mozambique, Maputo, 2005. Maputo, 2010. 23 World Bank, ‘PSIA II – Follow up Study of 7 Ibid. Primary Education and Baseline Study of 8 Ibid. Secondary Education, Mozambique’, World Bank, Maputo, 2007. 9 Ibid. 24 National Institute of Statistics, ‘MICS 2008, 10 Ibid. Relatório Final,’ Government of Mozambique, 11 Ministry of Education, Reunião Maputo, 2010. de planificação, 2010. Balanço de 25 World Bank, ‘PSIA II – Follow up Study of aproveitamento escolar, 2009. Government of Primary Education and Baseline Study of Mozambique, Maputo, 2010. Secondary Education, Mozambique’, World 12 Ministry of Education and Culture, Education Bank, Maputo, 2007. Statistics: Annual school results, Government 26 Ministry of Education and Culture, Relatório of Mozambique, Maputo, 2008. da Auscultação Através das Unidades de 13 National Institute of Statistics,’MICS 2008, Género, dos Conselhos Escolas, e Jovens Relatório Final,’ Government of Mozambique, Raparigas sobre Que Mecanismo a Adoptar Maputo, 2010. para Prevenção, Combate, Denúncia e Encaminhamento de Casos de Assédio e Todo 14 Authors’ calculations based on National o Tipo de Abuso, Incluindo o Abuso Sexual na Institute of Statistics, ‘MICS 2008, Relatório Escola, Government of Mozambique, Maputo, Final,’ Government of Mozambique, Maputo, 2008. 2010. 27 Makuwa, D., ‘What are the levels and trends 15 Ibid. in reading and mathematics achievement?’ 16 Ibid. Southern and Eastern Africa Consortium for Monitoring Education Quality, 2010. 17 World Bank, ‘PSIA II – Follow up Study of 28 Primary Education and Baseline Study of United Nations Educational, Scientific and Secondary Education, Mozambique’, Maputo, Cultural Organisation, ‘Booklet 5: Effective 2007.
128 129 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 4: EDUCATION AND CHILDREN’S RIGHT TO DEVELOPMENT
Learning. Good Policy and Practice in HIV 41 Ministry of Education, ‘Programme Document 51 Bartholomew, Ann, T. Takala and Z. Ahmed, 55 Ministry of Education and Culture, Financing & AIDS and Education (booklet series),’ for the funding request to the Catalytic Fund- ‘Mid-Term Evaluation of the EFA Fast Track Education in Mozambique: Analysis 2009– UNESCO, Paris, 2008. FTI’, Government of Mozambique, Maputo, Initiative Country Case Study: Mozambique’, 2010, Government of Mozambique, Maputo, September, 2010. Cambridge Education, Mokoro Ltd., and September 2009. 29 Ross, K., ‘How successful are textbook Oxford Policy Management, Cambridge/ provision programmes?’ Southern and 42 Ministry of Education and Culture, ‘Education 56 Ministry of Education and Culture, Apoio Oxford, UK, draft, September 2009. Eastern Africa Consortium for Monitoring Statistics: Annual school results’, Government Directo às Escolas: Situação actual e Education Quality, 2010. of Mozambique, Maputo, 2008. 52 United Nations Children’s Fund, O Que perspectivas, Government of Mozambique, Diz a Proposta de Orçamento do Estado Maputo, 2007. 30 Swedish Development Agency, ‘Education 43 Arndt, Channing, Sam Jones and Finn Tarp, 2010 Sobre a Previsão de Recursos no Sector in Mozambique’, (unpublished), ‘Aid and Development: The Mozambican 57 Ministry of Education and Culture, Sector de Educação?, Budget Brief, UNICEF September 2004. case’, University of Copenhagen, Discussion Programma das Actividade, Government of Mozambique, Maputo, 2010. 31 Ministry of Education and Culture, ‘Plano Paper series no. 06-13, 2006. Mozambique, Maputo, 2009. 53 Ibid. Estratégica de Educação e Cultura 2006–2011’, 44 Ministry of Education and Culture, 58 Ministry of Education and Culture, Avaliação Government of Mozambique, Maputo, 2006. Contribuição do Sector Para a Reunião 54 Fast Track Initiative Secretariat, ‘News release: do Programa de Apoio Directo às Escolas 32 Ministry of Planning and Development. de Planificação do QAD, Government of Education Fast Track Initiative Announces (7ª e 8ª fase), Government of Mozambique, ‘Poverty and Wellbeing in Mozambique: Third Mozambique, Maputo, 2009. US$ 180 Million to Educate Children Around Maputo, 2009. National Poverty Assessment. Government of the World,’ retrieved from: http://www. 45 Instituto Nacional do Desenvolvimento da educationfasttrack.org/news/171/177/EFA- Mozambique.’ Government of Mozambique, Educação, Avaliação do Impacto do Ensino FTI-Announces-US-180-Million-to-Educate- Maputo, September 2010. Bilingue no Novo Currículo do Ensino Básico, Children-Around-the-World/d,Whats%20New, 33 Government of Mozambique, Maputo, 2007. Authors calculations based on: Ministry of 2010. Planning and Development. ‘Poverty and 46 Mozambique National AIDS Council, Wellbeing in Mozambique: Third National Universal Declaration of Commitment on HIV Poverty Assessment.’ Government of and AIDS:. Mozambique progress report for Mozambique, Maputo, September 2010 and the United Nations General Assembly Special Census 2007 Session on HIV and AIDS, 2006–200’, Maputo, 34 Ministry of Education, ‘Programme Document January 2008. for the funding request to the Catalytic Fund- 47 Ministry of Education and Culture, Balanço do FTI’, Government of Mozambique, Maputo, Plano Quinquenal do Governo - Educação e September, 2010. Cultura, Maputo, 2009 35 UNICEF calculations based on: Ministério da 48 Educação “Plano de efectivos escolares”, FDC and United Nations Children´s Fund, 2010 and Ministry of Education ‘Programme O Que Diz a Proposta de Orçamento do Document for the funding request to Estado 2010 Sobre a Previsão de Recursos no the Catalytic Fund-FTI’, Government of Sector de Educação?, Budget Brief, UNICEF Mozambique, Maputo, September, 2010. Mozambique, Maputo, 2010. 49 36 Ministério da Educação e Cultura, Sal e Caldeira e Ximango Consultores, ‘Contribuição do Sector Para a Reunião ‘Análise do Impacto da Estrutura das de Planificação do QAD’, Government of Despesas sobre o Desenvolvimento Mozambique, Maputo, 2009. Económico e as Condições de Vida em Moçambique.’ Swiss Agency for Development 37 Ibid. and Cooperation, Maputo, 2009.
38 Ministry of Education and Culture, ‘Education 50 FDC and United Nations Children´s Fund, Statistics: Annual school results’, Government O Que Diz a Proposta de Orçamento do of Mozambique, Maputo, 2008. Estado 2010 Sobre a Previsão de Recursos no 39 Ibid. Sector de Educação?, Budget Brief, UNICEF Mozambique, Maputo, 2010. 40 Ibid.
130 131 CHAPTER CHAPTER 5 CHILD PROTECTION 5 1. Introduction
The Convention on the Rights of the Child, child-friendly justice, child separation and the African Charter on the Rights and unnecessary institutionalisation, among Welfare of the Child, and other international others. Effective child protection mitigates and regional level instruments, are the risks and vulnerabilities that underlie comprehensive in their consideration of these abuses. A protective environment the need for child protection. Such legal for children supported by a robust child frameworks recognise that children are protection system and infrastructure is a vulnerable to violations of their basic rights-based approach to boosting human human rights and are thus accorded the and economic development progress fundamental right to legal and social and improves the health, education and protection before and after birth. The well-being of children and their evolving duty of protecting children falls on both capacities to be parents, citizens and public and private actors, who have the productive members of society. A diffused responsibility to safeguard both boys and and fragmented child protection system, on girls from violence, abuse, exploitation the other hand, exacerbates poverty, social and neglect, including unnecessary exclusion and susceptibility to HIV infection, separation from their family environment, and increases the likelihood that successive and from the effects of emergencies. generations will face similar risks. Through appropriate legislative, social and administrative systems and services, The key Government ministries in including social protection programmes, Mozambique responsible for building, known risks to violations of children’s strengthening and sustaining a child rights can be addressed, and children’s protection system are the Ministry of vulnerability can accordingly be minimised Women and Social Action, Ministry of and their resilience strengthened. Justice, Ministry of Interior and the judicial courts. All branches of government, civil The many forms of harm and abuse that society and international organisations, threaten children include sexual abuse and alongside informal systems such as families exploitation; trafficking; hazardous labour; and communities, have a responsibility to violence; living or working on the streets; cooperate, coordinate and collaborate to disabilities; AIDS; and harmful practices nurture and sustain efforts to protect the such as child marriage, lack of access to rights of children. CHILD PROTECTION 135 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 5: CHILD PROTECTION
While there has been important progress in various administrative levels to effectively protecting children’s rights in Mozambique, protect children. Efforts also need to focus 2. Legislative and policy reform much remains to be achieved: increasing on increasing awareness at all levels of children’s access to protective and other society, including children, families and key social services, harmonising monitoring communities, of children’s rights and the The comprehensive package of legislation effective institutions to enforce the law, and tools to improve the collection and analysis obligation of all stakeholders to promote passed in 2008 demonstrates the work with civil society and the private sector of data to effectively track and plan for child protection. commitment of the Government of to promote positive values and practices to the well-being of children over time, and Mozambique to protect the rights of children enhance the effectiveness of legal protection. strengthening the capacities of relevant line This chapter describes the situation of and improve the situation of children and ministries to develop a robust and systemic child protection in Mozambique, examines women who are victims of violence, abuse An effective national Child Protection System approach to child protection, in order progress and provides an analysis of and exploitation. In addition, four specialised has been promoted through the approval to reinforce accountability and improve the gaps and issues in the protective courts for children have been established to of three instruments – the Children’s Act, coordination among these ministries at the environment for children. reduce the backlog of pending adjudication Juvenile Justice Act and Domestic Violence and improve the capacities of the judicial Act. The Children’s Act, adopted in 2008, system to effectively handle cases of effectively translates the Convention on the children in conflict with the law and improve Rights of the Child’s articles into national the protection of children’s rights. child rights legislation and outlines the responsabilities of all stakeholders in The Ministry of Interior has also been realising these rights. The development of creating and streamlining standard the Child Protection framework is on-going. procedures and applying more systematic Additional measures that have been adopted approaches within the police services to by the Government include: creation of the protect the rights of children and women. National Council of Children’s and Human Also, a multi-sectoral working group on Rights Commission and the Child Parliament, prevention of violence against children was and raising awareness of children’s rights established by the Ministry of Women and issues in the media. Minor courts have Social Action in 2009 as a follow-up to the been created in five provinces to strengthen United Nations Violence Study and the World protection for children in conflict with and in Congress III Against Sexual Exploitation contact with the law. of Children and Adolescents, where the Government acknowledged the urgent need Mozambique has ratified several key for a multi-sectoral approach to prevent and international and regional human rights respond to violence against children and instruments on the protection of children, to create a functioning referral system for signifying the Government’s commitment assistance to victims.1 to harmonise national legislation with international standards. The 2004 Effective national child protection systems constitution clearly states that all actions begin with laws, policies and regulations concerning children, whether by public designed to uphold a child’s rights in all bodies or private institutions, must consider circumstances. The absence of an adequate the best interest of the child, in accordance policy framework exacerbates a child’s with the Convention on the Rights of the vulnerability and increases the likelihood Child. The constitution sets the stage for that he or she will be denied a range of rights the legal and policy framework for children, extending beyond those strictly associated as described below. See Box 5.1 for recent with protection. The responsibility for developments in the legal framework for respecting, protecting and fulfilling rights child protection. is shared among many actors. However, the State is the primary guarantor of rights Social protection policies and programmes under both international law and the have proven effective at responding to the Mozambican constitution; it must ensure to needs of vulnerable families and children, as the fullest extent possible that protection social protection plays a key role in reducing exists in the law, establish and strengthen poverty, overcoming social exclusion and
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building human capital in order to mitigate unable to work or do not have the means to Box 5.1: Recently approved social protection legislation and policies the risks faced by vulnerable groups, satisfy their basic needs, namely: particularly children and their families. 2010 The Basic Social Protection Strategy includes child grants as an integral part of the strategy. Several forms of social protection policy ll People living in absolute poverty; have existed in Mozambique since 1975, ll Children living in difficult circumstances; The Domestic Violence Act aims to increase protection of both women and children from with the purported role of the State varying sexual abuse and exploitation at home and in communities. It makes domestic violence over the years from ambitious provider ll Elderly people living in poverty; 2009 a crime in Mozambique for the first time, calls for increased penalties for offenders, and of all services (following independence) ll Disabled people living in absolute poverty; places an obligation on the State to assist victims by providing services such as police to marginal provider of extremely limited investigation and medical treatment. pension schemes, emergency response aid ll People with chronic or degenerative and food subsidies for the elderly (following illnesses. The Children’s Act and Juvenile Justice Act, both approved in 2008, translate the structural adjustment programmes). In 2008 Convention on the Rights of the Child into national child rights legislation. This is a major The Basic Social Security Regulations step towards creation of a comprehensive legal and policy framework for children. recent years, however, increased attention approved in 2009 further divides basic social has been focused on strengthening security into direct social action, health The Trafficking of Persons, especially Women and Children, Act defines trafficking of social protection across the country, with related social action, education related persons in line with international legal instruments (namely the Palermo Protocol, ratified in protection of vulnerable children starting to social action and productive safety nets. 2006) and criminalises trafficking, particularly of children and women. Regulations for this be recognised as important in the national The multi-sectoral Basic Social Security act need to be drafted and approved. policy dialogue. In addition, the Health and Strategy was approved by the Council of The Labour Law explicitly prohibits the worst forms of child labour for children under 18. It Education sectors have specific programs Ministers in 2010. This strategy identifies establishes that children between 15 and 18 can only work up to 38 hours per week or 7 hours for children with specific needs (free health four programmes as part of the basic per day. In recognition of the economic realities of the country, it does allow children 12–15 to services for children under five and children social security package: two cash transfer work, provided that they do so with the permission of a parent or other legal guardian. suffering from malnutrition, and education programs (the current Programa Subsídio material support for vulnerable children). de Alimentos [PSA] and a new child grant 2007 The Social Protection Act calls for the provision of basic social security for poor people The Social Protection Act, passed in 2007, programme for families taking care of and children in difficult situations. The law defines social protection as “a set of measures calls for the provision of basic social orphans and vulnerable children); the current which seek to mitigate…absolute poverty of the population, guaranteeing the subsistence security for poor people and children in in-kind social transfer program (PASD); and a of workers in situations of deprivation or diminished capacity to work, as well as of the difficult situations. The Act defines social new productive safety net programme. There surviving family members in cases where the aforementioned worker has passed away, and protection as “a set of measures which are plans to scale up the PSA programme to ensure conditions for their survival.” seek to mitigate, in step with the economic to include a greater focus on orphans and The National Plan for Orphaned and Vulnerable Children identifies six key services to conditions of the country, the absolute vulnerable children as indirect beneficiaries. address children’s most fundamental needs: health, education, nutritional and food support, poverty of the population, guaranteeing The operationalisation of the proposed child financial support, legal help and psychosocial support. The Government of Mozambique the subsistence of workers in situations of grants programme depends on the findings has committed itself to ensuring that children have access to at least three out of these deprivation or diminished capacity to work, of the on-going PSA impact evaluation and 2006 six services, focusing particularly on children who live below the absolute poverty line, as well as of the surviving family members other feasibility studies. PASD’s currently including orphans and children living with or affected by AIDS. Implementation of the in cases where the aforementioned worker limited reach still includes a relatively plan is coordinated by the Ministry of Women and Social Action with the support of a has passed away, and to ensure conditions high percentage of child beneficiaries. It multisectoral technical working group and the Orphans and Vulnerable Children Technical 2 is anticipated that a mechanism will be for their survival.” The law further divides Working Group. social protection into three pillars: obligatory put in place to guarantee that vulnerable households have access to a range of basic social protection (social insurance under the 2006–2010 National Action Plan for Children aims to protect the civil and human rights and and protective services, possibly building Ministries of Labour and Finance for those in security of all children by developing and coordinatingthe activities of key stakeholders. the formal labour market); complementary on the experience of the current poverty 2005 social protection (additional initiatives via card. An operational plan to complement the The Family Law articulates new legal standards for parental responsibilities, guardianship, the private and voluntary sectors); and basic strategy will be finalised soon and will be an adoption and inheritance, and raises the age of marriage from 16 to 18 for both boys and girls. important tool in advocating for increased social protection, which has the greatest The Code of Civil Registration expands the period of free birth registration from 30 to 120 government funds to implement these 2004 potential to reach vulnerable children. Basic days after a child is born. social protection covers citizens who are programmes.
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not only in schools but also in communities. internal regulations of the MINED prohibiting 3. Violence, abuse and exploitation Many girls did not know whether these acts corporal punishment, it continues to be were prohibited by law or where to report inflicted on children by teachers and them when they occur.9 parents.” Violence against children is a profound concern in Mozambique. The 2001 National violation of human rights and has Survey of reproductive health and sexual The institutional response to sexual abuse in The UN Study on Violence against Children devastating short- and long-term mental and behaviour of young people indicated that 30 schools is limited. The study also examined considers raising awareness essential physical health consequences. Child victims per cent of women and 37 per cent of men the level of awareness of MINED officials to influencing social norms, not only for of violence include children who have been had directly witnessed violence between on the issue. Seventy per cent of provincial communities, including schools, but also sexually abused or subjected to violence as their parents as a child or teenager, and gender unit staff and 65 per cent of district for professionals in contact with children. punishment; forced to work in intolerable that 15 per cent of women and 20 per cent gender coordinators acknowledged that Appropriate media attention also raises conditions or trafficked into exploitative of men had suffered physical abuse from a sexual abuse against girls and early awareness, promotes open discussion and conditions of work; or forced into early relative in their youth.6 A study conducted pregnancy were major concerns and encourages communities to respond to marriage. This violence spans geographical by the Ministry of Women and Social Action important constraints on providing a safe cases of abuse and exploitation. Making boundaries and cuts across culture, race, class in 2004 indicated that as many as 54 per learning environment for girls. School support and rehabilitation services available and religion. It can be expressed as physical cent of women surveyed reported having council members were also concerned about are another key dimensions. Such responses or sexual assault or abuse, psychological or been beaten, and 23 per cent of respondents sexual abuse and harassment in school and are made significantly more effective by emotional abuse, or deprivation or neglect. reported having been subjected to some sought strict disciplinary measures against the existence of an effective coordination The risk of violence is exacerbated by poverty, form of sexual abuse.7 Most violators are teachers who abuse girls in school. mechanism. In 2009, the Ministry of Women which often goes hand-in-hand with a lack of known to the victims and are often close and Social Action established a multi- The MINED has a ‘zero-tolerance’ policy on adequate protection by caregivers and limited family members and friends. sectoral working group on the prevention sexual abuse in schools, but enforcement access to essential services. Ministry of the of violence against children as a follow- of this policy remains weak. In 2003, MINED Interior statistics reveal that more than 3,500 Laws to protect children and adolescents up to the United Nations Violence Study issued a decree (Despacho 39/GM/2003) cases of child violence were reported to the from sexual abuse leave considerable and the World Congress III against Sexual prohibiting teachers from having sexual police in 2009.3 The number of children who discretion to the judicial system to interpret Exploitation of Children and Adolescents. relations with female students and declared suffer from violence, abuse and exploitation whether a child was a victim of sexual abuse. While the legal reform process has ‘zero tolerance’ of sexual abuse in schools. is likely to be much higher than the number of For example, only with children under 12 progressed, translation of the new legislation The 2008 Mozambican Children’s Act reported cases. are sexual relations prohibited under any into effective regulations and programmes circumstances (including if consent has reaffirms the duty of school management remains a challenge due to lack of funds. The United Nations Violence Study been established) and criminal sentences to report to the relevant authorities any notes that violence against children is can be anywhere from two to eight years. cases of mistreatment of learners. However, The Plan of Action for the Prevention of significant in its scale, scope and under- For children over twelve, the judge is given follow-up on acts of violence in schools Violence Against Children is being finalised reporting, all of which are exacerbated by latitude to determine whether sexual abuse and implementation of the decree remain at present. The plan outlines activities societal acceptance of the phenomenon.4 has occurred, even in the case of adolescent weak. Revision of the gender strategy and of relating to protect of children from violence, 10 Some forms of violence are rooted in victims of abuse by adults. decree 39/GM/2003 to emphasise reporting neglect and sexual exploitation are in place. discriminatory and unequal gender violence and sexual abuse is integrated The promulgation of the 2009 Domestic into the 2010 MINED work plan. Integrating Violence Act may provide momentum dynamics and harmful practices, and 3.1. Violence and sexual abuse Mozambique is no exception. Available sexual abuse issues into the 2010 planning for strengthening mechanisms to protect studies and data provide a basis for arguing in schools guidelines is a significant step forward and women and children from sexual abuse. Civil is leading to developing defined actions to society partners have offered awareness- that the existing patriarchal culture and Sexual abuse in schools is an area of strengthen the capacity of provincial gender raising activities at the community level, male-dominated social order is exceptionally particular concern, as noted by the 5 focal points in monitoring and reporting including Action Aid’s campaign against strong in Mozambique. Victims’ low level Committee on the Rights of the Child.8 A cases of sexual abuse in schools. sexual abuse of girls in school. of knowledge of their rights and a culture of 2008 Ministry of Education (MINED) survey silence and acceptance of violence are the revealed that 70 per cent of girl respondents Corporal punishment remains lawful at key barriers to addressing the problem. reported that some teachers use sexual home and school and is often considered 3.2. Domestic violence intercourse as a condition for promotion Although recent quantitative data are the only way to discipline children. The Fifty-four per cent of women who between grades, and 50 per cent of girls limited, previous surveys reported a high Committee on the Rights of the Child participated in a 2004 Ministry of Women stated that not only teachers abuse them incidence of sexual exploitation and abuse expressed concern that “the Child Rights and Social Action study reported having sexually, but also boys in their peer group. of children and women at home, in the Protection Law (of Mozambique) does not been beaten. Cultural acceptance of violence Furthermore, 80 per cent of girls recognised workplace and at school. Sexual abuse explicitly prohibit corporal punishment is a major cause of domestic violence.11 The that sexual abuse and harassment occur of children and women remains a major at home and in schools…that in spite of perpetrator of violence was most frequently
140 141 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 5: CHILD PROTECTION
the woman’s husband or a close relative or percentage of women who believe that wife- Figure 5.2: Proportion of women aged 15-49 who believe that wife-beating is justified under certain acquaintance. Ten per cent of respondents beating is justified in certain circumstances circumstances, 2008 reported having been subjected to some varies from 10 percent in Maputo City to 80% form of sexual abuse. Higher levels of almost 70 per cent in Niassa province (see 12 70% violence against women were reported in Figure 5.2). The 2008 MICS also notes 69% rural areas than in urban areas.i that 24 per cent of women who attended 60% secondary school and higher accept 50% 51% The proportion of women who feel that men 48% violence, compared to 38 per cent of women 40% have the right to beat them under certain who have never attended school. The 2004 42% 35% circumstances has dropped from 54 per Ministry of Women and Social Action study 30% 35% cent in 2003 to 36 per cent in 2008.ii, iii While concluded that these differences are strongly 20% 26% 27% 26% the reduction is positive, the acceptance of 20% related to socio-cultural norms and practices 10% violence by women remains very high. The as well as lack of education and knowledge 10% reason most commonly cited in the 2008 0% of the rights of women and children in Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo MICS as justification for wife-beating is the society.13 Delgado pula bezia bane Province City perception by the husband that the wife is neglecting the children. This reason was A multivariate probabilistic regression Source: MICS 2008. cited by 21 per cent of respondents (see analysis was conducted to examine the Figure 5.1). factors correlated with women’s acceptance of domestic violence (see Figure 5.3).The are far less likely to consider wife-beating The model shows no statistically reliable Regional disparities in attitudes toward dependent variable is whether a woman acceptable than women with no education. differences in attitudes to domestic violence domestic violence exist. Education of men (15 to 49 years old) accepts being beaten Having primary education, however, does among women in polygamous versus and women is the key factor in reducing by her husband. The analysis revealed that not appear to influence women’s attitudes. monogamous relationships. Neither does violence against children and women. The women with secondary or higher education Wealth is found to be statistically related to the age of a woman, or a difference in ages women’s protection only at very high levels between husband and wife. In terms of (see Figure 5.3), which very few households geography, all women living in provinces Figure 5.1: Percentage of women aged 15–49 who think that a husband can beat his spouse, by specific reason, 2008 attain. Given the enormous challenges in other than Maputo City (especially in the promoting women’s wealth to this level, north) show a higher likelihood of accepting 40% promoting access to education may be the violence, while there seems to be no more feasible policy response to adjusting difference in attitudes between rural and 35% 36% 30% women’s attitudes to domestic violence. urban women. 25% 20% 21% 19% 19% Probability of wife accepting beating 15% 18% Figure 5.3: Probability of women aged 15-49 accepting domestic violence, by socio-economic background, 2008 10% 13% women 15-49
5% .4 0% When she goes When she When she When she When she For any of
out without neglects the argues refuses sex burns the these reasons .3 telling him children with him with him food
Source: MICS 2008. .2
i The Study, conducted in 2004 for the Ministry by the Eduardo Mondlane University, Centro de Estudos da População, .1 included 2052 women aged 18–45 in Maputo City, Maputo province, Sofala, Manica, Zambezia and Nampula (the Universidade Eduardo Mondlane 2004). Probability of wife accepting beating ii This is significantly lower than the average in eastern and southern African countries, where 65 per cent of girls and 0 women aged 15–49 think that a husband is justified in hitting or beating his wife under certain circumstances. Source: -1 0 1 2 3 UNICEF, Progress for Children - A Report Card on Child Protection, Number 8, UNICEF, New York, September 2009. Wealth score iii The DHS indicator is the percentage of women aged 15 and 49 who said that it would be justifiable to be beaten by their husband for one or more of the following reasons: stealing food, arguing with husband, leaving the house without Primary Secondary Higher informing the husband, refusing sex with husband, and/or not looking after children. Source: UNICEF calculations based on MICS 2008
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Breaking the culture of silence on abuse greater economic benefits. Many children Voluntary child migration is often driven are involved in child labour, with a large of children and women requires open who are exploited in commercial sexual take by poverty or as a result of being orphaned disparity between urban and rural areas (15 dialogue, increased awareness and drugs to cope with the situation and this or abandoned. Children in Mozambique per cent and 25 per cent, respectively).20 v protective external systems to intervene also affects condom use.15 Perpetrators of move to cities from villages or sometimes The proportion of children involved in child when abuse is identified. This is not easy commercial exploitation of children come cross illegally and unaccompanied into labour also varies by the age of the child: to do where gender-based violence and from all walks of life: local community neighbouring countries, mainly South one in five children aged 5–11 are engaged sexual abuse, especially of children, are members, national and foreign tourists in Africa, in an attempt to improve their own in child labour, rising to one in four children condoned by some communities and Mozambique’s resorts and transport drivers in lives or the lives of their families. These aged 12–14. Disparities across provinces individuals. Despite the progress made towns and on main roads. patterns of migration make both boys and are apparent; almost 40 per cent of children in strengthening the Government and girls vulnerable to abuse and exploitation in Inhambane are involved in child labour, developing a comprehensive legal and 3.4. Child trafficking and on their journeys and at their destination. A compared to less than 10 per cent of children policy framework to protect children from 2008 Save the Children report19 compiles the in Niassa. violence, abuse and exploitation, the limited migration experiences of migrant children in the sub- capacity of Government to enforce such laws In a report published in 2002/03 by the region, and indicates that girls in particular The prevalence of child labour is linked with and the limited knowledge of community International Organisation on Migration travel to South Africa from Mozambique in the mother’s level of education. Twenty-four members about the issues allow such (IOM) it was estimated that approximately search of work, but end up being sexually per cent of children whose mothers have practices to continue unabated. Furthermore, one thousand children and women are abused and exploited. Those who cannot no schooling are involved in child labour, customary law often prevails in many rural trafficked to South Africa every year for find employment and are unable or unwilling compared to 10 per cent of children whose areas of the country, particularly in relation the purpose of exploitative labour and to return to Mozambique sometimes resort mothers were educated to at least secondary level. The prevalence of child labour is to marriage and inheritance. Addressing commercial sexual exploitation.16 The to sex work in the absence of alternative social conventions and norms that contribute trafficking of children not only removes them options. slightly higher among girls (24 per cent) than to violence, exploitation and abuse is the from the protective environment of their boys (21 per cent). Also, girls work more first step towards halting such practices in family, but also increases their vulnerability 3.5. Child labour than boys in support of domestic tasks (8 per cent against 5 per cent, respectively). The Mozambique. to violence, exploitation and abuse. iv It is Child labour is another serious form of also suggested that trafficking of persons is percentage of children who work to support abuse and exploitation in Mozambique. Data linked with the extraction of human organs household businesses is the same for both 3.3. Commercial sexual reveal that 22 per cent of children aged 5–14 sexes (16 per cent). There is not a strong exploitation and abuse for ritual purposes, though this is still disputed by government agencies.17 Although data are extremely limited, In a study published by Save the Children evidence suggests that commercial sexual Figure 5.4: Percentage of children aged 5–14 who are involved in child labour by province and gender, 2008 exploitation and abuse of children does occur in 2009, children’s responses suggest that in Mozambique. Children are often forced to internal trafficking and exploitation in 45% Mozambique usually occur by means of engage in commercial sexual acts to obtain 40% help from adults in meeting their expenses ‘trickery’, fraud or deception, perpetrated 39% or as a coping strategy for extreme poverty. largely by children’s relatives and peers.18 35% Victims of commercial sexual exploitation Child trafficking usually occurs within a 30% wider regional context and can only be 30% commonly are poor and have suffered some 25% 27% 26% 25% 26% degree of prior violence or abuse. While effectively combated by strengthening 24% 20% 22% commercial sexual exploitation occurs with regional and cross-border mechanisms for both boys and girls, girls are considered to be a multifaceted and coordinated response 15% 16% tailored to regional and national differences. more commonly the victims. One study also 10% 11% For example, the Southern African 9% 10% found peer group pressure to be an important 5% factor in introducing girls to the child Regional Police Chiefs’ Cooperation is 14 working together with the Southern African 0% commercial sexual exploitation industry. Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Total This same study found that girls suffering Development Community on counter- Delgado pula bezia bane Province City trafficking measures, including regional from sexual exploitation are at further risk Source: MICS 2008. as they engage in sex without a condom for police training.
v A child is considered involved in child labour if, during the week prior to the survey, he/she was involved in: (i) at least iv Trafficking refers to the illegal transport of human beings, in particular women and children, for the purpose of selling one hour of economic work or 28 hours of domestic work per week, if the child is 5–11 years old, (ii) at least 14 hours of them or exploiting their labour. economic work or 28 hours of domestic work per week, if the child is 12–14 years old.
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correlation between wealth and child labour. In Mozambique, the Ministry of Labour is effectiveness of initiatives will be enhanced undertaken is appropriate for the age and Prevalence of child labour is relatively stable responsible for guiding and coordinating by a greater commitment to collecting capacity of the child and that it in no way for the bottom four quintiles, and only actions related to child labour. National data on the nature (including the gender compromises his or her survival, health, reduces for the best-off families. A 2009 responses to child labour focus on four dimension) and dynamics of child labour in education, development or overall well- study indicates that child workers are further areas: developing national legislation Mozambique. being. exploited by poor working conditions, that reflects the international standards The 2008 Children’s Act prohibits child including verbal and sexual abuse, and that Mozambique has ratified; developing 3.6. Child marriage wages paid late or not at all.21 effective enforcement mechanisms for labour and any form of work for children existing and complementary legislation, under 15 and provides for punitive measures In Mozambique, marriage before the age of MICS 2008 reveals that 86 per cent of including legislation on compulsory to be taken against the employer. The 16 is illegal. Under the Family Law of 2004, children who work in urban areas also education; enhancing the capacity of Children’s Act also defines prohibited the Government of Mozambique raised attend school, compared with 76 per cent in government institutions and other actors forms of work, including commercial the legal age of marriage without parental rural areas. Almost 30 per cent of students in to identify and act upon the issue of child sexual exploitation and work that could consent from 16 to 18. The minimum rural areas are involved in some type of child labour; and finally, raising awareness of be harmful to the health and well-being of age at which marriage can occur with labour before or after school. the issue among the general public. The the child. However, effective enforcement parental consent was raised from 14 to 16. requires dissemination of the act to all Nevertheless, capacity to implement the stakeholders, as well as considerable law is limited, and traditional marriages capacity strengthening of all authorities Figure 5.5: Prevalence of child labour by level of mother’s education, 2008 under customary law continue to present a charged with implementing its provisions. challenge to establishing 18 as the minimum 30% Finally, economic and social pressures that age of marriage. In many communities, girls 25% compel parents to force their children into 24% are considered to be ready for marriage on 20% 22% exploitative child labour must be addressed reaching puberty.22 15% through more effective social protection. 10% Recent data revealed that 18 per cent of girls 10% Reducing the burden of work on children 5% aged 20–24 were married before they turned depends on ensuring that children and 0% 15, with 51 per cent of them married before Never attended school Primary Secondary + their families, particularly the poorest and they turned 18.23 The proportion of girls most vulnerable, benefit from poverty entering into child marriages has dropped reduction programmes. As long as child slightly since 2003. There are significant work remains an economic necessity for differences in the rates of child marriage Source: MICS 2008. certain households, the Government should among the southern, central and northern focus on ensuring that any economic activity regions of Mozambique: the southern Figure 5.6: Child labour and school attendance by geographic area, 2008
100% Figure 5.7: Women aged 20–24 who were married before ages 15 and 18, by geographic location, 2008 90% 80% 86% 60% 70% 76% 50% 56% 51% 60% 40% 50% 30% 42%
20% 40% 21% 18% 30% 10% 11% 20% 25% 0% Urban Rural Total 10% 15% Married before age 15 Married before age 18 0% Children in child labour Child labourers who are also attending school Urban Rural Source: MICS 2008. Source: DHS 2003 & MICS 2008.
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provinces of Gaza, Inhambane, Maputo and of sexual abuse. Even when police or other Maputo City all have a child marriage rate of authorities want to pursue a case of sexual 4. Children and the justice sector below 10 per cent; the central provinces have abuse, the parents often halt the proceedings an average rate of 20 per cent; while Niassa because they consider it an issue to be and Cabo Delgado in the north have rates of solved within or between families. The lack The need to improve the justice sector Certain internal inconsistencies remain to 24 and 30 per cent, respectively. of a rigid legal instrument to penalise cases has been recognised as a key priority for be addressed, and initiatives and preventive of sexual abuse further exacerbates the enhancing child protection systems by measures, particularly in relation to Child marriage is not only a serious problem. both the Government and civil society children in conflict with the law, need to be contravention of a child’s rights in and of in Mozambique. This includes protecting strengthened, including the application of itself, but also seriously compromises the In many cases, child marriage, for both boys children who come into contact with the alternative corrective measures that are in realisation of a range of other rights. For and girls, has an economic motivation. Child justice system as victims, witnesses or line with international standards. Children example, marriage during adolescence marriage is a survival strategy to relieve the offenders towards the end of impunity for in conflict with the law in Mozambique often may have serious health implications for a family of what they perceive to be a financial crimes against children. Important progress do not benefit from protection as stipulated girl. Adolescent pregnancy and childbirth burden in the face of severe poverty. has been made, including the establishment in international instruments, including are associated with poor health and Although economic status is a factor in of a children’s section in the court in three Articles 37 and 40 of the Convention on the nutritional outcomes for both the mother child marriage, it is not the sole motivation. provinces and creation of more than 200 Rights of the Child, the Beijing Rules for the and her children. This is particularly true for Prevalence of child marriage is also linked Police Victim Support Centres (Gabinetes Administration of Juvenile Justice (1985), very young, first-time mothers.24 Married to the cultural practices of specific ethnic de Atendimento à Mulher e Criança) across and the Riyadh Directives for the Prevention adolescents often receive less information groups.27 Although campaigns to raise all provinces. The creation of these new of Juvenile Delinquency (1998). on reproductive health than their unmarried awareness of sexual health and pregnancy support structures has helped to ensure that peers.25 Married girls are much less likely are conducted at schools, condom use child rights are protected and that children Children in conflict with the law are often than their unmarried peers to attend school, is still low among children. Marriage is are treated in a child-friendly and gender- placed in adult prisons, though the law and girls are often removed from school sometimes arranged at an early age with sensitive manner when they come into stipulates that they should be placed in in order to marry or as a result of being girls entering their husband’s house at contact with the justice system, in line with separate quarters. The police have the pregnant, which can sometimes be related to puberty. Effective mapping of child marriage international norms and standards. authority to detain minors who have sexual abuse.26 within Mozambique by ethnic group would allegedly committed an offence for a support programme efforts and enhance the Justice systems are not yet effective for maximum of 30 days, following which the Child marriage is influenced by traditional effectiveness of prevention campaigns. most children. In the 2009 concluding child must be presented in Minor Court or gender relations and the values assigned observations of the Committee on the Rights Civil Sections. Ideally, a transition centre to women and girls in society. Marriage Polygamous relationships are also common of the Child noted in Mozambique’s second or intermediate facility should be used and may reflect the value placed on a girl’s in Mozambique, with almost a quarter periodic report, for example, perpetrators special considerations should be given to virginity and be regarded by parents as a of women aged 15-49 in a polygamous of violence and abuse are rarely brought ensure that such cases are brought to the means to prevent premarital sexual relations relationship.28 Though polygamy is not legal to justice, incarceration of children who courts in a timely manner. However, this is and pregnancy. In communities, many girl in Mozambique, it is particularly prevalent in are in conflict with the law is not used as a not common practice in Mozambique. victims do not report cases of sexual abuse the central provinces, with around a third of measure of last resort and pre-trial detention to the authorities partly because of the women in Manica, Tete and Sofala in such is frequent.29 Prison policies requiring that prisoners be stigma and myth that surround the issue unions. separated by gender and age and ideally The Ministry of Justice and the Ministry housed in separate facilities are frequently of the Interior have insufficient financial not adhered to, and safe and sanitary and human resources to improve the conditions in prisons are a problem.30 The effectiveness of the system for children. National Prison Service reports that no State budget allocations in 2008 to the centres for children in conflict with the law Ministry of Justice and the Ministry of the are currently operational; one has been Interior, which includes the police, were two rehabilitated (Centro de Rehabilitação and three per cent respectively, with limited Chiango) but is not functioning due to resources targeting children and youth resource constraints. Three juvenile justice programmes. detention centres for minors aged 16–18 (as well as youths up to 21, and exceptionally Mozambique has made great strides in up to 25) are planned or operational. These the area of legislative reform, bringing facilities are located in Nampula, Matutuine national legislation further in line with in Maputo province (still under construction), the Convention on the Rights of the Child. and Beira (planned).
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Thirty-five per cent of the total prison laws established in the Succession Book children without parental care. Lack of importance of (early) registration and improve population in Mozambique is 16–21 years of the 1966 Civil Code grant equal rights to a birth certificate can result in problems public access to birth registration services by old. Data issued by the National Prison female and male heirs. Under customary in determining family connections, legal bringing them closer to the population. Services on minors aged 16–18 in conflict law, however, men are better protected and relationships and inheritance rights and can with the law reveal that 898 males and 8 widows are vulnerable to property grabbing. lead to difficulties in accessing basic social Since the adoption of the national plan females are currently in prisons nationwide. services, including school enrolment and of action on birth registration and the There is only one prison for women, located A study in four provinces of Mozambique social assistance. Although the use of a birth launch of the campaign, about 4.2 million at Ndlavela in Maputo, with a capacity to revealed that widows and orphans tend to registration for children is currently only at children under 18 have been registered. house about 300 prisoners; however, there suffer some kind of material loss after the a rudimentary stage in Mozambique, the This represents 40 per cent of all children are female sections in all provincial prisons. death of their husband or father.36 Because modernisation process and the introduction in Mozambique. The proportion of children In 2008, there were 297 female prisoners out inheritance is seen as a private, family of the district as the centre of development under five who have had their birth registered of a total prison population of 14,309. The matter, other members of the community is rendering a legal identification document from 8 per cent in 200338 to 31 per cent in Access to Justice Study conducted as part usually choose not to interfere in such cases. more and more important for legal protection 2008.vi There are significant geographical of the PARPA II evaluation (2009) reports A 2009 follow-up study reported that most and for preventing socio-economic exclusion, disparities in registration: 39 per cent of that the Government is making efforts to of the research addressing the issue of especially of the most vulnerable in society. children under five had their births registered afford special treatment to women and property grabbing focuses on legal aspects in urban areas compared to 28 per cent in minors; however, these efforts are not yet of succession and noted that there is a lack Mozambique has significantly increased rural areas; and while 47 per cent of children being translated into practice according of quantitative data on the status of children access to birth registration services across under five are registered in Maputo City, only to the objectives of the prison policy and and women’s property rights.37 The study the country. A national plan of action on 11 per cent are registered in Tete province. the minimum rules and standards of highlights the need for: (i) an assessment of birth registration was developed in 2004, and The survey also found that respondents international instruments.31 the extent of property grabbing from children birth registration is an integral part of the cited the main barriers to registration as the and widows in Mozambique, (ii) prevention of 2006–2010 national plan of action for children. complicated procedures involved (25 per To protect vulnerable women and children property grabbing, (iii) ensuring that widows A long-term birth registration campaign was cent), distance to registration services (23 per and promote access to justice, the and their children receive justice, either launched in 2006 by the National Directorate cent) and expense (20 per cent), with only Government has decided to improve the through local conflict resolution mechanisms of Registry and Notaries at the Ministry of a relatively small proportion citing lack of capacity of the justice sector by prioritising or within the formal legal system. To address Justice. The campaign’s objectives are to knowledge of the service (9 per cent) or failure the constitutional right to representation. To these needs, advocacy to promote changes clear the extensive backlog of unregistered to see the importance of birth registration (6 that effect, allocation of funds to the Legal Aid in legislation and government policies and children, increase awareness of the per cent). (See Figure 5.8). Institute (Instituto do Patrocínio e Assistência to improve community monitoring and Jurídica [IPAJ]) has increased and it was support and promote behaviour change at the included in the state budget for the first time community level are required. Figure 5.8: Reasons for not registering births, 2008 in 2008. Recruitment of professional staff during 2007 and 2008 brought the number of employees receiving a state salary up from 10 4.2. Birth registration in 200232 to 138 by the first semester of 2008.33 Birth registration gives a child legal Other Cost 17% 20% During the same period, the total number existence and authority to claim citizenship It´s not of IPAJ staff members increased from 360 important and the rights, benefits and obligations 6% to 700. The coverage of services provided that accrue from citizenship. As such, birth by IPAJ has increased from 41 branches in registration is recognised as a right by 2005 to 57 by the first semester of 2008. The the Convention on the Rights of the Child number of persons benefiting from these (Article 7) and by the African Charter on the Distance 23% services increased from 7,327 in 2007 to 9,615 Rights and Welfare of the Child (Article 6). It´s complicated in the first half of 2008.34, 35 Mozambique’s obligation to register children 25% immediately after birth is legally recognised 4.1. Children’s access to in the Civil Registry Code. Lack of birth property and inheritance registration violates children’s inalienable human right to an identity and puts their Lack of Women and children’s rights to property knowledge development and protection at risk. Source: MICS 2008. 9% and inheritance are threatened by the AIDS pandemic, as an increasing number of Birth registration is especially important widows and orphans are faced with property in the context of the AIDS pandemic vi Not all districts surveyed had undertaken birth registration activities at the time of the survey, and as a result the data grabbing. In Mozambique, the succession that is leaving an increasing number of potentially underestimate the national average.
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In a country with low literacy rates (with the involvement of the Ministries of Health, The state food subsidy programme (a and the AIDS pandemic. Extended families illiteracy rates highest and registration Education, State Administration and Women small monthly cash payment to especially and communities have historically been rates lowest in rural areas), community- and Social Action. Close cooperation vulnerable people) is only available to the first line of response to the situation based radio has played a key role in with these state agents will be important citizens over 18, and therefore excludes of orphans and vulnerable children in mobilising families to register their children. in establishing an effective, efficient and disabled children.39 The national education Mozambique. Spots produced and broadcast in local sustainable system with a specific focus on policy foresees the possibility of children languages provide strong communication registration at birth. For the short to medium with mild disabilities attending regular Formal care falls under civil jurisdiction channels for local activists, who work not term, until the above-mentioned Ministries schools and children with more serious in the form of guardianship (tutor), only to disseminate the basic facts on have the institutional capacity to lead the disabilities attending special schools. foster care (família de acolhimento) and birth registration, but also to help families registration process, alternative registration According to “Education and Child adoption. Under Mozambican law, decisions overcome some of the socio-cultural barriers services are being offered by local development,” children with disabilities regarding formal care are taken through to timely registration of newborns. In some registration agents that link communities and are 40 per cent less likely to attend primary a judicial authority and in accordance communities, for instance, traditional Government and facilitate establishment of a school than non-disabled children. Data with the principle of the best interest of naming practices can extend well beyond culture of early child registration. indicate that 13 per cent of children aged the child, and placement in foster care or the 120-day period during which births can 2–9 are living with at least one disability (see institutions is used only as a last resort. Residential care is also considered a means be registered free of charge. The cultural 4.3. Children with disabilities Figure 5.10).40 The most common disability impediment to mothers registering a child reported was delay in sitting, standing or of formal care; however, the decision to without the presence of the father is another Mozambique is not a signatory to the walking (6 per cent of children). place a child in an institution is mainly challenge, especially in cases where the United Nations Convention on the Rights taken through administrative procedures father is absent from home for long periods of Persons with Disabilities and its Optional under the responsibility of the Ministry of of time, e.g., due to migration work. Protocol. The national policy for persons 4.4. Alternative care Women and Social Action. Recently, draft with disabilities makes the Ministry of mechanisms residential care regulations (Regulamento The birth registration campaign activities Women and Social Action responsible dos Centros de Acolhimento da Criança) lend critical momentum to the introduction for promoting the effective integration of In practice, Mozambique has two types have been developed to ensure quality of of routine birth registration services that children with disabilities into preschool of alternative care systems: formal and childcare services and the application of bring registration services closer to the activities, and guaranteeing the social informal. The Government of Mozambique minimum standards, and these are pending community and prevent a future registration protection of persons with disabilities and encourages strengthening of the protective final approval by Ministry of Women and backlog by establishing a culture of (early) their families by means of measures to role of families as the first step towards Social Action. This regulatory framework child registration. Long-term, sustainable, encourage their autonomy and integration realising children’s rights. However, specific also specifies how inspections are to be routine solutions are being developed with into the community. actions are needed to address alternative undertaken and how children’s well-being is care mechanisms for children who are not to be monitored in these institutions. under parental or familial care. The concept of the foster family for children Figure 5.9: Percentage of children under five whose birth was registered by province, 2008 The traditional alternative care systems without parental care was introduced by are increasingly pressured due to the Family Law. However, implementation 50% societal changes arising from economic procedures and regulations need to be 45% 47% development, migration and urbanisation developed in order to take the initiative 45% 46% 40% 40% 35% 36% 34% 34% Figure 5.10: Percentage of children aged 2–9 with at least one reported disability, 2008 30% 28% 25% 25% 24% 20% 20% 21% 19% 15% 15% 17% 15% 14% 15% 15% 14% 10% 10% 12% 12% 11% 9% 5% 8% 5% 5% 0% 0% Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Total Delgado pula bezia bane Province City Delgado pula bezia bane Province City Source: MICS 2008. Source: Calculations based on MICS 2008.
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forward. There is also a need to: (i) improve While in Mozambique quantitative data a broader group of vulnerable children, sexual exploitation, victims of trafficking, the network of child institutions and about the placement of vulnerable children though such a step would have challenges victims of the worst forms of child labour, boarding-type child institutions, transferring in different types of care are limited, there of its own, such as reaching consensus on married before the legal age, and refugee or state child institutions into family-based is evidence that residential care centres are where to set limits or potentially significantly internally displaced children. support centres; (ii) create a system of proliferating. As of 2010, data recorded by increasing the number of beneficiaries of alternative care services (community the Provincial Directorates of Women and existing programmes. The PACOV has identified six key services and family-based services, guardianship, Social Action indicated a total of 12,767 to address children’s most fundamental trusteeship, fostering, adoption); and (iii) children being cared for in 143 residential At present, the number of children orphaned needs: health, education, nutritional and food implement mechanisms to expand and institutions across the country. During 2009 by AIDS has been adopted as a marker support, financial support, legal help and stimulate the integration of children into and 2010, the Ministry of Women and Social to gauge the severity of the impact of the psychosocial support. The Government of family care (both biological or alternative). Action assessed 113 of these institutions to epidemic on children, families, communities, Mozambique has committed itself to ensuring determine the quality of care and services and on the country in general. Providing that children have access to at least three out Current legislation makes no distinction received by children. It was found that most support to children who have lost parents of these six services, focusing particularly between inter-country adoption and centres were not legally registered and was, and continues to be seen as an on children who live below the absolute domestic adoption. Adoption procedures most lacked sustainability and depended on imperative. In the context of HIV and AIDS, poverty line, including orphans and children need to be harmonised across institutions external aid or donations. Furthermore, most children are considered Orphaned or living with or affected by HIV and AIDS. In and Ministries to ensure adequate centres do not provide occupational activities Vulnerable Children (OVC) if one or both of addition to the PACOV, the 2005–2009 poverty placement procedures and supervision and do not have an exit program for children their natural parents is dead, if there was reduction strategy (PARPA II) also included during the period of integration. As for up to age 18. Employees lack sufficient an adult death in their household during specific targets for OVC, including the need inter-country adoption, Mozambique has knowledge and skills on childcare and child the previous 12 months after a prolonged to develop and consolidate social safety nets not signed the Hague Convention No. 33 on development. Actions are under way in every illness, if they live in households headed for orphaned children and ensuring that the the Protection of Children and Co-operation province to address issues encountered in by chronically ill adults, or if they live in ratios of school attendance and malnutrition in Respect of Inter-country Adoption the monitoring visits. While much remains households headed by other children, among orphaned children are the same as 1993 or any other bilateral agreements to be done, there has been some progress: youths, women or elderly persons. among non-orphaned children. on adoption, and this represents a gap a national data base to track the situation of There are an estimated 1.8 million orphans Some of the child protection threats facing in the legal framework. Ratification of each centre has been developed, and a series in Mozambique, 510,000 of whom have orphaned children include: an increase in the Hague Convention on Adoption will of training workshops have been carried out been orphaned due to AIDS.43 The number sibling or child-headed households, lower create the necessary legal framework to with centre staff to address human resource of orphans is expected to rise, with AIDS- school enrolment and performance, and ensure due process for adoption cases shortcomings. and also that the best interest of the child related illnesses increasingly becoming the increased risk of sexual abuse and HIV remains paramount. Signing of the Hague primary cause of orphanhood. The number infection, hazardous child labour, early sexual Convention was recommended by the 4.5. Orphaned, vulnerable and of orphans does not take into account activity and marriage, severe psychosocial Committee on the Rights of the Child in other marginalised children additional children who may be vulnerable problems and poor health and nutrition.45 2009.41 due to living with HIV or living in households Furthermore, stigma and discrimination Children’s vulnerability is not limited to their that include people living with HIV. There against people affected by AIDS remains a There is a need to provide comprehensive orphan or non-orphan status, nor is it solely are 100,000 children aged 0–14 living with challenging issue. Children and young people information about adoption to the general linked to being affected by HIV or AIDS. HIV.44 MICS further states that 17 per cent of with sick or dying relatives are particularly public, to develop specific regulations for Children who have lost parents to AIDS Mozambican children are orphaned or made exposed to stigma. They may be ostracised domestic and inter-country adoptions, and are part of a much larger group of children vulnerable due to AIDS. by their communities and receive minimal to harmonise adoption procedures with the who face severe and urgent needs. It is the support from their families due to the shame Convention on the Rights of the Child and interlinked triple threat of AIDS, poverty and The legislative framework for guiding the and stigma that are currently associated other relevant global agreements so as to food insecurity that renders a wide range of national response to OVCs comprises two with an AIDS-related death. In schools, ensure supervision of the adoption process children vulnerable. Indeed, analysis shows main action plans: the National Action discrimination against children is expressed by Social Welfare Services and appropriate that in settings of widespread destitution Plan for Children 2006-2010, and the Action through teasing and bullying. In some cases, judicial bodies. For instance, while the differences between orphans and non- Plan for Orphaned and Vulnerable Children children avoid their HIV-positive peers due to Children’s Act adopts the Convention on the orphans do not emerge, or are very small (PACOV). The PACOV also applies to children fear that they may become infected. Rights of the Child definition of a child as compared to the deprivation and suffering made vulnerable due to factors other than any person up to age 18, the Civil Code sets that all vulnerable children confront.42 HIV and AIDS. It includes those living on MICS found that twelve per cent of the age of adults at 21. Attempts to bring the street, living in institutions (orphanages, Mozambican children are orphans (of whom other aspects of national legislation in line Consequently, some experts recommend prisons, mental health institutions), in 11 per cent were single orphans and 1 per with human rights standards are on-going. re-defining the target group for a social conflict with the law, living with disabilities, cent were double orphans), while another protection intervention from ‘orphans’ to victims of violence, victims of abuse and 6 per cent were considered ‘vulnerable’.46
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Geographic differences were also observed, their non-orphaned peers of 0.90 and 0.92 for head were discriminated against in terms of cent). It therefore has the characteristics with more OVC living in urban than rural boys and girls respectively. their access to education, in both rural and of a non-contributory (old age) pension. areas (20 and 16 per cent, respectively), and urban areas.48 Mozambique is one of the few low-income in the southern provinces than the central The MICS further shows that only 22 per cent African countries with such a longstanding and northern regions of the country (see of households with OVC receive any external The 2003 Demographic and Health Survey cash transfer programme that is supported Figure 5.11). Only 68 per cent of children support; most of this goes for education, with found that female orphans aged 15–17 by state funds and national legislation. In were living with both parents in 2008. two per cent of households receiving material are more likely than non-orphans to have 2007 the PSA reached 128,000 households or financial support and less than one per experienced sexual debut and that female with monthly cash transfers, increasing to There is no evidence of a higher rate of cent receiving medical support. Only 20 per maternal orphans are more likely than 143,455 households in 2008 and 166,824 severe education deprivation for OVC cent of children from the poorest quintile non-orphans to have been married.49 households in 2009. In total, the programme than for non-orphans, However, there is a receive free external support, as compared to The implication is that adolescents, and reached 166,824 direct beneficiaries and difference in the school attendance rates 27 per cent in the second poorest quintile. particularly girls, are especially vulnerable. 140,643 indirect beneficiaries (dependents) of double orphans and non-orphans, with One study found that orphans were more in 2009. A significant proportion of the Orphaned and vulnerable children are likely male double orphans and female double likely to be bullied and depressed, and were indirect beneficiaries are children, including to live in poor households headed by elderly orphans having a school attendance ratio to less likely to have a trusted adult or friends. biological children of the direct beneficiary people. The MICS found that 10 per cent Caregivers of orphans also reported similar and orphans and vulnerable children who of households are headed by an elderly 50 depression and isolation. live within the household. Figure 5.11: Percentage of orphans and vulnerable person, over half of whom have at least one child dependant. A study conducted in 2006 children due to AIDS by province, 2008 4.6. Basic social protection In 2008, the PSA went through two found that meeting the costs associated with important reforms: an incremental increase childcare was an impossible burden for the At present, the National Institute for Social of the subsidy scale, and an increased elderly: caring for an orphaned or vulnerable Action oversees five social protection focus on inclusion of eligible dependants child cost an average of US$ 21 per month Cabo Delgado programmes: two assistance programmes as indirect beneficiaries in the payment 17% and caring for someone living with HIV cost Niassa (a cash transfer programme and an in- scheme. A significant part of these indirect 9% $US 30, while elderly people had an average kind social transfer programme) and three beneficiaries are children, which hitherto has 47 monthly income of $US 12.5. promotion and development programmes been problematic due to the fact that they (Social Benefit for Work, Income Generation, frequently do not meet the eligibility criteria. Some households are also headed by a child, Nampula and Community Development). In the case of children, this is often due to Tete 13% or have a child who must act as the main the lack of a birth registration document 12% provider due to the illness or disability of Of these, the Food Subsidy Programme or orphanhood status. According to the the adult family members (approximately Zambezia (PSA) has by far the largest outreach. This programme procedures, non-orphans living 19% one and two per cent, respectively, according unconditional cash transfer programme was with the elderly, even if they receive no to the MICS). In such situations, children Manica introduced in 1990 and was designed to financial support from their parents, are not 19% typically have very limited means of target the elderly, disabled and chronically eligible beneficiaries of PSA. Consequently, generating income and thus often have to sick and their dependants within the a significant number of extremely vulnerable Sofala resort to risky coping strategies, such as early 20% poorest section of society. Currently, its children are excluded from the programme. marriage, transactional sex and hazardous main direct beneficiaries are the elderly A planned inventory and update of the child labour. They also have limited access to (93 per cent), people living with disabilities registry forms of direct and indirect basic services such as health, education, food, (6 per cent) and the chronically ill (1 per beneficiaries in 2010 will shed more light on or legal, financial and psychosocial services. In addition to these challenges, children orphaned as a result of AIDS are often Table 5.1: Projected cash transfers to households headed by elderly people, people living with Inhambane living with social stigma and discrimination, deficiencies and the chronically ill, 2010-2014 15% and potentially face exclusion from their Gaza communities. For example, a study by the 31% 2010 2011 2012 2013 2014 Ministry of Planning and Development conducted in 2005 established that within Number of extended families 242,296 312,592 382,888 453,183 523,479 Allocated amount (Millions of Mts) 668.74 862.75 1,056.77 1,250.79 1,444.80 Maputo poor households, discrimination exists in the 19% allocation of resources to children who are Per cent of state funds 0.24% 0.29% 0.34% 0.38% 0.42% Maputo City not biological descendants of the household Number of elderly as direct and 20% head. The study found that children with no indirect beneficiaries 300,447 387,614 474,781 561,947 649,114 direct biological relationship to the household Source: MICS, 2008. Source: Governement of Mozambique, “Estratégia Nacional de Segurança Social Básica,” Maputo, March 2010.
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the number of potentially eligible children in regarding the introduction of a child grant, 4.7. Poverty certificates National Human Rights Policy, and reform of beneficiary households who are not currently as proposed in the Basic Social Security the Criminal Investigation Police Unit. receiving an entitlement. This information Strategy. The Government has created a system will feed into the new programme whereby poverty certificates are issued The entire justice sector, and particularly management system that will become The Strategy projects to scale the PSA to vulnerable households to ensure free the police force, needs to play a more active operational in 2011 and will ensure improved programme up to 452,000 households by access of children to education, health and role in ensuring that families, communities coverage of eligible dependants. A revision 2014. These households are expected to civil registration services. The beneficiary and schools provide safe and protective of the programme manual is foreseen as consist of 1,356,000 direct and indirect families are defined as those who have no environments for children by enforcing part of the operational plan of the Basic beneficiaries, of which 795,520 indirect resources to survive without help from the existing criminal laws and scaling up Social Security Strategy. It will include beneficiaries will likely be children. state. The process of obtaining poverty initiatives such as the Police Victim Support discussions of the criteria that determine the certificates requires interaction with the local Centres (Gabinetes de Atendimento). inclusion of dependent children. The current In addition to the PSA, the in-kind transfer registry (to confirm the place of residence), More than 200 centres have been set up birth registration campaign should address programme identifies orphans and then with the social action services at nationwide since the establishment of the the issue of a lack of a birth registration vulnerable children as direct beneficiaries. district level (to verify the applicant’s social first Police Victim Support Centre in Beira 52 document, thereby facilitating the inclusion Material support is provided to individuals status information) and finally with the in 2002. These centres were established of vulnerable children as entitlement holders. and families who need immediate assistance district administration (for issuance of the to create a safe space for victims to report in the form of nutritional products, school certificate). Reports from non-governmental incidents of violence to the police and to An impact assessment of the PSA is supplies, domestic utensils and building organisations supporting the access of be referred to necessary services by the on-going, in which a treatment (1016 material. In 2008 this support reached 24 families to this programme have revealed Ministry of Women and Social Action, the households) and control group (1650 per cent of households. The largest group that lengthy procedures and lack of clarity Ministry of Health and related government households) participate in a survey to of beneficiaries is children, including on which services the certificates apply ministries, including health workers and establish the impact of the monthly cash 26 per cent orphaned children, 23 per to (even among the service providers and social workers. Between January and transfer on consumption, health and cent malnourished children; 12 per cent administration agents), as well as lack of September 2009, more than 14,000 victims education (including access to services), twins; 10 per cent abandoned children; 6 means from the service providers to take of violence, abuse and exploitation, of employment, housing, and intra-household per cent babies that cannot breastfeed; on beneficiaries for free, represent major which 2,721 were children (1,219 boys and demographic changes. The baseline survey 6 per cent child heads of households; 2 constraints. 1,502 girls), were supported through these was conducted in 2008 with follow-up per cent adolescents and 0.24 per cent centres nationwide. However, significant surveys scheduled for 2009 (completed), triplets. Although this support is a valuable gaps remain before these centres can be 2011 and 2013. Its objective is to analyse the contribution to alleviating the deprivation 4.8. Capacity analysis considered fully operational. The available impact of the PSA on individual beneficiaries of families in dire need, it is given on a human and logistical resources are and families so as to inform the technical supply basis, and coverage is limited and The 2009 Access to Justice Study, insufficient to enable most centres to operate and political dialogue with Government insufficient to meet the current demand. commissioned by the Ministry of Planning on a 24-hour basis. Only seven of the 200 and partners on the future direction of and Development as part of the PARPA II Police Victim Support Centres have their the programme. It is anticipated that the The proposed child grant programme will evaluation process, concluded that during own vehicles, which represents a serious empirical evidence generated through this target families who care for orphans and the period 2005–2009 access to justice in constraint on mobility to investigate cases evaluation will influence key programmatic vulnerable children. The grant is expected Mozambique did not improve (although of violence against children and women 51 decisions such as the amounts and range of to be introduced in a phased approach (see it did not decline either). Weaknesses and to provide care and support for the the benefit scale, number of beneficiaries, Table 5.2). However, state funds for the persist in ensuring that the benefits of public victims. Further support must be mobilised constitution of target group, etc. The results introduction of this grant have not been services offered by the justice sector (i.e., to strengthen the capacity of the centres to of the assessment are also expected to secured yet, and launch of the programme in courts, Attorney General’s Office, Ministry of facilitate prompt referral of cases to essential inform the political and technical dialogue 2010 was not feasible. Justice, and Legal Aid Institute actually reach service providers and to ensure quality the majority of citizens, especially those services for children and women victims of most vulnerable. violence. Table 5.2: Cash transfers to families with orphans and vulnerable children, 2010-2014 The PARPA II impact evaluation revealed that The collection of reliable data on issues 2010 2011 2012 2013 2014 of 36 planned actions in the areas of justice related to child protection in the justice Number of extended families 66,780 133,559 200,339 267,119 333,899 reform, legality, order and public security, sector is key to improving child protection Allocated amount (Millions of Mts) 186.51 373.03 559.54 746.06 932.57 only six actions were fully completed, and but is extremely difficult in Mozambique, ten registered no progress at all. Important Percentage of state funds 0.20% 0.39% 0.55% 0.71% 0.85% particularly at the provincial and district actions that were not completed include the Number of child beneficiaries 203,531 407,062 610,594 814,125 1,017,656 levels. This is due in part to a tradition new Legal Aid Institute law, the digitisation of dealing with cases within families and Source: Governement of Mozambique, “Estratégia Nacional de Segurança Social Básica,” Maputo, March 2010. of judicial court data, approval of the households, rather than through formal legal
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channels, and in part to a lack of technical judicial sectors to prevent and respond to justice system into the training manuals Vulnerable Children with a specific focus on and material capacity in the Government cases of violence against children at both used by the national Legal and Judiciary the six basic services defined by the PACOV, and the justice system. Violence, exploitation national and provincial levels also requires Training Institute and the national police now in progress, will be an important guide and abuse thrive in conditions of illegality strengthening via improved data collection, academy, thereby mainstreaming attention for implementing activities for children in the and lack of transparency, making it difficult monitoring and reporting mechanisms at all to child protection issues. country. for the Ministry of Justice and the Ministry levels. of Interior’s statistics to reflect the true scale In spite of the constraints mentioned above, As stipulated in the Children’s Act, the and extent of the problems.53 A related capacity gap concerns the lack improvements have been made, particularly Council of Ministers approved the National of a national database on violence and within the courts and the prosecution Council of Children’s Rights in 2009. This The reality for most Mozambicans is that sexual abuse. Development of an effective service. According to the Second Strategic will be an important forum for different the judicial courts are inaccessible, blocked national system would greatly enhance the Integrated Plan of the Justice sector (Plano government institutions and civil society by a range of obstacles including high Government’s ability to record, monitor, Estratégico Integrado II) a total of 1,173 organisations to establish the main costs relative to income, distance and poor assess and respond to patterns of abuse persons have graduated from the various strategies for children’s rights and effectively transport networks. Mozambique faces and violence. This would be especially law faculties in the country since 2000. coordinate actions in the future. significant challenges in providing access useful for key ministries such as the Since the Legal and Judicial Training Centre to justice for the majority of its citizens and Ministry of Interior (for reporting criminal began its activities in 2001, approximately 4.9. Civil society partnerships in meeting constitutional and international cases), the Ministry of Women and Social 136 judges and prosecutors, 343 court standards of justice.54 The principal centres Action (to allow social workers to provide officials, 51 legal assistants and 45 public Civil society is also actively engaged in of the justice system are found in urban information on gender-based cases), and notaries have graduated from the Centre and advocacy, policy dialogue, capacity building areas, mainly in Maputo, leaving rural the Ministry of Education (for reporting an estimated 90 per cent of the graduates and community sensitisation on child areas unserved. The Justice Sector and incidents in schools) as well as to reinforce subsequently entered one of the sector protection issues in the justice system. Civil Rule of Law Report published by the Open community capacity to prevent and institutions. Since 2004 the Police Academy society partners have taken an active role Society Foundation (Sociedade Aberta) cited respond to violence in households or on has awarded the equivalent of Bachelor’s in disseminating several Acts, including the constraints in access to justice, including the street. The concluding observations of and Master’s Degrees in police science to child-friendly version of the Children’s Act. insufficient numbers of court staff and the Committee on the Rights of the Child approximately 85 candidates per year, and the lack of qualified existing staff, such as on Mozambique’s second periodic report 1,200 police officers graduate each year from Civil society organisations in Mozambique magistrates, attorney generals and court recognise that strengthening the evidence the basic police school. also play a vital role in providing basic clerks. Further obstacles noted were the base on child protection in the justice services, especially in support of households backlog of cases in the various sections, sector is vital, not least to ensure that data The Ministry of Women and Social Action and vulnerable children coping with lack of equipment and infrastructure (only are used to improve laws, policies and has received technical and financial support HIV and AIDS. Although specific data on provincial capitals and slightly more than practices.55 to implement the PACOV from a range support to orphans and vulnerable children half of district headquarters were covered of partners. However, an assessment by civil society organisations are not at this time) and a lack of lawyers available Another major challenge for the justice found that the Ministry operates with available, it should be noted that the US to represent children charged with a crime, sector is the need to coordinate, streamline limited resources and competences at the President’s Emergency Plan for AIDS Relief especially outside of Maputo City. These and maximise the impact of capacity district level, weakening their capacity to alone supported 16 non-governmental critical impediments in the justice system building and sensitisation efforts by a comprehensively respond to children’s organisations to reach 242,800 OVC in prevent the courts from meeting the growing wide variety of stakeholders. Donors, existing needs.56 Accordingly, a study is 2008.57 Civil society organisations spent demands for guardianship and other juvenile non-governmental organisations and currently being commissioned to generate approximately 38 per cent of all funds spent justice issues and contribute to an ever- UN agencies are targeting judges, court further evidence of where capacity gaps on HIV from 2004 to 2006.58 larger backlog of pending cases. personnel, prison officers and police or weaknesses lie at the district level, and officers at both the national and community consequently, how these gaps can be Improving coordination of civil society Although the capacity of justice systems levels. However, the Government has not transformed into strengths. organisation activities is needed to to prevent and respond to different forms established standards for training materials avoid duplication, to scale up what is of violence, abuse and exploitation has and sensitisation messages, and there is In order to assess the impact of often localised support and to ensure been strengthened, the overall response no systematic, coordinated approach to implementing the PACOV, the Ministry sustainability, given that up to 70 per cent continues to be fragmented, reactive, training and raising awareness. To better of Women and Social Action has of civil society organization support comes weak and underfunded. Improvement of institutionalise capacity building efforts, commissioned an evaluation. Its results will from external sources.59 A meta-analysis60 the capacity of the Ministries of Justice both the Ministry of Justice and the inform PACOV’s relevance and efficiency in of community-based groups that work on and Interior is urgently required to provide Ministry of Interior have been integrating providing care and support for children, in child protection and well-being underscored adequate attention and protection to training modules that describe in detail particular for those living in a situation of the need for longer-term funding to enable victims of violence, abuse and exploitation. how to protect children’s rights as victims, vulnerability. The elaboration of Minimum the development of community-owned child The capacity of social welfare, police and witnesses and offenders in the criminal Standards of Care of Orphaned and protection groups.
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4.10. Sector financing and of the state budget.62 The Ministry of Interior budget allocations absorbs about 70 per cent of allocated 5. Conclusions resources.vii In nominal terms, the allocations The Ministry of Women and Social Action have grown from 22 per cent to 25 per cent receives low levels of financial support by each year, with the exception of 2006 (an Children face a wide range of protection Social protection policies and programmes the Government of Mozambique: in 2010, it increase of 5 per cent). Budget allocations issues in Mozambique. Physical and sexual are effective means of responding to the was allocated only 1.1 per cent of GDP, a 0.3 per institution for investment expenditures violence, early marriage, child labour and needs of vulnerable families and children, as per cent decrease from 2009.61 In addition, have been irregular, and no clear trend can child trafficking continue to be prevalent; social protection plays a key role in reducing the ability of the Provincial Directorates be observed. although data are scarce in these areas, poverty, overcoming social exclusion of Women and Social Action to effectively available information indicates that and building human capital in order to Budget allocations to the provincial level are perform their roles and responsibilities has trends have not improved significantly in reduce the risks and vulnerability faced by increasing, but only proportionally to the been limited by the lack of human resources recent years. The number of orphans and vulnerable groups, particularly children and total budget increases. Allocations to the and adequate training (in terms of both social vulnerable children continues to increase, their caregivers. Specifically, three critical provincial level account for approximately work and programme management). principally as a result of HIV and AIDS. challenges have to be addressed to meet the 25 per cent of total allocations to the justice While extended families and communities in needs of and deliver effective and beneficial sector in 2008. There is little evidence of Since 2003, budget allocations to the Mozambique have historically represented outcomes for vulnerable children and their effective decentralisation of resources or justice sector have been reasonably stable, the first line of response, this traditional families: representing between six and seven per cent their administration to provincial level. support system is increasingly under pressure as the number of children in need ll Government-led support and services of care mounts. Also, significant progress must reach all children who need them has been registered in the area of birth in poor communities affected by HIV registration services across the country, with and AIDS. This includes children who close to 7 million children registered since have lost parents, but also many others, 2005; the challenge in this area will be to including victims of violence, abuse and ensure that current initiatives are sustained exploitation; to achieve universal coverage. ll Policies and programmes for vulnerable Significant progress has been achieved within the legal and policy framework children must strengthen the capacity of with regard to child protection in recent extended families and communities to years, notably the approval of the Domestic care for them at the grassroots level; Violence Act, Children’s Act and Juvenile ll Family poverty and gender inequality Justice Act, amongst others. Despite must be tackled to improve outcomes for these improvements, the overall response children. continues to be fragmented, reactive, weak and underfunded, and this new legislation While there has been important progress needs to be translated into effective in the area of protecting children’s rights regulations and programmes. The Basic in Mozambique, there is much more to be Social Security Strategy recently approved done to develop a holistic child protection by the Council of Ministers and currently in system that seeks synergy between the the process of operationalisation presents social welfare and justice sectors to increase a promising scenario to address child and children’s access to protective and other household vulnerability, particularly because key social services. This would principally it incorporates a child grant component. involve improving data and monitoring The progress achieved in the PSA social mechanisms; developing a more systemic transfer programme, where the number and coordinated approach within and of households rose from 90,000 in 2005 to between the key line ministries; and approximately 170,000 in 2009, provides an strengthening the capacities of relevant line encouraging example of how children could ministries to develop a robust and systemic benefit from social protection initiatives. approach to child protection. Furthermore, vii The budget of the Ministry of Interior is not disaggregated and therefore does not permit an identification of the share allocated to the police forces.
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since cultural and social norms play such the capacity of the Ministry of Women and References an important role in the context of child Social Action at national and sub-national protection, there is a continued need to levels to deliver on its mandate will remain effectively disseminate information on key constrained. Adequate financing and issues and increase awareness among implementation of the Government’s policy 1 United Nations Secretary-General, Study on 11 Ministry of Women and Social Action, society as a whole of children’s rights response to the threats posed to orphans Violence against Children and Adolescents, Inquérito sobre Violência Contra a Mulher and the obligation of all to protect them. and vulnerable children will be crucial to The World Congress III outcome documents, Government of Mozambique, Maputo, 2004. Brazil, 2008. However, without additional resources, protecting the rights of these children. 12 National Institute of Statistics, Inquérito de 2 Government of Mozambique, ‘Lei nº 3/2007, Indicadores Múltiplos 2008, Government of de 7 de Fevereiro sobre a Protecção Social,’ Mozambique, Maputo, 2010. Maputo, 2007. 13 Ministry of Women and Social Action, 3 Ministry of Interior, Department of Women Inquérito sobre Violência Contra a Mulher and Children, Relatório Annual de 2009, Government of Mozambique, Maputo, 2004. Government of Mozambique, Maputo, 2009. 14 Ibid. 4 Pinheiro, Paulo Sergio, Report of the 15 Ibid. independent expert for the United Nations study on violence against children, United 16 International Organisation for Migration, Nations, New York, 2006 Regional Office for Southern Africa, Seduction, Sale and Slavery: Trafficking in 5 Tvedten, Inge, Margarida Paulo and Georgina Women and Children for Sexual Exploitation Montserrat,Gender Policies and Feminisation in Southern Africa, 3rd ed., Pretoria, 2003. of Poverty in Mozambique, CMI Report, Chr. Michelsen Institute, Bergen, 2008. 17 Mozambique Human Rights League, Trafficking Body Parts in Mozambique and 6 National Institute of Statistics, Inquérito South Africa, Mozambique Human Rights Nacional sobre Saúde Reprodutiva e League, Maputo, 2008. Comportamento Sexual dos Jovens e Adolescentes (INJAD), Government of 18 de Sas Kropiwinicki, Zosa,The Internal Mozambique, Maputo, 2001. Trafficking and Exploitation of Women and Children in Mozambique, Save the Children, 7 Universidade Eduardo Mondlane, Centro de Norway,2009. Estudos da População, Inquérito Internacional sobre a Violência contra a Mulher (IVAWS- 19 Save the Children, Our Broken Dreams: 2004) em Moçambique, Maputo, April 2005. Child migration in southern Africa, Save the Children UK and Save the Children Norway in 8 United Nations Committee on the Rights of the Mozambique, Maputo, 2008. Child, 52nd session, Consideration of Reports Submitted by States Parties Under Article 44 20 National Institute of Statistics, Inquérito de of the Convention, Concluding Observations Indicadores Múltiplos 2008, Government of of the Committee on the Rights of the Child: Mozambique, Maputo, 2010. Mozambique, United Nations, Geneva, 2009. 21 deSas Kropiwinicki, Zosa,The Internal 9 Ministry of Education and Culture, Relatório Trafficking and Exploitation of Women and da Auscultação Através das Unidades de Children in Mozambique, Save the Children, Género, dos Conselhos Escolas, e Jovens Norway,2009. Raparigas sobre Que Mecanismo a Adoptar 22 Population Council, ‘Child Marriage Briefing: para Prevenção, Combate, Denúncia e Mozambique’, 2004, retrieved from:http:// Encaminhamento de Casos de Assédio e Todo www.popcouncil.org/pdfs/briefingsheets/ o Tipo de Abuso, Incluindo o Abuso Sexual na MOZAMBIQUE_2005.pdf, accessed 8 Escola, Government of Mozambique, Maputo, November 2010. 2008. 23 National Institute of Statistics, Inquérito 10 Ministry of Women and Social Action, de Indicadores Múltiplos, Government of Plano Nacional de Acção para a Criança, Mozambique, Maputo, 2010. Government of Mozambique, Maputo, 2005.
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Cross-cutting issues
6 1. Introduction 6 Improving the situation for the most being. Issues related to gender, geographical vulnerable members of society requires disparities, HIV and AIDS, lack of information an understanding of who they are, where and environmental conditions complicate they live and what specific challenges and and challenge each of the sectors discussed hazards they face. Mozambique is not a in the previous three chapters: child survival, homogeneous country, and children living education and protection. A thorough in different areas or even under the same analysis of these cross-cutting issues roof do not always face the same levels of and the institutional and social systems vulnerability. Certain children, households in place to address them is essential for and entire communities are threatened by effective interventions to be designed and the presence of physical, environmental implemented to decrease overall vulnerability. or social hazards that others do not have to worry about. In addition, there are a This chapter is focused on five cross-cutting number of factors that affect the capacity issues: gender, regional disparities, HIV and of certain subsets of the population to cope AIDS, environment and communication for with the presence of threats to their well- development.
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ll Both men and women are reluctant to headed households. The 2004/05 Labour 2. Gender resolve their conflicts in formal courts Force Survey (IFTRAB) indicated that 54 per of law. In rural areas the courts may be cent of all orphaned children were living in far away. Victims of domestic violence households headed by women, compared to Equal enjoyment of human rights by women also a signatory to the 2005 African Charter may be reluctant to bring their partner to 46 per cent in households headed by men.6 and men is a principle enshrined in the on Human Rights and Peoples’ Rights and the court. Domestic violence is not yet seen Recent studies indicate that the trend of Universal Declaration of Human Rights.1 Rights of Women. as a crime but rather as a normal part of feminisation of poverty is at least partly due In 1979, the United Nations approved the relationships between men and women. Convention on the Elimination of All Forms The Ministry of Women and Social Action was to women being more heavily involved in of Discrimination against Women (CEDAW), created in 2005.i Its mandate is to implement The Government’s Five-Year Plan 2010–2014 the agricultural sector than men (89 per cent 7 which further defined the legal and human and coordinate initiatives concerning the sets the objective of promoting equal compared with 68 per cent). At the same rights of women.2 The principle of equal rights of women and children. The National economic, social and cultural opportunities time, women have less access to education, enjoyment of rights was subsequently Council for the Advancement of Women for men and women.5 fewer opportunities for formal employment, reaffirmed by the Vienna declaration, is a multi-sectoral coordination platform lower incomes and fewer opportunities to adopted by 171 states at the World through which the Ministry of Women and 2.1. Gender aspects of poverty diversify their income sources. Studies have Conference on Human Rights in June 1993.3 Social Action monitors the implementation also shown that female-headed households, of the National Plan for the Advancement of in Mozambique besides being poorer than male-headed UNICEF is committed to promoting “the Women. As discussed in Chapter 1, poverty reduction households in monetary terms, have reduced equal rights of women and girls and to in Mozambique between 1996/97 and ‘social access’ as a consequence of the support their full participation in the political, In spite of progress in the legal framework, 2002/03 did not equally benefit all segments predominantly patriarchal societal structures social and economic development of their discrimination on the basis of gender, of the population. Poverty was reduced in Mozambique.8 communities.” Only by ensuring equal and especially discrimination against much more significantly among male- Further evidence of the feminisation of opportunities for women and men, girls women, does occur in Mozambique. This headed households than female-headed poverty comes from an analysis of three and boys, can societies expect to create the discrimination is reflected in aspects of the households. While poverty was reduced National Agricultural Surveys (2002, 2005 conditions for ending poverty and enable social, cultural, political and economic life of by 26 per cent in male-headed households 4 and 2008), which revealed that female- every person to develop to his or her full women, including the following: (from about 70 per cent in 1996/97 to 52 headed households were over-represented potential. per cent in 2002/03), it was only reduced ll In the family, women are discriminated among the poorest households in all three by 6 per cent in female-headed households Gender and gender development are not against by their direct relatives and do not survey years.9In contrast, the proportion of (from about 67 per cent to 63 per cent solely concerned with the rights of women receive the same treatment afforded to male-headed households tends to increase between 1996/97 and 2002/03). This may and girls; rather, they address all forms of men. For example, boys are often favoured with increasing income quintile (see Figure have implications for orphaned children, discrimination or bias encountered in the in decisions over which members of a 6.1). as they are more often found in female- realisation of human rights or achievement family are to receive formal education, of development that are based on the although gender inequality in education gender of an individual. In many cases, has narrowed in recent years. Decisions Figure 6.1: Proportion of male-headed households by wealth quintile, 2002, 2005 and 2008 women and girls are most often the victims are often made based on customary of gender discrimination, although it can practice, which have defines boys and men 100% also be the case that boys or men are as the breadwinners and girls and women discriminated against, and these cases as the home-makers. The higher levels 80% should be given equal consideration. of illiteracy among women and a lack of 60% Mozambique ratified the United Nations knowledge regarding their rights means Convention on the Elimination of all that cases of discrimination against women Forms of Discrimination against Women are rarely brought before a court of law; 40% in 1993, and it entered into force in 1997. ll In the labour sector, few opportunities exist 20% Mozambique has also ratified the Optional for women in the formal sector, especially Protocol to the Convention. Mozambique is in senior positions; 0% 2002 2005 2008 2002 2005 2008 2002 2005 2008 2002 2005 2008 2002 2005 2008 Percentage of male headed households Lowest Second Middle Fourth Highest
i In 2000 the Ministry for Coordination of Social Action was established. In 2005, the Ministry was re-structured and became known as the Ministry for Women and Social Action, the name the reflecting the elevation of gender equality Source: Cunguara, Benedito and Brendan Kelly, ‘Trends in agriculture producers’ income in rural Mozambique’, study as input to issues in Mozambique. Impact Evaluation Report of PARPA II, MPD, 2009.
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The trend towards a feminisation of poverty of 0.229, placing it 123rd of 130 countries Under scenarios A and C, the PARPA II target of women in decision-making bodies such is supported by the perceptions of change for which the index was calculated. This for the GDI was reached in 2008, and the as the parliament, where following the 2004 held by male- and female-headed households reflects that while Mozambique improved report ascribed this result to the high levels election, 36 per cent of seats were held by respectively. A higher proportion of female- in gender equality in absolute terms, it did of gender equity achieved in primary school women.12 Until the new Government was than male-headed households believe that not improve as much as other countries. enrolment. announced in 2010, the position of prime their situation has worsened over the last five The GDI was lower in central and northern minister was held by a woman. Although years. At the same time, the perception of provinces than in the south. Mozambique fared much better under the there has been a reduction in the proportion deteriorating conditions is more pronounced Gender Empowerment Measure (GEM), of women in Government following the 2009 among rural than among urban female- The GDI used was based on three indicators which was calculated at 0.350, placing elections, female political participation in headed households, which may indicate assigned equal weight: Mozambique 61st of 116 countries. The Mozambique is high by regional standards. better opportunities for female-headed higher GEM was a reflection of the relatively Currently, 18 per cent of ministers (full ll Life expectancy at birth; household heads in urban areas. high proportion of parliamentary seats held and junior) and 27 per cent of provincial ll A combination of the adult literacy rate by women in Mozambique (15 per cent in governors are women. Overall levels of participation in the workforce and the combined net enrolment rate 1994) and the proportional earned income are slightly higher among women of active across primary, secondary and tertiary share of women (40 per cent in 1994), which 2.3. Gender disparities age (15–59), at 82 per cent, than among was higher than for several other countries education levels; men of a similar age (79 per cent). Women’s in the rankings. No GEM is provided A study conducted by the Ministry of participation in the labour force is primarily ll Per capita Gross Domestic Product for Mozambique in the 2009 Human Planning and Development as part of the concentrated in subsistence agriculture in expressed as US dollars purchasing Development Report. There is a high degree 2009 PARPA II Impact Evaluation revealed no rural areas, where women make up 62 per power parity. of regional disparity in the GEM. The four difference in the proportion of girls and boys cent of the working population, while men provinces with the lowest (worst) indices are experiencing absolute poverty, as measured predominate in all the other major sectors A study to update the United Nations all in the north of the country. by the deprivations-based approach (see of the economy, where earning potential is Development Programme GDI for Chapter 1, Child poverty in Mozambique, for higher. Women in the labour force have lower Mozambique was commissioned as part of Arguably, the area in which most progress a more detailed discussion of deprivations- 11 educational levels than men, with 15 per cent the 2009 PARPA II impact evaluation. has been made in terms of gender equality based poverty). A higher proportion of boys in Mozambique is political participation of suffer from severe nutritional deprivation of men in the workforce having attained upper The GDI was calculated according to four women. Mozambique has a high proportion than girls (23 per cent versus 17 per cent). primary education or better, compared with different scenarios: three using different 10 only five per cent of participating women. methods of determining the salary gap Although women make up the majority of between men and women, and one using a life expectancy adjusted for the impact of the economically active population, they are Figure 6.2: GDI based on different methods of determining salary gap, 2009 predominantly engaged in the agricultural AIDS: sector, where they are mostly involved in ll Scenario A: non-agricultural salary gap 0.430 household production with limited surplus. calculated based on different levels of 0.410 Where income generating opportunities qualification of men and women; exist, men tend to be more likely to access 0.390 these opportunities and derive benefits from ll Scenario B: global salary gap (agricultural 0.370 them. In urban areas, women are more likely and non-agricultural) based on different 0.350 to depend on the informal sector due to low levels of qualification of men and women; entry requirements and the fact that access 0.330 to formal jobs is largely controlled by social ll Scenario C: non-agricultural salary 0.310 capital (social contacts) that favour men since gap based on the United Nations Gender Development Index 0.290 they are still seen as the breadwinner. Development Programme assumption that on average women earn 75 per cent 0.270 of the salary of their male peers; 0.250 2.2. Gender development and 2004 2005 2006 2007 2008 gender empowerment ll Scenario D: using life expectancy Year estimates adjusted for AIDS. Scenario D Scenario A Scenario B Scenario C Scenario D In the 2009 Human Development Report, provides an illustration of the impact of Mozambique is ranked 145th of 155 countries HIV on the Gender Development Index Source: Ministry of Planning and Development, Ministry of Women and Social Action and Gender Coordination Group (GCG), and is assigned a Gender Development in the absence of interventions for the ‘Calculando o GenderDevelopmentIndex no Contexto da Avaliação do PARPA II (2006–2009)’, Maputo, 2009. Index of 0.395 for 2007. In 1995, Mozambique prevention and treatment of AIDS. achieved a Gender Development Index (GDI)
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There are numerous hypotheses on the primary school has decreased since 1999, 2.5. Violence, abuse and extreme violence resulting in actual bodily reasons for this difference, including but remains high at 14 per cent.14 exploitation harm is unacceptable to communities as well differences in nutrition requirements, as to individual men and women. food habits, access to food and childcare Gender disparity in enrolment shows Some forms of violence against women practices, but there is insufficient evidence considerable geographical variation, and children are rooted in discriminatory The prevalence of child labour is slightly to confirm or refute any of these possible with fewer girls enrolled in the central and unequal societal gender dynamics.16 higher among girls (24 per cent) than among explanations. and northern regions, whereas in some Available studies and data suggest that boys (21 per cent). A higher proportion of southern provinces, such as Maputo and the traditional patriarchal culture and girls than boys work in domestic tasks (eight Girls are more likely to experience severe Inhambane, slightly more girls are enrolled male-dominated social order is strong in per cent against five per cent, respectively). education deprivation than boys (13 and than boys. In 2007, the completion rate Mozambique.17 Child marriage, for example, The percentage of children who work to 10 per cent, respectively). Education for the first stage of primary education continues in spite of the provisions of the support household businesses is the same deprivation was reduced significantly for was 65 per cent for girls and 80 per cent 1997 Family Law and appears to be related for both sexes (16 per cent).20 both girls and boys, however, between for boys. This gender gap persists in the to traditional gender relations persistence 2003 and 2008. Completion (especially at second stage of primary education, with of the gender roles assigned to women and It is women and girls who traditionally secondary level) and literacy rates for girls completion rates of 39 per cent for girls girls as mothers and care-givers in society. collect water for the household. The MICS found that an adult woman collects water are also lower than for boys. and 53 per cent for boys.15 Many girl victims do not report cases of in 86 per cent of households, and a girl Gender is a major factor influencing the rape or sexual abuse to the authorities (under 15) collects water in 7 per cent of 2.4. Gender issues in education education sector; its effect is particularly partly because of the stigma that surrounds households. Water sources are usually far from the household, an average of nearly PARPA II discusses the relationship between strong among poorer households, in the issue of sexual abuse. In its combined rural areas and in central and northern first and second reports to the United 50 minutes’ walk from the family home education, poverty reduction and economic (excluding those households with water on growth, with a particular emphasis on provinces. Gender disparity is also Nations Committee on the Elimination of undermining some apparent gains, with Discrimination against Women (CEDAW), their premises – 9 per cent of households). the role of girls’ education. The PARPA Typically, multiple trips are made each day to II objectives for primary, secondary and substantially lower completion rates for Mozambique reported that most families the water source.21 tertiary levels of the education system girls than for boys. Although the gender prefer to resolve cases of sexual abuse out explicitly refer to inclusion on the basis of gap has narrowed in recent years, there of court through indemnity or marriages. gender, vulnerability and special needs. remain marked disparities that need to be The report also recognises lack of knowledge 2.6. Lineage systems examined in the context of poverty, place about the legal system and unreasonable Strategies to increase girls’ education are In Mozambique, both patrilineal and of residence, and cultural practices and delays in the court system as further also presented, including dealing with the matrilineal lineage systems exist. Under sensitive but critical issue of reducing the traditions. obstacles to a legal solution to such 18 the patrilineal system, the wife and children incidence of sexual abuse in schools. The cases. Weak access to the justice system, To promote girls’ education, the Ministry insufficient knowledge of women’s rights, ‘belong’ to the husband and his family, and it Government’s Five-Year Plan 2010–14 also is the husband who grants his female spouse prioritises gender parity in primary school. of Education is focusing on improving and the lack of a system for enforcing legal safety in schools, including defining penalties further exacerbate the problem. access to land. In the matrilineal system, the woman and her children continue to Low levels of literacy, especially among key steps to respond to sexual abuse in Domestic violence against women is also be regarded as members of the woman’s women, have been a consistent feature of schools. There have also been efforts to a serious issue in Mozambique. Although matrilineal family. Under the matrilineal Mozambican society for many years. For strengthen the capacity of the Ministry’s quantitative data are scarce, data from 2004 system, it is the woman’s uncle who grants example, the 2003 Demographic and Health unit in charge of gender in order to better indicate that 54 per cent of women surveyed access to land, while the children belong Survey recorded a 62 per cent illiteracy rate mainstream gender and AIDS in the reported having been abused, as discussed to the mother’s blood relatives.22 In both among women, compared to 33 per cent planning, implementation and monitoring in Chapter 5. Data also reveal a widespread patrilineal and matrilineal systems, women’s among men. The 2008 MICS reports that 41 processes initiated and to work with acceptance of the use of violence. In 2008, positions are based on submission to the per cent of female Mozambicans aged 20– communities to promote girls’ education, the proportion of women who stated that male members of the family – i.e., her 24 are literate, and this figure rises to 53 per prevent sexual abuse and premature men had the right to beat them under certain husband/father or brothers, respectively.23 cent among young females aged 15–19.13 pregnancy. Further, capacity of gender units needs to be strengthened in the circumstances, such as leaving the house without informing the husband or refusing Land rights are somewhat problematic in In the period 1992–2009, the number of monitoring and reporting of sexual abuse sex, was 36 per cent, a reduction from 54 per Mozambique due to the existence of two learners in primary and secondary schools and violence. Focusing on girls’ education cent in 2003. Educated women are less likely contradictory systems. Officially, and in rose dramatically for both boys and girls. is both a means of addressing gender to accept domestic violence, as are women accordance with the constitution and the A gender gap remains at all levels of disparity and a strategy for leveraging living in urban areas (see Chapter 5). Despite Land Act, land is an inalienable property of education, however. The absolute gender gains in dealing with other disparities. the apparent cultural acceptance of domestic the State. However, under customary law gap in gross enrolment in the first stage of violence, other studies19 have shown that and tradition, land belongs to the community
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living in its surrounding area and that decisions and are less able to negotiate for between men and women has decreased in Considerable disparities remain, however community’s ancestors. Access to land is safe sex, fidelity or abstinence. Coerced or Mozambique in recent years. in terms of literacy and completion rates. managed by a complex network of social forced sex and sexual violence exacerbate Improving safety in schools is crucial in traditions that is built around marriage, women’s biological and social vulnerabilities There is an unambiguous relationship promoting female access to education. as a basis of alliances among families. As to infection. Girls tend to begin regular between the well-being of women and To this end, the capacity of gender units a result, hereditary rights to land depend sexual relations earlier than boys, increasing the well-being of their children. Educated to monitor and report sexual abuse and on age, sex and social status, including the risk of transmission.26 mothers are far more likely to have better violence needs to be strengthened. kinship or other ties to the families that were educated, healthier, less vulnerable children. first to have populated the area. Formal As a result of these two groups of factors, Targeting girls in education, health and Violence against women is common and is land titles do not seem to be relevant for prevalence of infection among women aged protection programmes is likely to not only considered acceptable by a large proportion inheritance purposes. In patrilineal societies, 15–49 (13.1 per cent) is more than a third improve the well-being of those targeted, of women, as well as by society at large. problems arise in case of divorce or death higher than among men of the same age but also generate significant positive spin-off Sensitisation initiatives to change minds of a husband, where a woman runs the risk (9.2 per cent). Among women in the 15–24 effects on the future children of these girls. and improved information dissemination are of losing her land and all her belongings age group, HIV prevalence is 3 times higher necessary to reduce the incidence of gender- than among males of the same age.27,28 Gender parity in education, in terms of related violence. in favour of other members of her late attendance rates, has been improving. husband’s family, even where she has the AIDS Accountability International has responsibility to look after her offspring and prepared a Scorecard on Women that rates other relatives.24 Government responses to the AIDS epidemic from a gender perspective. The six key elements included in the scorecard are: data 2.7. HIV and gender collection, gender mainstreaming, policy and legal environment, national programmes, The 2001 Declaration of Commitment on knowledge and behaviour, and impact. HIV/AIDS acknowledges that women are Countries are assigned a rank from A (very disproportionately affected by AIDS in the good) to E (very poor) for each element. See global context and must be given priority Table 6.1 below for Mozambique’s score.29 in national and global responses.25 The gender dimension of HIV and AIDS has both a biological and a social component. 2.8. Conclusions Biologically, women are more vulnerable to infection with HIV than men, and young girls Women are more likely to experience are more vulnerable still. However, it is the poverty than men in Mozambique. The social component that is most important in poverty headcount for female-headed determining the differential in transmission households is higher than for male-headed and impact on women. Women in households. Women have less access to Mozambique are taught that sex is a survival formal employment than men, and tend strategy and thus they often submit men’s to work in lower-paid industries. There is evidence, however, that the inequality
Table 6.1: Scorecard for Government of Mozambique’s gender response to AIDS
Score Data collection A – Very Good Gender mainstreaming C – Medium Policy and legal environment C – Medium National programmes B – Good Knowledge and behaviour A – Very Good Impact C - Medium
Source: AIDS Accountability International, ‘The AIDS Accountability Scorecard on Women 2009’, Joint United Nations Programme on HIV/AIDS, Geneva, 2009.
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3. Geographical disparities Table 6.2: Proportion of children experiencing two or more severe deprivations, 2003 and 2008 2003 2008 Overall 59% 48% Mozambique is a large country with within regions and provinces than between Urban 30% 22% a relatively low population density. them.35 Rural 73% 60% The country covers a surface area of Province approximately 802,000 km2 and has a In its first Poverty Reduction Strategy Paper coastline that stretches almost 2,500 km (PARPA I), the Government of Mozambique Niassa 58% 35% from South Africa in the south to Tanzania in acknowledged the economic and social Cabo Delgado 62% 45% the north. The average population density is inequalities between the Maputo-Matola Nampula 66% 59% approximately 26 inhabitants per km2. Linked conurbation area and the rest of the country Zambezia 80% 64% to the country’s wide geographic expanse as being the “most noticeable characteristic” Tete 65% 60% of the country. This inequality is ascribed to is its linguistic, cultural and ethnic diversity. Manica 58% 52% various factors, including the civil war. The Traditions and customs vary from one Sofala 68% 53% region to another. More than a dozen local Government’s second Poverty Reduction Inhambane 48% 37% languages, some with their own dialects, Strategy Paper (PARPA II) also noted that are spoken in Mozambique. Portuguese is both consumption-based and non–income- Gaza 53% 39% the official language and the language of based poverty measures vary considerably Maputo province 24% 18% Government, but less than ten per cent of among the provinces. Dealing with regional Maputo City 11% 4% the population speak Portuguese as their disparities was a priority objective of both Wealth quintile mother tongue and only an estimated 40 per PARPA I and PARPA II. The 2009 impact Lowest 95% 91% evaluation of PARPA II concluded that there cent of the population have learned to speak Second 87% 65% Portuguese.30 had been a modest reduction in disparities, although disparities in relation to agriculture Middle 60% 41% Data reveal the existence of clear disparities had increased, while those in the health and Fourth 36% 33% in poverty headcount among provinces. education sectors continue to persist at high Highest 13% 5% 36 For example, the poverty headcount in levels. Source: UNICEF, Trends in Child Poverty in Mozambique: A deprivations-based approach, Ministry of Planning and Development, the 2008/09 survey varies from 71 per cent Maputo, 2009. in Zambezia to 31 per cent in Niassa. A Provincial disparities are also seen in relation to non–income-based measures significant urban/rural divide remains in south of the country, the poverty headcount ll Besides urban/rural disparities in access of poverty. A study on severe deprivation terms of poverty rates: 57 per cent of rural index is much higher than the proportion of among children conducted as part of the to sanitation services, there are also dwellers are living in absolute poverty children suffering from two or more severe large disparities between provinces. In compared to 50 per cent of the urban PARPA II evaluation (see Chapter 1) revealed deprivations. This difference is because the Zambezia, 73 per cent of children are 31 that in both 2003 and 2008, the highest population. deprivations-based approach incorporates a proportion of children experiencing severe experiencing severe sanitation deprivation measure of access to basic social services, Access to basic social services is generally deprivation lived in Zambezia province, 80 compared to less than one per cent in including health, education, water and 39 higher in the south of the country. Provincial per cent in 2003 and 64 per cent in 2008 Maputo City; sanitation, whereas the poverty headcount disparities in the Human Development (see Table 6.2).37 Maputo City has by far the does not directly capture these aspects. ll Provincial disparities in relation to health Index (HDI) and the related GDI of the lowest levels of child poverty, as measured deprivation also occur. Five per cent of United Nations Development Programme using this method, with only around 4 per An examination of the proportions of children in Maputo City experience severe have observed that provinces in the north cent of children experiencing two or more children experiencing individual deprivations health deprivation, compared to 19 per of the country generally exhibit lower severe deprivations. also reveals a pattern of wide disparity cent in Zambezia and Nampula;40 levels of human development than those among provinces. These findings are 32 A comparison of the levels of poverty in in the centre or south. All provinces of the presented in more detail in the relevant ll Disparities in HIV prevalence and access 2008, measured using the consumption- country demonstrated improvements in sectoral chapters of this report, but to to prevention and treatment services are 33 based approach and the severe deprivations- their GDI between 2001 and 2006. Other summarise: marked among provinces and regions based approach, reveals some interesting key indicators, including per capita GDP, of the country, with both prevalence findings. For most provinces in the northern also show considerable variation among ll Levels of severe nutritional deprivation and treatment higher in the south. HIV 34 and central regions of the country, the provinces. There is some evidence that are highest in the northern provinces, prevalence varies from 25 per cent in Gaza levels of poverty measured using the two the inequalities in consumption that exist followed by the central provinces and in the south to 4 per cent in Niassa in the methods are quite similar. However, in the in Mozambique are often more pronounced lowest in the southern provinces;38 north;41
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ll Only three per cent of children in developed provinces receiving a lower allocation is higher in the southern provinces 3.2. Disparities in health Gaza experienced severe educational allocation from the state budget than other than in the centre and north of the country. deprivation in 2008, compared with 22 per more developed provinces.43 The study It should be noted that the cost of providing There are severe disparities in per capita cent in Tete, 15 per cent in Niassa and 12 confirms the perception of inequality and services is not equal in different provinces. health expenditure by province. Zambezia per cent in Zambezia.42 reports that the observed provincial patterns In rural areas, per capita costs are generally receives the lowest per capita allocation, 60 of funding allocation are strongly indicative higher. per cent of the national average, compared 3.1. Disparities in budgetary of an unequal geographical distribution of to 156 per cent in Niassa. Zambezia has the resources, with the most populous provinces Sectors and Ministries tend to plan their lowest performance with regards to many allocations of Nampula and Zambezia consistently activities and consequently allocate child health outcome indicators. their funding according to key themes, In its 2006 Childhood Poverty in receiving less than they should, based on programmes and projects that span Mozambique: A Situation and Trends the size of their populations. For example, Child mortality several provinces, rather than planning Analysis, UNICEF made the following in 2008, per capita expenditure in Zambezia interventions by province. As a result, recommendation: “…it is particularly striking was 69 per cent of the national average for There are significant disparities in provincial 44 centrally-administered funds are not explicitly that state budget allocations for key sectors health and 73 per cent in education 2008. under-five mortality rates. The highest rates allocated and accounted for on a provincial often do not correspond to the pattern of are recorded in Zambezia (206 deaths per Provincial disparities in budget allocations basis, complicating the quantification of total child development indicators…. There is 1,000 live births) and Cabo Delgado (181 have not been reduced in recent years. As funding received at the level of the province. therefore a clear need to review, based deaths per 1,000 live births). Tete has the can be seen from Figure 6.3 below, per capita Recurrent expenditures, which include on evidence, the criteria used to allocate third highest under-five mortality rate, at 175 expenditure increased from 2005 to 2008. salaries, generally show close agreement state budget resources and to attain a per 1,000 live births. Maputo province and Relative provincial allocations remained between central financial accounts and more equitable allocation.” A recent study Maputo City report the lowest under-five reasonably constant, however. Per capita provincial or sectoral financial reports. Much 45 further investigated this issue of the least- mortality rates (103 and 109, respectively). more variation is observed with respect to A comparison of the child survival rate and investment expenditures. health expenditures per provinces reveals
Figure 6.3: Combined per capita expenditure for health, education and justice, 2005, 2006 and 2008 Figure 6.4: Health expenditure per capita, percentage of national average, 2008 1200 160% 1000 140% 120% 800 100% 80% 600 60% 40% 400 20%
Per capita expenditure (Mzn) 0% Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo 200 Delgado pula bezia bane Province City
Source: Sal e Caldeira and Ximango Consultores,‘Análise do Impacto da Estrutura das Despesas sobre o Desenvolvimento 0 Económico e as Condições de Vida em Moçambique,’ Swiss Agency for Development and Cooperation, 2009. Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Delgado pula bezia bane Province City
2005 2006 2008
Source: Sal e Caldeira and Ximango Consultores. “Análise do Impacto da Estrutura das Despesas sobre o Desenvolvimento Económico e as Condições de Vida em Moçambique,” 2009.
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a significant correlation. Provinces with low HIV and AIDS part of their antenatal consultation are large, southern provinces of the country, and 55 health expenditures also tend to have low varying from only 28 per cent in Zambezia to per cent were living in Maputo City. In 2008, child survival rates (see Figure 6.5). HIV prevalence also demonstrates marked 94 per cent in Maputo City. The proportion the southern provinces accounted for 56 per geographic disparities, with the highest of women tested for HIV in 2008 also varies cent of all children receiving antiretroviral Antenatal care coverage varies among rates recorded in the southern provinces considerably among provinces, with only 19 drugs, and Maputo City accounted for 33 per provinces, with a range of between 81 per of Gaza and Maputo (25.1 and 19.8 per per cent of pregnant women being tested cent. The geographic distribution of children cent in Zambezia to universal coverage in cent, respectively) and the lowest rates in Zambezia, compared with 95 per cent in accessing treatment is still highly inequitable: Gaza and Maputo City. The proportion of recorded in the northern provinces of Niassa, Maputo City. Forty-three per cent of women in the southern region of the country, Nampula and Cabo Delgado (3.7, 4.6 and 9.4 births attended by skilled personnel also received their test results.47 approximately half of children in need of varies across provinces. The provinces with per cent, respectively) (see Figure 6.6). antiretroviral treatment are able to access it, the lowest proportion of births attended by In 2006, 68 per cent of all children receiving Geographic disparities in the proportion of while the percentage of unmet needs is much skilled personnel were Manica (33 per cent) treatment for AIDS were living in the four higher in the central and northern regions. and Zambezia (38 per cent).46 women who received HIV counselling as
Box 6.1. Zambezia: The forgotten province? Figure 6.5: Per capita expenditure for health (2008) and child survival (1998-2008)
920 180 – Lowest per capita budget allocation (health, education and justice) 900 160 – Highest deprivation-based child poverty rate (64 per cent) 880 140 – Highest consumption-based poverty rate (71 per cent) 860 120 – Highest child mortality rate (206/ 1,000, 10 year average 1998-2008) 840 100 820 80 – Highest proportion of children to have received no vaccinations (20 per cent) 800 60 – Lowest access to safe water (26 per cent) 780 40 – 3rd lowest access to safe sanitation (8 per cent) 760 20 Expenditure per capita (Mzn) Child survival rate (10 year average) – 2nd lowest net completion rate for primary school (6 per cent) 740 0 Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo – Lowest net attendance rate for secondary school (8 per cent) Delgado pula bezia bane Province City – 2nd lowest women’s literacy rate (27 per cent) Child survival rate Health expenditure per capita – Lowest access to antenatal care from skilled person (74 per cent) Source: Sal e Caldeira and Ximango Consoltores, ‘Análise do Impacto da Estrutura das Despesas sobre o Desenvolvimento Económico e as Condições de Vida em Moçambique,’ Swiss Agency for Development and Cooperation’ 2009 and MICS 2008. – 3rd lowest proportion of registered births – 3rd highest child marriage (22 per cent of girls under 15) Figure 6.6: HIV prevalence by province, 2009 – 2nd highest in lack of knowledge on HIV transmission (34 per cent not aware of any of the three 35% main methods of transmission) 30% 30% – Lowest proportion of women receiving HIV information during antenatal care (28 per cent) 25% – Lowest possession of carta de saúde (64 per cent) 20% 20%20% 21% 15% 18% 17% 15% 16%15% 10% 13% 12% 10% 10% 8% 9% 9% 5% 6% 6% 6% 3% 4% 3% 0% Niassa Nam- Tete Cabo Inham- Zam- Manica Sofala Maputo Maputo Gaza pula Delgado bane bezia Province City
Women 15-49 Men 15-49
Source: National Institute of Statistics, Ministry of Health, ‘Inquerito Nacional de Prevalencia. Riscos Comportamentais e Informação sobre o HIV e SIDA em Moçambique (INSIDA), Relatorio Preliminar sobre a Prevalência da Infecção por HIV, 2009.
184 185 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 6: CROSS-CUTTING ISSUES
Figure 6.7: Proportion of women receiving HIV information and testing during antenatal consultation visit, 2008 literacy are closely correlated with per capita in Maputo City to below 50 per cent in Cabo education expenditure (see Figure 6.9). Delgado, Zambezia and Nampula. The latter 100% Women’s literacy rates vary substantially by three provinces also receive the lowest levels 97% 79% 96% province. Literacy rates vary from 84 per cent of education expenditure. 74% 80% 73% 72% 91% 86% 68% 85% 69% 60% 61% 59% 60% 52% 49% 52% 47% Figure 6.9: Education expenditure per capita and literacy rates, 2008 40% 39% 34% 31% 900 90 29% 28% 20% 800 80 19% 700 70 0% 600 60 Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Total Delgado pula bezia bane Province City 500 50 Were provided information about HIV prevention during ANC visit Were tested for HIV at ANC visit 400 40 Literacy rate Source: National Institute of Statistics. ‘Inquérito de Indicadores Múltiplos 2008. Sumário’, Maputo, Mozambique, 2008. 300 30 200 20 Expenditure per capita (Mzn) 100 10 3.3. Disparities in access and northern provinces are receiving a 0 0 to education substantially lower allocation than the Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo southern provinces.48 Delgado pula bezia bane Province City An analysis of education expenditure per Expenditure per capita (Mzn) Literacy rate capita reveals a situation similar to that for Central and northern provinces receive a health expenditure. Zambezia and Nampula lower budget allocation and have lower Source: Sal e Caldeira and Ximango Consoltores, ‘Análise do Impacto da Estrutura das Despesas sobre o Desenvolvimento provinces receive the lowest allocation of education outcomes than southern Económico e as Condições de Vida em Moçambique’, Swiss Agency for Development and Cooperation, 2009 and MICS 2008. funds (see Figure 6.8). Again, the central provinces. Educational outcomes in terms of
Figure 6.10: Net enrolment ratio primary (EP1 and EP2) by province, 2008 Figure 6.8: Expenditure per capita on education by province, percentage of national average, 2008 100% 180% 95% 97% 93% 93% 94% 95% 90% 85% 87% 87% 89% 160% 80% 81% 83% 79% 78% 77% 75%74% 74% 140% 73% 70% 60% 67% 120% 40% 100%
80% 20%
60% 0% 40% Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Delgado pula bezia bane Province City 20% Girls Boys
0% Source: MICS 2008. Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Delgado pula bezia bane Province City Source: Sal e Caldeira and Ximango Consoltores, ‘Análise do Impacto da Estrutura das Despesas sobre o Desenvolvimento Económico e as Condições de Vida em Moçambique’, Swiss Agency for Development and Cooperation, 2009 and MICS 2008.
186 187 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 6: CROSS-CUTTING ISSUES
Although the 2008 gross enrolment ratioii for 3.4. Disparities in relation to marriage between the south, centre and HIV prevalence, with the southern provinces the first phase of primary education (EP1) north of Mozambique. The southern reporting higher levels of HIV infection. But exceeded 100 per cent regardless of region, child protection provinces of Maputo City, Maputo province, these provinces also benefit from greater province or gender, the gross enrolment There are significant geographical disparities Gaza and Inhambane all have a child access to prevention and treatment services. ratio for the second phase of primary in birth registration. Again, central and marriage rate of below 10 per cent. The These observed geographical disparities in education (EP2) reveals marked geographical northern provinces are far worse than the central provinces have an average rate of Mozambique originate in patterns of early disparities. In Maputo City and Maputo south. Thirty-nine per cent of children under 20 per cent, while the two most northern human settlement and colonisation that province, which recorded the highest levels five had their births registered in urban provinces, Niassa and Cabo Delgado, have resulted in cultural, religious and linguistic of enrolment, the gross enrolment ratio areas, compared to 28 per cent in rural areas. rates of 24 and 30 per cent, respectively. differences among provinces; the centralised of girls in EP2 exceeds that of boys. Other Fourty-seven per cent of children under five and deliberately discriminatory nature of provinces recorded gross enrolment ratios are registered in Maputo City, while only 11 3.5. Conclusions the Portuguese administration during the of less than 100 per cent for EP2, with lower per cent are registered in Tete.49 enrolment ratios for girls than boys in most Provincial disparities are evident and colonial years; and the lack of a system provinces. Regionally, the provinces with the Regional disparities in attitudes toward persistent across almost all indicators of for the allocation of State resources to lowest EP2 gross enrolment ratios and the domestic violence also exist. For example, the access to and performance of basic social provinces based on criteria related to human greatest gender gaps are those in the central percentage of women who believe that wife- services. The overall pattern is for the development status. In addition, the lack and northern parts of the country. beating is justified in certain circumstances central and northern provinces to have of road and rail infrastructure, including varies from 10 percent in Maputo City to lower budget allocations, reduced access to the absence of a bridge (until recently) Similar regional disparities are observed almost 70 per cent in Niassa.50 A 2004 Ministry services and lower outcomes, compared to across the Zambezi River, and poor access in the net enrolment ratios. Although the of Women and Social Action study concluded the southern provinces. Zambezia province to markets from rural areas in many parts net enrolment ratio for EP1 is over 80 per that these differences are strongly related to is frequently the worst off in resource of central and northern Mozambique have cent in every province, significant provincial socio-cultural norms and practices as well as allocation and development outcomes. This further contributed to provincial differences differences appear at the EP2 level. Maputo lack of education and knowledge about the general pattern is reversed in relation to in socio-economic development. City is the best performing area, with 43 rights of women and children in society.51 per cent net EP2 enrolment for boys and 57 Education is a key factor in reducing violence per cent for girls. Cabo Delgado, Nampula, against children and women. Niassa and Zambezia are among the worst performing provinces, each with a net Data from the 2008 MICS show that there enrolment ratio of less than 15 per cent. is a significant difference in rates of child
Figure 6.11: Percentage of women aged 15-49 in marriage or union before their 15th birthday, 2008 35% 30% 30% 25% 20% 24% 21% 22% 21% 19% 19% 15% 10% 9% 9% 5% 6% 4% 0% Niassa Cabo Nam- Zam- Tete Manica Sofala Inham- Gaza Maputo Maputo Delgado pula bezia bane Province City
Source: MICS 2008.
ii The gross enrolment ratio is the proportion of children of any age attending the last grade of school for the given level of education. A ratio higher than 100 per cent indicates over-age children in school.
188 189 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 6: CROSS-CUTTING ISSUES
factors. In its incipient phase, prevalence in period immediately following the cessation 4. HIV and AIDS Mozambique was assumed to be lower than of hostilities. Poverty, discrimination, in its neighbouring countries (although there oppression, illiteracy, mobility or migration The vulnerability of a country to the effects ll The presence of AIDS in a household was a paucity of data at the time) due to the of people, the status of women, levels of of infectious disease, including HIV and quickly results in depletion of household on-going civil conflict from 1975 to 1992, urbanisation, levels of violence, access to AIDS, depends to a large extent on the income-earning capacity and of which kept Mozambique somewhat isolated health care, and the distribution of wealth, level of human development attained by household savings and assets. Many from its neighbours. The cessation of among others, all might have contributed to that country. Individuals and society as a households quickly move into conditions violence and the signing of a Peace Accord the spread of the epidemic in Mozambique. whole are better able to protect themselves of poverty: very little income or wealth, in 1992 were followed by mass population A number of studies have found no clear movements, as people returned from other link between HIV infection and wealth. against the impact of illness and disease debt, reduced access to services, and parts of the country or from neighbouring Poverty may actually reduce the spread in developed countries. This is the result even fewer options for attaining socio- countries to their original homes, increasing of the epidemic, for example, if people of constrained financial resources at the economic security. Women and girls are people’s vulnerability to infection and have less money to spend on transactional national and household level in developing likely to be most affected; countries, as well as reduced human capital, opportunities for transmission of the virus. relationships. The INSIDA 2009 showed that which arises from a lack of educational ll AIDS exacerbates and is exacerbated by Due to its geographic location, Mozambique HIV prevalence in Mozambique is higher opportunities and poor access to other basic prevailing economic conditions. It is not is an important transport hub for goods among the population, in particular among social services. In developing countries, a stand-alone condition, but exists within arriving at the ports of Maputo, Beira and women, of the highest quintile. Women, endemic diseases adversely impact a wider socio-economic context that Nacala and moving inland to Mozambique’s particularly those living in rural areas, are development and obstruct the fulfilment of deepens the vulnerability of households, landlocked neighbours. especially vulnerable because they are human rights, as reflected in key indicators communities and nations; legally, culturally and socially disadvantaged Poor coverage of basic social services, such as life expectancy at birth, child in comparison to men. Many women have especially health and education, contributed mortality, school attendance, literacy and ll The economic costs of AIDS, the stigma been exposed to the risk of sexual assault or to the spread of the epidemic during the 55 household income, among others.52 surrounding the disease that leads to rape or other forms of violence. discrimination and withdrawal, and It is at the level of the family and community the inability to access social services that the fullest impacts of the AIDS pandemic all combine to expand socio-economic Figure 6.12: Distribution of new infections by mode of exposure in Mozambique, 2008 will be felt. Illness and death among the inequalities in society. AIDS is not only main breadwinners in a household will killing people, it is further dividing have a negative impact on the whole national societies. household and will ultimately raise the level of dependence across the whole population, 4.1. Profile of the HIV epidemic as other households, including those headed in Mozambique by elderly persons who are themselves One sexual partner 47.3% dependent, take on responsibility for caring According to estimates and projections for the increasing number of orphans and based on the 2007 Sentinel Surveillance vulnerable children. Through its effects on results, more than 1.7 million Mozambicans Medical injections 1.7% the numbers of trained teachers, health were estimated to be living with HIV in workers and other providers, AIDS also Blood transfusions 0.1% 2010. Fifty-five per cent of people living with Injecting Drug Use (IDU) 3% affects the mechanisms for generating future HIV were estimated to be women, 9 per cent human capital. The structural implications Partners IDU 0.3% (almost 150,000) were children under 15 and Sex workers 2% of HIV-related mortality on public services five per cent were children under five.54 The are projected to be severe. Staff mortality Government of Mozambique is expected Partners of MPs 18% and long periods of illness will reduce to release updated population estimates, Clients 7% productivity, increase absenteeism and based on prevalence data from the National Related to multiple partner require the relevant authorities to replace lost Survey on Prevalence, Behavioral Risks Multiple partners Sex-work behaviours, 24% related 24% staff or operate with fewer staff. and Information about HIV and AIDS in (MPs) 6% Partners of Clients 10% Mozambique (INSIDA) carried out in 2009, in The Commission on HIV/AIDS and Female partners Men who have early 2011. of MSM 0.1% sex with men Governance in Africa recognises three (MSM) 5.1% generalisations about the impact of AIDS on The evolution of the epidemic in families and households:53 Source: Joint United Nations Programme on HIV and AIDS, Mozambique Modes of HIV Transmission and HIV Prevention Study, Mozambique has been shaped by several UNAIDS, Geneva, 2009.
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Heterosexual relations remain the most AIDS is a common cause of death among 25–29 (16.8 per cent) and for men at ages 35– therapy, people infected with HIV are living common form of transmitting HIV in the children under five in urban areas.60 It is 39 (14.2 per cent); furthermore, young girls longer and staying healthier. Prevalence rates country. About 90 per cent of HIV infections estimated that 18 per cent of child deaths have a prevalence three times higher than may therefore increase, even if new infection are estimated to occur via this route. Sex in Maputo and 16 per cent of child deaths boys of the same age (11.1 per cent among rates are falling. With only prevalence between different generations, casual in Gaza province are due to AIDS. These girls aged 15–25, versus 3.7 per cent in boys measurement, it is difficult to determine unprotected sexual activity, lack of male figures could be an underestimate, given of the same age). These results highlight the if the number of new cases is increasing, circumcision, multiple concurrent sexual that AIDS could in many instances be the increased vulnerability of adolescent and decreasing or has reached a plateau and partners and low use of condoms are all underlying cause of death in cases where young girls to HIV in Mozambique. stabilised. Analysis of HIV incidence has hypothesised to be involved in the spread other opportunistic infections were recorded therefore become essential in order to answer of the epidemic.56 A substantial percentage as the direct cause of death. Analysis of trends can at present only be this question, but all the methods used to (47 per cent) of new infections are, however, done by observing the HIV prevalence determine HIV incidence have disadvantages.iv estimated to occur in individuals who The 2009 INSIDA showed a national HIV obtained through epidemiological report being in a mutually monogamous prevalence among 15–49 year olds of 11.5 surveillance in 2004 and 2007, as the INSIDA The Spectrum analysis of 2007 surveillance relationship.57 per cent. The prevalence disaggregated by information uses a different methodology data estimated that the annual HIV incidence region confirmed the situation emerging and is hence not comparable. in adults has decreased from about 2.2 The total number of deaths from AIDS in in previous sentinel surveillance, with the per cent in 2000 to about 1.6 per cent in Mozambique in 2009 was estimated at highest prevalence in the south (17.8 per HIV prevalence dropped markedly in young 2008. This translates into 129,000 new HIV 96,000. AIDS is fast becoming a major cause cent), followed by the centre (12.5 per antenatal-care clients between the 2004 infections in adults in 2008. Annual estimated of mortality among children, with 18,000 cent). The northern region shows a much and 2007 epidemiological surveys, but this incidence is about 2 per cent in the central children under five and 21,000 children lower prevalence (5.6 per cent). Urban HIV decreasing tendency was not confirmed and southern regions and much lower in the 62 under 15 estimated to have died from prevalence, at 15.9 percent, is significantly in 2009. In countries with generalised north, around 0.7 per cent. AIDS in 2009.58 The 2009 National Child higher than the prevalence in rural areas (9.2 epidemics where the main form of HIV Mortality Study data indicate that AIDS was percent), across all regions.61 transmission is through heterosexual sex, HIV incidence in children under 15 is also among the top four conditions contributing like Mozambique, the trends in prevalence estimated to be decreasing, from about to the mortality of children under five in INSIDA also reveals that HIV prevalence in among young women 15–24 years old can 38,500 new infections in 2005 to about Mozambique, accounting for almost 10 per both male and female populations increases be used to estimate trends in incidence 31,000 in 2009, equivalent to about 85 new cent of all deaths among these children.59 with age until it peaks for women at ages (new infections).iii, 63 HIV prevalence among infections every day. This decrease is mainly antenatal-care clients aged 15–24 peaked attributed to the roll-out of the Prevention in 2004, at 16 per cent, and showed a of Mother-To-Child Transmission (PMTCT) significant decrease in 2007 to 11 per cent. In programme (preventing infections in infants) Figure 6.13: Estimated HIV incidence and prevalence by region in Mozambique, 1998–2010 2009 the prevalence was estimated at 12 per and the antiretroviral therapy programme cent for the same group.64 At a national level, (reducing infectiousness of pregnant and 20% there was no significant reduction in the lactating women who are on antiretrovirals). 18% prevalence of HIV over the period 2002–2009 The major burden of new infections occurs in 16% among females aged 15–24. The northern the central region, which in 2009 accounted 14% region had the lowest prevalence rate in the for 60 per cent of the national total of new country in this age bracket. In 2009, urban cases. This is due to high HIV prevalence, 12% areas presented higher prevalence rates in relatively low coverage of prevention of 10% the same age group than rural areas.65 mother-to-child transmission services, the 8% high population and a high fertility rate.66 Prevalence reflects both the incidence of a 6% disease (i.e., the number of new cases) and Because the HIV epidemic is mainly 4% the long and variable incubation of HIV. With concentrated within the economically active 2% improvements in provision of antiretroviral portion of the population, namely those aged 0% 1998 2000 2002 2004 2006 2008 2010 iii Since most of the young women in this age group would have just started their sexual activity, changes in the prevalence Prevalence (S) Prevalence (N) Incidence (S) Incidence (N) in this age group can represent changes in the number of recent infections. Prevalence (C) Prevalence (Nat) Incidence (C) Incidence (Nat) iv True incidence data are obtained through large-scale cohort studies. While incidence data are better than prevalence data for monitoring the HIV epidemic, these studies have disadvantages including cost, ethical considerations, participation and/or selection biases and the fact that those included in a cohort will inevitably have more exposure to HIV Source: CNCS, UNAIDS and GAMET, ‘Draft Mozambique Analysis of Modes of HIV Transmission and National Response to HIV and interventions. Other methods are also used to estimate incidence, including: indirect HIV incidence estimates, laboratory- AIDS,’ Maputo, 2009. based methods andmathematical modelling of HIV incidence.
192 193 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 6: CROSS-CUTTING ISSUES
15–49, its effects are disproportionately ll P3 – Paediatric AIDS Increased knowledge is not proof of changed safe sex.73 Therefore, sexual relationships borne by the very age groups that play a key attitudes and behaviours. One such example between older men and younger women role in the development of the economy and ll P4 – Protection of orphans and vulnerable is the discrepancy between knowing where are a possible explanation of different of the country’s social sectors. A simulation children (OVC) an HIV test can be obtained, 77 per cent of infection rates in male and female study conducted in 2002 and based on This following section discusses each of the women interviewed, and having an HIV test, adolescents. two scenarios (one with AIDS, and one Four Ps. 31 per cent of the same group (see Figure without) concluded that HIV and AIDS could 6.14). Geographical differences in knowledge Condom use remains relatively low in have a wide-ranging economic impact in of testing availability and actual testing may Mozambique, especially in rural areas and Mozambique, with a visible reduction in the 4.3. P1 – Primary prevention be linked to the availability of counselling among less educated females. Only 44 growth of per capita GDP.67 and testing services across the country, with per cent of females aged 15–24 who had MICS 2008 data show an overall positive had sexual relations with a non-regular or trend in knowledge and awareness of HIV higher availability in the south, followed by According to projections over the period the central and northern regions.72 non-cohabiting partner in the previous 12 2000–2010, the HIV epidemic will result transmission and prevention, compared to months used a condom at their last sexual in a loss of some 17 per cent of education previous data from the 2003 Demographic Women in Mozambique tend to enter into relation. The proportion was greater for sector staff. Across all levels, some 9,200 and Health Survey. Improved knowledge, sexual relations at a relatively early age. females in the wealthiest quintile (64 per teachers are expected to be lost to AIDS. awareness and adoption of safe practices Overall, 29 per cent of females aged 15–19 cent) than for females from the poorest For each staff member lost in the education are correlated with living in an urban first had sexual intercourse before they households (12 per cent). A multivariate sector, nearly eighteen months of productive area, having higher education levels and turned 15, and 77 per cent of females aged probabilistic regression analysis (using the working time will be lost.68 The HIV epidemic belonging to a higher wealth quintile. 20–24 first had sexual intercourse before probit model) was conducted to examine the also has negative consequences for other For example, the data demonstrate an reaching 18. The proportion of females aged factors correlated with women’s exposure sectors, given the need to replace and renew improvement in women’s knowledge about 15–19 who reported entering into sexual to risky sexual behaviour. The dependent skilled labour. AIDS and how HIV is transmitted. Eighty- relations before age 15 is higher in rural variable was whether a condom was used one per cent of women know at least one areas, at 32 per cent, than in urban areas at a woman’s last sexual relationship with a The health system faces difficulties in of the three main ways of preventing HIV (24 per cent). Around 16 per cent of sexually non-cohabitating partner, as this is deemed responding to the growing demand for its infection, and 13 per cent know all three of active females reported having had sexual to be a good proxy for attitudes towards services from the public, exacerbated by the the main ways. While knowledge of all three relations with a man 10 years or more older risky sexual behaviour. The basic rationale effect the HIV epidemic has on health service main forms of prevention is generally low, than themselves during the 12 months prior is that women who have protected sexual workers. HIV and AIDS will likely worsen the it is higher among women living in urban to the interview. Studies in Southern Africa intercourse with a non-cohabitating partner already poor health worker–to-patient and areas (17 per cent) than among those living have consistently found that the larger the are less willing to expose themselves to HIV doctor-to-patient ratios in Mozambique. The in rural areas (10 per cent). Almost 65 per age disparity, the lower the probability of and other sexually transmitted diseases. high numbers of patients in hospitals and cent of women aged 15–49 know that using health facilities requiring relatively expensive condoms is one way to avoid infection by treatment for AIDS and related infections will the virus.70 Figure 6.14: Identifying misconceptions about HIV, women 15-49 years, 2008 also place a considerable economic toll on The percentage of women aged 15–49 who the health sector. 80% do not accept the three main misconceptions 72% 72% concerning HIV and AIDS has grown in recent 70% 63% 64% 4.2. Priority actions for children years. Almost three in every four women 60% 47% 45% in relation to HIV and AIDS aged 15–49 (72 per cent) know that HIV cannot 50% be transmitted through sharing food and that Mozambique has adopted the 2001 a person who looks healthy may be infected 40% 37% Declaration of Commitment from the UN with the virus, while in 2003 the figures were 30% Special Session on AIDS for HIV and AIDS, 63 per cent and 45 per cent, respectively. 20% which includes priority actions for children Similarly, the percentage of women who 10% and AIDS, later renamed in the “Unite for know that HIV cannot be transmitted by a Children, Unite against AIDS” campaign as mosquito bite rose from 37 per cent in 2003 to 0% 69 1997 2003 2008 the Four Ps: 64 per cent in 2008.71 An apparently healthy person can have HIV ll P1 – Primary prevention While general knowledge about HIV and HIV cannot be transmitted by sharing food its transmission modes has shown positive ll P2 – Prevention of mother-to-child HIV cannot be transmitted by mosquito bites trends in the last five years, there is still much transmission (PMTCT) room for improvement in actual prevention. Source: DHS 1997 & 2003, MICS 2008.
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Women with secondary or higher education 4.4. P2 – Prevention of mother- The population coverage of PMTCT and the country have significantly higher access are less likely to expose themselves to risk; to-child transmission of HIV paediatric antiretroviral therapy interventions to treatment than their central and northern this group shows an almost 50 per cent were revised in 2010 based on the more counterparts. lower probability of risky behaviour than Around the world, 700,000 children under accurate population estimates from INSIDA 78 women with no education. Having only a 15 are infected with HIV each year, and data. The revised estimates indicate that PMTCT policies in Mozambique primary education does not appear to be more than 90 per cent of paediatric HIV previous studies had over-estimated the correlated with women’s attitudes towards infections are the result of mother-to-child population of HIV positive women. The In November 2006, the Ministry of Health risky sexual behaviour. Surprisingly, the transmission of the virus.74 Up to two thirds proportion of HIV positive women estimated issued a guidance note81 introducing several model shows that women with correct of infections of children occur during labour, to be receiving PMTCT services (population key policies: provider-initiated (‘opt out’) knowledge about HIV transmission are as birth and pregnancy, and one third occur coverage) has therefore increased testing to be offered in both antenatal care likely to have unprotected sex as women during breastfeeding.75 Without preventive significantly. Previous estimates79 indicated and maternity settings; blood samples for who are not aware of the transmission measures, transmission rates are between that around 46 per cent of pregnant women CD4 counts to be drawn in the antenatal care channels of HIV. Another interesting 15 and 40 per cent, but with effective were receiving the necessary prophylaxis to facility; and DNA polymerase chain reaction result is that the likelihood of high-risk antiretroviral treatment and care, this rate reduce the transmission of HIV from mother (PCR) testing for HIV-exposed children under activity increases with age for women in can be reduced to as low as two per cent, as to child. Revised estimates indicate that 70 18 months. Use of combination therapy for monogamous relationships while decreasing is the case in developed countries.76 per cent of women are actually receiving prophylaxis (single dose nevirapine [NVP] for women in polygamous relationships treatment.80 Figure 6.16 shows the absolute during delivery, plus (zidovudine) [AZT] from (see Figure 6.15). In terms of household and In 2008, it was estimated that PMTCT number of pregnant women receiving 28 weeks) was officially introduced, and the location characteristics, wealth seems to interventions in Mozambique averted an PMTCT treatment and the proportion initiation of nevirapine treatment to pregnant have a positive relationship with condom estimated 5,820 new HIV infections in of women receiving ARVs for PMTCT women was moved forward from 36 to 28 use, while living in rural areas is positively children under 15, which translates to a based on previous and the most recent weeks. Integration of PMTCT services into 77 associated with high-risk sexual behaviour. 15.6 per cent reduction nationally. The population estimates. While the revised maternal and child health services was PMTCT programme was first introduced treatment estimates are encouraging, it strengthened in order to increase uptake of Interestingly, these behavioural indicators in Mozambique in 2002. Since the should be noted the treatment is distributed antiretroviral therapy by pregnant women. don’t seem to correspond to the HIV- establishment of the national programme, inequitably. Pregnant women in the south of Reviving the practice of consultations for at- prevalence profile that recently emerged the number of health facilities offering from the INSIDA preliminary results: For prevention services has expanded rapidly, both men and women, HIV prevalence was from eight in 2002 to more than 800 by Figure 6.16: Trends in PMTCT coverage between 2002 and 2009 higher in the highest wealth quintile, and end 2009.v At inception, the majority of higher among individuals with education services were concentrated in and around 80.000 100% than among those with no education. The provincial capitals, but by 2009, prevention 70.000 68,248 90% final INSIDA report will certainly shed more interventions had been integrated into 80% light on possible correlations between antenatal care services in all districts, 60.000 behavioural and seroprevalence findings. including several peripheral health facilities. 70% 70.4% 50.000 46,848 60% 40.000 50% 49.3% Figure 6.15: Probability of not using condom in sexual relationship, women 15-24, 2008 30.000 24,320 45.8% 40% 1 32.0% 30% 20.000 26.4%
12,150 20% Percentage of PMTCT needs met 16.0% 10.000 7,690 13.7% 3,182 10% 253 877 8.9% 0 0
-75 Number of HIV+PW receiving PMTCT prophylaxis 2002 2003 2004 2005 2006 2007 2008 2009 Number of HIV + pregnant womem receiving ARV prophylaxis Percentage of total estimated HIV + PW received PMTCT (new estimates) Percentage of total estimated HIV + pregnant womem receiving ARV prophylaxis
Probability of not using condom -5 (UNGASS estimate) 15 17 19 21 23 24 age Source: Ministry of Health, Annual Report, National Laboratory Services, Maputo, 2009. Polygamous Monogamous
Source: UNICEF calculations based on MICS 2008. v Data from UNGASS Report 2010
196 197 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 6: CROSS-CUTTING ISSUES
risk children (Consulta de Criança em Risco) and continuation of Nevirapine by the infant HIV counselling and testing as part of Among pregnant women who received HIV was recommended to strengthen follow-up until weaning from breastfeeding. antenatal care counselling, 82 per cent received an HIV test, of children born to HIV positive mothers. according to MICS 2008. This is likely the The success of a PMTCT programme depends Although HIV counselling for pregnant consequence of provider-initiated testing and The establishment of mother support groups on a complex cascade of interventions, women during antenatal care visits increased counselling at antenatal care services, as well by health facilities was also included in the integrated with the maternal and child health from 51 per cent in 2003 to 57 per cent in as progressive normalization of including an guidance note as a necessary step towards services, as described below. 2008, it remains low. Geographical disparities HIV test as part of antenatal services. supporting pregnant and lactating women in the proportion of women who received to adhere to PMTCT interventions and the Knowledge of prevention of mother-to- HIV counselling as part of their antenatal Access to HIV information and testing subsequent follow-up of their HIV exposed consultation are large, varying from 28 per during antenatal visits is highly correlated children. The guidelines on mother support child transmission of HIV cent in Zambezia province (27 in 2003) to 94 with the wealth of women. Only 26 percent groups were further developed following The level of knowledge about mother- per cent in Maputo City (81 per cent in 2003).84 of the poorest women were tested for HIV, a nationwide mapping of this intervention to-child transmission of HIV among the compared to 86 per cent of the best-off The proportion of women tested for HIV as in 2008. The final guidelines are awaiting Mozambican population has increased. women (see Figure 6.18). part of their antenatal care has improved approval. The 2003 Demographic and Health Survey dramatically. In 2008, 46 per cent of pregnant showed that only 44 per cent of women Recent changes in the global guidelines for women aged 15–49 underwent an HIV Antiretroviral prophylaxis for pregnant and 43 per cent of men aged 15–49 knew prevention of mother-to-child transmission test as part of their antenatal consultation, women that HIV can be transmitted from mother call for a more comprehensive and compared with only 3 per cent in 2003. The to child during pregnancy, delivery and In order to reduce mother-to-child ‘aggressive’ approach. These changes proportion of women tested for HIV varies breastfeeding. Data from MICS 2008 reveal transmission of the virus, as well as for their include: lifelong antiretroviral therapy for across provinces, with only 19 per cent of that among women of the same age group, own treatment, when eligible, HIV-positive HIV-positive women in need of treatment; pregnant women being tested in Zambezia this knowledge has increased to 78 per cent. pregnant women receive antiretroviral drugs earlier initiation of efficacious prophylaxis province in 2008, compared with 95 per Knowledge levels are higher in urban areas for prophylaxis. Access to antiretroviral regimens; and continuation of these during 85 cent in Maputo City. Forty-three per cent of therapy has increased gradually since post-partum and breastfeeding.82 In early (89 per cent) than in rural areas (72 per cent). women received their test results. inception of the programme in 2002. 2010, the Ministry of Health policy changed Furthermore, the data show that 70 per cent to reflect some of the revised international of women interviewed know that the virus indications from WHO, including raising the can be transmitted through breastfeeding levels at which pregnant women with low (compared to 50 per cent of women in 2003). CD4 counts are considered eligible for Highly Only slightly more than half (55 per cent) of Figure 6.18: HIV test and counselling during antenatal visits, by wealth quintile, 2008 Active Antiretroviral Therapy (HAART),83 women know all three main methods of HIV early initiation of prophylaxis for women, transmission (MICS 2008). 90% 87% 86% 80%
Figure 6.17: Testing and counselling during antenatal visits, 2003 and 2008 70% 72% 64% 60% 60% 58% 50% 57% 50% 48% 51% 40% 40% 41% 41% 46% 30% 30% 33% 26% 20% 20%
10% 10%
3% 0% 0% Were provided information about HIV Were tested for HIV at ANC visit Lowest Second Middle Fourth Highest prevention during ANC visit* Were provided information about HIV Were tested for HIV at ANC visit 2003 2008 prevention during ANC visit Source: DHS 2003, MICS 2008. Source: MICS 2008.
198 199 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 6: CROSS-CUTTING ISSUES
Coverage of antiretroviral prophylaxis estimated HIV-positive pregnant women in PMTCT, as well as the fact that newborns are children. Anecdotal evidence from for the overall population of HIV-positive the country). at times brought to maternity services within supervision visits to health facilities indicates pregnant woman (including both tested 72 hours of birth to receive antiretroviral that this intervention is widely implemented and non-tested women) was 0.2 per cent in Although progress is being made, the treatment. in the country, but reliable national coverage 2002, increasing to 30 per cent in 2007, 32 number of pregnant women receiving figures are not yet available. 86, vi antiretrovirals for their own health remains per cent in 2008 and 46 percent in 2009. Cotrimoxazole coverage It is important to note that these coverage below expectations. HAART in 2010 is A significant proportion of women drop out figures refer only to services provided delivered in only selected health facilities, for HIV-exposed children of the services at each stage in an antenatal during antenatal care, and exclude those termed Antiretroviral Therapy sites. This International guidelines recommend and post-natal cascade (see Figure 6.20). Not women accessing antiretroviral therapy means that pregnant women, instead of administration of cotrimoxazole prophylaxis all pregnant women attending antenatal care at maternity facilities. This approach was being able to access HAART as an integrated to children born to HIV-positive mothers received counselling and testing, and even adopted by the Ministry of Health in order to component of PMTCT services, are mainly or children living with HIV.89 This is a fewer received antiretroviral prophylaxis. avoid double-counting of women accessing referred to Antiretroviral Therapy sites, proven cost-effective intervention that can Similarly, despite the increasing number both antenatal and maternity services, but which may be in a different health facility. be widely applied even in low-resource of children exposed to HIV who are able to it results in under-reporting. It is hoped that This interferes with access, including settings. National guidelines indicate access antiretroviral prophylaxis, those who the new Antenatal Care Card, now being screening for eligibility. that cotrimoxazole prophylaxis should finally do have their HIV status confirmed finalised, will facilitate clarity in reporting commence at four weeks for exposed through testing are relatively few. and allow collection of reliable information Antiretroviral therapy prophylaxis for on coverage of PMTCT in the near future. babies Figure 6.19: Attended deliveries, 1997, 2003 and 2008 Prioritising access of pregnant women to According to international PMTCT guidelines 100% HAART is critical. HAART minimizes the risk and the revised national Antiretroviral 56% 52% 55% of post-natal transmission in breastfeeding Therapy protocol for pregnant women mothers with low CD4 count and high viral (option A),88 all exposed children born to HIV- 90% load, who face challenges in implementing positive mothers should receive antiretroviral recommended infant feeding options. prophylaxis with nevirapine within 72 hours 80% Women with CD4 counts of less than 200 of birth, and continued nevirapine until the cells/microlitre (µl) are five times more likely child is weaned from breastfeeding. Ministry 70% to transmit HIV during breastfeeding than of Health data reveal, however, that only women with CD4 counts over 500 cells/µl.87 an estimated 40–50 per cent of HIV-positive HAART can reduce the risk of transmission pregnant women give birth at health facilities 60% to approximately two per cent, as compared in Mozambique. The fact that institutional to other interventions, e.g., single dose deliveries account for only around half of all 50% nevirapine, which reduces the risk to 10–15 deliveries is a clear bottleneck in the provision 48% per cent. of antiretroviral prophylaxis to newborns 45% 40% 44% in the first 72 hours of life. Despite this In 2009, out of all pregnant women who constraint, the number of children receiving received PMTCT interventions, 48 per cent antiretroviral prophylaxis increased from 328 30% received single dose nevirapine, 40 per in 2002 to 41,266 in 2009, corresponding to cent a combination of nevirapine and AZT 58 per cent of all children estimated to be 20% (bitherapy), and 11 per cent HAART for their born to HIV-positive mothers and 83 per cent own health. The number of HIV-positive of pregnant women who received any form 10% pregnant women who received HAART for of antiretroviral for PMTCT in the same time their own health was 53 in 2003, increasing period. The increase may be attributable, in to 3,647 in 2007, 6,388 in 2008, and 7,791 part, to the increasing institutional delivery 0% 1997 2003 2008 in 2009 (equivalent to 5 per cent of all rate for HIV-positive women enrolled in Traditional midwives/others/nobody Skilled personnel
Source: DHS 1997 and 2003, MICS 2008.
vi Note that population coverage of PMTCT and paediatric antiretroviral interventions will be revised during the last part of 2010, based on the more accurate population estimates in the INSIDA.
200 201 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 6: CROSS-CUTTING ISSUES
Future plans and targets the benchmark of 90 per cent coverage of More than half of children living with HIV children (less than 12 months) on antiretroviral PMTCT in HIV-positive pregnant women in Mozambique are likely to die before treatment immediately. The Ministry of Health The reduction of mother-to-child latest by the year 2015. reaching their second birthday, unless they estimate that in 2009, 47,500 children under transmission of HIV has been a key are treated for opportunistic infections 15 required antiretroviral treatment, with the Government priority for several years. The and receive early initiation of antiretroviral total predicted to rise to slightly above 50,000 second national strategic plan to fight HIV 4.5. P3 – Paediatric AIDS therapy. AIDS is fast emerging as a major by 2010.95 and AIDS, which covers 2005–2009, set out It is estimated that there were about cause of mortality among children, with an a target of PMTCT coverage of 90 per cent 148,000 children under 15 living with HIV estimated 19,000 child deaths due to AIDS The number of children under 15 receiving by the year 2009, building on the Ministry in Mozambique in 2009, and this number in 2008.93 The 2008 National Child Mortality treatment in the country grew from fewer of Health target of 60 per cent coverage is expected to increase to over 150,000 Study estimates the proportion of deaths than 500 in 2004 to 9,393 in 2008 to 13,510 by the year 2008.90 Mozambique has also by 2010.91 More than half of all infected due to AIDS among children under five is nationwide by the end of December 2009. committed to the universal access goal to children live in the four central provinces 10 per cent.94 AIDS is threatening to reverse This represents 19 per cent of children reach at least 80 per cent of pregnant women of the country. Among infected children, the gains made by Mozambique in reducing considered eligible by the Ministry of and their babies with PMTCT interventions slightly more than half are under five years child mortality in recent years and represents Health, based on application of the updated by 2010. Targets set in 2009 remain below 96 old. Estimates show that following an initial one of the greatest obstacles in meeting the Spectrum model. While representing a what is required to reach the goal of rise in the number of new infections among MDG target of a two-thirds reduction in child significant improvement from the three universal access, on the grounds that the children during the period 2002–2005, the mortality by 2015. per cent coverage recorded in 2005, the country did not have the capacity to reach number of new infections apparently started treatment coverage for children is still far more ambitious targets. Targets have been to decrease after 2006 (possibly due to the Children infected with HIV through vertical from satisfactory. Despite the increased revised upwards in July 2010, given the very impact of the PMTCT programme, as well transmission from their mother, either absolute number of children on antiretroviral positive progresses made in the previous as the natural progression of the epidemic), at birth or during breastfeeding, require treatment, the coverage shows a reduction years, and in particular in 2009 (where the although it still remains alarmingly high. It is treatment with antiretrovirals much earlier trend due to the increased number of eligible country already achieved what was initially estimated that there were more than 30,941 than do adults infected through sexual children resulting from the application of planned as the target for 2011). The revised new infections in 2009, representing about 85 contact. National paediatric guidelines the revised paediatric guidelines referred to Ministry of Health targets aim at achieving new infections every day (see Figure 6.21).92 address this by putting all HIV-positive above.
Figure 6.20: PMTCT antenatal and post-natal cascade, 2009 Figure 6.21: Estimated number of children under 15 living with HIV, under 5 living with HIV, number of new infections in children under 15, and numbers of children under 15 in need of treatment/antiretroviral therapy, 2006–2010 1.000.000
900.000 180.000 888.861 160.000 800.000 140.000
700.000 120.000
600.000 649.820 100.000 80.000 500.000 60.000 400.000 40.000 20.000 300.000 0 200.000 2006 2007 2008 2009 2010 150.000 <15 LHIV <5 LHIV <15 need ART New infections <15 100.000 70.289 68.248 41.266 Source: National Institute of Statistics, Ministry of Health, Ministry of Planning and Development, Centro de Estudos Africanos da 0 Universidade Eduardo Mondlane, Conselho Nacional de Combate ao HIV/SIDA, Faculdade de Medicina, Impacto demográfico do PW attending PW counselled Estimated HIV positive PW receiving Children HIV/SIDA em Moçambique: Actualização - Ronda de vigilância epidemiológica 2008, Government of Mozambique, Maputo, 2010. ANC and tested HIV+PW ARV prophylaxis receiving ARV prophylaxis
Source: Ministry of Health, Annual Report, National Laboratory Services, Maputo, 2009.
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Similarly, the increase in the number of A number of constraints are hampering Table 6.3: Paediatric HIV targets, 2009 sites providing antiretroviral therapy has effective PCR testing, including long delays been rapid. In 2009, 220 health facilities were due to transportation of samples and 2007 2008 2009 2010 2011 2012 2013 2014 providing antiretroviral therapy services intermittent lack of testing materials. One Children on ARV and 173 of them (78 per cent) were treating positive innovation was the introduction 6,451 9,393 13,500 18,817 23,818 29,058 34,258 39,743 HIV-positive children, compared with 32 of in 2009, on a pilot basis, of short message Goal of the treatment Projection 150 sites in 2006 (21 per cent). By 2009, 95 service printer technology for feedback of Model for Children as a per cent of all sites providing antiretroviral PCR results to facilities. This technology is children on proportion of total 7.1% 7.3% 8.5% 9.9% 10.7% 11.4% 11.9% 12.3% therapy were also treating children, although planned to be rolled out nationally in 2010 TARV (lower on ART many are not yet operating at full capacity.97 and is expected to substantially improve limit) early infant diagnosis in the country. Coverage 21% 28% 37% 45% 52% 58% 64% Early infant diagnosis remains critical to ensuring access to timely paediatric care In 2005, the Government made the scale-up Source: Ministry of Health, Departamento Nacional de Assistência Médica, HIV Programme Report, Ministry of Health, Maputo, 2009. and treatment for children, given that AIDS of paediatric treatment a priority in the fight progresses rapidly in infants and children against AIDS and poverty. In PARPA II, a target under five. According to WHO guidelines,98 of treatment for 33,000 children by the year all children born to HIV-positive mothers 2009 was established. However, this was not should receive a DNA polymerase chain achieved; the evaluation of PARPA II shows 4.6. P4 – Protecting orphans and receive minimal support from their families reaction (PCR) test at 4–6 weeks. It also that only 11,000 children were receiving vulnerable children affected due to the shame and stigma currently recommends that children with severe treatment in 2009. In 2008 the Ministry of by AIDS associated with an AIDS-related death. In malnutrition and compromised growth Health decided to drastically reduce the schools, discrimination against children is should undergo a clinical evaluation that annual targets to 11,500 children receiving There are an estimated 1.8 million orphans expressed through teasing and bullying. In includes HIV testing. When the PCR test is treatment in 2008, compared with the PARPA in Mozambique, 510,000 of whom have some cases, children avoid their HIV-positive not available, the child should be tested II target of 20,826. This revised target was been orphaned by AIDS.101 This number peers due to fear that they may become through antibody testing after 9 months and based on a review of progress and projections is expected to rise, with AIDS being the infected. A participatory study on the coping again at 18 months. of the number of new children starting likely cause of orphanhood in a majority mechanisms of families and communities in antiretroviral therapy each month during of cases. This does not take into account the context of AIDS, carried out nationwide All infants under 24 months with confirmed the previous year. After intense advocacy, additional children who may be vulnerable by UNICEF in collaboration with the Ministry HIV infection should be started on and following adoption by Mozambique of due to the impact of HIV on their family. A of Women and Social Action in 2004, found antiretroviral therapy, irrespective of clinical the new paediatric antiretroviral therapy child is considered an Orphan or Vulnerable that approximately half of the households or immunological stage, according to normsvii and the expansion of early infant Child (OVC) if one or both of his/her natural surveyed felt that children orphaned due to 103 international recommendations and national diagnosis through the installation of two parents is dead, if at least one parent is AIDS were likely to be stigmatised. guidelines issued in October 2008.99 In 2009, PCR machines in the northern and central chronically ill, if there was an adult death in the PCR test was being performed in two regions of the country, the Ministry of Health, the household during the previous twelve 4.7. Nutrition and HIV laboratories in Maputo and Nampula, with a in collaboration with its partners decided to months after a prolonged illness, or if there third in Beira expected to commence testing revise the targets in 2009 (see Table 6.3). is a chronically ill adult in the household. Undernutrition, food insecurity, HIV in 2010. As of 2009, national universal access infection and AIDS mutually reinforce each data100 reported at least 287 sites collecting While representing an improvement, these Orphaned children are more exposed to other. People living with HIV have increased dried blood spot samples at peripheral level revised targets remain far below the original risks than non-orphans. These risks include: energy needs, but the HIV infection or health facilities for PCR analysis at referral PARPA II targets and even further from the an increase in sibling- or child-headed related opportunistic infections can reduce laboratories. universal access commitment. households, lower school enrolment and their ability to absorb nutrients and reduce performance, increased risk of sexual abuse appetite. This can lead to them losing weight and HIV infection, risk of hazardous child and becoming weak. A vicious cycle may labour, early sexual activity and marriage, ensue where they are less able to work, increased risk of severe psychosocial maintain a job and take care of themselves, problems, and poor health and nutrition.102 so they become even weaker. In addition, if Furthermore, stigma and discrimination they do not receive treatment, they are more against people infected or affected by HIV or susceptible to opportunistic infections and AIDS remains a challenging issue. Children ultimately progress to AIDS. Their family and young people with sick or dying relatives members might also be affected, if they vii Initiate antiretroviral therapy for all seropositive children aged 0–1 year; PCR testing for all children aged 0–9 months using rapid tests; changes to the CD4 cell count norms; use of the four stages of the World Health Organisation, rather are particularly exposed to stigma. They depend on the person with HIV for their than three; and introduction of soluble tablets in place of syrups. may be ostracised by their communities and food, living expenses and care.
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For children, who need energy and nutrients children under five. Concentrated in the to grow, the impact of HIV infection on population between 15 and 49, HIV and 5. Environmental issues and climate change their nutritional status can be even more AIDS is having a wide-ranging social and severe. OVC are especially vulnerable to economic impact. Skilled labour needed for undernutrition, depending on whether they both economic growth and the provision Children around the globe, and particularly lack of strength and speed also make them live in a family environment or not and on of social services such as health care and in developing countries, are among those particularly vulnerable in emergency events their access to the necessary resources. The education has been reduced. Mozambique is least responsible for environmental such as floods, cyclones and landslides. deprivation-based poverty study examined responding to the epidemic through a Four degradation and climate change. Likewise, Children are also likely to be in close OVC as a group and found that 22 per cent P campaign: Primary prevention, PMTCT, children are not the primary focus of proximity to their mothers during cooking, had severe nutritional deprivation (either Paediatric AIDS and Protection of orphans most environmental impact assessments increasing their exposure to pollutants from severe stunting, underweight or wasting).104 and vulnerable children. or climate change studies, nor are they the burning of fossil fuels. Some researchers the primary targets of most policies or assert that climate change, because of its Antiretroviral treatment can help to improve Despite the progress made in implementing interventions related to environmental issues wide-reaching and cross-sectoral impact, the nutritional status of people living the PMTCT programme, the lack of follow- or climate change. poses the single greatest threat to the with HIV since it improves people’s health up of mothers and children remains a world’s children.106 status. At the same time, however, the major constraint. The health system faces Children are among the most vulnerable medicines can have side effects, which can a lack of human resources which has to the devastating impacts of many types be exacerbated when food consumption compromised access to and provision of of environmental hazards. Even natural 5.1. Environmental issues in is not adequate. People’s appetite usually quality services. On the other hand, the disasters of relatively short duration can Mozambique increases when their health improves, and stigma and discrimination associated with have long-lasting effects on children’s The country’s 13 largest river basins are in an environment of food insecurity and HIV may prevent many pregnant women and development. Health, nutrition, and water heavily populated and are characterised poverty this can be challenging. Anecdotal their newborns from accessing and adhering and sanitation challenges are often caused or by relatively high levels of soil fertility, but evidence suggests that lack of food can be to PMTCT interventions. Mothers fear they exacerbated by unfavourable environmental these areas are also vulnerable to flooding, an important reason for abandonment of will lose their families as a result of getting conditions, while education, child protection droughts and saline intrusion, as well as treatment. tested or disclosing their HIV status to their and other areas also face challenges as the effects of water demand, poor rainfall partners. indirect consequences of environmental and pollution in the neighbouring countries An analysis of the nutritional status and issues. With climate change threatening to in which most of the rivers originate. The vulnerability of 920 people living with The Mozambican health system needs to increase the incidence and severity of many central region, characterised by many large HIV and receiving antiretrovirals in 33 develop strategies to create an enabling environmental hazards in Mozambique, it is 105 river deltas and a wide coastal plain, is districts found that one quarter of them environment that encourages the active particularly important to focus attention on particularly vulnerable to environmental were undernourished (body mass index involvement of partners and families in how children can be spared from its negative 2 hazards, as it is the area with both the below 18.5 kg/m ). One fifth received food maternal and child health (e.g., couple effects. support. Food security and vulnerability counselling and testing, births assisted by largest coastal population and the greatest were measured based on food consumption skilled staff, etc.). The PMTCT programme Environmental hazards affect children both risks of cyclones and flooding. The northern and the use of survival strategies. The study should be made more comprehensive and as part of a greater household and also in region is characterised by moderate to low concluded that two thirds of the interviewees acceptable to male participation, and should unique ways. Children are at greater risk soil fertility and a narrow coastal plain. Soil were vulnerable and food insecure. be linked to community health interventions of many potential health effects simply fertility is lowest and risk of drought the to facilitate active follow-up for mothers and because of their physiology: their organs, highest in the southern region, particularly in children who currently drop out. Experience immune systems and nervous systems the arid inland areas.107 4.8. Conclusions from Rwanda shows that when partners are are still developing; their metabolisms and More than 60 per cent of the population involved and informed, a woman is more respiratory rates are faster; and they have a It is estimated that in 2010 more than 1.7 lives along the coast, a bioregion that is likely to participate in PMTCT services and higher surface area to body mass ratio than million Mozambicans are living with HIV, susceptible to cyclones, over-fishing, erosion actively seek other maternal health and HIV adults. Their natural behaviour and curiosity including almost 150,000 children under 15. and saline intrusion into river systems. services. also place them at greater risk of acquiring In urban areas such as Maputo City, AIDS Mozambique can be divided into bioregions certain diseases and injuries because their has become a common cause of death for based on latitude (north, central and south) propensity to explore the world around and on geographic features (coastal, flood them often leads to greater exposure to plain and inland). contaminants, pollutants (particularly due to a lack of unpolluted play space in urban The physical state of the environment is areas). Children are more likely to pick not only subject to uncontrollable weather up and chew on soil, pieces of waste and events such as cyclones and droughts, but landmines. Their smaller size and relative also to the effects of human activity such as
206 207 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 6: CROSS-CUTTING ISSUES
unsustainable use, exploitation and pollution access to exhaustible resources, renewable Sustainable development is inherently and habitat degradation are diminishing of the land, water and natural resources. resources and agricultural land. A 2009 an intergenerational as well as coastal communities’ ability to maintain study108 measured the per capita wealth of intragenerational question. Fulfilment of their livelihoods. The plan identified several This section lays out the current Mozambique using an expanded definition human rights by adults today (e.g., right actions for promoting environmental environmental conditions and challenges of wealth. In addition to the produced output to food and shelter) affects the ability of sustainability while increasing economic and future predictions for Mozambique, of the economy, the authors included in today’s children and of future generations productivity;112 however, the PARPA II followed by the country’s institutional their calculations the accumulation of other to fulfil their human rights in the future. evaluation report suggested that these goals framework for environmental and disaster assets: human capital, the environment and Environmentally destructive consumption were not entirely met.113 management. In this context, the cross- natural resources. patterns by today’s adults (e.g., over-fishing, cutting vulnerability of Mozambique’s over-logging, poor soil conservation) will Health children to environmental hazards is This study found that 49 per cent of have a serious impact on future generations’ examined, and the section concludes with Mozambique’s wealth is derived from ability to fulfil their human rights. A 2006 report commissioned by the WHO priority areas to be addressed. natural capital, including mineral resources, found that while 23 per cent of all premature agricultural land, forests and marine deaths were attributable to modifiable reserves. This is far higher than the sub- 5.3. Impact of environmental environmental factors, that number rose 5.2. Sustainable development in Saharan average of 24 per cent, implying degradation and to 36 per cent among children under 15. Mozambique a high dependence on natural resources. emergencies on children in Researchers and health professionals have The study also found that degradation of Mozambique long noted the link between environmental Economic theory tells us that there is a Mozambique’s natural capital costs the factors such as air pollution and health effects strong link between changes in wealth country $US 360 million per year, or around Pollution such as asthma, but recently they have begun and the sustainability of development: if 6 per cent of GDP. Water pollution (unsafe to sound the alarm with more urgency. a household (or a nation) is running down water supply, sanitation and hygiene) Pollutionix was found to take a significant Among those whose health is threatened by its assets, it is not on a sustainable path. constitutes the biggest environmental cost toll on the country’s environment, health environmental hazards, children represent In Chapter 1 of this study, poverty analyses in Mozambique (see Figure 6.22). While the and economy in the study referred to above. the biggest group. Younger children are even were presented using consumption- depletion of natural capital was found to The health effects of polluted water supplies more vulnerable: the number of healthy life- based and deprivations-based measures. be relatively low in Mozambique overall,viii alone were estimated to have cost nearly years per capita lost to environmental factors However, when discussing the wealth of the effects of climate change are likely to be 3 per cent of GDP in 2008,x while those of was about five times greater in children under a child or a nation, we can also consider high. indoor air pollution (mainly from the carbon five than in the total population. Malaria and monoxide released by burning fossil fuels) respiratory infections, the leading causes of cost an additional 1 per cent.109 Only 10 child mortality in Mozambique (see Chapter Figure 6.22: Cost of environmental degradation per year, 2009 per cent of the Mozambican population 3), are also some of the diseases most were connected to the electricity network strongly linked to modifiable environmental 180 in 2008.110 This has a double environmental factors. Diarrhoea, a major underlying cause 160 impact: first, it increases air pollution of child mortality, has an environmental 140 through cooking with fossil fuels, and burden of disease of 94 per cent.114 120 second, it increases the use of natural Natural disasters affect children’s health 100 resources for firewood. by disrupting access to health facilities. 80 Polluted marine environments and Cyclones and floods, in particular, can $US (millions) 60 overexploitation of fisheries have become damage health infrastructure and roads, 40 an increasing problem in many coastal which can make delivery of medical supplies 20 areas for the communities that depend difficult or impossible. Families who have 0 on the diminishing stock of fish for their been displaced from their homes due to Soil Deforestation Water Air pollution Drought Floods livelihood.111 PARPA II explicitly noted the emergencies are often unable to access Degradation Cost Pollution economic importance of the fisheries and health care or continue regular treatments, acknowledged that overfishing, pollution such as for HIV. Source: Ollivier, T, et al, ‘Natural Resources, Environment, and Sustainable Growth in Mozambique, AgenceFrançaise de Développement, 2009.
viii The study noted, however, that national figures include many areas with very low population density and may obscure ix Pollution includes outdoor air pollution, indoor air pollution and water pollution. some of the unsustainable and exploitative agricultural practices that take place at local levels. x As discussed in Chapter 3, less than half of households have access to safe drinking water.
208 209 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 6: CROSS-CUTTING ISSUES
Water and sanitation rain-fed agriculture, making the country Table 6.4: Coping strategies used in rural Mozambique during the lean season each year, 2009, percentage particularly vulnerable to the water stresses Water stress increases many health threats. that occur regularly, though not always Agricultural season Poor sanitation is often made worse by Rural Households experiencing food shortage (%) in the same places at the same time. For 2005 2006 2007 2008 environmental conditions such as floods and example, in 2001–2002, droughts in southern 38 37 27 31 droughts, with the former typically leading Mozambique caused the loss of about Eat less-preferred food 88 90 87 87 to an increase in water-borne diseases, one third of the expected harvest, leading Reduce number of meals 82 85 82 82 such as cholera, and the latter leading to the Government to request additional an increase in water-washed diseases, such international aid to feed some 650,000 Eat all or part of seeds 54 49 41 54 115 as trachoma. An additional water-related people. The very same year, however, the Increase income-generating activities 38 51 50 41 health risk that sometimes arises, particularly northern part of the country saw a surplus Coping strategies used during Share food with family/neighbours 40 38 47 39 in northern Mozambique, is the higher levels in food production, much of which was sold the lean season (%) Sell assets abnormally 18 26 19 18 of cyanide that become concentrated in through informal markets to neighbouring Borrow money 11 17 15 12 the cassava root during times of drought. Malawi.120 In 2006, the Technical Secretariat High concentrations of the toxin are a Seek government/church/NGO assistance 4 5 4 3 of Food and Nutritional Security (SETSAN) Send children to other households 3 3 4 3 cause of spastic paraparesis (also known determined that about 35 per cent of the Remove children from school 2 2 2 2 as konzo or mantakassa), especially among population was chronically food insecure,121 children and women who may already be though the number of people with acute Other 2 2 3 2 undernourished.116, 117 food insecurity at any given time varies; Source: Cunguara, Benedito and Brendan Kelly, ‘Trends in agriculture producers’ income in rural Mozambique’, study as input to Impact Evaluation Report of PARPA II, MPD, 2009. Most of the country’s vulnerability to the October 2009 figure published by environmental hazards is directly linked to SETSAN was 281,300, or less than 2 per water, whether there is not enough or too cent of the population in immediate need of 122 much. Both droughts and floods can have assistance. On average, rural households only have enough stable crop for 6–8 devastating effects on children’s access to regain fertility. In areas of higher population such as fetching water, or simply because months.123 safe drinking water and sanitation. Shallow density, however, farmers grow crop after they lack the energy to focus on their studies wells that normally sustain a community can Decreased food security often leads crop, ‘mining’ or depleting the soil of as a result of undernutrition. dry up in times of drought, putting excess resource-poor households to engage in nutrients while giving nothing back. With Environmental pollution and natural pressure on any deeper wells that may exist. coping mechanisms that are not in the best little access to fertilisers, the farmers are resource management affect the success Floods can contaminate drinking water interests of child nutrition. The effects of forced to bring less fertile soils on marginal of Government interventions in education. supplies, especially in areas that also have undernutrition on children can be severe land into production, at the expense of Illnesses caused by environmental factors poor sanitation. Weak water and sanitation and lifelong. The main strategies used by wildlife and forests. like air and water pollution have an impact on infrastructure can be easily damaged by rural, food-insecure households are to eat Short-term environmental disasters in areas school attendance rates. Undernourishment, floods and cyclones, and areas with poor less-preferred foods, reduce the number of that had previously been relatively food- whether due to soil depletion or loss of drainage can increase the risk of cholera meals eaten per day, and eat all or part of the secure may lead to higher rates of acute harvest, will affect children’s ability to absorb and other waterborne diseases, as well as seed stock for the next growing season (see undernutrition among children, while long- instruction. Deforestation and lack of safe becoming breeding grounds for mosquitoes Table 6.4). While adults may be able to adapt term crises may increase the numbers of water close to the household may also affect that carry malaria and other vector-borne to such changes in their diet, at least in the 118 underweight and stunted children. children’s attendance rates, as they spend diseases. As noted earlier, children are short term, the effects on children are more more time collecting firewood and water. particularly vulnerable to sanitation-related severe because of their different nutritional These situations can also affect teachers and diseases because of their physiology and needs. Education because their behaviour often places them in their attendance rates. greater contact with contaminated water.119 Soil depletion and erosion also affect Children’s education is another area that Children who have been displaced because food security in Mozambique. Without is affected by both long-term and short- of natural disasters face additional enough fertiliser to sustain the land, levels term environmental conditions. Poorly Nutrition challenges with regard to their education. of nutrients in the soil, and consequently constructed schools are often damaged or The impact of extreme climatic events Food security and nutrition in Mozambique agricultural yields, rapidly decline. Growers destroyed by severe storms and cyclones. In and the increasing scarcity of water due are strongly linked to environmental must then clear and cultivate new land, at 2008, for example, cyclone Jokwe disrupted 124 to climate change are likely to increase conditions. Both flooding and drought cause the expense of wildlife and forests. Farmers education for more than 38,000 students. the number of displaced people in extensive agricultural losses to households in Mozambique have traditionally cleared Long-term disasters, such as droughts, often Mozambique. Temporary migration can dependent on subsistence farming. Over land, grown crops and then moved on to cause children to drop out of school, either cause children to miss school and can 70 per cent of the population rely on clear more land, leaving the land fallow to because they must perform additional work,
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also cause overcrowding in locations that are colluding to strip precious tropical value. A rights-based approach is necessary Climate change receive many environmental refugees. The hardwoods,”127 with large quantities of not just for sustainable conservation term ‘environmental chaos’ has been used illegal, unprocessed hardwoods being and management of forests, but also for A comprehensive report conducted by the to describe situations with high levels of exported through Nacala port in northern accountability and equitable economic National Institute for Disaster Management noise and crowding and lack of structure or Mozambique. The same study estimates that returns in the sector. (INGC) paints a sobering picture of the daily routines, which is the situation faced illegal logging is at least as large in scale as environmental conditions that are anticipated if current climatic trends continue.135 by many children in post-disaster settings. legal logging. Child Protection This sort of chaos has been observed to Data collected over the course of several negatively affect children’s learning and Almost half of Africa’s forest loss is a result The protection of children is a particular decades were used to generate predictions social interactions.125 of people chopping trees for firewood challenge in emergency situations, as by applying seven different climate change or charcoal.128 Charcoal is the main fuel children are exposed to greater risks of models. Increases in average temperatures, source for an estimated 80 per cent of the maximum temperatures and duration of Deforestation family separation, sexual exploitation and population of Mozambique,129 and it is psychosocial trauma. Disruption of social heat waves have already been recorded Commercial logging has increased estimated to have an even greater effect services particularly affects orphans and throughout the country, and this trend is dramatically, and often illegally, in recent on deforestation than commercial logging. vulnerable children in their access to basic expected to continue. Mean temperatures years. Some analysts estimate that tropical Deforestation may lead to children missing services. are predicted to rise by 1.8 to 3.2°C by 2075. hardwoods from slow-growing, semi-arid school as more time is needed daily to Rainfall will also decline by two to nine and dry tropical forests are being depleted at collect cooking fuel. A rights-based approach Although there has been little research percent, especially between November and a rate that could see the resource exhausted may be effective in combating deforestation conducted on the impact of emergencies on May, the key growing season. The data in 5–10 years.126 A 2006 study concludes in Mozambique. When individual and child protection concerns in Mozambique, regarding rainfall suggest that the country that, “Asian timber buyers, local business community rights over a particular area reports from a mission of the Government’s is already seeing increasing delays in the people and members of the Government are recognised and enforced, people may vulnerability assessment committee in 2005 start of the rainy season. The climate change of Mozambique and their forest services act to safeguard some of its conservation raised concern over the use of negative models predict that precipitation will become coping strategies by children in drought- even less predictable in the next several affected areas, such as ‘survival sex’ for decades, with increased rainfall expected money, which increases their vulnerability to in most of the country from December to BOX 6.2. Emergency Preparedness HIV and other sexually transmitted infections. May, surpassed by even greater increases in evapotranspiration during the rest of the year.
In early 2000, severe flooding devastated five provinces in Mozambique. In addition to Landmines Rising sea levels present yet another approximately 700 people who lost their lives in the floods, almost two million people were Landmines present an environmental challenge. The lack of reliable data in the otherwise seriously affected and in need of external assistance.130 2001 brought more flooding, challenge in Mozambique. Although de- past makes it difficult to know precisely causing additional damage and placing additional stress on many areas that had not yet mining efforts have continued steadily to what extent sea level rise has already recovered from the previous year’s disaster. At a workshop funded by the United Nations Office since 1993, and four provinces (Cabo affected Mozambique, but the projections for the Coordination of Humanitarian Affairs in July of 2001, some 130 delegates – including Delgado, Niassa, Nampula and Zambezia) discussed in the INGC report show that this governors and district administrators from affected provinces and other representatives of the were recently declared to be mine-free, particular result of climate change is bound Government, UN agencies, bilaterals, and non-governmental organizations – met to draw lessons the National De-mining Institute estimated to have serious consequences. Even in a from the rescue and relief operations. Among the group’s conclusions and recommendations that more than ten square kilometres of low–sea-level-rise scenario, tropical cyclones were several that concerned preparedness, efficiency and coordination. One key recommendation mined areas remained at the end of 2008, will present a greater risk to the coast and was for greater integration of activities by the various parties involved in emergency response.131 representing 386 sites scattered across will contribute to greater coastal erosion. 133 Urban centres will sustain infrastructure One key measure of progress in this area is the full integration of sectoral contingency plans 59 districts in the other 6 provinces. In PARPA II, de-mining joined natural disasters damage due to more frequent flooding, into the National Institute for Disaster Management (INGC) contingency plan. In several sections and in a high–sea-level-rise scenario, many within the contingency plan, specific attention is paid to children’s needs in an emergency. More and environmental issues as a cross- cutting theme that must be addressed ports and homes along the coast would be recently, INGC, together with Save the Children, UNAIDS, UNFPA and UNICEF, developed and completely submerged by the end of the approved the Code of Conduct for Humanitarian Workers in the context of Mozambique, based on in order to achieve poverty reduction; the 2009 evaluation found that much century. Beira, Maputo and Quelimane are the UN Secretary-General’s Bulletin on Special Measures for Protection from Sexual Exploitation all expected to be heavily affected even by 132 progress had been made on this front, and Sexual Abuse (October 2003). This effort builds upon the experience gained during the low sea level rises; in the high–sea-level- emergency response in 2008, which revealed that humanitarian agencies and workers active in significantly decreasing the hazards posed 134 rise scenario, present-day Beira would the field (both Government and non-governmental) had little knowledge and had not developed by landmines. The Government’s national become an island, while the Maputo port, mechanisms or approaches to address sexual abuse and exploitation against women and mine action plan aims to clear all known train station and Costa do Sol areas would children by their own staff. minefields before the Mine Ban Treaty extension deadline of March 2014. disappear underwater.
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Many environment-related health hazards INGC and MICOA”141 constitute a major 5.5. Conclusions disaster management have not been are predicted to intensify in developing challenge to Mozambique’s ability to respond sufficiently integrated across the sectors. countries as a result of global warming. to natural disasters. Coordination issues Environmental issues affect children Insufficient funds have been dedicated to A 2009 Lancet Commission report called with other ministries are gradually being in myriad ways, and the effects of addressing environmental degradation, climate change “the biggest global health resolved, at least in terms of how to deal environmental degradation are likely to both by the Government of Mozambique threat of the 21st century.”136 In Mozambique, with emergencies; for example, INGC now intensify in coming years. Environmental and its partners, possibly due to the one of the predicted consequences of publishes an annual contingency plan142 that degradation negatively affects the long-term return on these investments. increasing temperatures and changes in includes sector-specific activities for nine development of Mozambique as a country Without such investments, however, precipitation noted in the INGC study is an different ministries to undertake before, and has profound negative effects environmental degradation has the increase in the range and seasonality of during and after a natural disaster. The on children individually. Children are potential to significantly reduce or even vector-borne diseases, including malaria and impending threat of climate change, which particularly vulnerable to emergencies in reverse progress made on child survival, African sleeping sickness.137 Other diseases has begun to attract more attention in recent terms of their education, health and safety. education and protection. Urgent action that may increase in Mozambique as a result years, has also involved both MICOA and Emergencies are likely to intensify as climate is needed to sensitise communities to the of climate change include chikungunya fever, INGC; for example, the ministry developed change increases the occurrence of cyclones need to reduce environmentally destructive meningococcal meningitis, cholera and a national action plan for adaptation to in Mozambique. practices and to ensure that public and other diarrhoeas, and rodent-borne diseases. climate change in 2007,143 while in 2009 INGC private sector initiatives are conducted in an Increasing temperatures and the gradual loss produced a comprehensive report detailing The environment is considered a cross- environmentally sustainably manner. Climate of shade trees may also increase the effects the predicted effects of climate change on the cutting issue by the Government of change is an issue that must be tackled in of heat stress on children. Because children country.144 Mozambique. However, actions to address cooperation with Mozambique’s regional and (and the elderly) sweat less and have higher climate change, the environment and international partners. surface area to body mass ratios than adults, The 2009 PARPA II evaluation was they tend to suffer greater health effects as a generally favourable to the environmental result of heat stress.138 component. The review noted that several new strategies and policies were developed during the timeframe covered by PARPA 5.4. The institutional context II, and environmental management had Environmental issues in Mozambique did been integrated into some of the district not make their way onto the national agenda development plans. Addressing the until the worst years of the civil war had challenges presented by climate change, come to an end. Article 90 of the constitution environmental degradation and sustainable confers upon Mozambican citizens the right management of natural resources was to live in a balanced environment, as well identified as a high priority for the as the duty to defend it. The article further development of subsequent medium-term states that State and local authorities shall Government plans. The evaluation was adopt policies to protect the environment also complimentary of the Government’s and promote the rational use of natural attention to the natural disasters component resources.139 The national environmental of PARPA II, noting in particular the commission was formed in 1990, followed strengthening of the INGC, which was in 1994 by the creation of the Ministry of credited with keeping losses to a minimum Coordination of Environmental Affairs. The during the floods of 2007–2008. Among the new ministry, in turn, developed the legal achievements reported in the evaluation framework for environmental management, were increased training for communities which includes a wide range of policies, and other sectors involved in reducing laws, strategies and action plans.140 the risk of disasters, creation of local committees for disaster risk management, In 1999, another governmental body was and resettlement of 44,000 families from created specifically to address the country’s high risk areas. Continued challenges vulnerability to environmental crises: include integrating disaster management (INGC). The INGC is separate from MICOA, into the Social and Economic Plans and although the World Bank noted in 2009 that allocating more sufficient funds provinces “unresolved coordination issues between and districts.145
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80 per cent of the population, broadcasting major daily newspapers (Notícias, Diario 6. Communication for Development via 11 affiliates in 21 languages, including de Moçambique and O País), and several Portuguese and English for national service additional periodicals have established and local languages for provincial news themselves in the market in the past At the United Nations General Assembly was enabled through the Constitution,147 and programmes. According to a 2005 years, including the first free newspaper, in 1996, a resolution was adopted which provides for freedom of expression study conducted by the African Media A Verdade. Despite the increase in print stressing “the need to support two-way and the citizen’s right to information. Development Initiative, 98 per cent of media, the issues of availability and price communication systems that enable Article 74 of the Constitution states that the urban population had listened to the – compounded by illiteracy rates of 48 per dialogue and that allow communities to “the mass media play an important role in radio in the past 12 months, of which 91 cent among those aged 15 or older156 – result speak out, express their aspirations and implementing these rights, as well as giving per cent had listened to radio in the past in low access, such that only one per cent of concerns and participate in the decisions value to the other individual and collective seven days.150 Although Radio Mozambique the population makes use of print media.157 that relate to their development.”146 rights enshrined in the Constitution.”A controls the most widely listened-to radio These communication systems and the comprehensive Press Law,148 approved in stations in urban areas, the National Forum At the TV broadcasting level, there are four emerging field of communication for 1991 and under revision in 2009, further of Community Radios (FORCOM), created television broadcast stations, including development (C4D) are receiving increasing promotes freedom of the press and covers in 2004, has registered over 60 community public and private television networks. acknowledgment in Mozambique for the most aspects of media and journalistic work. radio stations across the country, up from Televisão de Mocambique (TVM), the integral role they can play in advancing Media regulation in Mozambique is under only one in 1994.151 The community radios state-owned network launched in 1981, the human rights situation of children and the leadership of the Information Bureau cover nearly half of Mozambique’s 128 continues to dominate broadcasting and communities. (GABINFO), the state body tasked with the districts152 and broadcast in both Portuguese now reaches most of the country as the administrative registration of all media. and local languages. Most are non-profit result of the establishment of relay stations Since the adoption of a new constitution in GABINFO also issues licences for new print community radio stations, many of which in 1992, followed by a move to satellite. 1990, Mozambique has seen its media sector and broadcast media outlets, though the were established with the involvement of Private broadcast companies have been grow in both breadth and depth. Private Instituto Nacional das Comunicações de the UNESCO Media Project; others pertain gaining in economic strength and visibility media outlets have proliferated, state- Moçambique (INCM), part of the Ministry of to religious organisations (mainly the and are beginning the process of setting run media have worked to adopt a public Transport and Communications, provides Catholic Church), municipal authorities, up offices and repeaters in the provinces. service format, and increasing numbers licenses for the use of radio frequencies.149 or the Institute of Social Communication Though household television ownership of community-based radio stations serve (ICS), a Government department under went from five to ten percent between the rural areas. Though still nascent, growth Acknowledging that interventions focused on GABINFO with the mandate to develop rural years 1997 to 2007158,159 and group viewing of the information, communication, and information and communication are central communications. patterns mean that even those without a entertainment industries has created an to bringing about participation of all citizens, television set are sometimes able to watch important enabling environment for C4D meeting their information needs and hearing In a country where only 40 per cent of the broadcasts, television remains out of reach activities. The improving organisation and their voices, the country’s Plan of Action for population speak Portuguese (and only for the majority of Mozambicans: access to capacity of civil society agencies, including the Reduction of Absolute Poverty “PARPA 6 per cent as a mother tongue),153 these television depends on access to electricity those specialising in C4D, health promotion, II” placed special attention on access to community-based radio stations with and penetration of service, and as such HIV prevention, and human and child rights information and knowledge as essential programming in local languages are a key remains largely confined to urban centres. advocacy, has facilitated coherent – and means to increasing participation and vehicle for mobilising community leaders increasingly decentralised – communication dialogue, and engaging citizens in the fight and promoting participation of children, Mobile service penetration and number planning and implementation. against poverty. This strategic commitment, young people and women in community of subscribers in Mozambique increased combined with the Constitution and Press debates. A 2006 assessment of the impact of significantly during the first decade of the new century, with two mobile 6.1. Mass media development in Law, has facilitated rapid improvements eight community radio stations found that in general access to information in almost 100 per cent of the interviewees said network operators, Mcel (owned by Mozambique Mozambique, and the country has witnessed they listen to local community radio; many Telecomunicações de Moçambique) and Vodafone, dividing the market. In 2000, The development of the media sector in expansion from limited, State-owned expressed opinions that radio belongs to the networks to a more pluralistic media sector community, as it provides local information, less than one per cent of the population Mozambique has been playing a crucial role had access to a mobile phone; this number in supporting governance, development, comprising radio, print, television stations, gives opportunities for people to express increased to about 23 per cent160 in less and information dissemination since internet and mobile services, owned and their opinions and concerns, and promotes operated by various State, community, faith- local culture.154 than ten years, with total subscribers the 1975 founding of the state-owned 161 based and private sector bodies. estimated at 4.2 million in 2008. Internet Rádio Moçambique (RM) and Agência de In the print media sector, the number access, on the other hand, is almost entirely Informação de Moçambique (AIM), the Radio remains the mass medium with of registered newspapers, magazines, confined to urban centres and remains country’s domestic news agency. The greatest coverage. The national public pamphlets and information bulletins even more limited than television. Data emergence of free and independent media broadcaster, Radio Mozambique, reaches grew to 254 in 2006.155 There are three from 2006 indicated there were over 18
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internet service providers nationally. Only 6.3. Promising initiatives in activities are designed with the participation performers. Through their performances, two per cent of the population have internet Mozambican media of local leaders and, where available, youth they raise awareness and promote positive access.162 Nevertheless, the internet is being association members. The units also provide attitudes and behaviours167 in the areas increasingly used by the media sector, Besides the more conventional forms of an opportunity for testing and counselling on of child survival, girls’ education, gender represented by several online news sites and radio, television, and print media, several HIV and AIDS. awareness and HIV prevention. At the end of a growing number of blogs and discussion alternative forms of media have been each play, a dialogue is established between fora. gaining increased popularity in Mozambique. To stimulate engagement and participation the actors and the audience. By using an approach that combines of more children and young people in the media arena and provide them with a more 6.2. The changing role of the several forms of media and dialogue, these 6.4. Child-friendly networks and media: communication initiatives have a tremendous potential to regular platform to express their opinions, engage more people, particularly youth, in Radio Mozambique established the Child-to- partnerships for development and Child programme, comprising community educational activities, public dialogue and In addition to the initiatives being carried community mobilisation radio broadcasts for children by children. debate. These initiatives include Community out at local levels, national networks and The Child-to-Child programme facilitates the Not only has the reach of the media Multimedia Centres (CMCs), Multimedia partnerships with key players in the media link and communication between parents expanded over the years, but so has the Mobile Units, Child-to-Child Radio, and and communications industry are starting and children at the community level on key Community Theatre programs. to show potential as vehicles to spread content and purpose of programming. child rights issues. The programme also In addition to the more traditional use of messages about children’s rights throughout Community Multimedia Centres combine contributes to the fulfilment of articles 12, the country. media as a means of disseminating public community radio with other forms of 13 and 14 of the Convention of the Rights of information and broadcasting music, Information and Communication Technology the Child, which establish children’s rights To report on the situation of children’s rights radio and other forms of media now also (ICT). By having a physical ‘telecentre’ with to freedom of expression, freedom to seek in Mozambique, the non-governmental include social education and community computers, internet service, telephones, and impart information, and freedom of organisation Media Institute of Southern development programmes designed to fax machines, photocopiers and printers, thought, conscience and religion. Over one Africa established a Child-Friendly Media prompt people to adopt and maintain individuals and community organisations thousand children and adolescents ranging Network (Rede de Comunicadores Amigos healthy behaviours. Media activities and are able to make better use of information from 11 to 18 years – of whom 60 per cent da Criança) in 2007, involving more than strategies have been developed to raise and media. The Community Multimedia are female166 – are actively involved in the 300 journalists nation-wide. The network awareness of development issues among Centres also provide training opportunities development, production and presentation uses the mass media to publish articles mass audiences and opinion formers, and enable the community organisations of the radio programmes. In 2007, Radio on child rights, disseminate information to influence attitudes and behaviour at that run them to earn a small income from Mozambique’s child-to-child programme and knowledge on children’s issues, and individual and collective levels, and to fees charged for training, use of the internet, won the International Children’s Day of denounce violations of child rights. In empower vulnerable and marginalised or other services. By 2007, 18 Community Broadcasting Award competition for “Radio addition, the network conducts training for groups including children and young people. Multimedia Centres were operational Excellence” in recognition of the central role capacity building of journalists, publishes across the country, with at least one in each that children play in addressing child rights regular reviews and recommendations for This kind of media support has also province.164 The institutional framework issues through developing, producing and the media on how to cover issues related received special attention as a critical driver of the Community Multimedia Centres is presenting radio programmes for their peers. to children, engages in public debates with for securing the necessary participation, still weak,165 and their utility and success experts on topics related to child rights, Across the country, but especially in areas ownership and accountability for achieving will depend on increased public sector and participates in advocacy campaigns for with more limited access to technology, the MDGs.163 In this light, communication ownership and investment. the adoption and implementation of child- community theatre has proven to be an for development strategies and approaches friendly policies and legislation.168 A second promising initiative, run by effective interpersonal communication relating to key child survival interventions the Institute of Social Communication, means to strengthen community knowledge (such as the Child Health Weeks and In terms of partnerships with the private makes use of Multimedia Mobile Units. and to stimulate and encourage debate on the National Sanitation Campaign), and sector, mobile telephone service providers The twelve units – each vehicle equipped matters of social interest, particularly for promotion of child rights (such as birth have been leveraged to disseminate with a video projector, a giant screen for children and young people. The Community registration and prevention of violence and occasional pro-social messages. Mcel, projection of films, a radio, a tent and Theatre Network, comprising over 100 which claims over 3 million subscribers abuse) are currently being developed and supplies for HIV testing, and educational theatre groups nation-wide, uses the and a market share of 70 per cent, has been promoted nationally. They aim to provide xi materials – travel to rural communities ‘Teatro do Oprimido’ approach to stage supporting activities which promote the well- caregivers and community members with where they typically stay for four days at drama performances that invite members being of children in Mozambique. In 2008, a essential information to develop the skills a time. Once there, the mobile unit team of the audience to actively participate as partnership for Child Rights in Mozambique and self-confidence to make informed mobilises the community around key issues decisions on issues that affect their lives and using audiovisual presentations to engage their children’s well-being. participants in dialogue and debate. The xi Theatre of the Oppressed – a style of drama developed in Brazil as a tool of exploring real life experiences.
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was able to build on Mcel’s marketing in effecting change in child welfare are still References power by using its distribution channels limited in the country, especially in relation to disseminate child rights messages. to the print media, television, and internet. Information related to the Children’s Act and The reinforcement of freedom of expression 1 United Nations General Assembly, Universal 12 Tvedten, Inge, Margarida Paulo and Georgina general child rights messages were printed and sustainability of the newer initiatives Declaration of Human Rights, United Nations, Montserrat,Gender Policies and Feminisation on over 10 million Mcel recharge cards. This are among the greatest challenges to the New York, 1948. of Poverty in Mozambique, CMI Report, Chr. Michelsen Institute, Bergen, 2008. collaboration grew into a national campaign, media sector. The high and unchanging level 2 United Nations General Assembly, with television and radio spots, newspaper of information deprivation suggests that Convention on the Elimination of All Forms 13 National Institute of Statistics,‘MICS advertisements and out-of-home media. messages transmitted through conventional of Discrimination against Women, United 2008,Relatório Final,’ Government of forms of media are unlikely to reach a large Nations, New York, 1979. Mozambique, Maputo, 2010. proportion of children. Increased attention 6.5. Information deprivation 3 14 therefore should be placed on the alternative United Nations General Assembly, Vienna Ministry of Education and Culture, Education Declaration and Programme of Action, World Statistics: Annual school survey, Government forms of media and communication that Unfortunately, the recent growth in Conference on Human Rights, Vienna, 14-25 of Mozambique, Maputo, 2004, 2005, 2006, are gaining strength in Mozambique, the media sector has yet to decrease June 1993, A/CONF.157/23, 13 July 1993. 2007, 2008. the incidence of Mozambican children especially in rural areas. Communication for experiencing severe information deprivation, Development strategies focusing on children 4 Ministry of Planning and Finance, Plano de 15 Ibid. need to involve more local leaders, social Acção para a Redução da Pobreza Absoluta, defined as the proportion of children 16 Pinheiro, Paulo Sergio, World Report on 2001–2005, Government of Mozambique, between 5 to 18 years of age with no mobilisers and activists in the interventions. Violence Against Children, United Nations Maputo, 2001. possession of or access to a radio, television Secretary-General’s Study on Violence against The Child-Friendly Media Network or newspaper at home. A 2009 analysis 5 Ministry of Planning and Development, Children, Geneva, 2006. of childhood poverty169 commissioned demonstrates that journalists across the Proposta de Programa do Governo para 2010– 17 Tvedten, Inge, Margarida Paulo and Georgina for the Impact Evaluation of PARPA II country can unite behind children’s issues, 2014, Government of Mozambique, Maputo, Montserrat,Gender Policies and Feminisation using a deprivations-based measure of but additional work in local languages using 17 February 2010. of Poverty in Mozambique, CMI Report, Chr. poverty drawing on the Bristol Indicators170 mass media and community media still 6 Ibid. Michelsen Institute, Bergen, 2008. revealed that 40 per cent of children needs to be mainstreamed to disseminate were experiencing severe information the communication messages more 7 Tvedten, Inge, Margarida Paulo and Georgina 18 United Nations Committee on the Elimination deprivation in 2008. There was no evidence intensively. Partnerships with the private Montserrat, Gender Policies and Feminization of Discrimination against Women, of any change in the proportion of children sector can also be strengthened. As proven of Poverty in Mozambique, CMI Report, Chr. ‘Consideration of reports submitted by States experiencing severe information deprivation by the 2008 Mcel campaign, there is room Michelsen Institute, Bergen, 2008. Parties under article 18 of the Convention on to explore the systematic use of mobile the Elimination of All Forms of Discrimination between the 2003 Demographic and Health 8 Cruzeiro do Sul, ‘Análise multidimensional telephony for development and rights- against Women, Combined initial and Survey and the 2008 MICS, on which the da pobreza em três aldeias do norte de oriented results; other partnerships may second periodic reports of States Parties 2009 analysis was based. The analysis also Moçambique, Relatório Final,’ Maputo, 2007. – Mozambique,’ CEDAW/C/MOZ/1-2, United reported that severe information deprivation also hold great potential if strategically 9 Nations, Geneva, 14 November 2005. is highly correlated with the wealth of a developed. Cuangara, Benedito and Brendan Kelly, ‘The impact of the PARPA II in promoting the child’s household. Children in the poorest 19 Tvedten, Inge, Margarida Paulo and Carmeliza A final challenge is that monitoring and agricultural sector in Mozambique,’ retrieved households are nearly seven times more Rosário, “Opitanha”: Social relations of rural evaluation of C4D interventions remains from: http://www.open.ac.uk/technology/ likely to experience severe information poverty in northern Mozambique, CMI Report expensive—and therefore—limited, with mozambique/pics/d119369.pdf, 2009. deprivation than those in the wealthiest 2006:16, Chr. Michelsen Institute, Bergen, heavy reliance on qualitative data that households. 10 Ministry of Planning and Development, Norway, 2006. are difficult to apply across programmes Plano de Acção para a Redução da Pobreza 20 National Institute of Statistics, ‘MICS 2008, and geographic locations. This situation Absoluta, 2006–2009, Government of Relatório Final,’ Government of Mozambique, 6.6. Conclusions should change in the coming years with the Mozambique, Maputo, 2006. growing recognition that achievement of the Maputo, 2010. Despite the progress made in the 11 Ministry of Planning and Development, Government’s poverty reduction objectives 21 Ibid. communication sector, the full potential – as well as the MDGs – will depend Ministry of Women and Social Action 22 of the media to disseminate information, significantly on the expansion, consolidation, and Gender Coordination Group, Gender Tvedten, Inge, Margarida Paulo and Carmeliza engage communities in debate, and and alignment of communication efforts Development Index no Contexto da Avaliação Rosário, “Opitanha”: Social relations of rural do PARPA II, 2006–2009), Government of poverty in northern Mozambique, CMI Report contribute to an improved environment across the public, private, and civil society Mozambique, Maputo, 2009. 2006:16, Chr. Michelsen Institute, Bergen, for children has yet to be realised. Overall, sectors. the reach of the media and its usefulness Norway, 2006.
220 221 CHILD POVERTY AND DISPARITIES IN MOZAMBIQUE 2010 CHAPTER 6: CROSS-CUTTING ISSUES
23 Tvedten, Inge, Margarida Paulo and Georgina 32 Fox, Louise, Beating the Odds: Sustaining de Vida em Moçambique, Swiss Agency for 56 Ibid. Montserrat, Gender Policies and Feminisation inclusion in Mozambique’s growing economy, Development and Cooperation, 2009. 57 Joint United Nations Programme on of Poverty in Mozambique, CMI Report, Chr. The World Bank, Washington, D.C., 2008. 45 National Institute of Statistics, ‘MICS HIV/AIDS, Mozambique Modes of HIV Michelsen Institute, Bergen, 2008. 33 United Nations Development Programme, 2008,Relatório Final,’ Government of Transmission and HIV Prevention Study, 24 United Nations Committee on the Elimination Mozambique National Human Development Mozambique, Maputo, 2010. 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London School of Hygiene and Tropical June 2001. 36 Ministry of Planning and Development, 49 National Institute of Statistics, ‘MICS 2008, Medicine, and UNICEF, Mozambique National Relatório de Avaliação de Impacto do PARPA 26 Southern African Research and Relatório Final,’ Government of Mozambique, Childhood Mortality Study 2009, Government II, 30 October 2009, para. 108, Government of Documentation Centre, Instituto Superior de Maputo, 2010. of Mozambique, Maputo, 2009. Mozambique, Maputo, 2009. Relações Internacionais, National Institute of 50 Ibid. 60 Ibid. Statistics and United Nations Development 37 UNICEF, Trends in Child Poverty in Programme, Mozambique National Human Mozambique. A deprivations-based approach, 51 Ministry of Women and Social Action, 61 National Institute of Statistics and Ministry Development Report 2007, UNDP, Maputo, Ministry of Planning and Development, Inquérito sobre Violência Contra a Mulher, of Health, Inquerito Nacional de Prevalencia. 2007. 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