While Mozambique has made sustained progress in reducing under-five mortality, over 28,000 of the more than 950,000 children born each year die during the first 28 days. Neonatal deaths account for over 30% of deaths among children under-five years of age. Successive national surveys since the late 1990s have shown a continuing downward trend, accelerating since the 2008, falling to 97 child deaths per thousand live births placing the country on track to achieve MDG 4.
Unfortunately, for new-borns, progress in reducing mortality has been much slower. A number of both supply and demand factors have persistently contributed to the slower progress. Access to skilled assistance during delivery is still low, as approximately 40% of pregnant women deliver their children at home; the low quality of obstetric and neonatal services at health facilities; and there is a low level of awareness as well as cultural barriers to healthy practices during pregnancy, child birth and postpartum care.
At health service delivery level, the greatest constraints are related to low number of health facilities; they are insufficient to permit all pregnant mothers convenient access to delivery services. This is made worse by the poor infrastructure, lack of equipment and an irregular availability of supplies and medicines in many health facilities. Additionally, there is an insufficient health workforce to cope with the demand for services, and issues such as personal motivation, retention and staff skills are also major determinants of the quality of services.
Immunization is the most successful and cost-effective public health intervention to reduce child mortality and improve children health. The Expanded Program on Immunization was launched in Mozambique in 1979, under the Primary Health Care Program, with the main objective of reducing mortality and morbidity from vaccine preventable diseases. The program focuses on children under one year of age and pregnant women and uses a two-pronged approach to ensure that children may receive immunization: routine immunization services as part of the regular primary healthcare system and twice yearly “National Health Weeks” designed to reach all children to further increase coverage.
Immunization services are offered in 95% of health facilities, however, more than 50% of the population lives more than 8 km away from the nearest health facility. These communities can only be reached by outreach visits performed by health facility staff. National Health Weeks, conducted twice a year since 2008, have reached hundreds of thousands of children who had not been reached previously by static routine immunization services. In 2014 alone, the two National Health Week campaigns reached over 8.5 million of children with vaccination against measles, provided vitamin A and iodine supplements and offered deworming medicine and long-lasting insecticide treated mosquito nets.
With support of the Global Alliance for Vaccines and Immunization, Mozambique has successfully introduced several new vaccines during the past decade – extending the benefits of vaccination to prevent infection by many causes of severe pneumonia and meningitis and hepatitis B. Later in 2015, Mozambique will also introduce the rotavirus vaccine, effective in reducing the most severe and life-threatening forms of diarrhea – a major cause of child mortality.
What is being done and the way forward
Supporting national policy development, coordination
- Discussions at the national level for ensuring policies are adjusted to the new vaccines being introduced
- The planning for vaccination program as well as adjusting and increasing of the staff serving the vaccination program
- The update of guidelines in view of the new vaccines being introduced
- The strengthening of the health system through technical support to the Ministry of Health for routine and supplementary immunization activities
- The strengthening of the logistical capacity of the Ministry of Health, including an efficient cold chain system.
Strengthening capacity of care givers, including families and health staff
UNICEF continues to support the implementation of communication initiatives to promote increased dialogue between communities and service providers and encourage people to adhere to routine and campaign immunization activities, involving Community Health Workers in this approach
Support the introduction of new vaccines
- Provide technical and financial support to put in place adequate infrastructure to support service delivery for the new vaccines, such as the vaccine against Rotavirus
- Support the logistics for the purchase and delivery of vaccines and keep improving the cold chain through revision and monitoring the program
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