Mozambique is a country with an approximate area of 802 thousand sq. km. (UNO, 2001). Its population is 19.183 million, and the sex ratio (men per hundred women) is 93 (UNO, 2004). The proportion of population under the age of 15 years is 44% (UNO, 2004), and the proportion of population above the age of 60 years is 5% (WHO, 2004). The literacy rate is 62.3% for men and 31.4% for women (UNESCO/MoH, 2004).
The country is a low income group country (based on World Bank 2004 criteria). The proportion of health budget to GDP is 5.9%. The per capita total expenditure on health is 47 international $, and the per capita government expenditure on health is 32 international $ (WHO, 2004). The main language(s) used in the country is (are) Portuguese (official), Emakua, Xichangana and Elomwé. The largest ethnic group(s) is (are) African. The largest religious group(s) is (are) Roman Catholic, and the other religious group(s) are (is) Muslim and indigenous groups. The life expectancy at birth is 41.2 years for males and 43.9 years for females (WHO, 2004). The healthy life expectancy at birth is 36 years for males and 38 years for females (WHO, 2004).
There is a paucity of epidemiological data on mental illnesses in Mozambique in internationally accessible literature. In 2003, the Ministry of Health conducted a mental health community study in an urban and a rural district. The prevalence of psychoses, mental retardation and epilepsy in the urban area were 1.5%, 1.1% and 1.3%, while the prevalence of these disorders in the rural area were 5%, 1.8% and 3.9%, respectively. Rural-urban differences were highly significant (MoH, 2002-2003). Granja et al (2002) conducted a retrospective hospital-based study on deaths from injuries among pregnant/postpartum women (n=27) and found that suicide was the cause in one-third of cases.
MENTAL HEALTH RESOURCES
Mental Health Policy A mental health policy is absent. The final draft is now ready and is awaiting approval.
Substance Abuse Policy A substance abuse policy is present. The policy was initially formulated in 1997. The policy is to be reviewed every two years.
National Mental Health Programme A national mental health programme is present. The programme was formulated in 1990. The draft National Mental Health Strategic Plan is likely to be approved in 2004.
National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. It was formulated in 1999.
Mental Health Legislation Specific legislation on mental health is not available. However, Law No 1/99 (formulated in 1999) controls and regulates access of youngsters to the night clubs as well as projection of certain videos and also controls the sale of alcohol and tobacco. Details about the year of enactment of the mental health legislation are not available.
Mental Health Financing There are budget allocations for mental health. Details about expenditure on mental health are not available. The primary source of mental health financing is tax based. The state budget as well as funds from different partners are allocated to the health sector as a whole and re-distributed through different programmes. The specific amount for mental health is determined according the national yearly plans and priorities, which often vary. The country has disability benefits for persons with mental disorders. Disability benefits are provided for persons with chronic mental disorders, such as epilepsy and psychosis by the National Institute of Social Welfare. Patients with chronic mental illness are also given a discount on their medical prescription.
Mental Health Facilities Mental health is a part of primary health care system. Actual treatment of severe mental disorders is not available at the primary level. Few health centres have outpatient facilities. Regular training of primary care professionals is not carried out in the field of mental health. Seminars are organized from time to time to train health workers in mental health. There are community care facilities for patients with mental disorders. Few such centres exist.
Psychiatric Beds and Professionals
psychiatric beds per 10 000 population
beds in mental hospitals per 10 000 population
beds in general hospitals per 10 000 population
beds in other settings per 10 000 population
- Number of
psychiatrists per 100 000 population
- Number of
neurosurgeons per 100 000 population
- Number of
psychiatric nurses per 100 000 population
- Number of
neurologists per 100 000 population
- Number of
psychologists per 100 000 population
- Number of
social workers per 100 000 population
Each province has at least 2 mental health professionals. Since May 2004, three newly trained Mozambican psychiatrists have joined the workforce; the remaining 7 are foreigners. Twenty-seven psychiatric technicians are now working in the health system. It is expected that by September 2005 the number will increase to 58 (31 technicians are under training). There is one psychiatric hospital in the country located in Maputo City, the nation’s capital, with a bed capacity of 260. The second psychiatric hospital located in the northern province of Nampula was closed as it did not offer minimal conditions for service delivery, and a Mental Health Community Centre was opened in its place. Service delivery (outpatient and inpatient care) primarily occurs at the provincial hospital level. Admissions are also made in general medicine wards, where approximately 3 to 5 beds are allocated to mental health.
Non-Governmental Organizations NGOs are involved with mental health in the country. They are mainly involved in promotion, prevention and rehabilitation. Some NGOs focus on rehabilitation of drug abusers.
Information Gathering System There is mental health reporting system in the country. New indicators for mental health reporting system in the country have been approved; they are introduced in the General Health Information System.
The country has data collection system or epidemiological study on mental health. Data collecting systems are being tested, statistical information on patients are being collected.
Programmes for Special Population A school for mentally challenged children exists. Efforts are now being made to mainstream the education of such children.
Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: carbamazepine, phenobarbital, phenytoin sodium, sodium valproate, amitriptyline, chlorpromazine, diazepam, fluphenazine, haloperidol, biperiden, levodopa. The essential drug list is under revision. Inclusion of newer (more effective) drugs has been proposed. The final list and new policy might be approved in early 2005.
Other Information WHO has undertaken a project in Cuamba district to integrate mental health into general health care at the primary level. Special emphasis is given to psychosocial support in collaboration with traditional healers. WHO has also assisted the Ministry of Health in drafting a mental health policy and updating the mental health programme. This programme would also be used in building the capacity of mental health professionals to provide community-based care.