Table 5 Vertical funding and inequalities within national health system

Lack of integration

“In vertical programs, the results are immediate…if you invest in Malaria you will see the results in a short time, it’s good for those who want to see the impact of funding but when you talk about the National Health Service, this is bad, since the resources are allocated for specific areas and we are not sorting out the problems of the communities.” (National director)

“The importance people give to these three diseases [HIV, malaria and TB] is a detriment to, for example, mother and child health, diarrhea, environmental health or mental health…I think that we should integrate all programs, and we would have better results.” (Provincial manager)

“We should look at the system, because if the partners are saying that they are giving funds to improve the health of population, then they should improve health in general and not choose specific areas, because what affects population health is a set of factors, a range of diseases that already exist, so if we look at one disease, we will help in that specific disease but the global result, to improve health, will not happen because there will be a lot of gaps.” (Provincial manager)

Refresher training

“[M]ost funding for ongoing training comes from vertical programs, and it’s natural that the programs have an interest in investing in people who perform such activities, they are not interested in funding ongoing training for all the workers.” (District manager)

“[F]or example, in a health center, if you talk with the health workers, some will tell you that in the last very few years they had 10 training courses and you will find out that 8 or 9 are HIV-related courses.” (Provincial manager)

“[B]ecause these [vertical] programs have a lot of funds, they absorb all existing capacity for ongoing training, and unfortunately in planning we never plan ongoing training per se.” (Provincial manager)

Neglected services and infrastructure

“No one has ever thought of strengthening the capacity of archiving the clinical files…That’s where we often lose patient information.” (National director)

“[T]hen we buy equipment [for a vertical program], where will this equipment be placed? Under a tree? It’s necessary to fund infrastructure, as well electricity, water in order for that equipment to work until we achieve the final goal, to test that patient with that specific disease. Well, we can’t think about strengthening the health system if all these basic conditions are not satisfied.” (National director)

“Well, if we talk about infrastructure, you will see that this laboratory, I think that this doesn’t have either good equipment nor good infrastructure. Because we have support from NGO “A”, we have a good laboratory outside this building where we perform all HIV patients’ analysis.” (District director)

Source: 41 interviews of Mozambique Ministry of Health managers 2008