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					Oficina de Trabalho sobre Desenvolvimento de Políticas de Recursos Humanos para Países Africanos
de Expressão Portuguesa




                     Instituto Multilateral da Africa
                            Instituto do Banco mundial,
        Organizaçõ mundial da Saúde, Instituto de Higiène e Medicina Tropical,
          Associação para o Desenvolvimento e Cooperação Garcia da Orta,
                       Governo do Brasil, Governo da Irlanda




                                              M EDI CI N A
                                              T RO PI CA L




  Oficina de Trabalho sobre Desenvolvimento de Políticas de Recursos Humanos
                 para Países Africanos de Expressão Portuguesa

                               Sandton, 17-21 de Outubro de 2005




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                Conteudo:
                Relatorio da oficina:
                      Antecendetes, p.2
                      Objectivos da oficina, p.2
                      Oficina de Trabalho, p.3
                      Pontos principais das apresentações finais, p3
                      Conclusões, p.6
                      Agenda da próxima fase, p.6
                Anexo I: Sumario das propostas das equipes nacionais, p.7
                Anexo II : Lista de participantes, p.10
                Anexo III : Agenda, p.13
                Anexo IV : (a) Apresentação geral dos paises (em inglès), p. 14 (b)
                Dados sobre Recursos humanos em saúde, p.33
                Anexo V: Avaliaçõ, p. 35


Antecedentes: A Instituto Multilateral da Africa (Joint Africa Institute, JAI), o Banco
Mundial e a Organização Mundial da Saúde estão empenhados em desenvolver a
capacitação dos países Africanos em planear e implementar políticas com aqual irão
melhorar o seu ambiente económico e o bem estar da população. Eles estão
comprometidos com os Objectivos de Desenvolvimento do Milénio (ODM), adoptados
pela comunidade internacional em 2000. Estes objectivos incluem três compromissos
directamente relacionadas com a saúde, aqual não seriam provávelmente alcançadas
sem uma boa qualidade de serviços de saúde e intervenções que são acessíveis,
particularmente para as populações mais vulneráveis.
Efectiva prestação de serviços de saúde não è possível sem uma força de trabalho que
(1) é suficiente em número, (2) possui uma relevante combinação de habilidades, (3) é
treinada apropriadamente, (4) é colocada em sítios aqual fazem acessíveis os serviços
para aqueles que mais precisam deles e (5) é apoiada por um ambiente instituicional que
encoraga e sustenta práticas de boa qualidade.
O maior passo para melhorar a actual situação, pode ser feito adoptando e
implementado melhores políticas e práticas para recursos humanos para a saúde RHS).
É neste contexto que o Instituto do Banco Mundial (WBI) e o JAI, em colaboração com
os seus parceiros, o Instituto de Higiène e Medicina Tropical (IHMT), a Associação
para o Desenvolvimento e Cooperação Garcia da Orta (AGO), e o Governo do Brasil,
com apoio financeiro do Governo da Irlanda, organizou a primeira Oficina de Trabalho
sobre “Desenvolvimento de Política sobre Recursos Humanos para Saúde”, em
Português, para os cinco países Africanos de língua oficial Portuguesa (PALOPS). No
médio prazo, os organizadores desejam desenvolver competências individuais e
capacidade institucional em apoiar o desenvolvimento de políticas e criar uma equipe de
especialistas em políticas para RHS nestes países, que irão trocar experiências,
aconselhar e apoiar-se mútuamente..

Objectivos da oficina : Ajudar as equipes nacionais em:
  o Aprender a identificar a ligação entre as várias dimensões de políticas sobre
      RHS, o desempenho de seus sistemas de prestação de cuidados de saúde, e
      progresso em direcção aos ODM;
  o Aprender quais os instrumentos existentes para apoiar a planificação,
      implementação, monitorização & avaliação de práticas e políticas para RHS;


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      o Rever criticamente o ambiente político sobre RHS;
      o Formular um plano de acção ou acelerar os processos de políticas sobre RHS em
        seus países.
      o Contribuir para a construção de uma política sustentável de RHS e a capacidade
        de gestão nos seus países.


Oficina de Trabalho : A Oficina teve a participação de responsáveis dos RHS e
dirigentes de alto nível do ministério da saúde, de educação e das finanças, provenientes
de todos os PALOPS (lista em anexo I). Se juntaram pofissionais da OMS, responsaveis
do tema RHS nos paises participantes, para favorecer uma percepçõ comparthilada dos
problemas e uma definiçõ des opções de solução em comum.
O programa alternou apresentações sobre temas específicos (agenda em anexo II) e
trabalhos de grupos relativos à situação dos RHS em cada contexto sanitário,
identificação das necessidades e planos de acção. Ênfase particular foi dada a hipóteses
e mecanismos de cooperação intra-países e com as agências organizadoras. Even though
the five countries are quite different in many respects (see annex III for country and
health workforce profiles), participants were able to identify many common issues and
opportunities to effectively collaborate. Os participantes foram capazes de identificar
assuntos de interesse comun e com diferentes oportunidades para uma colaboração
efectiva. Trata-se, portanto, de uma primeira etapa, que deverá ser seguida por uma fase
de reflexão interna em cada país, com vista a identificar em detalhe objectivos e acções
a serem tomadas. Participants were asked to assess a few dimensions on the
workshop, and as shown in annex 1V, levels of satisfaction were high, with 96% of
respondents saying that they were satisfied of the “overall usefulness” of the event.

Pontos principais das apresentações finais1: Nas propostas de soluções, surgiu a
necessidade de uma abordagem global e integrada na promoção da melhoria da
capacidade dos vários países nas seguintes áreas prioritárias:

           A – Política de Saúde
                  1 – Na construção das políticas de RHS
                  2 – Na implementação das políticas de RHS
           B – Financiamento
           C – Planeamento e Gestão de Serviços de Saúde
           D - Gestão da informação / conhecimento
           E – Associativismo Profissional e Função Reguladora
           F – Formação
           G – Condições de trabalho
           H – Cooperação inter-países

Quanto a acções concretas a desenvolver em cada uma das áreas, emergiram as
seguintes:
A – Política de Saúde
1 – Na construção das políticas de RHS
       - os planos de desenvolvimento dos RHS devem ser concebidos numa
perspectiva global e integrada, incluindo-os na política nacional de saúde


1
    As propostas de ca pais estão resumidas no Anexo V


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         - realização de um censo dos profissionais da Saúde do Sector Público e
colmatar o vazio de informação sobre o sector privado.
         – melhoria da capacidade dos serviços de cada país, a nível nacional, regional,
distrital e local, na construção e monitorização de políticas de RH e da sua capacidade
negocial junto dos outros sectores da governação
         – escolha dos indicadores mais sensíveis do sucesso das políticas de RHS
         - devem ser implementados mecanismos de estabilização e garantia de
sustentabilidade das políticas de RHS independentemente da sucessão dos governos,
nomeadamente através da sua ancoragem a objectivos mais amplos como os Objectivos
de Desenvolvimento do Milenio (ODM), do combate à pobreza, tentando-se consensos
com a sociedade civil, partidos políticos, associações profissionais, ONGs,
financiadores, entidades reguladoras, mobilizando a população de modo a criar um
ambiente de pressão adverso a mudanças constantes de rumo

2 – Na implementação das políticas
        - desenvolvimento de estratégias para criar ambientes favoráveis à
implementação de políticas de RHS inovadoras, nomeadamente quanto à mobilização
dos actores (“stakeholders”) e comunicação efectiva das mudanças
        - desenvolvimento de capacidade técnica e financeira de implementação das
políticas
        - criação de sistemas de monitorização da evolução do processo
B – Financiamento
        - foi expresso o desejo de uma maior autonomia dos governos na alocação de
recursos derivados do apoio externo, tendo como contrapartida a demonstração de uma
postura ética e de uma capacidade técnica de utilização do financiamento
        - implementação de mecanismos financeiros que garantam que os fundos
cheguem nos montantes e no cronograma estabelecidos
        - deve ser desenvolvida a capacidade de solicitar financiamentos de um modo
mais efectivo, nomeadamente ligando objectivos a acções, fazendo orçamentos-
programa, com monitorização por sistemas de “public expenditure tracking system”

C – Planeamento e Gestão de Serviços de Saúde
         – capacitação em planeamento e gestão dos profissionais com responsabilidades
de direcção aos vários níveis dos serviços de saúde
        - capacitação para a promoção de ambientes institucionais favoráveis a um bom
desempenho profissional, como formulação de regulamentação, estruturação de
carreiras profissionais, ligação das actividades de formação à progressão na carreira
        - criação de uma base de recursos de ferramentas da qualidade de apoio à gestão
como questionários de satisfação de utentes e profissionais, de sistemas de
monitorização da qualidade organizacional, sistemas de registo e análise de não-
conformidades
        - criação de um pacote de incentivos financeiros e não-financeiros adequados a
cada país

D - Gestão da informação / conhecimento
       - apoio na criação de sistemas de informação e formação de profissionais que
consigam proceder à recolha e tratamento da informação sobre RHS
       - criação de bases de dados de material didáctico e técnico dos PALOPs.

E – Associativismo Profissional e Função Reguladora


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        – desenvolver estratégias de como fortalecer o movimento associativo
profissional em cada país e o surgimento de órgãos reguladores efectivos e de
acreditação da actividade profissional que zelem pelas boas práticas e deontologia
profissional
        - fomentar o fortalecimento de “massa crítica” sobre políticas de saúde, em
particular RHS, boas práticas profissionais, ...

F – Formação
        – apoio no aumento da capacidade formativa dos países com apoio técnico em
programas de formação de formadores
        – apoio nos programas de formação inicial, contínua e de desenvolvimento
profissional dos profissionais de saúde, incluindo os prestadores directos de cuidados de
saúde, mas também os responsáveis da gestão e planeamento em Serviços de Saúde, os
administrativos e o pessoal técnico de manejo e manutenção das tecnologias da Saúde
        – apoio na revisão dos currículos das Faculdades da área da Saúde para os
adaptar aos novos desafios assistenciais e epidemiológicos
        – apoio em processos de reorientação e “reciclagem” de profissionais de outros
níveis para os Cuidados de Saúde Primários
        - organizar estruturas de formação o mais próximo possível do local onde o
profissional é suposto ir trabalhar
        - incentivos às organizações para promoverem a formação contínua e o
desenvolvimento profissional
        – criação de centros nacionais e regionais2 de excelência para apoio de sistemas
de ensino à distância.

G – Condições de trabalho
      – melhoria das condições de trabalho, nomeadamente das infra-estruturas e
equipamentos (nomeadamente a sua manutenção)

H - Cooperação
       - existe a vontade de reiniciar contactos multilaterais mais frequentes e
consequentes com o objectivo de recolha e disseminação da informação e boas práticas,
apoio mútuo e “benchmarking” nos PALOPs, através de reuniões regulares, contactos
por e-mail e por um Observatório de RHS dos PALOPs a criar
       - fomentar o intercâmbio entre associações profissionais similares dos vários
países
       - agilizar os mecanismos de acção dos órgãos da Comunidade de Paises de
Lingua Portuguesa (CPLP).




2
   Foi discutido o caso do CRDS (Centro Regional de Desenvolvimento Sanitário): esta instituição
promoveu cursos de curta duração de formação continua com pouco impacto; os cursos não eram
acreditados nem em Moçambique nem nos outros países de origem dos participantes, não sendo utilizados
para progressão na carreira profissional. A responsabilidade caiu só no País que hospeda a infra-estrutura.
Entre as razões do fracasso foram indicadas: falta de gestão colegial; falta de staff docente interno; falta
de comparticipação financeira pelos outros países; falta de competências administrativas (em Maputo: um
financiamento de USD 100,000 pela OMS não foi justificado, o que levou ao bloqueio dos
financiamentos). Maior intervenção between PALOP countries and da OMS regional foi considerada
necessária para revitalizar CRDS.



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Conclusões: Esta oficina veio demonstrar que existe uma África de expressão
portuguesa com uma identidade partilhada e que, embora em estádios diferentes do seu
processo de desenvolvimento, têm problemáticas que podem beneficiar de abordagens
comuns nas suas definições básicas. Por outro lado, ficou igualmente patente a vontade
que estas abordagens sejam encontradas também no seio da CPLP com o apoio das
estruturas internacionais assim como de outros países.
Todos os países participantes têm ideias estruturadas sobre os RHS dos respectivos
países assim como do seu papel nos sistemas de saúde, existindo em todos, planos de
desenvolvimento de recursos humanos. No entanto, igualmente todos têm dificuldades
na implementação desses planos por, muitas vezes, na sua concepção não terem sido
devidamente acautelados aspectos financeiros, técnicos e políticos. O grande desafio é:
como se pode apoiar a revisão destes planos de modo a torná-los viáveis? Isso vai
requer maior capacidade a nivel da definição, analise das politicas, da gestão. Tambem é
preciso desenvolver capacidade financeira (endogenea, apoio dos doadores) para iniciar
mudanças de medio e lungo prazo.
O segundo desafio que se perfila é como dar continuidade à implementação de uma
política apesar de eventuais instabilidades políticas e de governos sucessivos que, de
cada vez, anulam todo o trabalho anterior? O apoio da sociedade civil as politicas de
RHS solidas pode permitir atravessar periodos de instabilidade.

Agenda da próxima fase:
  1) manter a comunicação, usando contactos individuais: identificação do ponto
     focal de cada País.
  2) Relatório aos Ministérios da Saúde; o responsável da OMS em cada país vai
     jogar um papel de coordenação na organizaçõ de uma reuniõ de “feed-back”
     para completar e validar analise dos problemas de RHS e as opções de
     intervenção propostas (ex. Moçambique: fórum do GT-SWAP sobre RHS). As
     relações de cooperação técnica já existentes entre as diferentes instituições serão
     analisadas, de forma a não duplicar as iniciativas (em relação ao Brasil:
     FIOCRUZ, Universidade de S.Paulo, etc., Portugal); o mesmo é válido em
     relação aos programas da OMS, Banco Mundial e os outros parceiros
     interessados. Devem ser consideradas as “boas práticas”, que poderão ser melhor
     desenvolvidas. Um sistema de comunicação via E-mail poderá melhor acertar e
     definir as necessidades de cada País.
  3) Uma reunião virtual por videoconferência dos grupos, mais alguns elementos
     chave (ex. decanos das faculdades de medicina), a fim de discutir as acções para
     futura implementação; durante o período deverão ser identificadas as
     necessidades de formação e assistência técnica.




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                Anexo I: Sumario das propostas das equipes nacionais


Angola
As prioridades são construídas sobre o PDRH do sector. Este responde ao plano de
redução da pobreza. A mortalidade materna (1700/10000, com uma cobertura estimada
de partos assistidos estimada em 20%) é tomada em consideração. Em Angola há 1500
maternidades periféricas.
       Formação de parteiras, regionalização das escolas, instalações, recursos
       financeiros; objectivo inicial é o treino de 100 parteiras por ano. Os alunos são
       quadros de enfermagem polivalente de nível médio que trabalham nas
       maternidades periféricas; estes quadros serão treinado em cuidados maternos. A
       formação dura 18 meses. São necessários financiamentos para internato.
       Complementação de formação de docentes. Assistência técnica é necessária para
       garantia da qualidade (supervisão das aulas, componente pedagógica, aumento
       do nível de assistência dos Centros de Saúde). Dependência de financiamentos
       externos.
       Treino de novos médicos; objectivo formação de 750 médicos. A actual
       capacidade é de 50/ano. Regionalização da formação (segundo pólo universitário
       em Huambo: necessitam residências para professores e transportes); revisão
       curricular (a formação baixou, no curriculo deve-se inserir o HIV/SIDA etc.).
       Nova especialidade em clínica geral, para médicos que trabalhem nas áreas
       periféricas: há 405 candidatos; avaliação curricular, para serem especialistas em
       clínica geral. Portugal ajudou a montar o modelo. O Brasil poderia apoiar, como
       modelo.
       Observatório nacional e observatório em rede com os PALOPS (recolha de
       dados, sistema informático de informação do pessoal). Recolhe vários parceiros,
       quais a faculdade de medicina, o ministério das finanças e da educação. São
       necessários assistência técnica e recursos financeiros.
       Formadores de enfermagem, para melhorar a qualidade do ensino do Instituto
       superior de enfermagem (ISE). Recursos necessários: docentes visitantes,
       internato para professores das províncias, material didáctico e transportes. A
       OMS deixou de financiar o centro desde 1989. O centro manteve actividades de
       âmbito nacional e funcionou só com financiamentos angolanos.
       Escola nacional de saúde pública. Já existem docentes e instalações e verbas
       para funcionamento. São necessários: a elaboração de manuais, transportes
       ensino a distância, despesas para pessoal do exterior. A FIOCRUZ já é parceira.
       Mas todos os custos são suportados por Angola (Brasil dá apoio técnico, não
       financiamentos).
Em geral, pede-se aos parceiros a garantia de continuidade nos planos mesmo quando
haja mudanças nos governos.

Cabo Verde
Reforço numérico do pessoal por categoria, melhoria da gestão RHS, do sistema de
informação de RHS e mobilização de fundos para tal.
Planificação: aumentar os postos de trabalho (de acordo com o nível de US e de forma a
diminuir a sobrecarga de trabalho), com responsabilidade do Governo de Cabo Verde e
utilizando recursos financeiros internos.
Formação:


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       Formação inicial, conforme o plano de abertura de postos de trabalho. Criação
       de escola politécnica de saúde: planificação da escola e mobilizar recursos.
       Pós-graduação no País e no exterior e em saúde pública, com responsabilidade
       do Governo de Cabo Verde e fundos internos e externos.
Gestão:
       Reforço das competências em planeamento e gestão de RHS (novos postos de
       gestão, mecanismos de incentivos etc.)
       Desenvolvimento de um sistema de informação (banco de dados e relatórios).
       Mobilização recursos para implementação do PDRH, a partir de fundos do
       Estado e ajuda externa.
Cabo Verde apoia a constituição de um observatório de RHS: planeamento e gestão de
RHS, intercâmbio no desenvolvimento das carreiras e informação e regulamentação de
RHS de forma a beneficiar das experiências dos outros países.

Guiné-Bissau
Resumo do plano de desenvolvimento de recursos humanos (PDRH) e recomendações
gerais para sua implementação:
        Formação de parteiras, actualização na saúde materno-infantil e dos médicos.
        Formação, retenção e redistribuição do pessoal.
        A curto prazo: diagnóstico da situação dos RHS, finalização do quadro do
        pessoal; observatório RHS.
        A longo prazo: expansão sustentável.
        Estabilidade política e disponibilidade financeira são considerados como
        factores críticos.
Revisão e implementação do PDRH, largamente dependente de recursos
financeiros duvidosos e com necessidade de assitencia técnica externa.

Moçambique
Resumo das “acções necessárias”, à luz do PDRH:
     Reforço do pessoal docente, bibliotecas e ensino a distância.
     Formação contínua dos gestores de RHS a nível periférico.
     Estrutura de regulação dos profissionais de saúde (regulatory body) para
     acreditação, regulamentação e fiscalização da prática profissional.
     Troca de informação com os PALOPs no contexto do observatório dos RHS
     sobre: sistemas de informação do pessoal e situação dos RHS; curricula dos
     cursos de formação de saúde; produção bibliográfica sobre material técnico-
     profissional para formação; boas práticas de motivação do pessoal.


São Tomé
A mortalidade materna (MM - que cresceu de 132 para 298 por 100,000 em 2 anos
seguidos) é o ponto de partida do plano de prioridade; são identificadas as zonas do país
com menor acesso e maior pobreza. Objectivo é a redução da MM em 2/3.
Para tal, duas estratégias principais:
        Formação do pessoal, médico, enfermeiros e parteiras. RHS disponíveis,
        recursos financeiros externos.
        Comunicação e informação para saúde, com os profissionais de saúde, mass
        media e canais locais de comunicação dirigidas em particular para o grupo alvo
        (mulheres em idade fértil).



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Comentários:
As diferentes apresentações mostram um padrão semelhante: a maioria dos países tem
produzido planos e estratégias de desenvolvimento de recursos humanos; os problemas
são identificados na sua implementação. Como questões a analisar emergem: a
viabilidade dos planos (foi feita uma análise situacional exaustiva e correcta?); os
aspectos relativos à operacionalização: as vertentes financeiras, políticas e as
capacidades técnicas (Guiné, Angola, Moçambique, São Tomé); só Cabo Verde
constitui uma excepção (melhores capacidades de planificação e maiores recursos
financeiros internos, numa escala relativamente pequena). Em foco a gestão do
processo, a capacidade de analisar os dados, os factores críticos para definição das
estratégias.
Uma grande instabilidade política em S. Tomé e Angola (2002-2005) e mudanças
políticas importantes em Moçambique (2004-2005) praticamente não afectaram o
PDRH. A questão é despolitizar o processo dos Recursos Humanos, no sentido de
ligar os planos a objectivos de interesse global para os quais os governos estão
comprometidos, como os ODM, a iniciativa 3x5 e acesso universal, e não às situações
políticas contingentes de cada país. Ao mesmo tempo, é necessário criar o maior apoio
possível dentro da sociedade (tendo em conta, contudo, que associações profissionais de
categoria podem resistir políticas que visam aumentar o acesso aos cuidados básicos de
saúde e a equidade).
Nota-se que, em relação às apresentações finais de cada país, sempre que foram
consideradas áreas de saúde prioritárias, deu-se maior consideração à mortalidade
materna; o problema do HIV/SIDA, já dramático em Moçambique e em preocupante
aumento nos outros países vai requerer maior atenção.
A ligação entre problemas de saúde e necessidades de RHS foi melhor demonstrada
pelo grupo de São Tomé. A abordagem foi abrangente (teve em conta aspectos de
educação, assim como de formação e colocação de pessoal). Isso é a “boa pratica”, mas
pode ser mas dificil aplica-la a uma população na ordem de grandeza 10 vezes (Guiné-
Bissau), 100 (Moçambique e Angola), ou 1000 (Brasil) maior.
Em definitivo, foi reconhecida a complexidade da planificação e gestão dos RHS; a
projecção das necessidades por categorias e especialidades e a formação inicial e
contínua formam só uma dimensão do fortalecimento das capacidades do sector; uma
abordagem efectiva deve integrar organizacional (condições de trabalho, sistema de
carreiras, de incentivos) e institucional (regras, regulamentação) dimensões. Os
participantes demontraram que sabem disso.




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Anexo II: Lista de participantes


         Nome                      País             Título                Organização                  E-Mail

 Evelize FRESTA           Angola             Directora Nacional de    Ministerio Saude        frestaang@netangola.com
                                             Recursos Humanos


 Luzizila Helena          Angola             Professora e Decano      Instituto Superior de   luzipanda@hotmail.com
 PANDA                                                                Enfernagemda
                                                                      Universaded
                                                                      Agostinho Neto
 Paulina Elisa Maria      Angola             Assesora da              Gabinete da Direcção    cedumed@hotmail.com
 XAVIER                                      Universidade             da Faculdade de
                                                                      Medicina da
                                                                      Universidade
                                                                      Agostinho Neto
                                                                      (UAN)
 Eleutério Augusto Dos    Angola             Consultor da Ministra    Ministério do           mbaessamendes@worldban
 SANTOS                                                               Planeamento             k.org
 FREIRE
 Dulce Helena SANTOS      Cabo Verde         Responsavel dos          Ministério da Saúde     Dulce.ferreira@MS.Gov.cv
 FERREIRA                                    Recursos Humanos
 José Carlos Ramos        Cabo Verde         Responsavel Dep.         Hospital D. A. Neto     Zechilopa@hotmail.com
 FURTADO                                     Pessoal
 Eneida Alice             Cabo Verde         Administradora           Ministério da Saúde     eneidalima@hotmail.com
 BARBOSA FORTES                              Hospitalar
 LIMA
 Carlos Jorge Pereira     Cabo Verde         Tecnico Superior de      Ministerio das          jorger@gov1.gov.cv
 RODRIGUES                                   Finanças                 Financas e Plano

 Augusto Paulo SILVA      Guiné Bissau       Director-Geral           Ministério da Saúde     augustopaulo2@yahoo.com.
                                             Planeamento                                      br
                                             e Cooperação                                     apaulo@eguitel.com
 Francisco José PINTO     Guiné Bissau       Chefe de                 Ministério da Saúde     duto3@yahoo.com.br
 de PINA                                     Departamento
                                             de Pessoal
 Clotilde MONTEIRO        Guiné Bissau       Directora dos            Ministério da Saúde     minsapgov@hotmail.com /
 dos                                         Recursos                                         clotildeneves@yahoo.com.b
 SANTOS NEVES                                Humanos                                          r

 Mamadu DJICO             Guiné Bissau       Director do Serviço de   Ministério da Saúde     djicoblama@hotmail.com /
                                             Estatística e                                    oulddjicoblama@yahoo.co
                                             Planeamento                                      m.br

 Higino CARDOSO           Guiné Bissau       Assessor do Ministro     Ministerio da Reforma   higinocardoso@yahoo.com.
                                                                      Administrativa          br
                                                                      Funcion Publica e
                                                                      Travalho
 Domingos                 Moçambique         Técnica Profissional     Ministério da Saúde     ddmbent@yahoo.co.uk
 MONDLANE                                    de
                                             Administraçao
                                             Pública
 Hortência Faira          Moçambique         Tecnico                  Ministério da Saúde     ddmbent@yahoo.co.uk
 RIBEIRO




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 João Guimrães TEMBE        Moçambique          Director                   Hospital Central        ddmbent@yahoo.co.uk
                                                Administrativo             de Maputo
 José Dos Ramos Lucena      São Tomé e          Director do Plano,         Ministério da Saúde     jlucsilva9@yahoo.com.br
 R.E Silva LUCENA           Príncipe            Administração e
                                                Finanças
 Haria Albana CEITA         São Tomé e          Director,                  Ministério da Saúde
 COSTA ALLEGRE              Príncipe            Administração
 João Paulo Prazeres        São Tomé e          Administrador              Ministério da Saúde     cassandrajp@hotmail.com
 CASSANDRA                  Príncipe            Regional de Saúde
 Daniel Da Silva            São Tomé e          Administrador              Hospital Central
 AFONSO                     Príncipe            Hospitalar                 Dr. Ayres de Menezes


                                                PARTICIPANTES DA OMS

 Nando CAMPANELLA              Angola             Conselheiro                Organização            campanando@yahoo.com
                                                  HIV/AIDS                   Mundial da Saúde       campanellan@ao.afro.who
                                                                                                    .int
 Maria Gabriela de Fátima      Angola             Oficial para a área de     Organização            guerrag@ao.afro.who.int
 Rocha Oliveira GUERRA                            HSD,                       Mundial da Saúde
                                                  Desenvolvimento
                                                  Sustentável
 Yolanda ESTRELLA              Cabo Verde         Economista de Saúde        Organização            mpnoms@cvtelecom.cv
                                                                             Mundial da Saúde

 Maria Augusta ROSA            Guiné Bissau       Conselheira para os        Organização            regoms-
 DIAS FERNANDES BIAI                              Recursos Humanos           Mundial da Saúde       bissau@eguitel.com
                                                  para                                              hrh-bissau@eguitel.com
                                                  a Saúde
 Eva PASCOAL                   Moçambique         Economista de Saúde        Organização            pascoale@mz.afro.who.int
                                                                             Mundial da Saúde

 Abdou MOHA                    Moçambique         Coordenador do "3 by       Organização            mohaa@mz.afro.who.nit
                                                  5"                         Mundial da Saúde
 Fernando NEVES                São Tomé e         Conselheiro MPN            Organização            feneves.who@undp.org
                               Príncipe                                      Mundial da Saúde

                                                     FACILIDADORES

 André BISCAIA                 Portugal           Responsavel da             Centro de saúde      andre.biscaia@netcabo.pt
                                                  qualidade                  de Cascais

 Norbert Erich DREESCH         Suiça              Technical Officer          WHO                  dreeschn@who.int
 Gilles DUSSAULT               Estados Unidos     Senior Health              World Bank           gdussault@worldbank.org
                                                  Specialist                 Institute
 Christina FEKETE               Brasil            Consultora                 Universidade         fekete@medicina.ufmg.br
                                                                             Federal
                                                                             de Minas Gerais
 Ines FRONTEIRA                Portugal           Assistente Convidada       Instituto Higiene    ifronteira@ihmt.unl.pt
                                                                             e Medicina
                                                                             Tropical

 Manuela FRANCISCO             Estados Unidos     Economista                 World Bank           mfrancisco@worldbank.org

 Jennifer NYONI                Rep. do Congo      Assesor regional,          WHO                  nyonij@afro.who.int
                                                  RHS



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 Carolina OMAR                Moçambique       Consultor                                  carolina.omar@tvcabo.co.mz
 Celia PIERANTONI             Brasil           Directora de Recursos   Ministerio da      Celia.Pierantoni@saude.gov.
                                               Humanos                 Saúde              br
                                                                                          pieranto@iufounk.com.br

 Ferrucio VIO                 Italia           Consultor               Ministerio do      ferruciovio@yahoo.co.uk
                                                                       Planeamento,
                                                                       Moçambique




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                                                     Anexo III: Agenda da oficina
                                Instituto Multilateral da Africa, Instituto do Banco mundial, Organizaçõ mundial da Saúde, Instituto de Higièn
                                                                                 Governo do Brasil, Governo da Irlanda

                        Oficina deTrabalho sobre Desenvolvimento de Políticas de Recursos Humanos Para Países Africanos de E

                                                                     Sandton, Africa do Sul 17-21 de Outobro de 2005



               Segunda-Feira 17 Outubro         Terça-Feira18 Outubro                                                     Quinta-Feira 20
                   Diagnostico geral                  Analise situaçional             Quarta-Feira19 Outubro                  Outubro
                                                                                                                       Objectivos e estrategias
                                                                                             Politicas e gestão
08:30-     1- Abertura, Objectivos, programa,   5- Força de trabalho na saúde:        9- Instrumentos para as          13- Apresentação e
10:30      métodologia de trabalho              Técnicas para avaliação e             políticas: recrutamento,         revisão das opções
           Desempenho do Sector da Saúde e      planificação: colheita de dados e     colocação, retenção,             políticas dos países       C
           os MDGs                              análise                               produtividade, reforma da        participantes
           O processo de decisão política                                             educação, gestão.
                                                Norbert Dreesch, Christina Fekete
           Gilles Dussault                                                            Eric Buch, André Biscaia,
                                                                                      Gilles Dussault                  Equipes

11:00-     2- O Diagnóstico da força de         6- A dinámica do mercado laboral      10- Análise do ambiente          14- Capacitação para o
12:30      trabalho na saúde em Africa          da força de trabalho na saúde         político: viabilidade, análise   desenvolvimento de
                                                                                      dos grupos de interesse          política de colocação,
           Norbert Dreesch, Jennifer Nyoni,     Gilles Dussault                                                        mobilização dos grupos
           Carolina Omar                                                              Gilles Dussault , Christina      de interesse
                                                                                      Fekete
                                                                                                                       Norbert Dreesch, Inês
                                                                                                                       Fronteira, Christina
                                                                                                                       Fekete, Ferrucio Vio
Almoço

14:00-     3- O Diagnóstico da força de         7- A motivação da força de            11- O ambiente macro-            15- A experiencia do
15:30      trabalho na saúde nos PALOPs         trabalho e suas determinantes         ecomico: constragimentos e       Brasil no campo RH         p
           Preparação de um relatório sumário                                         oportunidades.                   Celia Pietrantoni
           sobre                                André Biscaia
                                                                                      Manuela Francisco (por VC)
           Equipes e facilitadores

16:00-     4- O Diagnóstico da força de         8- Trabalho em grupo                  12- Trabalho em grupo            16- Trabalho em grupo      2
17:30      trabalho na saúde nos PALOPs         Avaliação da força de trabalho dos    Revisão das opções políticas     Preparacão de um plano     c
           Apresentação dos relatórios          países participantes: identificação   da força de trabalho dos         de acção: O que irá ser    E
                                                da informação em falta, estratégias   países participantes             feito, quem faz o quê,     N
           Equipes                              para preencher esta lacuna                                             em que tempo, o            J
                                                Equipes e facilitadores                                                financiamento?
                                                                                      Equipes e facilitadores
                                                                                                                       Equipes e facilitadores




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                               Annex IV-A: Apresentação geral dos paises (Country profiles)3

                                                                            ANGOLA

Introduction
Despite substantial and varied natural resources, Angola remains one of the poorest countries in the world. Although growing revenues from oil
and diamonds have boosted per capita income to over $1000, human development indicators are poor, reflecting the heavy toll of nearly three
decades of conflict:
In 2003 only 38 percent of the population had improved access to water sources.
Infant mortality is high and decreased only marginally, from 172 in 1995 to 154 per 1,000 in 2003.
The prevalence of HIV/AIDS has increased from 2.1 percent in 1997 to 5.5 percent in 2001.
Primary school enrollment is only increasing slowly, from 72 percent in 1995 to 74 percent in 2000.
Female primary school enrollment was only 69 percent in 2000, while male primary school enrollment was 78 percent in the same year.

Not surprisingly, the performance of Angola's economy at the macroeconomic level has been mixed:
GDP growth since 1995 averaged 6.6 percent but, on the strength of increased oil revenues, was estimated for 2004 to be over 11 percent.
Annual inflation was 44 percent in 2004—still high, but down significantly from the late 1990s and early 2000s, when inflation was consistently
well above 100 percent annually. (More data are available in the World Development Indicators.)




Challenges ahead
Since Angola’s peace agreement in April 2002, the process of demobilization and reintegration of former combatants has been successful; and
now the government is turning its attention to the challenges of post-conflict reconstruction. With much of both national and local infrastructure
destroyed during the civil war, the challenge is enormous.

Angola is a potentially wealthy country, with enormous resources of oil, gas, and diamonds, as well as considerable hydroelectric potential,
varied agricultural land, and adequate rainfall. Despite these benefits, the decades of war, a largely non-supportive policy environment, and
widespread corruption have resulted in economic performance well below potential in the industry, manufacturing, and agriculture sectors,
where most of the population has traditionally been employed. The lack of substantial economic activity outside of the oil and diamond sectors
has left most Angolans without sustainable incomes, while the government has not yet been able to build up a skilled civil service or the
infrastructure needed to provide basic services to most of the population.

World Bank assistance to Angola
Assistance to the government and society: Angola joined the World Bank Group in 1989, and World Bank assistance began in 1991 with a credit
from the World Bank's International Development Association (IDA) for economic management capacity building. The World Bank has
established a Country Office in Luanda from which country dialogue and project oversight take place. The World Bank works closely with
the International Monetary Fund (IMF), UN agencies, official donors and nongovernmental organizations active in Angola through the country
office.

IDA’s assistance strategy is set out in the Interim Strategy Note (ISN), presented to IDA’s Board of Executive Directors in February 2005. The
ISN sets out IDA’s program of assistance in terms of preparation of potential future projects and areas of research until June of 2006. The
Angola ISN’s support for the government’s program for 2005 and 2006 is based on three pillars:
    •     Enhancing transparent governance and intensifying capacity development, especially support for public sector reform and civil society
          empowerment;
    •     Providing basic services, especially for returnees, ex-combatants, and other vulnerable groups, and rehabilitation of emergency
          infrastructure;
    •     Supporting broad-based equitable growth, especially through improving the environment for private sector growth, identifying pilot
          interventions in the rural economy, and facilitating better private infrastructure financing.

The ISN has a strong focus on economic and sector work, particularly with respect to economic advisory services—for example, public
expenditure and financial management reforms and the climate for private sector investment; technical assistance, in particular for the
government’s preparation of a Poverty Reduction Strategy Paper (PRSP); and diagnostics intended to lead to additional lending support. IDA
anticipates new lending operations in the areas of health and education training, continued support for infrastructure rehabilitation, and support


3
    Fonte: Banco mundial


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for agriculture development. In addition, IDA hopes to support a Donor Consultative Group (CG) meeting to facilitate coordination among
donors working in Angola.
IDA’s portfolio now comprises five active projects with a total amount of credits and grants of US$177 million.

The projects are:
   Emergency Multisector Recovery Program (EMRP) ($24.9 million Credit and
   $25.8 million grant)
   HIV/AIDS, Malaria, and Tuberculosis Control Project (HAMSET) ($21 million
   credit)
   Third Social Action Fund (FAS III) ($55 million credit)
   Emergency Demobilization and Reintegration Program (EDRP) ($33 million
   grant)
   Economic Management Technical Assistance Project ($16.6 million credit)

Investment in and assistance to the private sector: The International Finance Corporation (IFC) has been building its portfolio of investment in
Angola; to date it has two major investments:
A 15 percent shareholding in Novobanco Enterprise Bank of Angola S.A.R.L., a bank targeting medium and small enterprises. The bank has a
capital base of US$4.2 million and is expected to have a strong developmental impact by helping to create new jobs, accelerate business growth,
and boost confidence in the banking sector. The bank has already made approximately $2.5 million in credits to local small businesses.
A $1 million equity investment in Nova Sociedade de Seguros de Angola, S.A.R.L. (Nossa), which represents 16.7 percent of Nossa’s share
capital. Nossa is the third insurance company in Angola and the first private insurance company.
IFC has also provided technical assistance to private enterprises in Angola. For example, IFC helped Odebrecht of Brazil structure a
comprehensive HIV/AIDS program in their Angolan operations. The program includes outreach, counseling, testing, and treatment for
Odebrecht employees and for the communities in which the company operates, reaching about 100,000 people. This work will likely lead to
further involvement with the company.

The Multilateral Investment Guarantee Agency's (MIGA) provides guarantees to private companies investing in client countries. MIGA's
outstanding portfolio in Angola consists of two guarantees in the services and manufacturing sectors with a gross exposure of USD 6.4 million.
In addition, MIGA’s on-line investment promotion services (www.fdixchange.com and www.ipanet.net) feature 103 documents on investment
opportunities and the related legal and regulatory environment in Angola.


Country Assistance Strategy



Interim Strategy Note for Angola
Countries in transition from conflict (like Angola) do not have a CAS—instead, the Bank may prepare an Interim Strategy Note (ISN). An ISN
is a short to medium-term plan for Bank involvement in the country.
The World Bank's Board of Directors approved the ISN for Angola in February 2005 to cover the Bank’s strategy until June 2006. The
strategy intends to help gain stability and support implementation of a pro-poor, post-conflict public expenditure program for the 18-month
period which will involve:

         Enhancing the transparency, efficiency, and credibility of public resource management
       Expanding service delivery to war-affected and vulnerable groups
       Preparing the ground for pro-poor economic growth.

Given its post-conflict status and the challenges in implementing current projects, Angola is a high-risk, high-reward country. Lending and
technical assistance depends especially on good performance of the existing portfolio and progress in implementing the government’s Estratégia
de Combate à Pobreza (Strategy to Combat Poverty).

Status of the Angola Poverty Reduction Strategy Paper (PRSP)

Discussions between the donor community and the government of Angola regarding Angola’s Estratégia de Combate à Pobreza (ECP, or
Strategy to Combat Poverty) took place in 2004, and the ECP is in its final stages of revision before being presented to the Boards of the Bank
and the IMF. The Bank is working closely with the Ministry of Finance and the National Statistics Department to enable successful monitoring
and evaluation of the ECP, in particular, establishing a robust set of baseline indicators against which progress of the ECP can be assessed.


HNP sector issues
In April 2002, Angola (pop. 13.9 million, GNI/cap $6501) emerged from 27 years of war with its health system badly damaged, a
maternal mortality rate (MMR)of 1,300 per 100,000 live births, and an infant mortality rate (IMR) of 154per 1,000 live births.
HIV/AIDS, TB, and malaria account for 75 percent o f all deaths from infectious diseases in Angola. Malaria is the main cause of


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morbidity, with 40 percent of children dying in the first five years o f life and one-fourth of maternal mortality associated to
malaria conditions.

The HIV epidemic is spreading, with prevalence in adults aged 15 to 49 estimated to be 5.5 percent or 350,000 adults, and some
studies in urban prenatal clinics have shown rates close to 10 percent. TB incidence has increased over the past decade paralleling
the HIV/AIDS epidemic. At the macroeconomic level, these epidemics could have devastating effects on Angola's economy.
Studies have shown that an HIV/AIDS epidemic can reduce GDP by up to 1.0 percent per year. The effect of malaria has been
estimated to be as much as 1.3 percent GDP reduction per year'.

With a prevalence of 5.5 percent (and possibly higher as may be shown by the December 2004
sentinel survey), the epidemic appears to be generalized. The project will combine
     (i)       education and communication efforts to improve knowledge and protection of the population, with
     (ii)      targeted efforts on high-risk groups such as CSW, soldiers, and truckers.

Also, the government has a clear geographical strategy for priority interventions. The results of the December 2004
prevalence survey will be used to further refine the government strategy.




Operationalization of the National AIDS Commission (NAC)
(This trigger has been met.)
    (i)          key staff for the HAMSET Project Implementation Unit (PIU) are contracted;
    (ii)         the PIU provides support to the National AIDS Secretariat; and
    (iii)        draft regulations for NAC be produced, in which the relations between NAC and Angola’s Country Coordination
                 Mechanism (CCM) for the Global Fund are defined, while ensuring the participation of civil society.

    The government is organizing the PIU: the Project Coordinator, Deputy Coordinator, and Accountant are in place; other
    professionals responsible for the various components have been contracted. It has been agreed with GOA that the PIU will
    support the NAC Secretariat. The relation between the NAC and the CCM is being defined in the first draft o f the NAC
    regulations.


Human Resources in Health.

In 2000, there were 45,563 workers in the public health system with 45 percent of them technicians and 55 percent administrative
and support staff. There were a total o f 921 medical doctors, including 120 specialists and 122 doctors doing training outside the
country. Included in the 921 doctors are 281 foreign doctors contracted by the government. The distribution of doctors i s unequal
in the country, Luanda having 68 percent o f all the doctors and almost all the specialists.

There were 16,196 nurses. Of these, 74 percent had a medium level training and 25 percent had a basic training, and less than one
percent had college training. There were 3,670 diagnosis and therapeutics technicians. These include laboratory technicians,
radiologists, pharmacy specialists and physical therapists. (Source: HAMSET-PAD, pg. 31 pdf)


WHO – Medium Term Strategic Plan for HRH development in the African Portuguese Speaking Countries (PALOP):
2002-2006
Angola’s focus on human resources for health development will be oriented to
the following issues:

            Re conversion and specialization of technical cadres;

             Strengthening of institutional capacities of the HRH divisions and Training
            Institutions at all levels;

         Development and implementation of retention strategy of skilled health
        Workers;




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           Sharing of experience with other training institutions;

           Inter-country human and finance resource mobilization for the inter-country
          Institutions.



Data profile
                                 Series                             2000          2001           2002           2003           2004
Births attended by skilled health staff (% of total)                        ..           45              ..             ..             ..
Fertility rate, total (births per woman)                                    ..            ..             7              7              ..
GDP (current US$)                                               9,129,180,000 8,936,023,000 10,834,760,000 13,825,040,000 20,107,560,000
GDP growth (annual %)                                                       3             3             14              3             11
Immunization, measles (% of children ages 12-23 months)                    41            72             74             62              ..
Life expectancy at birth, total (years)                                     ..            ..            47             47              ..
Literacy rate, adult female (% of females ages 15 and above)                ..           54              ..             ..             ..
Literacy rate, adult male (% of males ages 15 and above)                    ..           82              ..             ..             ..
Malnutrition prevalence, weight for age (% of children under 5)             ..           31              ..             ..             ..
Mortality rate, infant (per 1,000 live births)                            154             ..             ..           154              ..
Mortality rate, under-5 (per 1,000)                                       260             ..             ..           260              ..
Population growth (annual %)                                                3             3              3              3              3
Population, total                                                  12,386,000 12,747,060        13,121,250     13,522,110     13,963,180
Prevalence of HIV, total (% of population aged 15-49)                       ..            4              ..             4              ..
Source: World Development Indicators database




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                                                                 CAPE VERDE


Introduction
Cape Verde is a small archipelago of ten islands located off the coast of Senegal. About one-tenth of the country's surface is arable. While the
islands are home to about 470,000 Cape Verdeans, twice as many Cape Verdeans live abroad while maintaining close ties with their homeland.
Cape Verde became independent from Portugal in 1975 and has achieved a strong development performance record, with sustained gains in
health, education, and economic growth.

Cape Verde’s growth performance since the late 1980s has raised it to the ranks of lower middle income countries, with a GNI per capita of
US$1,800 in 2004. Recent economic growth of around 2.5 percent per capita (2004) has been sustained through public and private investment
based on a high level of donor support, strong private capital flows, and remittances. Thanks to this growth, poverty has declined by one-fourth
over the last decade, while the human development index has increased from 0.59 in 1990 to 0.67 in 2003. Adult literacy rates are high
(approximately 76 percent in 2002), and life expectancy at birth (69) is the third highest in Africa.
Political openness has accompanied this economic and social progress. Since the adoption of a multi-party system in 1991, there have been three
national elections and two orderly changes in government. A free press further supports the building of an open society. The next presidential
and legislative elections will be in early 2006.

World Bank role
With an emphasis on national capacity building, policy reforms and private sector development, the Bank has been playing an important role in
Cape Verde's economic and social development. As of August 2005 the Bank had approved 20 credits for Cape Verde amounting to US$227.9
million equivalent, of which about US$196.1 million equivalent had been disbursed. Sixteen credits have been closed, and the current portfolio
of four credits represents about US$53.0 million equivalent, with an undisbursed balance of about US$31.2 million. These four credits are (a)
Energy and Water, (bi) HIV/AIDS, (c) Growth and Competitiveness, and (d) Road Sector Support.
A Country Performance Portfolio Review (CPPR) was held in Praia in June 2004 with the goal of improving the management and
implementation of the portfolio. Overall, Cape Verde's portfolio performance is good. A new Country Assistance Strategy was approved in
FY05, as well as two new lending operations, a first Poverty Reduction Support Credit, which has been fully disbursed, and a Road Sector
Support Project. A second Poverty Reduction Support Credit is under preparation and is scheduled for Board presentation in FY06. An
investment climate assessment is also planned in FY06.
The International Finance Corporation's (IFC) involvement in Cape Verde stands at US$6.15 million, including a line of credit of US$6 million
to Caixa Economica de Cabo Verde (CECV), the second largest bank in Cape Verde. This loan is providing much needed foreign exchange
denominated term finance to CECV and ultimately to the local private sector. The other investment (US$0.15 million) is financing a shoe
manufacturing company. In line with IFC’s new Strategic Initiative for Africa, IFC, in collaboration with the World Bank, is focusing activities
on improving the investment climate in Cape Verde. They are also looking for investment opportunities in financial and transportation services
and in industries with comparative advantage and export potential, such as tourism and fisheries. IFC’s Private Enterprise Partnership for Africa
(PEP Africa) planned a scoping mission in September 2005 to identify potential areas within the economy that could be sources of growth in
view of the country’s poverty reduction efforts.
The Multilateral Investment Guarantee Agency’s (MIGA) portfolio in Cape Verde consists of one contract of guarantee in the mining sector
with a gross exposure of US$540,000 for the development of a basalt quarry and installation of a crushing plant to produce sand and gravel
aggregates. It has significant direct economic benefits both at the local and national levels.

Country Assistance Strategy
The Country Assistance Strategy (CAS) is the most important World Bank document for each country. It is tailored to the needs and
circumstances of each country and lays down the Bank Group's development priorities, as well as the level and type of assistance to be
provided by the group for a period of three years.
The CAS preparation is a participatory process. Before its adoption, key elements of the strategy are discussed with government
representatives, and to ensure the widest possible involvement, public dialogues are also held, with Internet-based discussions
taking place in many countries.

However, the CAS is not a negotiated document. Any differences between the country's own agenda and the Bank's strategy are
highlighted in the CAS document. A progress report is issued in the intervening year.



Profile of Country Assistance Strategy for Cape Verde
The Cape Verde Country Assistance Strategy (CAS) covers the four-year period from FY05 to FY08. It sets out planned lending
and non-lending activities of the World Bank Group in support of Cape Verde’s Growth and Poverty Reduction Strategy (GPRS)



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and their intended results, which are in line with the country’s Millennium Development Goals (MDGs). The Bank’s strategy is
articulated around three objectives that constitute the CAS pillars:
 (a) ensuring macroeconomic stability and sound public finance and budget systems;
 (b) supporting private-sector-led growth through an enhanced investment climate and increased competitiveness through public-
     private partnerships in infrastructure;
 (c) implementing social programs aimed at alleviating poverty and inequity.
The CAS takes into account achievements to date, and integrates key development challenges and relevant sector strategies.

Poverty Reduction Strategy Papers

Background
Poverty Reduction Strategy Papers (PRSP) describe a country's macroeconomic, structural, and social policies and programs to promote growth
and reduce poverty, as well as associated external financing needs. PRSPs are prepared by governments through a participatory process that
involves civil society and development partners, including the World Bank and the International Monetary Fund (IMF).
Poverty Reduction Strategy Papers provide the basis for World Bank and IMF assistance as well as debt relief under the HIPC
(Heavily Indebted Poor Countries) Initiative. PRSPs should be country-driven, comprehensive, partnership-oriented, and
participatory. A country only needs to write a PRSP every three years; however, changes can be made to the content of a PRSP
using an Annual Progress Report.

Profile of Cape Verde's Growth and Poverty Reduction Strategy Paper
The Cape Verde Growth and Poverty Reduction Strategy Paper (GPRSP) for the period 2004-2007 was prepared by the Government of Cape
Verde through a broad participatory process. It brought together input from representatives of the private sector, civil society,
municipalities, multilateral and bilateral organizations, and community-based groups. The GPRSP defines a comprehensive
poverty reduction strategy for the country, building on the interim PRSP that was presented to the Boards of the International
Development Association (IDA) and the International Monetary Fund (IMF) in April 2002.
Five main development challenges are identified by the GPRSP for Cape Verde over the next three years:

i.     Promoting good governance
ii.    Improving competitiveness and private sector-led growth;
iii.   Fostering human capital development
iv.    Strengthening social security and solidarity
v.     Improving infrastructure and land use management




WHO – Medium Term Strategic Plan for HRH development in the African Portuguese Speaking Countries
(PALOP): 2002-2006

Cape Verde, which is making some significant effort to limit brain drain,
expressed its needs as follow:

       •    Training of health specialists at all levels remains a priority (1/3 of medical
           doctors in the country are foreigners);

       •    Strengthening of the basic training (153 medical doctors are being trained in
           Cuba and are expected to return from 2003 to 2005);

       •    Implementation of alternative ways of training, particularly for the
           postgraduate training for specialists by module system (one part in the Cape
           Verde and another outside: Project MOH/University Jean Piaget/
           Portuguese Cooperation).

Data profile
                             Series                    2000        2001        2002        2003        2004
Births attended by skilled health staff (% of total)          ..          ..          ..          ..          ..



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Fertility rate, total (births per woman)                                  ..          ..          3           3           ..
GDP (current US$)                                               531,386,016 550,199,616 616,209,216 797,314,304 948,117,056
GDP growth (annual %)                                                     7           4           5           5           6
Immunization, measles (% of children ages 12-23 months)                  80          72          85          68           ..
Life expectancy at birth, total (years)                                   ..          ..         69          69           ..
Literacy rate, adult female (% of females ages 15 and above)              ..          ..         68           ..          ..
Literacy rate, adult male (% of males ages 15 and above)                  ..          ..         85           ..          ..
Malnutrition prevalence, weight for age (% of children under 5)           ..          ..          ..          ..          ..
Mortality rate, infant (per 1,000 live births)                           30           ..          ..         26           ..
Mortality rate, under-5 (per 1,000)                                      40           ..          ..         35           ..
Population growth (annual %)                                              3           3           3           3           2
Population, total                                                   434,810     446,402     458,029     469,680     481,342
Prevalence of HIV, total (% of population aged 15-49)                     ..          ..          ..          ..          ..
Source: World Development Indicators database




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                                                                      GUINEA-BISSAU




    Introduction
  Guinea-Bissau gained its independence from Portugal in 1974 after a protracted liberation war that resulted in the dislocation of about one-
  fifth of the population and the destruction of important economic infrastructure. During 1998 and 1999 an armed conflict again left a
  substantial part of the economic and social infrastructure in ruins, intensifying the already widespread poverty. After two decades of
  independence and with poor infrastructure and low social indicators, Guinea-Bissau is one of the poorest countries in the world, ranking 172
  of 177 countries on the United Nations Human Development Index of 2004. Its population is about 1.5 million and the economy is based
  primarily on agriculture. The country’s main export is cashew nuts. More than two-thirds of the population lives under the poverty line.

  Despite difficult conditions, progress has recently been made on the political and economic fronts. The government prepared an emergency
  economic management plan (EEMP) by end-2003, with the support of the international community. The preparation of a regular budget for
  2005, with technical assistance financed by the UNDP and the EU, was an important step towards normalizing fiscal management. The
  economic situation remains difficult and the fiscal situation remains critical. The recorded production of cashew nuts reached a record level in
  2004, increasing by more than 15 percent compared to 2003. GDP growth was 2.2 percent in 2004 and real GDP is projected to grow by
  about 2 percent in 2005, close to the population growth rate.
  The orderly transition in May 2004 to a government elected on the basis of a broad reform program, and the recent presidential elections offer
  the prospects for an effective return to normal economic activity. The government draft PRSP is now in its final stages of preparation and will
  become the basis of the medium-term economic and social policies. The main objectives are to rebuild the administrative capacity of the
  government and prepare the ground for improving the economic situation.

  World Bank role
  As of August 2005, the World Bank had approved a total of 25 projects for Guinea-Bissau, totaling about US$303 million equivalent. Total
  disbursements have been about US$287 million equivalent. The current portfolio consists of four projects: National Health Development,
  Private Sector Rehabilitation and Development, HIV/AIDS Global Mitigation Support, and Coastal and Biodiversity Management. An
  Interim Strategy Note is planned for Board presentation in the first part of 2006. Two operations are also being prepared for Board
  presentation in FY06: Economic Management Reform (EMRC) and Multisector Infrastructure. A Fiduciary Assessment is scheduled for
  FY06.
  The International Finance Corporation (IFC) has a 15 percent equity stake (totaling US$0.28 million) in the financial sector to the Banco da
  Africa, the only domestic institution providing commercial banking and trade finance to companies in the country. No new investments have
  been made since 1998 because IFC’s strategy of involvement in Guinea-Bissau was put on hold due to the country’s political developments in
  the recent past. As the economic situation returns to normal, IFC will resume looking for investment opportunities in industries with a definite
  comparative advantage and export potential, such as agribusiness, fisheries, and cashew nut processing.
  The Multilateral Investment Guarantee Agency (MIGA) does not have any active applications for Guinea-Bissau. However,
  Guinea-Bissau signed the MIGA Convention on September 27, 1990, but is yet to ratify the Convention and subscribe to its
  share of MIGA’s capital.

Country Assistance Strategy


Background on Country Assistance Strategy (CAS)
The Country Assistance Strategy (CAS) is the most important World Bank country document. It is tailored to the needs and
circumstances of each country and lays down the World Bank Group's development priorities, as well as the level and type of
assistance the Bank will provide for a period of three years.
The CAS preparation is a participatory process. Before the adoption, key elements of the strategy are discussed with government
representatives; and to ensure the widest possible involvement, public dialogues are also held, with Internet-based discussions
taking place in many countries.
.

However, the CAS is not a negotiated document. Any differences between the country's own agenda and the Bank's strategy are
highlighted in the CAS document. A progress report is issued in the intervening year.




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Country Assistance Strategy for Guinea-Bissau

As of December 2004, Guinea-Bissau did not have a Country Assistance Strategy, however it is a member country of the Regional
Integration Assistance Strategy for West Africa.

Poverty Reduction Strategy Paper

Background on Poverty Reduction Strategy Papers (PRSP)
Poverty Reduction Strategy Papers (PRSP) describe a country's macroeconomic, structural, and social policies and programs to promote growth
and reduce poverty, as well as associated external financing needs. PRSPs are prepared by governments through a participatory process that
involves civil society and development partners, including the World Bank and the International Monetary Fund (IMF).
Poverty Reduction Strategy Papers provide the basis for World Bank and IMF assistance as well as debt relief under the HIPC
(Heavily Indebted Poor Countries) Initiative. PRSPs should be country-driven, comprehensive, partnership-oriented, and
participatory. A country only needs to write a PRSP every three years; however, changes can be made to the content of a PRSP
using an Annual Progress Report.

Guinea-Bissau's Interim National Poverty Reduction Strategy Paper
Guinea-Bissau's presented their interim National Poverty Reduction Strategy Paper (I-NPRSP) for the period 2000-2003 in September 2000.
The strategy provides an analysis of poverty, however the weak available data and its incidence, causes and determinants hindered the
formulation of a detailed and precise poverty reduction strategy. The government followed a broad-based participatory process to develop the
strategy which includes input from government departments, the People's National Assembly, civil society (including NGOs, labor unions,
religious associations, grassroots associations, the armed forces) and international organizations. The I-NPRSP includes a set of measures
intended to enable sustained growth in per capita income, improve the living conditions of the population, and bring about a reduction in
poverty. It also presents an implementation timetable and consultation procedures for preparing the full NPRSP.
The Government of Guinea-Bissau fully endorses the development objectives set for the year 2015 by the OECD/DAC and accepted at several
UN conferences:
  Reduction of the extreme poverty index by half
  Two-thirds reduction in infant mortality rates
  Achievement of universal enrollment in primary education
  Elimination of gender disparities in education (by 2005)

  Implementation in all countries, by 2005, of national strategies to reverse environmental resource trends by 2015.

In order to attain its primary objectives for 2000-2003, the government's strategy will be designed essentially around four main axes:
     Create conditions for rapid and sustainable growth
     Increase access to essential social goods;
     Implement programs aimed at mitigating poverty
     Improving governance.

In preparing the full NPRSP, the government will continue its broad-based participatory consultations with local communities in urban and rural
areas, with the goal of achieving a national consensus on aspirations and strategies and preparing regional programs to reduce poverty and
improve living standards.




WHO – Medium Term Strategic Plan for HRH development in the African Portuguese Speaking Countries
(PALOP): 2002-2006

Guinea Bissau is experiencing a critical brain drain and priorities are defined
based on this problem:

     •  To develop and implement the TOKTEN experience with UNDP to address
       the brain drain issue;
     • To encourage the re-launching of the activities of the School of Medicine of



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           the Amilcar Cabral University;
     •     To give the main priority to Training of Trainers (ToT);
     •     To rationalize the continuing education;
     •     Stimulate and turn viable the in-country training of specialists

Data profile
                                 Series                            2000        2001        2002        2003        2004
Births attended by skilled health staff (% of total)                     35           ..          ..          ..          ..
Fertility rate, total (births per woman)                                  ..          ..          7           7           ..
GDP (current US$)                                               215,455,488 199,034,144 203,589,728 238,644,192 280,153,152
GDP growth (annual %)                                                     8           0          -7           1           4
Immunization, measles (% of children ages 12-23 months)                  59          48          47          61           ..
Life expectancy at birth, total (years)                                   ..          ..         45          46           ..
Literacy rate, adult female (% of females ages 15 and above)              ..          ..          ..          ..          ..
Literacy rate, adult male (% of males ages 15 and above)                  ..          ..          ..          ..          ..
Malnutrition prevalence, weight for age (% of children under 5)          25           ..          ..          ..          ..
Mortality rate, infant (per 1,000 live births)                          132           ..          ..        126           ..
Mortality rate, under-5 (per 1,000)                                     215           ..          ..        204           ..
Population growth (annual %)                                              3           3           3           3           3
Population, total                                                 1,367,000 1,406,168 1,446,881 1,489,209 1,533,223
Prevalence of HIV, total (% of population aged 15-49)                     ..          ..          ..          ..          ..
Source: World Development Indicators database




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                                                                   MOZAMBIQUE
Introduction
Mozambique became independent from Portugal in 1975, ending almost five centuries of Portuguese administration of the territory. An UN-
backed peace agreement between FRELIMO and rebel Mozambique National Resistance (RENAMO) forces ended 16 years of civil war in
1992. In 1994, the first multiparty elections took place. In December 2004, as a result of the third presidential and legislative elections, Armando
Emílio Guebuza replaced Joaquim Chissano, who had held office for 18 years. President Guebuza, like his predecessor from FRELIMO, is
committed to continuing the sound economic policies that have encouraged large foreign investment.
Today, the country is still in transition, with a large number of social and economic challenges, including unemployment, low agricultural
production, and limited infrastructure and social services. Due to these and many other problems, Mozambique is still considered one of the
poorest countries in the world. In 2003 per capita income was $210, the prevalence of AIDS was 12.2 percent, and infant mortality was 101 per
1,000.
Still, over the last couple of years Mozambique has made some substantial progress in fighting poverty and improving human development.
According to the 2002-03 Household Sur vey, the percentage of the population living in absolute poverty declined from 69 percent in 1996-1997
to 54.5 percent in 2002. Adult literacy rose from 33 percent in 1990 to 45 percent in 2001. Total youth literacy increased from 49 percent in
1990 to 62 percent in 2001. Gross enrollment rates for primary schooling increased from 60 percent in 1995 to 92 percent in 2000 (girls
enrollment, however, is considerably lower). GDP per capita grew an average 6 percent since 1995.
The performance of Mozambique's economy at the macro level has been impressive: real GDP growth since 1993 has averaged 8.1 percent , and
was 7.2 percent in 2004. Annual inflation decreased from over 54 percent in 1995 to 13.5 percent in 2003, and was 12.6 percent in 2004. For
more data, please refer to the 2005 World Development Indicators.




Challenges ahead
The Bank and other donors fully endorse Mozambique's poverty reduction agenda defined in the Action Plan for the Reduction of
Absolute Poverty (PARPA), Mozambique’s PRSP, which was presented to the Bank and the International Monetary Fund (IMF)
Boards in 2001. Since then the PRSP has been updated in the first PRSP Progress Report of March, 2004. The Government of
Mozambique is now finalizing the preparation of its second PRSP/PARPA.
The PRSP/PARPA, which was developed through a participatory process, intends to reduce absolute poverty through action in the
following areas:
Education
Health
Agriculture and rural development
Infrastructure
Good governance
Macroeconomic and financial management
Employment and business development
Social action
Housing
Fisheries
Tourism
Processing industry
Transport and communication
Technology



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Environment
Reduction of vulnerability to natural disasters
One of the key challenges is the rising rates of morbidity and mortality from HIV/AIDS. The national HIV prevalence among
adults (15–49 years olds) was estimated at 13.8 percent in 2004. The impact of the epidemic is likely to grow more serious during
the decade, with the prevalence of HIV/AIDS among adults projected to increase to 16 percent by 2010. Economic models
indicate that AIDS has reduced per capita GDP growth by as much as 1 percent per annum because of reduced productivity
growth, lower human capital accumulation, and reduced physical accumulation, not to mention the social burden of the disease.




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World Bank assistance
Mozambique joined the World Bank Group in 1984, and assistance began in 1985 with a credit from the World Bank's International
Development Association (IDA) for reconstruction and economic rehabilitation. Since the early 1990s World Bank assistance to Mozambique
has been defined in its Country Assistance Strategies (CAS). The current World Bank CAS was prepared in November 2003, and covers the
four-year period 2004–07. The CAS is aligned with the government priorities set forth in the PARPA, and has three main areas of focus: (a)
strengthening governance; (b) spurring broad-based economic growth by improving the business environment; and (c) improving the provision
of services, particularly to the poor.
This is the first country assistance strategy prepared by the World Bank as a joint effort of IDA, IFC, and MIGA, which confirms the strong
emphasis of the CAS on strengthening the investment climate. The CAS is also among the first results-based strategies prepared by the World
Bank. It includes an evaluation of achievements under the previous CAS, as well as a set of monitoring indicators for the coming four years to
determine to what extent the CAS's outcomes are achieved.

In April 1998 Mozambique was the sixth country in the world to be declared eligible for debt relief under the World Bank and IMF Heavily
Indebted Poor Country (HIPC) Initiative, ensuring some US$1.4 billion (in nominal terms) in debt relief. In September 2001 Mozambique
reached the completion point under the enhanced HIPC Initiative. Of the total estimated debt-service relief under HIPC of some US$4.3 billion,
the World Bank provided about US$1,055 million ($444 million in net present value terms). This reduced Mozambique's debt service payments
by approximately half, from over $100 million before 1999 to an average of $56 million from 2002 to 2010. It reduced Mozambique's debt
service-to-export ratio from around 20 to less than 5 percent on average. Resources made available by debt relief provided under the HIPC
Initiative are being allocated to key anti-poverty programs, as outlined in the PRSP/PARPA.
World Bank support to Mozambique consists of lending and non-lending activities:
IDA non-lendingactivities include technical assistance and studies, which are prepared in collaboration with government, donors and other
stakeholders, and are disseminated on completion. The resources for these studies come from IDA’s administrative budget, often complemented
by support from other donors. One of the most important and recently approved of these studies is the Country Economic Memorandum (CEM),
completed in August 2005. The CEM outlines and analyzes the major challenges ahead for the country at all major sectors.
IDA lending supports government development projects through either concessional credits or grants. As of August 2005, IDA lending to 20 on-
going projects totaled $1,038 million, distributed by sector as follows:
Infrastructure - $553 million (or 53% of the total)
Education and Health - $208 million (20%)
Public Sector Modernization and Decentralization - $163 million (16%)
Private Sector and Industrial Development - $74 million (7%)
Agriculture, Rural Development and Natural Resources $40 million (4%).




Recently approved projects include a credit for the Beira Railways Project ($110) in October 2004, and the first Poverty Reduction Support
Credit (PRSC) to Mozambique (US$60 million) in July 2004. The second PRSC is scheduled to go to the Board for approval in September 2005.
It will pursue the same goals and will build on the achievements of the PRSC1. The credit seeks to promote growth and employment, human
resource development, good governance, and progress towards achieving the Millennium Development Goals (MDGs).

In June 2004 the World Bank Board approved a US$55 million grant HIV/AIDS Response Project—the Multi-Country AIDS Program (MAP).
This project is complemented by a Regional HIV/AIDS Treatment Acceleration Project (TAP), a US$25 million grant, which is the first World
Bank-funded project to focus primarily on HIV/AIDS treatment through non-government organizations (NGOs).
Also under IDA lending, six investment projects and a second poverty reduction support credit are under preparation: all are scheduled for Board
presentation this fiscal year. The investment operations are: Trans-frontier Conservation Areas and Tourism Development Project; the Technical
and Vocational Education Project; Roads and Bridges Management Project II; Legal Sector Capacity Building Project; the Financial Sector
Technical Assistance Project; and the Urban Development Project.
The World Bank works in close collaboration with the International Monetary Fund (IMF) on the macroeconomic program.




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As of August 2005 the International Finance Corporation's committed portfolio totaled $154 million. It consists of fourteen projects in
agribusiness, the hotel industry, banking, and general manufacturing. Six of these projects are in the small-and medium-sized enterprise (SME)
sector. IFC's main initiative in Mozambique has been the Mozal aluminum smelter. IFC support―$120 million for the first phase in 1997―was
crucial for financing the US$1.3 billion project and was IFC's largest single investment globally at the time. Mozal entered production in June
2000, and its resulting output more than doubled Mozambique's total exports in 2001 from 1999 levels. IFC provided $25 million for the second
phase in 2001. IFC has further supported Mozal's HIV/AIDS programs and is assisting the company with a SME linkage program to expand its
sourcing to local firms.

In 2004 IFC committed an $18 million investment to finance part of the government's equity in the Pande/Temane Gas pipeline, along with IDA
and MIGA support, and approved a $3 million contribution to a $12 million SME financing and technical assistance facility. In the same year,
IFC Advisory Services (CAS) was the lead advisor to the Government of Mozambique in the selection of the coal developer for the Moatize
Project. This project, awarded to the Brazilian mining company CVRD (Companhia Vale do Rio Doce), will probably be the largest investment
in Mozambique in the medium to long term (between US$ 1-2 billion). Given its dimension, multiple components and location, the Moatize
Project is expected to have a massive impact on poverty reduction in the Zambezi Valley, one of the most populated regions in Mozambique
and, so far, also one of the poorest.

The Multilateral Investment Guarantee Agency’s (MIGA) outstanding portfolio in Mozambique consists of eighteen contracts of guarantee in
the agribusiness, financial, infrastructure, manufacturing, oil and gas, and tourism sectors with a total of $262 million in gross exposure, and
$192 million in net exposure. Mozambique has been a member of MIGA since 1994 and is its fourth largest client country and the largest in
Africa. MIGA guarantees have facilitated an estimated $2.8 billion of direct foreign investment in Mozambique. MIGA has nine projects in
agribusiness, infrastructure, manufacturing, oil and gas, services and tourism. Clients include Mozal, Companhia de Sena (Marromeu sugar),
Sasol (gas pipeline), Moma Mining (KfW), and Maputo port. MIGA also provides technical assistance to the Center for Investment Promotion
(CPI).
The World Bank Institute (WBI) engages in several distance-learning activities in Mozambique. Training for local government officials was the
most popular of these activities, followed by health, and journalism during 2002. This level of activity is likely to be sustained over the next few
years.
The Consultative Group (CG) chaired by the World Bank is the main coordinating forum for donor activities in Mozambique. During the CG
meeting in October 2003, donors pledged $790 million in the form of investments, balance of payments support, and program support. The
World Bank works closely with other UN agencies and non-governmental organizations active in Mozambique through its country office in
Maputo.


  Country Assistance Strategy


  Background of Country Assistance Strategy (CAS)
  The Country Assistance Strategy (CAS) is the most important World Bank document for each country. It is tailored to the needs and
  circumstances of each country and lays down the Bank Group's development priorities, as well as the level and type of assistance to be
  provided by the group for a period of three years.
  The CAS preparation is a participatory process. Before its adoption, key elements of the strategy are discussed with goverment
  representatives, and to ensure the widest possible involvement, public dialogues are also held, with Internet-based discussions
  taking place in many countries.

  However, the CAS is not a negotiated document. Any differences between the country's own agenda and the Bank's strategy are
  highlighted in the CAS document. A progress report is issued in the intervening year.

  Country Assistance Strategy (CAS) for Mozambique, 2004 - 2007
  The World Bank Board of Directors presented a new Country Assistance Strategy for Mozambique in November 2003. The
  new CAS plans a continuation and deepening of past Bank efforts which helped the government to achieve growth, deliver
  services, build capacity, and transform aid modalities to sector-wide approaches and budget support against agreed performance
  indicators. The Mozambique CAS, which supports the government’s poverty reduction strategy, focuses on three areas:
                          broad-based economic growth by improving the business environment, Improve
  Strengthen governance, Spur
  the provision of services, particularly to the poor


      This is the first country assistance strategy prepared by the World Bank as a joint effort of IDA, IFC, and MIGA, confirming
     the strong emphasis of the CAS on strengthening the investment climate. The CAS is also among the first results-based
  strategies prepared by the World Bank and it includes an evaluation of achievements under the previous CAS as well as a set of
  monitoring indicators for the coming four years to determine to what extent the CAS’s outcomes are achieved.




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Poverty Reduction Strategy Paper
Background
Poverty Reduction Strategy Papers (PRSP) describe a country's macroeconomic, structural, and social policies and programs to promote growth
and reduce poverty, as well as associated external financing needs. PRSPs are prepared by governments through a participatory process that
involves civil society and development partners, including the World Bank and the International Monetary Fund (IMF).
Poverty Reduction Strategy Papers provide the basis for World Bank and IMF assistance as well as debt relief under the HIPC (Heavily Indebted
Poor Countries) Initiative. PRSPs should be country-driven, comprehensive, partnership-oriented, and participatory. A country only needs to
write a PRSP every three years; however, changes can be made to the content of a PRSP using an Annual Progress Report.


Mozambique's Poverty Reduction Strategy Papers
The Mozambique Poverty Reduction Strategy Paper (PRSP) is also called the Action Plan for the Reduction of Absolute Poverty
(PARPA). It describes the country's macroeconomic, structural and social policies and programs to promote growth and reduce
poverty, as well as associated external financing needs. The PRSP/PARPA was prepared by the Government of Mozambique
through a participatory process involving civil society and development partners, including the World Bank and the International
Monetary Fund (IMF).
The current PRSP/PARPA for the period of 2001-2005 explains the strategic vision for reducing poverty, the main objectives, and
the key actions to be implemented, all of which will guide the preparation of the Government's medium-term and annual budgets,
programs, and policies. The PARPA 2001-2005 is also Mozambique's first full PRSP (after an interim PRSP from 2000).

Joint Review of PRSP/PARPA Implementation
On April 5, 2004 the World Bank, together with other donors and the Government of Mozambique, conducted a joint review of
the Government's Poverty Reduction Strategy (PRSP/ PARPA). For the first time ever stakeholders jointly signed a Memorandum
of understanding that will serve to align the Bank and donors' assistance to Mozambique based on the Government planning
procedures and implementation cycles.

WHO – Medium Term Strategic Plan for HRH development in the African Portuguese Speaking Countries
(PALOP): 2002-2006
Mozambique identified the followings needs:

    •  Strengthening of Continuing Education
    •  Need for the learning and teaching materials in the Portuguese language
    •  Training of Public Health Specialists and specializations in selected areas
       like radiology
    • Upgrading the training of health professionals- Pharmacists, dentists,
      nurses, laboratory technicians, etc.
    • Strengthening the quality and quantity of trainers at basic, graduate and
       postgraduate levels
    • Support for the implementation of the country HRH Plan




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Data profile
                                 Series                             2000          2001          2002          2003          2004
Births attended by skilled health staff (% of total)                        ..            ..            ..           48             ..
Fertility rate, total (births per woman)                                    ..            ..            5             5             ..
GDP (current US$)                                               3,684,662,784 3,435,864,320 3,598,551,296 4,320,574,464 5,547,729,408
GDP growth (annual %)                                                       2            13             7             7             8
Immunization, measles (% of children ages 12-23 months)                    71            74            77            77             ..
Life expectancy at birth, total (years)                                     ..            ..           41            41             ..
Literacy rate, adult female (% of females ages 15 and above)                ..            ..           31             ..            ..
Literacy rate, adult male (% of males ages 15 and above)                    ..            ..           62             ..            ..
Malnutrition prevalence, weight for age (% of children under 5)             ..            ..            ..            ..            ..
Mortality rate, infant (per 1,000 live births)                            110             ..            ..          101             ..
Mortality rate, under-5 (per 1,000)                                       167             ..            ..          147             ..
Population growth (annual %)                                                2             2             2             2             2
Population, total                                                  17,691,000 18,071,156 18,438,334 18,791,420 19,129,326
Prevalence of HIV, total (% of population aged 15-49)                       ..           12             ..           12             ..
Source: World Development Indicators database




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                                                          SAO TOME AND PRINCIPE



Introduction
São Tomé and Príncipe comprises two small tropical islands in the Gulf of Guinea, 400 kilometers off Gabon. The total
population, estimated at 157,000 is growing at about 1.8 percent per year. The official language is Portuguese, and the currency is
the Dobra. São Tomé and Príncipe is ranked 123/177 in using the 2002 UNDP Human Development Index. Life expectancy at
birth is 66 years, adult literacy rate 83.4 percent, and the gross enrollment ratio for education is 62 percent.
Upon attaining independence from Portugal in 1975, São Tomé and Príncipe inherited an economy based exclusively on
agriculture and the production and export of a single crop, cocoa. Both the education and health indicators have generally been
good compared to African averages, although they declined during the 1990s because of a lengthy economic crisis.

Soon after independence in 1975, the government adopted a socialist rule. However, by 1985 major political and economic
liberalization initiatives were undertaken. In 1990, a new multiparty constitution was adopted, and the first multiparty election of
1991 voted Miguel Trovoada president. He was re-elected in June 1996 for a second and last term as allowed by the constitution.
The following presidential elections in July 2001 led to the victory of Fradique de Menezes for a five-year term. In July 2003 the
political scene was disrupted by a bloodless military coup. The discovery of oil puts São Tomé and Príncipe in a strategic
political/economic position as foreign countries are now interested in increased economic relations.

São Tomé and Príncipe's economy is fragile. It is burdened by a high debt per capita with a debt to GDP ratio over 600 percent. Its
productive base is undiversified as it relies almost exclusively on cocoa exports and external donations. This has substantially
increased the country's vulnerability to exogenous shocks. A long period of decline in the world price of cocoa, combined with
increased import prices, put severe strains on incomes and living standards. However, the last two years have been more favorable
due to strong international cocoa prices. Additional economic activities include modest fishing, small artisanal industry, and
tourism, which is only slowly being developed.
The country's macroeconomic performance in 2002, 2003, and 2004 has been satisfactory. The government and IMF staff reached
an understanding in January 2005 on a three-year PRGF program, which will be presented to the Board in mid-2005.
Prospective off-shore oil production could significantly modify the medium and long-term economic outlook, with oil exploration
expected by 2005-2006 and production by 2008-10.

São Tomé and Príncipe/World Bank partnership
São Tomé and Princípe joined the Bank and IDA in 1977 and became a borrower in 1985. The Bank's previous involvement
included structural adjustment operations, as well as support in the agriculture, health, and education sectors.
The country reached the HIPC decision point in December 2002, at which time the International Monetary Fund (IMF) and the
World Bank Group's International Development Association (IDA) agreed to provide US$200 million in debt service relief under
the Enhanced HIPC Initiative. São Tomé and Príncipe is expected to achieve the completion point by mid-2006.
The country's PRSP was promulgated by the President of the Republic in January 2003 and will be presented to the IMF and Bank
in April 2005. The current IDA Country Assistance Strategy (CAS) for the period 2000-2005 supports the government in
promoting the objectives of the Interim Poverty Reduction Strategy Paper: (a) sustaining strong economic growth to raise income
and reduce poverty; and (b) broadening access to services and improving their quality. The next CAS under preparation, covering
the 2006-2009, period is scheduled for Board presentation in May 2005.
The World Bank has approved fourteen IDA credits for São Tomé and Príncipe for a total amount of approximately US$83.3
million. Current IDA commitments for the two ongoing projects amount to US$11.5 million with US$10.7 million undisbursed as
of April 2005. The Social Sector Support Project of US$6.5 million assists the country in achieving the human development goals
as defined at the UN Millennium Summit, whereas the Governance Capacity Building Project in an amount of US$5 million
equivalent supports São Tomé's public finance management and helps build the institutional framework of the nascent petroleum
sector.



Country Assistance Strategy
Background on Country Assistance Strategy
The Country Assistance Strategy (CAS) is the most important World Bank country document. It is tailored to the needs and
circumstances of each country and lays down the World Bank Group's development priorities, as well as the level and type of
assistance the Bank will provide for a period of three years.
The CAS preparation is a participatory process. Before the adoption, key elements of the strategy are discussed with government


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representatives; and to ensure the widest possible involvement, public dialogues are also held, with Internet-based discussions
taking place in many countries.
.

However, the CAS is not a negotiated document. Any differences between the country's own agenda and the Bank's strategy are
highlighted in the CAS document. A progress report is issued in the intervening year.



Country Assistance Strategy for Sao Tome and Principe
This Country Assistance Strategy (CAS) for Sao Tome and Principe covers the four-year period from FY06 to FYO9. The CAS
supports the implementation of the Poverty Reduction Strategy Paper and sets out the planned lending and non-lending activities
of the World Bank and their intended results.
This CAS benefits from a more robust analysis and knowledge base of the country than existed at the time of the previous CAS
(FY01-05) as a result of the broader economic and sector work that has been conducted since then and the more intensive dialogue
between the Bank and the Government.
Above all, the strategy remains tightly focused, building upon on-going activities and enhancing and deepening the strategy laid
out in the previous CAS, as well as building on the lessons learnt from its implementation.

Poverty Reduction Strategy Paper
Background of Poverty Reduction Strategy Papers (PRSP)
Poverty Reduction Strategy Papers (PRSP) describe a country's macroeconomic, structural, and social policies and programs to promote growth
and reduce poverty, as well as associated external financing needs. PRSPs are prepared by governments through a participatory process that
involves civil society and development partners, including the World Bank and the International Monetary Fund (IMF).
Poverty Reduction Strategy Papers provide the basis for World Bank and IMF assistance as well as debt relief under the HIPC (Heavily Indebted
Poor Countries) Initiative. PRSPs should be country-driven, comprehensive, partnership-oriented, and participatory. A country only needs to
write a PRSP every three years; however, changes can be made to the content of a PRSP using an Annual Progress Report.
São Tomé and Príncipe PRSP, 2002
The São Tomé and Príncipe PRSP (PDF) of 2002 seeks to significantly reduce poverty by the horizon of 2015, through optimal
use of the country’s human, natural, and physical resource potential, as well as bilateral and multilateral cooperation. The strategy
revolves around the following five basic pillars:
  Reform public institutions, capacity building and promotion of a policy of good governance
  Accelerate and redistribute growth
  Create opportunities to increase and diversify income
  Develop human resources and access to basic social services
  Create Mechanisms for monitoring, assessing, and updating the strategy




WHO – Medium Term Strategic Plan for HRH development in the African Portuguese Speaking Countries (PALOP): 2002-2006

Sao Tome and Principe identified the following needs:
    • At basic level, all cadres required for training due to insufficient numbers
     available
    • At post graduate and specialization- all cadres including post graduate
      nursing
    • Specialization of the available medical doctors in clinical areas and public
      health
    • Continuing education be established within the human resources
      department to cater for short term needs
    • Need for scholarships to cover the identified areas since all training except
      for general In service training in health management for the different health cadres
    • Study visit on human resources, planning and management for 2-4
      technicians
    • Hospital based workshops and seminars in hospital administration and
      stock control activities
    • Continuing education for all technicians and professionals




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Data profile
                                 Series                            2000       2001       2002       2003       2004
Births attended by skilled health staff (% of total)                    79          ..         ..         ..         ..
Fertility rate, total (births per woman)                                 ..         ..         4          4          ..
GDP (current US$)                                               46,484,292 46,934,552 50,229,416 59,608,884 62,251,132
GDP growth (annual %)                                                    3          4          4          5          5
Immunization, measles (% of children ages 12-23 months)                 69         75         85         87          ..
Life expectancy at birth, total (years)                                  ..         ..        66         66         66
Literacy rate, adult female (% of females ages 15 and above)             ..         ..         ..         ..         ..
Literacy rate, adult male (% of males ages 15 and above)                 ..         ..         ..         ..         ..
Malnutrition prevalence, weight for age (% of children under 5)         13          ..         ..         ..         ..
Mortality rate, infant (per 1,000 live births)                          75          ..         ..        75          ..
Mortality rate, under-5 (per 1,000)                                    118          ..         ..       118          ..
Population growth (annual %)                                             2          2          2          2          2
Population, total                                                  148,000 151,100 154,200 157,400 160,600
Prevalence of HIV, total (% of population aged 15-49)                    ..         ..         ..         ..         ..
Source: World Development Indicators database




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                            Annex IV-b Dados sobre Recursos humanos em saúde
                             Profissionais qualificados
 Angola                       1997 (pop.: 11,446,708)             2004 (pop.: 13,625,000)
                            total     per 100,000 pop.          total     per 100,000 pop.
       medicos               881             7.7               1165*             8.6
       parteiras             492             4.3                 NA              NA
      enfermeiros          13106            114.5              18975            140.4
     farmaceuticos           24              0.2                 NA              NA
     odontologistas           0               0                  NA              NA
        técnicos             NA              NA                 3786             28.0
         outros              NA              NA                19974            147.8

 Cabo Verde                     1996 (pop.: 400,035)               2004 (pop.: 463,000)
                            total      per 100,000 pop.        total      per 100,000 pop.
        medicos              68              17.0               245              55.4
     odontologistas           6               1.5                6                1.4
      enfermeiros            222             55.5               531             120.0
     farmaceuticos           NA               NA                 8                1.8
        técnicos             NA               NA                217              49.0

 Guiné-Bissau                  1996 (pop.: 1,224,479)             2004 (pop.: 1,493,000)
                            total     per 100,000 pop.         total      per 100,000 pop.
       medicos               203             16.6               130              8.7
       parteiras             156             12.8               150             10.1
      enfermeiros           1340            109.9               769             51.5
     farmaceuticos           12               1.0                11              0.7
     odontologistas          11               0.9                3               0.2
        técnicos             NA               NA                243             16.3

 Moçambique                   2000 (pop.: 17,861,203)            2004 (pop.: 18,863,000)
                            total     per 100,000 pop.         total     per 100,000 pop.
        medicos              424             2.4                480             2.5
        parteiras           1414             7.9               2380             12.6
      enfermeiros           3664            20.5               4025             21.3
     farmaceuticos           419             2.3                530             2.8
     odontologistas          136             0.8                NA               NA
        técnicos            2628            14.7               2815             14.9
         outros             7377            41.3               8905             47.2


 São Tomé e Principe            1996 (pop.: 134,450)                2004 (pop.: 161,000)
                            total      per 100,000 pop.        total       per 100,000 pop.
        medicos              63              46.7                82               50.9
        parteiras            40              29.6                52               32.3
      enfermeiros            171            126.7               372              231.0
     farmaceuticos            2               1.5               NA                 NA
     odontologistas           7               5.2               NA                 NA
        técnicos             NA               NA                231              143.5
         outros              NA               NA                367              227.9

 * dos quais 369 estrangeiros; Fonte: OMS e relatorios dos paises




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                                   Trabalhadores qualificados (per 100,000 pop., 2004)
                                                                                                                São Tomé e
                                              Angola         Cabo Verde       Guiné-Bissau Moçambique           Principe
                            Médicos               8.6             55.4             8.7          2.5                   50.9
                            Parteiras             NA               NA             10.1         12.6                   32.3
                           Enfermeiros           140.4           120.0            51.5         21.3                  231.0


                                                            Trabalhadores qualificados
                          250.0
                                                                                                                Angola
per 100,000 pop. (2004)




                          200.0                                                                                 Cabo Verde


                          150.0                                                                                 Guiné-Bissau

                                                                                                                Moçambique
                          100.0

                                                                                                                São Tomé e
                           50.0                                                                                 Principe


                            0.0
                                         Médicos                 Parteiras               Enfermeiros




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                                          Anexo V: Avaliação da oficina

Participantes responderam a perguntas sobre as seguintes dimensões, numa escala de 1 (mais baixo) a 5
(mais alto):
Pertinência: relação entre o evento e as funções actuais
Informação : medida na qual nova informaçõ foi adquirida
Utilidade da informação recebida
Concentração da actividade sobre o que necessitava aprender
Alcance dos Objectivos
Utilidade global do evento




Resultados estão apresentados na tabela:




                                                      Percentagem de participantes respondendo 4 ou 5
                                                                                                                         Formatted: Portuguese Brazil



                                            100%      92                   92                   92          96
                                                                 88
                                                      %                    %                    %           %
                                             80%                 %                    72
                                                                                      %
                                             60%

                                             40%

                                             20%

                                              0%
                                                   Pertinência    Nova     Util     Concen.    Alcance       Utilidade
                                                                  info                         objectivos    globall




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