Health in a Changing Landscape in Africa
Mozambique
Dr. Feng Zhao
Health Manager
Human Development Department
The African Development Bank
Outline
 A rapidly changing landscape in Africa
 An innovative strategy for engaging in health
 AfDB’s engagement in health in Ghana
 Plan for next phases
 Areas of interest
Changing Landscape
 Continued economic growth
 Population dividend
 Changing aid dynamics
 Increased need for value for money and
domestic accountability
 Opportunity for innovative ways of delivering
services (e.g. ICT solutions)
Guiding documents
Medium-Term Strategy
Human Development Strategy
 Focus Area 1. Improve Competitiveness and Employment
Opportunities
 Focus Area 2. Value for Money and Accountability in Service Delivery
 Focus Area 3. Risk Protection, Inclusion and Social Cohesion
Instruments
Public sector window
Private sector window
Lending: Loan/grant
Non-lending: Analytical work; TA
New strategic thinking on health
 The Bank has been supporting health since 1970s
 Traditionally, the Bank focused on health sector infrastructure
e.g., hospital construction
 Shift in Instruments: Stand-alone vs. partnership; focusing on
value for money and domestic accountability (Kaberuka’s
paper).
 Shift in focus: Health infrastructure vs. system strengthening
 Partnership: PPP; alternative financing mechanism (e.g. value
for money trust fund)
Leadership
 Demand for African leadership
 The Bank has recently made strategic HR
investments ( for example the hiring of health
economists, HRH and health insurance
specialists) and is now well positioned to
exploit the new opportunities
New approach
(a). The new approach includes multi-sector
operations e.g. health (including nutrition) in
agriculture, climate change, water and
sanitation; private sector operations such as
PPPs for hospital construction and
management; provision of essential drugs e.g.
for HIV/AIDS; ICT operations in eHealth.
New approach
(b). The Bank will pursue innovative partnerships
to mobilize and leverage resources for the
Continent. For example, the Bank is currently
discussing a new Multi-donor TF to support
value for money and domestic accountability as
well as to sustain the coverage of essential HIV
services that are affected by the decrease of
ODA from the traditional donor community.
New approach
(c). The Bank will work with RMCs and private
sector to revitalize the pharmaceutical industry
and make it an engine for economic growth and
job creation. In this regard, the Bank is
discussing with South Africa to explore the best
way of supporting the first ARV production line of
the continent.
New approach
(d). The Bank will also focus on knowledge
products in critical areas such as health
insurance and eHealth. For example the Bank is
currently working on a Continent-wide study of
health insurance models which can be applied in
Africa.
Past support to Mozambique
 The Bank’s involvement in Mozambique dates back to 1977, while involvement in
health only commenced in 1992 when it financed a comprehensive health sector
requirements study commissioned by the Government.
 The Government of Mozambique with the support of development partners prepared its first Health Sector
Plan (2000 - 2004) that aimed at reducing morbidity and mortality through primary health care, development
of technical and managerial capacity of health providers and managers. This coincided with the first Country
Strategy Paper for the period 1999 -2001. The priorities for this maiden CSP were poverty alleviation and
human resources development and supporting, the GoM in the areas of i) infrastructure development and ii)
training and control of infectious diseases. The implementation of both the Beira Corridor health Project and
Mozambique Health II was prolonged due to capacity constraints with the result that they were completed in
2009 and 2010 respectively in the third CSP (2006-2010). During this period, the GoM submitted a
preliminary request for support from the Bank for assistance in health human resources development,
which was identified as a need in 2008. However this was not followed with a formal request for financing.
Thus Mozambique Health II was the last Bank intervention in Mozambique health sector. The focus of this
project was on i) Improved Primary Health Care Delivery; ii) Institutional Development; and Management
Capacity Building both of which were expected to contribute to improved service quality and efficiency of
delivery.
Current CSP
 The Bank’s current CSP for the period 2011-2014 has been anchored on the pillars
of the PARP 2010-2014.
 The operations under this CSP are selective and focus on enhancing
competitiveness by promoting regional integration through the development of key
infrastructure, and fostering private sector through human capital development by
supporting public service delivery and efficiency in line with the Bank Group’s 20082012 Medium Term Strategy (MTS) and the Southern Africa 2011-2015 Regional
Integration Strategy Paper (RISP).
 The CSP has been prepared in response to the prevailing country’s challenges
through the following pillars: (i) Pillar I: Enhanced private sector competitiveness
through infrastructure development; Pillar II: Governance in support of inclusive
growth.
CSP Analysis of Health
 The CSP notes that health and social indicators in Mozambique are still poor with
life expectancy at 48 years in 2010 well below the SSA average of 56 years. There
is also a high prevalence of infectious diseases such as malaria (responsible for25%
of annual deaths), HIV/AIDS (prevalence rate of 11.5% in 2009), and child
malnutrition (with stunted growth affecting 46% of children in 2008). The CSP also
acknowledges that the high disease burden has a negative impact on labour force
productivity via increased absenteeism and deterioration of cognitive skills as well as
aggravating poverty. The document nonetheless points out that certain
inefficiencies need to be addressed in the health sector, in particular the referral
system, management of decentralized health services and provision of drugs. While
pointing out the need for an increase in public expenditure allocated to the sector
which remains below developing countries level of 4% of GDP, there is no planned
financing for the sector under the current CSP.
Possible future support
 The Bank should explore more PPP activities in the
Health sector.
 Analytical work
 Regional operations including Mozambique