Conference on Health Financing and its impact on citizens’ access to services: evidence from Civil Society

It was an open conference, with a very clear connection and objectives, following the Declaration of Commitments for health financing assumed by the Ministry of Health and the Ministry of Economy and Finance. The objectives and contextualization of the event's themes were presented, at the beginning of the work, by the Coordinator of the Alliance for Health, Violeta Bila, and the General Director of Chemonics UK, Louise Quy.

Mozambique has a challenging context and, for this reason, stimulating for our creativity. Some of the structural constraints mentioned, such as the high rate of poverty, an exponential population increase, constraints in the management of the health budget, or the recent instability and insecurity related to terrorism in the country, place the sector under unprecedented pressure.

 The First Panel featured two presentations:

Within the scope of the presentation made on user fees and their impact on access to healthcare, by Rogério Simango from the Citizen Observatory for Health, with the support of Dr Daniel Simone, the following stand out:

• It is important that we receive the expected budget in a timely manner and improve (as a sector) the execution of the resources received, as a sign of the sector's operational capacity and the ability to attract more resources.

• Mozambique remains committed to the mission that the health sector must guarantee universal coverage, without harming the user.

• In this sense, user fees must be operationalized in the country, and it is an ongoing discussion;

• In the end, the aim is for the sector to function fully in its flow, from the primary level to the quaternary level, in all access arms – medicines, HR, equipment, among others.

In the following presentation, essential issues related to access to health and the right to privacy were addressed, with the participation of Eduardo Malo from NAMATI Mozambique, supported by Dr Clemencia Dgedge, turning our attention to an area that substantiates the evident need sector financing, so that we can invest in and improve our health facilities at all levels and in all the services they provide.

In this same presentation, the need to invest with a sustainability perspective was highlighted, so that the achievements demonstrated in NAMATI Mozambique presentation can be maintained. “It is important that we work with the health system from the perspective that this is a living system with several key actors”, including community-based actors and citizens themselves. We must, therefore, be innovative and comprehensive to think about sustainable health and true universal coverage in Mozambique.

The discussion held during the morning was supported by presentations of studies carried out in Mozambique and internationally.

The Second Panel also featured two presentations:

The first marked the start of the afternoon session and featured the remote participation of Elis Borde, from the Research Group on Health Inequalities, Ecology - Employment Conditions Network, from Pompeu Fabra University in Barcelona, who shared the research carried out over the last 3 years, in partnership with medicusmundi and the National Institute of Health. Through an analysis based on the social determinants of health, this research provides evidence on inequalities in access to health in Mozambique and highlights the need for increasingly more scientific information in Mozambique's health system, so that we can better understand how it works and, based on this same evidence, make the most sustainable decisions that are appropriate to the country's needs.

In this sense, the need to invest in the production of scientific and collaborative knowledge (civil society, government, scientific community, cooperation partners, among others) was reiterated, as was demonstrated and made clear at this conference, based on approaches such as that of health determinants, which is fundamental to guarantee financing for sustainable universal health coverage in Mozambique.

With the second presentation made in this panel, this time on the Argentine health system, given by Marcelo Ochoa, from the General Sarmiento National University of Buenos Aires, topics such as public sector financing strategies, or the recovery of benefits from public hospitals. And the argument was reinforced that creativity, innovation and ingenuity are crucial in the face of intricate scenarios such as health in Mozambique.

It was also clear that, by seeking alternatives to guarantee financing for the sector, it is possible to achieve a resilient health system for everyone without exception and, perhaps, even generate greater efficiency. For those present at the Conference, Mozambique is not an isolated case and, therefore, exchanges of experiences can always be fruitful, so that the country can find other alternatives and position itself as a case study for others, through its successes and learning.

Therefore, Civil Society is, without a doubt, a “mechanism” that must support the monitoring, transparency, and accountability of the health sector, but also an actor that supports the Ministry of Health in finding creative solutions to the complex reality in that we operate. We believe that, through the Conference organized by the Alliance for Health, it was possible to take another step in this direction – guaranteeing financing for the health sector for quality, sustainable and resilient universal coverage.

The Alliance for Health is funded from the Spanish Agency for International Development Cooperation (AECID) and other donors such as the Potenciar Program, on this occasion.