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Eye Health System Assessment in Mozambique

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Eye Health System Assessment in Mozambique Eye health system assessment in Mozambique November 2018 1 Eye health system assessment in Mozambique | Nov 2018 Authors Mariamo Abdala1; Margarida Chagunda1; Izidine Hassane3; Sérgio Chicumbe2; Pedro Pedroso2; Ana Mutola2; Ofélia Rambique2; Mariza Chivangue2; Mohomed Saide2; Mércia Cumaio3; Hélder Nhamaze4 & Stevens Bechange3 From 1National eye care programme: Ministry of Health, Mozambique; 2National Health Institute, Ministry of Health, Mozambique; 3Sightsavers Mozambique country programme; and 4KULA: Studies and Applied Research, Ltd Mozambique. 2 Eye health system assessment in Mozambique | Nov 2018 Contents Authors 2 Acknowledgements 5 Key abbreviations and acronyms 6 Executive summary 8 Background 8 Methodology 8 Key findings 9 Introduction 15 Study objectives 16 Overall objective 16 Specific objectives 16 Methodology 17 Study design 17 Sampling 17 Data collection, management and analysis 17 Ethical approval 17 Mozambique health system overview 18 Country context 18 Health services structure 18 Health care financing 18 Human resources for health 19 Management of health services 19 Medical products and technologies 21 Health services delivery 22 Health management information system 23 Overview of the eye health system in Mozambique 24 Eye health status 24 Eye health governance 24 Eye health financing 27 Eye health service delivery 29 Human resources for eye health 31 Drugs, products and equipment for eye health 36 3 Eye health system assessment in Mozambique | Nov 2018 Eye health information systems 36 Conclusions 38 Eye health governance 38 Eye health financing 39 Eye care service delivery 40 Human resources for eye health 40 Eye health medicines and medical products 42 Eye health information system 42 References 44 Appendices 47 Appendix 1: Study respondents 47 Appendix 2: Relatório annual de oftalmologia – 2016 49 4 Eye health system assessment in Mozambique | Nov 2018 Acknowledgements This publication is a result of efforts and contributions of various organisations and individuals. We would like to thank: • the government of Mozambique and the Ministry of Health for their leadership on all aspects of the study. • Sightsavers global teams, specifically Ms Bhavisha Virendrakumar, Ms Ziporah Mugwang’a, Mr Moses Chege and Dr Elena Schmidt for their overall technical assistance and methodological guidance. • Sightsavers country office in Mozambique for their organisational and logistical support. • Mr Helder Nhamaze and Ms Rita Sousa for the facilitation of the data analysis workshop and drafting the report. • numerous study respondents for their time and willingness to take part in the assessment. This study was funded by the UK Department for International Development (DFID) through a grant to Sightsavers. However, the views expressed in this report are those of the authors and do not necessarily reflect the UK government’s official policies. 5 Eye health system assessment in Mozambique | Nov 2018 Key abbreviations and acronyms ACAMO Blind and Amblyopic Association of Mozambique APE Elementary polyvalent agent AR Regulatory authority HSA Health System Assessment EHSA Eye Health System Assessment BHV Brien Holden Vision Institute WB World Bank CA Supply Centre CIBS-INS Institutional Bioethics Committee for Health of INS CMAM Drugs and Medical Supplies Centre CNSO Eye health national coordinator PEC Primary eye care DAF Administration and Finance Directorate DF Pharmaceutical Department DNAM Medical Assistance/Care National Directorate DNSP Public Health National Directorate DPC Planning and Cooperation Department DRH Human Resources Directorate EH Eye health EHS Eye health system PPE Personal protective equipment FAMOD Forum of Mozambican Associations for Disabilities FNM National drug form FSSO Eye health system strengthening GAAC Support groups and community membership GEMT Traditional Medicine Studies Office HS Health system 6 Eye health system assessment in Mozambique | Nov 2018 HCM Maputo Central Hospital HIV Human Immunodeficiency Virus HMIS Health management information system ICEH International Centre for Eye Health IMT Traditional Medicine Institute INS Health National Institute LNCQM National Laboratory for Drugs Quality Control LOLE Government municipality law LSHTM London School of Hygiene and Tropical Medicine MINED Ministry of Education and Human Development MISAU Ministry of Health MONASO Mozambican Network of AIDS Service Organisations NABP Norwegian Association of the Blind and Partially Sighted NAIMA Network of International NGOs working in Health and HIV in Mozambique WHO World Health Organization NGOs Non-government organisations OPD Organisation of people with disabilities PCI Infection Prevention and Control Program PEPFAR President's Emergency Plan to Fight AIDS PEP Post-exposure prophylaxis PVT Prevention of vertical transmission SMI Maternal and child health SS Sightsavers HAART Anti-retroviral treatment TB Tuberculosis OT Ophthalmic technicians UNICEF United Nations Children's Fund USAID United States Agency for International Development 7 Eye health system assessment in Mozambique | Nov 2018 Executive summary Background There are 253 million people who are visually impaired globally, including 36 million who are blind and 217 million who have low vision [2]. The majority of people with visual impairments live in low- and middle-income countries (LMICs). However, the scope of eye health interventions in many of these settings is limited due to the weaknesses of the broader health systems. It is widely acknowledged that the effectiveness of eye care programmes can only be improved through a better understanding of how eye health systems work and how they are integrated in the overall health systems. The purpose of this assessment was to examine different components of the eye health system in Mozambique and to assess its links with the broader health system, providing evidence for improved eye health programming and strengthening the system. The study specific objectives were: • describe the nature and functions of the broader health system in Mozambique. • describe the nature, scope and functions of the eye health system and how it is integrated in the broader health system. • document good practices and the key lessons learnt for consideration in future policy reviews and developments. • determine relative strengths and weaknesses of the eye health system to guide country-specific actions for eye health system strengthening. Methodology The study used the Eye Health System Assessment (EHSA) methodology developed in 2012 by a consortium of eye care and health experts, coordinated by the International Centre for Eye Health (ICEH) at the London School of Hygiene and Tropical Medicine (LSHTM) with funding from Sightsavers. The methodology builds on the more general Health Systems Assessment approach (HSA) previously developed by the United States Agency for International Development (USAID). The study used primarily qualitative data collection methods, a documentary review and in-depth interviews with key policy stakeholders. The fieldwork was conducted June–August 2017. Of the 11 provinces that make up Mozambique, seven were included in this study: Manica, Gaza, Maputo City, Niassa, Nampula, Maputo and Zambézia. Respondents to the in-depth interviews were selected, taking into consideration their involvement in eye care and in the health sector more broadly. A total of 45 in-depth interviews were conducted using a semi-structured topic guide. The study received ethical approval from the National Committee on Bioethics for Health of Mozambique. All participation was voluntary and informant written consent for an interview was obtained in all cases. 8 Eye health system assessment in Mozambique | Nov 2018 Key findings Eye health governance Strengths • The national eye health programme (PNO) is established under the Ministry of Health (MISAU) and is part of the National Directorate of Medical Assistance. • There is a national eye care coordinator, who provides leadership to the national programme and is responsible for the implementation of eye health policies throughout the country. • The government, through MISAU, has established partnerships with several international non- government organisations (NGOs), who support the delivery of eye care services across the country. • The eye health system in Mozambique complies with the same regulations as the broader health system. Standards, protocols, codes of conduct and certification procedures are the same as in the general health system. • There is also the Mozambique Eye Care Coalition (MECC), an advisory body to the PNO on matters related to eye health. The committee is comprised largely of non-governmental organisations and technical experts from MISAU. Weaknesses • Eye health stakeholders, and particularly civil society organisations (CSOs) and disabled people’s organisations (DPOs), are not adequately involved in setting priorities and budgets for eye health at all levels. • The visibility of eye health in both decision-making and allocation of resources is limited, as other diseases with high morbidity and mortality – such as malaria, HIV/AIDS and tuberculosis – receive more attention from both the government and development donors. • The capacity of the national eye health programme is limited, as it has to rely on voluntary contributions of technical staff who are engaged in multiple activities; at present, there are no senior technical experts who are exclusively involved in eye health policy-making. • Although advocacy efforts with
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