Background: Despite substantial investment in women’s health over the past two decades, and enthusiasticgovernment support for MDG 5 and SDG 3, health indicators for women in Mozambique remain among the lowest inthe ...Background: Despite substantial investment in women’s health over the past two decades, and enthusiasticgovernment support for MDG 5 and SDG 3, health indicators for women in Mozambique remain among the lowest inthe world. Maternal mortality stayed constant from 2003 to 2011, with an MMR of 408;the estimated HIV prevalencefor women of 15-24 years is over twice that for men;and only 12.1% of women are estimated to be using moderncontraception. This study explores the perspectives of policy makers in the Mozambican health system and affiliates onthe challenges that are preventing Mozambique from achieving greater gains in women’s health.Methods: We conducted in-depth interviews with 39 senior- and mid-level policy makers in the Ministry of Health andaffiliated institutions (32 women, 7 men). Participants were sampled using a combination of systematic randomsampling and snowball sampling. Participants were asked about their experiences formulating and implementinghealth policies and programs, what is needed to improve women’s health in Mozambique, and the barriers andopportunities to achieving such improvement.Results: Participants unanimously argued that women’s health is already sufficiently prioritized in national healthpolicies and strategies in Mozambique;the problem, rather, is the implementation and execution of existing women’shealth policies and programs. Participants raised challenges related to the policy making process itself, including anever-changing, fragmented decision-making process, lack of long-term perspective, weak evaluation, and misalignmentof programs across sectors. The disproportionate influence of donors was also mentioned, with lack of ownership,rapid transitions, and vertical programming limiting the scope for meaningful change. Finally, participants reported adisconnect between policy makers at the national level and realities on the ground, with poor dissemination ofstrategies, limited district resources, and poor consideration of local cultural contexts.Conclusions: To achieve meaningful gains in women’s health in Mozambique, more focus must be placed onresolving the bottleneck that is the implementation of existing policies. Barriers to implementation exist across multiplehealth systems components, therefore, solutions to address them must also reach across these multiple components.A holistic approach to strengthening the health system across multiple sectors and at multiple levels is needed.展开更多
基金supported through the National Evaluation Platform(NEP)project,funded by Global Affairs Canada and implemented by the National Institute of Health[of Mozambique](INS)and the Institute for International Programs of Johns Hopkins University(IIP-JHU).
文摘Background: Despite substantial investment in women’s health over the past two decades, and enthusiasticgovernment support for MDG 5 and SDG 3, health indicators for women in Mozambique remain among the lowest inthe world. Maternal mortality stayed constant from 2003 to 2011, with an MMR of 408;the estimated HIV prevalencefor women of 15-24 years is over twice that for men;and only 12.1% of women are estimated to be using moderncontraception. This study explores the perspectives of policy makers in the Mozambican health system and affiliates onthe challenges that are preventing Mozambique from achieving greater gains in women’s health.Methods: We conducted in-depth interviews with 39 senior- and mid-level policy makers in the Ministry of Health andaffiliated institutions (32 women, 7 men). Participants were sampled using a combination of systematic randomsampling and snowball sampling. Participants were asked about their experiences formulating and implementinghealth policies and programs, what is needed to improve women’s health in Mozambique, and the barriers andopportunities to achieving such improvement.Results: Participants unanimously argued that women’s health is already sufficiently prioritized in national healthpolicies and strategies in Mozambique;the problem, rather, is the implementation and execution of existing women’shealth policies and programs. Participants raised challenges related to the policy making process itself, including anever-changing, fragmented decision-making process, lack of long-term perspective, weak evaluation, and misalignmentof programs across sectors. The disproportionate influence of donors was also mentioned, with lack of ownership,rapid transitions, and vertical programming limiting the scope for meaningful change. Finally, participants reported adisconnect between policy makers at the national level and realities on the ground, with poor dissemination ofstrategies, limited district resources, and poor consideration of local cultural contexts.Conclusions: To achieve meaningful gains in women’s health in Mozambique, more focus must be placed onresolving the bottleneck that is the implementation of existing policies. Barriers to implementation exist across multiplehealth systems components, therefore, solutions to address them must also reach across these multiple components.A holistic approach to strengthening the health system across multiple sectors and at multiple levels is needed.
