Mozambique - Health Service Delivery Project

Page 1 PROJECT INFORMATION DOCUMENT (PID) CONCEPT STAGE Report No.: AB2566 Project Name Health Service Delivery Project Region AFRICA Sector Health (100%) Project ID P099930 Borrower(s) REPUBLIC OF MOZAMBIQUE Implementing Agency Environment Category [ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined) Date PID Prepared September 22, 2006 Estimated Date of Appraisal Authorization Estimated Date of Board Approval December 13, 2007 1. Key development issues and rationale for Bank involvement Health Status. In 2003, Mozambique had an infant mortality rate (IMR) of 101 per 1,000 births and an under-five mortality rate of 153 per 1,000. The maternal mortality rate (MMR), estimated at 408 per 100,000 live births in 2003, has decreased significantly over recent years, but remains high. With 41 percent of children under 5 years old stunted and 24 percent underweight, malnutrition remains a problem as it constitutes one of the major underlying risk factor for childhood diseases, in particular infections. Mozambique is one of nine African countries hardest hit by the HIV/AIDS epidemic, with prevalence estimated at 16.5 percent. Malaria is the primary cause of death among children under five and was among the first three primary causes of certified deaths in a 2001 study done 1 . The effect of malaria for African countries has been estimated to be as much as 1.3 percent GDP reduction per year 2 . On the positive side, it is remarkable that, with only about 50-60 percent of the population with access to health services, Mozambique has managed to reduce the IMR by 32 percent between 1997 and 2003. However, much remains to be done as the allocation of resources has not been optimal: (i) the poor, while suffering from the worst health problems, have benefited the least from health spending; (ii) rural families have suffered from the relative decline of financial support to primary health care services, their main source of health care in rural areas; and (iii) regional imbalance remains salient. The Northern provinces, although with worse poverty and health status, still receive less help compared with other regions particularly the better-off Southern region. As a result, the coverage of essential health services for the poor, rural families and the disadvantaged regions remains low, and the corresponding service delivery system remains weak. 1 Principais causas de morte registadas, nas cidades de Maputo, Beira, Chimoio , Nampula, Manhi