Drought Situation in Mozambique

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					                         DROUGHT SITUATION IN MOZAMBIQUE :

NUTRITION ,
HEALTH ,
WATER AND SANITATION




                Under 5 Mortality Rates



                                253.6        295



               225.8                        292.4


                                   321.7


                        249.5
                   226.1




                197.5   190.5



                138




                                   Source: 1997 Census




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NUTRITION
Nutrition can be seen as an outcome of access to adequate food, health and care. The immediate
causes of malnutrition are related to food intake and disease status of the individual.

The underlying causes of malnutrition have three essential, yet alone insufficient components. One is
related to food security, the other to availability of health and sanitation services, and the third is
related to how these resources and others are used to care for the mother and child during vulnerable
periods of pregnancy and infancy.

Household Food Security is tenuous in Mozambique at the best of times. Using the national poverty
line constructed for Mozambique, 69.4% of inhabitants live in a state of absolute poverty, or food
insecurity. The situation is worse in rural (71.2%) that urban areas (62%). The impact of the drought
on household food security is discussed in Section … of this report.

The provision of Health and Sanitation Services varies considerably across the provinces. The
situation of Health and access to Water and Sanitation are discussed later in this report.

Maternal and Child Caring Practices are known to have a significant influence on child nutrition. Of
particular concern are feeding practices (such as the low rates of exclusive breast-feeding in the first 6
months and the low frequency of active feeding of infants) and inadequate hygiene practices relating
to food preparation. How women are treated and cared for within a society are reflected by indicators
such as the percentage of girls in school, the percentage of girls aged 15-19 that are mothers, and the
total fertility rate. In general, women are treated better in the south of the country, compared with the
centre and north.

1. Nutritional Status in Mozambique
Stunting is a good long-term indicator of the nutritional status of a population as it reflects historic food
intake. Acute malnutrition (wasting) indicates recent changes in food intake. Results from the QUIBB
published in 2001 show that 43.8% of all Mozambican children are stunted (49.2% in rural areas) and
5.5% are wasted. Although stunting is higher in the rural areas than in the urban areas, almost a third
of urban children are stunted. Twenty-six percent of the total under-five population are underweight,
i.e. 12 times the level expected in a healthy, well-nourished population.


                                                                  Maternal Malnutrition (% of
                                   Stunting in Children 0 - 4
                                                                  Mothers Malnourished and
                                      Years (% of Total)
                                                                    with Children under 3)
               Mocambique                    43.8                             11
               Maputo                        26.3                              6
               Gaza                          35.4                              6
               Inhambane                     31.2                              3
               Sofala                        44.6                             10
               Manica                        40.1                             13
               Tete                          44.5                             13
                Data Source:             QUIBB, 2001                    DHS, 1997

Protein-energy malnutrition, anaemia, endemic goitre resulting from iodine deficiency, vitamin A
deficiency and pellagra (a condition resulting from niacin deficiency) constitute the most common
health problems associated with nutrition and food security. Immediate causes of malnutrition are
inadequate food intake (both quantity and quality) and diseases such as diarrhoea, malaria, IRIA.
Lack of access to adequate health services including maternal and childcare and nutrition education


Page 2 of 20
programmes, and illiteracy of mothers are major factors which contribute to malnutrition and would
explain higher levels of stunting in rural areas.

The Nutrition Programme of MISAU has an ongoing nutrition surveillance system in which growth
faltering and low birth weigh indicators are be measured. Growth faltering in Mozambique is defined
as a decline in the weight of the child from one weighing to the next. This indicator is difficult to
interpret. In 1999, the overall growth-faltering rate was 9.2%. The high prevalence of low birth weight
(12.5%) remains a public health problem and reflects the poor nutritional status of mothers.

HIV/AIDS
As AIDS decimates the labour supply, household agricultural production can decrease significantly.
The loss of even a few workers at the crucial planting and harvesting periods can significantly reduce
the size of harvest, potentially exacerbating malnutrition. Poverty places households at greater risk of
becoming even more food insecure if the household suffers a shock such as the death or sickness of
a family member.

Nutrition is one of the key components in keeping people living with HIV/AIDS (PLWHA) healthy. A
prolonged food shortage will render PLWHA more vulnerable to opportunistic infections, and will
augment the mortality rate due to HIV/AIDS. Consequently, this will increase the number of orphans
and child headed households, whose diet is generally meagre and will get worse due to the drought.
Effective supply of vitamins is advisable to help keep PLWHA healthy. Organisations involved in food
distribution should consider the possibility of supplying vitamins and/or micro-nutrients to all their
beneficiaries (as it is usually not known who is HIV positive).

The additional burden that can be placed on caregivers because of deaths within the family or as they
themselves become sick, places the household at even greater risk of not being able to obtain and
prepare food in appropriate hygienic conditions.

2. Main Threats of Drought on Nutrition
Due to the decreasing access to and availability of food, combined with existing poor food preparation
and utilisation practices in terms of food frequency, energy density, active feeding and hygiene
(especially for young children) there is a severe threat of an increase in malnutrition in the drought-
affected areas. The levels of micro-nutrient deficiency are also likely to increase, impacting in
particular upon lactating and pregnant women and children under five.

3. Government Policy
In 1999, the Ministry of Health’s Nutrition Programme developed a Strategy to Combat Micro-nutrient
Deficiencies. The Micro-nutrient Strategy is an integral component of the National Strategy for Food
Security and Nutrition and will be integrated into the inter-sectoral Food and Nutrition Action Plan.
Progress has been made in the implementation of the plan of action particularly in the areas of
capacity building, nutrition education (breastfeeding promotion, campaign for vitamin A) and
interventions aimed at combating micro-nutrient deficiencies.

Similarly, the 5-year National Plan of the Ministry of Health (2000-2004) has a nutrition component
with the objective of reducing morbidity and mortality as a consequence of malnutrition particularly
among women and children. The Nutrition Programme continues to address malnutrition problems by:

   Developing guidelines for the implementation of nutritional interventions aimed at populations in
    critical situations;
   Carrying out research activities on micro-nutrient deficiencies (iodine, vitamin A & iron) and other
    nutritional diseases in the country and develop strategies to combat them;
   Preparing District Food Security and Nutritional Profiles;

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   Developing programmes to combat nutritional deficiencies and diseases, and strengthening the
    links between improved health care (particularly improved immunisation coverage and the
    prevention and treatment of diarrhoeal diseases) to improved nutrition;
   Promoting infant nutrition practices with the emphasis on breastfeeding and introduction of
    adequate complementary foods between the age of 4 and 6 months.

4. Resources
The Government has limited human resources working in the area of nutrition. At the central level
there are a small number of staff with advanced degrees in nutrition, and each province has on
average only two nutrition technicians. The Governments’ financial resources are also low and the
Nutrition Programme relies mainly on external financing for programme implementation. It is hoped
that the introduction of sector wide approaches (SWAps) in both health and agriculture will increase
resources.

Contingency plan

5. Key Challenges
The key challenges include:

   Increase trained Human Resources: The main challenge facing the nutrition sector is the lack of
    professional staff to implement the various strategies and policies. The challenge is to increase
    the number of staff qualified in nutrition. A further challenge is the implementation of nutrition
    education programmes which are an integral part of the surveillance system but are often
    neglected again due to the limited qualified staff.
   Status of Women and Girls: The role of women is essential in food production, food access and
    preparation. Girls’ education is a key factor in longer term improvements in the care and nutrition
    of the youngest children.
   Community participation and education: Food availability is a necessary but not sufficient condition
    to improve nutrition, therefore the importance of education programmes to improve knowledge on
    feeding practices and other care elements, maternal and child health and nutrition is evident.
   Building partnerships: MISAU collaboration with NGOs needs to be strengthened and more
    information is needed about such organisations. It is also crucial to involve and collaborate with
    the private sector working in food security and nutrition to implement policies
   Health Service Delivery: Limited access to health services hinders effective coverage of nutrition
    programmes targeted at women and children, and this increases vulnerability. Improving access to
    health services by increasing the number and coverage of functioning health facilities, both in
    terms of improving access to health care as well as specifically looking at improving access to
    nutritional and food information remains a challenge.

6. Government / UN Response to Current Situation

Assessment and Monitoring
From 4th – 30th June 2002, a series of multi-sectoral assessments will be carried out in the districts
identified as being worst affected in terms of food security. These will include a MUAC survey, in
which a sample of 900 children per district (30 clusters of 30 / district) will be measured. The
assessment will also look at the frequency of diarrhoeal disease in children under five, measles
coverage, access to health services, hygiene practices and access to water, and the capacity of the
family to respond to threats (child headed versus adult headed households).

Provincial Health staff, with financial and technical support from UNICEF, will participate in the
assessments. Data will be collated and analysed at central level with technical assistance being
provided by a UNICEF consultant.

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To monitor the situation over the longer-term, sentinel sites in the drought-affected districts will be
developed, with routine monitoring of weight / height at community or Health Unit level.

Assistance Provided by UN
As part of UNICEF’s normal programme, financial and technical support is being provided to improve
management of severe malnutrition and therapeutic feeding centres in the provinces. Increased
support will be channelled to those areas identified by the assessments, and in the longer-term
additional training will be supported to improve the provincial level’s capacity to manage severe
malnutrition programmes.

Expected Areas of Intervention
WHO will provide financial support and technical expertise to the Ministry of Health to update the
manual of “Nutrition Interventions During Emergencies” and the training of technicians in its use.
Health promotion activities including nutrition education will also be carried out in the affected areas
with WHOs technical and financial support. WHO will also participate in further nutrition assessments
and surveillance activities in the affected areas with the evolution of the drought.

If the assessment shows the situation in some districts to be critical (MUAC: global malnutrition
>10%), supplementary feeding will be started for children under five and pregnant and lactating
women, in addition to the WFP food aid programme.




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HEALTH
The health status of a population contributes to and depends on the level of development of basic
services available within a country. In addition to access to preventative and curative health services,
a healthy population depends also on the level of education, access to safe water and sanitation, and
access to and availability of adequate food.

1. Health Situation in Mozambique
In general, the health status of the population in Mozambique is a result of the current socio-economic
profile of the country. Low education levels, limited access to safe water and sanitation, poor
nutritional status and limited access to health care all contribute to the poor health status of the
population.
                                                                            Under 5 Mortality Rates
In 1997 the life expectancy was estimated at 42.3 years for both
sexes (44.0 years for females and 40.6 years for males). The
HIV/AIDS epidemic will have a major impact on this indicator.
According to the 1997 census, it was calculated that the life
                                                                                              253.6       295
expectancy would increase to 47 years by 2005, but it is now
expected to decline to 35.7 years by 2005 due to HIV/AIDS.
                                                                             225.8                       292.4
According to the 1997 census, the infant mortality rate (IMR) is 146
per 1000 live births but with major differences between sexes                                    321.7
(152.9 for boys and 137.8 for girls). The under-5 mortality rate
(U5MR) is 246/1000 (251 for boys and 239 for girls). Regional                         249.5
disparities are startling, as are urban and rural disparities (IMR –             226.1
101 and 160 and U5MR – 166 and 270 respectively) reflecting the
poor levels of health care coverage in rural areas. Maternal
mortality is estimated at 1,500 per 100,000 deliveries and the
maternal mortality ratio remains one of the highest in the world and          197.5 190.5

is highly influenced by the low position of women in Mozambican
society.                                                                      138

The major causes of mortality in the under 5 age group are malaria
(18% of deaths), diarrhoea (13%), acute respiratory infections (8%),                 Source: 1997 Census
and measles and neonatal tetanus (3%). Diarrhoea has been found
prevalent in 20% of under five-year children.

Mozambique’s epidemiological profile is typical of Sub-Saharan African countries, the main causes of
illness and death among adults being common infectious diseases, such as malaria, tuberculosis.
Because of the precarious environment, the vulnerability to epidemics such as cholera and dysentery
also remains high.

Immunisation
In 2001, only 47% of children between 12 and 23 months were fully immunised: 78% against BCG,
59.2% polio (3rd dose), and 67.5% measles. Urban/rural immunisation disparities exist (85% and 36%
respectively), but figures desegregated by sex are not easily available. Coverage of tetanus toxoid
vaccination for mothers giving birth stands at 34% (urban 58% and rural 27%). The urban-rural divide
indicates the problems related to scattered populations still relying on costly mobile teams. The
progressive expansion of fixed vaccination posts, cold chain facilities and outreach facilities through
the National Expanded Programme on Immunisation (EPI) will reduce this disparity.

                      Detailed Immunisation Table from WHO Report


Page 6 of 20
HIV/AIDS
HIV/AIDS has a negative impact on the provision of health services. Care of AIDS patients has
overwhelmed health services in many countries, both in the number of hospital beds occupied and in
the high cost of treatment. In Mozambique, an estimated 40% of hospital beds are occupied by
HIV/AIDS patients. AIDS is also decimating the ranks of health workers.

Children infected with HIV are particularly vulnerable. Intensified immunisation campaigns would help
to reduce this vulnerability to opportunistic illnesses. The Government is not able to provide
prophylactic drugs through clinics and heath units in the rural areas, though some NGO pilot projects
are being started in Tete, Gaza and Maputo provinces.

Although hospitals are overloaded with AIDS patients, the vast majority of patients are cared for in
their home communities. Extending health care to communities has the double advantage of
strengthening communities’ capacity to cope with the impacts of HIV/AIDS and reducing the strain on
facility-based care of AIDS patients. Underreporting of AIDS cases and HIV infections by health
administrations seriously hinders the realistic design and planning of health care structures, staffing
systems and basic support systems.

Health Service Delivery
Only 30% of the population lives in an area within 5Km of a Health Unit. In the central provinces,
access is even lower and Health Units often only offer key basic services with staff having received no
formal training.

Pharmaceuticals and Medical supplies
The main challenge with regard to pharmaceuticals is the need to increase resources for purchase
and internal distribution of drugs. The Government budget allocations for drugs are increasing but
there are still imbalances on drug distribution. Procurement of family planning commodities is outside
the national procurement system, but distribution is integrated into the distribution plan of the
Pharmaceutical Department of MISAU.

                             Annex 3 of WHO Report

Human Resources
Serious imbalances exist in staff deployment between provinces and between urban and rural areas.
MISAU estimates that 23% of the most peripheral health units and health centres have no qualified
health personnel. In addition, programme staffing levels do not correlate to output, eg MCH personnel
currently constitute 17% of the total health sector workforce but represent at least 40% of the health
care delivery output. After a situation analysis, MISAU established several measures for tackling the
problem including provincial training of elementary midwives, increasing training of basic MCH nurses
and re-deployment of the existing MCH staff to under-staffed areas.

2. Main Health Threats Caused by Drought

Cholera and Other Diarrhoeal Diseases
The incidence of diarrhoeal diseases usually increases during a drought. This is exacerbated by a
reduced access to clean drinking water, to sufficient water for personal and household hygiene, and to
existing poor sanitation practices. Cholera is endemic in Mozambique and therefore the likelihood of
an outbreak can be considered as high.

                             Table of cholera cases since January



Page 7 of 20
Immunisable Diseases
During the dry season, there is an increased risk of diseases such as Measles and Meningococcal
Meningitis. The morbidity and mortality of measles is especially influenced by the nutritional status of
a population.

Skin / Eye Infections
A reduced access to sufficient water for personal and household hygiene can lead to escalation in the
number of cases of infections relating to cleanliness. Skin irritations and conjunctivitis are the most
common of these, and previous experience in Mozambique shows that this is likely to become a
significant issue.

Malaria
Accounting for 70% of all paediatric admissions, malaria is also the major cause of anaemia, low birth
weight and miscarriages. In Mozambique, malaria creates immense burdens on families and loss of
life. It inhibits productivity and reduces school attendance. The National Malaria Control Programme
aims to implement an integrated, sustainable malaria control programme to prevent mortality and
morbidity.

In dry conditions however, a reduction of malaria transmission could normally be expected. However
this can reverse if even reduced rainfall creates mosquito breeding sites. Again, the morbidity and
mortality rates will be influenced by the nutritional status of the population.

Thiocyanate Intoxication
There have been several outbreaks of spastic paralysis caused by Thiocyanate Intoxication in
Mozambique since the 1980s. These have mostly been associated with the consumption of
embittered cassava insufficiently processed during drought periods. Although this has been most
frequently reported in the north, there have been some reported cases in Gaza and Manica provinces.

3. Government Policies
The National Integrated Programme for Mother and Child Health, Family Planning, Extended
Programme of Immunisation and School/Adolescents Health contributes to the reduction of maternal,
child (specifically school children) and adolescent morbidity and mortality. The National Integrated
Plan for Contagious Diseases and the five-year National Malaria Control Strategy also work to
improve prevention and treatment of a number of diseases.


4. Resources
Presently, annual per capita spending on health is estimated at around USD 8.84. While the
Government’s contribution is currently only 22%, it is programmed to increase annually both in real
terms and as a share of total expenditure. In 1999, the Government budget for health increased by
more than a third from 1998. The Government covers almost all costs for health personnel.
Dependence on external funding sources is high. Of total sector resources, 33% comes from
international agencies, 19% form households, and 25% from NGOs, employers and other sources.
International assistance pays for 92% of medical and surgical supplies and 77% of all investment
expenditure.

Within the UN Contingency Plan some additional supplies were pre-positioned with the Ministry of
Health (catheters, ORS, Ringer Lactate, Cholera Treatment Centre equipment, disposable syringes,
gloves and sterilising materials, and other small items). However, these have mostly been used to
respond to cholera outbreaks at the beginning of the year.



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5. Key Challenges
 Increasing access to services to address current disparities in equity of access (particularly in rural
    areas), staffing , infrastructure and management
   Expanding IEC activities to increase knowledge and to influence positively health seeking
    behaviour especially in relation to diarrhoeal diseases, complications in pregnancy, to
    complications in malaria and to sexual behaviour such as increasing the use of condoms
   Development of a Human Resource Development Plan to ensure adequate and appropriate
    deployment of health personnel
   Acquisition of equipment and additional materials required for the drought related diseases


6. Government / UN Response to Current Situation

Assessment and Monitoring
From 4th – 30th June 2002, a series of assessments will be carried out in the districts identified as
being worst affected in terms of food security. The assessment will look at the nutritional status of
children under five, the frequency of diarrhoeal disease in children under five, measles coverage,
access to health services, hygiene practices and access to water, and the capacity of the family to
respond to threats (child headed versus adult headed households).

Provincial Health staff, with financial and technical support from UNICEF, will participate in the
assessments. Data will be collated and analysed at central level with technical assistance being
provided by a UNICEF consultant.

Assistance Provided by UN
UNICEF and WHO have worked with the Ministry of Health to develop the assessment framework.
And technical support is being provided for the compilation and evaluation of the assessment data.

At the provincial level, two consultants have been based in Gaza Health Department and Tete Health
Department to assist in the planning and implementation of nutrition and health activities, in particular
in response to the drought.

Expected Areas of Intervention
In accordance with the UN Contingency Plan, UNICEF and WHO will provide technical, financial and
material support for the implementation of activities in response to the drought. These include
activities undertaken to reduce the threat of diarrhoeal diseases including cholera and dysentery, the
threat of outbreaks of immunisable diseases, meningitis and plague and the increase of severe cases
of anaemia due to malaria. WHO will assist the Ministry of Health with co-ordination efforts and with
the planning at central and provincial level with the participation of 10 epidemiologists.




Page 9 of 20
WATER AND SANITATION
Access to safe water and the practice of safe hygiene behaviours is a major contributing factor to
health and development. Lack of these has a negative impact of the health and nutritional status of a
population, and subsequently on education levels (in particular girls’ education), and capacities for
productive work.

1. Water and Sanitation Situation in Mozambique

Access to Water in Mozambique
It is estimated that in the country there are in total 12,500 water points for safe water supply to the
rural population of which 4,500 of them are reported as broken-down. This implies that less than 35%
of the rural population has access to a reliable water supply. The major causes of the breakdowns are
related to poor community involvement, weak preventive maintenance system, lack of a spare parts
network near to the community, and the continued reliance on old pumps. Although coverage has
slightly increased, there is strong consensus that a greater focus needs to be placed on community
involvement through Demand Responsive Approach (DRA) in all aspects of rural water supply and
sanitation in order to ensure sustainability. This is reflected in the Government’s policy and strategies
for rural water supply and sanitation, widely viewed as a positive development for the sector.


                                       Coverage Tables from NOA

It is important to note that although coverage or access ratios for urban and rural water supplies have
increased to the target levels expressed by the Government, care must be taken in interpreting these
figures. Issues of quality, quantity, and availability (i.e. available 24 hours per day, 7 days per week)
are not fully considered. For rural areas, for example, coverage is calculated on the basis of one
protected water point for every 500 people within a radius of 500 metres. Estimates for rural coverage
also assume that all known protected water points are functioning properly which is far from the case.
Experience has shown that it is common for about one third of all water points to be malfunctioning
while in many sparsely populated rural areas it is often difficult to find 500 people living within a radius
of 500 metres of a water point. This infers that coverage is likely to be far lower in real terms than
expressed here. The same concepts apply to the sanitation situation.

Hygiene Behaviours and Access to Sanitation
In relation to rural sanitation, very little is known regarding access to improved sanitation facilities.
However it is nationally estimated that around 26% of the population has access to improved
sanitation facilities.

Inappropriate household water management, excreta disposal, and personal hygiene practices
contribute considerably to unhygienic conditions which exist close to communities, creating a breeding
ground for disease and the possibility of diarrhoea, dysentery, and cholera. Repeated diarrhoea is a
major cause of malnutrition and underweight, leading to susceptibility to other illnesses. Diarrhoea
causes 13 percent of under-five deaths. Epidemiological data show high rates of faecal-oral
transmitted diseases.

Women, with the major responsibility for collection of water and for childcare at household level,
perform a key role in water and sanitation and are potentially significant agents of change.

HIV/AIDS
The provision of safe water and sanitation is essential for the prevention of opportunistic illnesses in
people living with HIV and AIDS (PLWHA). The existing poor access to these, compounded by
inadequate hygiene practices will have a particularly negative impact on PLWHA, and this will only

Page 10 of 20
increase with the effect of the drought on access to water and the ability to implement safe hygiene
practices is reduced.

2. Main Threats Caused by the Drought

A significant proportion of the rural population (65%) rely on insecure water sources (shallow hand-
dug wells, small streams, ponds, rivers). Those relying on these surface water sources are already
experiencing some difficulties in particular in parts of Tete, Inhambane and Gaza provinces (districts
habitually dry). If the rainy seasons for the next few years are below average, as predicted, almost all
of these sources will be affected.

For boreholes and deep wells, the water tables throughout the country should be currently fairly well
charged, having had good rainfall for the past few years. However, little accurate information on rural
groundwater conditions in the affected areas exists. As the water table slowly draws down during the
dry season, it can be expected that many of these sources will dry partially and some totally.

As the access to water is reduced, populations will be forced to travel greater distances to find water,
and available sources will be put under significant pressure. Experience from the drought of 1992 – 94
showed that available boreholes with hand-pumps often suffered frequent breakdowns due to the
increased usage. In the meantime, if the drought continues and there is consequently no aquifer
recharge, the water levels will continue to go down resulting in some water points becoming unusable.

The problems described above are likely to impact on the amount of water available within the
household for personal and household hygiene. The consequences of this will be seen in an increase
in the cases of diarrhoeal diseases, and higher rates of skin and eye infections. This in turn will
negatively impact on the health status and coping mechanisms of the members of the household. This
contributes to increased human poverty.

3. Government Policy
The Government Policy for the Water Sector focuses on development of infrastructures necessary to
ensure access to basic services mainly for the low-income groups in rural and peri-urban areas. This
is in line with the National Action Plan for the Reduction of the Absolute Poverty (2001-2005). To
ensure sustainability and maximise benefits the set pursues two strategies: effective involvement of
the communities and integration of water sanitation and hygiene.

In line with the decentralisation, implementation of water, sanitation and hygiene promotion activities
are undertaken by the provinces in co-operation with NGO’s and private sector.

As part of the emergency preparedness the Government has established under the INGC a working
group on Shelter Water and Sanitation chaired by MOPH/EC.

4. Resources
While efforts are being made to build capacities of provinces to undertake the new roles and
responsibilities, provinces have difficulties in attracting qualified and experienced personal. This is
often resulted in weak co-ordination among all stakeholders.

As part of the UN Contingency Plan, various water, sanitation and hygiene supplies have been pre-
positioned and most of them could be used in response to the drought emergency. These include
Water Treatment Plant, water storage bladders with tap-stands, chlorofloc sachets, jerry cans,
buckets, and plastic latrine slabs.




Page 11 of 20
5. Key Challenges
The overall response to water and environmental sanitation conditions should focus on increasing
sustainable access for rural and low-income groups and promote improved behavioural change. It is
vital to ensure that water, sanitation, and hygiene promotion interventions are planned with
communities. However, it is important that the need for community interventions to be technically and
financially sustainable does not prevent poorer communities from benefiting from adequate water and
sanitation facilities. Furthermore, communities must be made aware of local water issues so that an
informed decision is made in agreeing appropriate interventions. Communities must also be
supported in obtaining the relevant information in order to allow them to make informed decisions
regarding their own development priorities and strategies.

Provision of facilities needs to take place in tandem with hygiene promotion activities in order to
maximise interventions and community well-being.

A number of barriers to improving access to water and sanitation exist in the context of the drought,
namely:
 Weak co-ordination of the various actors in the sector in particular at the provincial level.
   Lack of updated information on the extent of impact of the drought, on water facilities susceptible
    to drought conditions, contributions of the various players.
   Lack of involvement of users in design and implementation of projects
   Lack of empowerment of women as powerful change agents in hygiene practices.
   Lack of emphasis by technicians on social issues related to water systems (technicians
    concentrate on technology);
   Under-utilisation of NGOs and the private sector;
   Strong cultural taboos and beliefs interfering with behaviour change.
   Difficulties in implementing demand responsive approaches in the context of the drought
    emergency.


6. Government / UN Response to Current Situation

Assessment and Monitoring
From 4th – 30th June 2002, a series of assessments will be carried out in the districts identified as
being worst affected in terms of food security. Among other issues, the assessment will look at the
frequency of diarrhoeal disease in children under five, access to water, and household sanitation and
hygiene practices. Results will be available by the end of June and will be used to finalise the drought
emergency response plans.

In the longer-term, support will be provided to the Provincial Departments for Public Works to monitor
critical water sources.

Assistance Provided by UN
UNICEF is providing technical and financial assistance to the provinces to undertake the assessment.
At the request of the Government and as part of the emergency preparedness, water and sanitation
supplies have been ordered and are in position around the country.

Expected Areas of Intervention
UNICEF will work to support the Ministry of Public Works and Housing to plan, implement and monitor
response actions to the drought situation. Results from the assessments will define the extent and

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geographical coverage of interventions, but given the experiences of previous droughts in
Mozambique, the actions that will be taken to increase access to water supplies will include:
 Rehabilitation of malfunctioning water facilities through replacement of broken pumps and flushing
   of old boreholes
 Establishment and capacity building of the community water committees
 Development of new water facilities in rural areas (wells / boreholes)
 Trucking of water
 Provision of water treatment supplies

In addition, some education activities to improve existing hygiene and sanitary conditions will be
implemented:
 Promotion of appropriate hygiene and sanitation practices
 Campaign for better use of available water supplies, in particular in urban and peri-urban areas

WHO will provide technical and financial support to RESP (IEC Unit), Ministry of Health at the central
and provincial level for the revision of the “Emergency Manual on Health Promotion Activities for
Community Volunteers” and the implementation of the hygiene promotion activities.




Page 13 of 20
EDUCATION
1. Situation of Education in Mozambique

Primary Level
In EP1 schools, 32% of children attend only one shift and not a full school day. In 1999 it required
13.1 years (males 12.7 and females 13.8) for the average pupil to graduate from EP1, rather than the
five years were envisaged. Still, this represents significant progress over 1992 when an average of
15.5 years per graduate was recorded (14.5 males and 16.6 females). The pupil: teacher ratio at EP1
is 62.2 with a pupil: class ratio of 46.9. For the large majority of children, the language of instruction is
not their mother tongue. Annually, about 30% of all children repeat at least one class, 8% drop out,
and only 8% complete the first cycle without repeating. Only 32% who enter the first grade eventually
graduate from EP1. 32% of all teachers have no training, and only 24% are women.

Table 6 Primary Education Indicators
EP1 indicators                  1997    Boys     Girls 1999      Boys     Girls 2000      Boys     Girls
Gross Enrolment Rate (%)        68.2    79.7     56.7   75.6     86.3     64.8    96.6    102.9    78.3
Net Enrolment Rate (%)          38.5    42.9     34.1   43.6     47.4     39.8    53.8    58.1     49.5
Dropout Rate (%)                                        18.3     17.8     19.1
Repetition Rate (%)                                     25.0     24.3     26.1
% Completing Grade 5                                    46.2     48.9     42.8
Source: MINED

Secondary and Higher Education
As a consequence of the inefficiencies of primary schools, secondary education is also subject to low
participation rates and low quality. Only 7% of primary school graduates enter the first cycle of
secondary education. The small number of secondary schools, 71 at ESG1 and 18 at ESG2, limits
access. Most secondary schools are located in urban centres. Schools in rural areas are boarding
schools with few resources for quality education. With a repetition rate of 41.4% (46.5% male and
53.5% female), the efficiency of the secondary level leaves much to be desired.

As with the transition from primary to secondary level, the curriculum and quality of secondary
education does not allow for smooth progression to tertiary levels such as university and
technical/vocational institutions. Only 1% of students enter higher education institutions; the further
and higher education sub-sector is small and under developed and in need of expansion and reform.
The World Declaration on Higher Education for the 21st Century suggests that “without adequate
higher education and research institutions, no country can assure genuine endogenous and
sustainable development.” The Declaration further suggests that “developing countries cannot reduce
the gap separating them from the industrially developed ones” without a dynamic higher education
sector. A key goal of the new Ministry for Higher Education Science and Technology is an increase in
the participation rate for higher education, improved management of state and non-state higher
education facilities and a further diversification of the sector to allow for greater provision by non-state
entities including the private sector. Additionally, the intention is to facilitate a higher level of research
and application of science and technology to allow higher education to contribute to economic and
social development goals of the country.

Teachers and Teacher Training
The crisis of teacher supply requires urgent attention. One third of teachers are not trained, with a
much larger proportion of untrained teachers outside urban areas. The growth in enrolment,
particularly in primary education, is outstripping the capacity of the system to produce sufficient

Page 14 of 20
trained teachers, and the ravages of HIV/AIDS will further undermine the supply of teachers in the
years ahead. To improve the efficiency and effectiveness of teacher education, a unified teacher
training system, linking a wide range of current initiatives, including the use of distance teaching and
learning strategies needs to be promoted. Further attention is also required to improve the status of
teachers through provision of accommodation and increased salaries.

HIV / AIDS
HIV/AIDS has a multiple, and generally negative impact on education. It affects the demand for
education, the supply of educational services, the quality of education, and the management of
education. In the context of the drought, this situation is likely to be intensified.

2. Main Threats Caused by the Drought
The drought is expected to cause higher levels of pupil absenteeism and drop-outs mainly due to: (1)
an increased need for children to contribute to family labour children - having to spend more time
searching for food, fetching water or caring for other family members (younger children / elderly); and
(2) a reduction in disposable income for expenditure on the children’s education within the household.

Higher absenteeism will in turn have an impact on the levels of performance, and will ultimately result
in even higher repetition rates. If the dry spell continues there is likely to be a negative impact on
school enrolment for the next school year (January 2003).

3. Government Policy
Mozambique boasts key right-to-education clauses in its Constitution. It has also formulated and
publicised a National Education Policy, and the Education Sector Strategic Plan (ESSP) which has
the full support of the donor community. The poverty reduction priority for education is improved
access, especially in rural areas, reducing gender disparities in both admissions and school
performance. Current admission and enrolment rates are being improved and the school network
expanded through the construction of new classrooms, and the recruitment and training of teachers.

MINED has prepared an Action Plan to address the HIV/AIDS pandemic which focuses on providing
prevention activities for secondary school pupils, providing life skills training for pupils and teachers,
and support for teachers living with HIV. Children affected by HIV/AIDS need to learn in safe, stable
environments and gain the knowledge, skills, and values needed to develop together with their peer
and communities.

Contingency plans for the drought are being prepared by a working group in the Planning Directorate,
following similar procedures used during previous emergencies.

4. Resources
The improvement of quality and the implementation of planned reforms require increasing the
allocation of resources to the education sector. In 1997 the Government expenditure on education
was 15.4 % of total public expenditure and 2.9% of GDP. The budget of MINED for 2001 is 1,320.2
billion meticais (800.1 billion for salaries and 520.2 for goods and services). This is still below the
target set under the mid-term expenditure framework. A declining budget in real terms is a concern,
taking into account the opportunities available for additional resources to be released to education
under the HIPC arrangements.

Within the UN Contingency Plan, UNICEF will support the Ministry of Education to assess and
respond to an emergency situation. Within this plan, a contingency stock of pupil, teacher and school
kits have been pre-positioned around the country. The use of these will be reoriented to those areas
most affected by the drought.



Page 15 of 20
5. Key Challenges

   Continued expansion of the school network through construction and rehabilitation

   Developing teacher education processes through a unified system under MINED supervision
   Promoting family and community involvement in education
   Expanding the scope of an integrated health programme (including attention to the nutritional
    needs of pupils through provision of hot meals) for schools, out-of-school youth and communities
   Teacher training as well as parent education on Early Childhood Development delivered via non-
    formal education channels
   Educating young people about HIV/AIDS – about the causes, risk factors and prevention
   Ensuring continued schooling for HIV/AIDS-affected children and orphans
   Training key personnel at central and provincial level in education planning and financial
    management, and in pedagogical supervision


6. Government / UN Response to Current Situation

Assessment and Monitoring
The Ministry of Education is working with the Provincial Education Directorates to identify sentinel
schools in the drought-affected districts. These schools will collect data on attendance rates and
reasons for absenteeism and report back to the provincial authorities on a monthly basis. The
Provincial Education authorities will supervise and monitor this process.

Assistance Provided by UN
UNICEF has been working with the Ministry of Education to identify the numbers of school children
living in the districts considered to be affected in terms of food security due to the drought. Support for
planning and co-ordination of their emergency response will also be provided.

Expected Areas of Intervention
Under the UN Contingency Plan, UNICEF will support the Ministry of Education to maintain access to
basic education. UNICEF has supplied a contingency stock of pupil, teacher and school kits to be
used in case of an emergency situation. As there have been no floods / cyclones this year, the
Ministry of Education and UNICEF are planning to reorient the use of this stock for the areas affected
by the drought. In addition, support will be channelled to the Provincial Education Departments to
enable them to monitor the situation of school attendance.




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SPECIAL PROTECTION
1. Situation in Mozambique
High level political commitment to women and children has been demonstrated in Mozambique
through the ratification of the CEDAW (1993), CRC (1994) and the African Charter on the Welfare and
Rights of Children. In addition, policy development took place in the areas of youth, social integration
of children and disabled children. Nevertheless, the combined effects of poverty, HIV/AIDS, and social
dislocation due to population movements during the civil war mean that the number of children in
need of special protection remains high. By end 2002, there will be an estimated 435,000 children in
Mozambique who have lost their mother or both parents due to HIV/AIDS. Although exact numbers
are not known, there are children involved in exploitative and harmful labour. Problems of abuse,
neglect and sexual exploitation exist, and over 50,000 children are living with disabilities

HIV / AIDS                                                                        Maternal AIDS Orphans
Mozambique has one of the highest HIV prevalence rates in the
world. It is estimated that in 2002, more than 1.3 million
Mozambicans are infected with HIV – 13.8% of the adult population.
Over 57% of the Mozambican adults living with HIV are women.                                     6.15             6.15
Data from 2000 shows that the epidemic is particularly severe in the
central provinces of Tete, Manica and Sofala with the average HIV                 10.29                           6.1
prevalence exceeding 19%, and in the southern province of Gaza                                                    5
                                                                                                    10.2
with more than 16% of the population infected. The provinces                                        9
hardest hit by HIV coincide with the drought-affected areas of the                          10.29
                                                                                   10.29
country.

In 2000 there were at least 60,000 new maternal orphans. The                             % of children
number of children in Mozambique aged under 15 and orphaned
                                                                           4.17
                                                                                  4.17   0 – 14 years
                                                                                         who are
from their mother is expected to reach 1.12 million by 2006, with the
                                                                                         maternal
increase due entirely to the impact of HIV, and therefore having a           4.1
                                                                                         orphans
                                                                             7
greater impact in the central region. In the past, most orphan
children have been absorbed into extended family networks,
however, with the advent of AIDS, the extended family has become over burdened, increasing the risk
of children loosing out on school opportunities, reduced access to health and other social services,
loss of inheritance and putting them in situations of risk such as sexual exploitation, child labour and
exposure to HIV.
                                                Child Labour in Mozambique: Results of 2000 Survey
Child Labour and Sexual Exploitation
Although the Labour Law prohibits the
employment of children under 15 (except
with the agreement of the Ministries of                                    43.8
                                                                                                           40.3
                                                                                                                         46.6
                                                                   44
Labour, Health and Education as well as
their legal guardians), children do work in                                 43            43.3                           43.2
various sectors.                                  48.3
                                                                                                             40.4
                                                                    37.3

A rapid assessment of the situation of
child labour in Mozambique focused on                30.5
                                                            33.9
                                                                                             28.9
                                                                                                    36.9

children who work as domestic workers,
traders and in agriculture. The results
suggest that the worst forms of child                                                            24.7
                                                  22.6      23                            21.9
labour are in commercial agriculture
(cotton), domestic work and child                            % of male rural
                                                                                                    % of female rural
prostitution. For most of the children            23.6       children aged 7 –            21.7
                                                                                                    children aged 7 –
working hours were long and payment                          14 years working
                                                                                                    14 years working

Page 17 of 20
extremely low. Working girls are especially exposed to all forms of abuse, including sexual abuse.

The data indicate that many children started working as a consequence of family break up, through
either death or separation of the parents and the subsequent weakened economic power of the
family. Most children work in order to contribute to the household income or because school is not
affordable. The law prohibits minors from undertaking heavy or dangerous tasks that require
significant physical strength, but since most child labour takes place in the informal sector, labour laws
are difficult to enforce. More detailed studies are needed to verify if the legal mechanisms are being
respected.

Landmines
Landmines in Mozambique are not randomly scattered across the country but were laid tactically to
protect villages and infrastructure. However, no reliable maps exist indicating the locations of these
mines. This is now hampering development by denying access to the assets they were originally
intended to protect. There is an increased presence of landmines around conflict lines, but the nature
of the extended conflict blurred these areas to encompass virtually all of the country, including many
of its international borders. With the floods in 2000, landmines were washed from higher lying areas to
previously cleared areas, causing renewed worries for the population in these areas.

2. Main Threats Caused by the Drought

HIV / AIDS
In many of the drought stricken areas, the impact of HIV/AIDS has already resulted in high numbers of
child headed households, households with older caregivers caring for orphans, and other families with
a high number of vulnerable children and adults infected and affected by HIV/AIDS. The drought will
further stretch the capacities of these safety nets to provide care and protection for vulnerable
children. These conditions force children and their families to look for alternative means of survival to
ensure livelihoods, that might put children at risk where their rights are violated and/or reduce their
access to basic services. Many girls will have to stay home and care for the ill as well as take care of
domestic chores, limiting their access to education. As community resources are stretched,
discrimination against AIDS orphans or people living with HIV or AIDS could increase, reducing
access to support mechanisms for these groups.

It should be noted that HIV prevention initiatives will face an additional challenge among distressed
and impoverished populations whose main concern will be immediate survival. The situation is
therefore likely to fuel complacency about the HIV epidemic.

Child Labour
Boys and girls may be forced into various forms of child labour to assist with the household income,
reducing their educational opportunities and putting them at risk. Young girls may be exposed to
sexual and economic exploitation in the search of alternative means of earning an income. This will
place them at increased risk of contracting HIV.

Landmines
The threat of exposure to landmines might be further increased due to especially children and women
being forced to forage for water and food by venturing into areas, which have not previously been
cleared of landmines.

3. Government Policy

HIV / AIDS
Approved in 2000, the Government’s Nation Strategic Plan (2201 – 2003) out lines the following
priorities: (1) Prevention activities focusing on young people and highly mobile population and their

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sexual partners; (2) Improvement in the quality and coverage of VCT, care and treatment; (3) Impact
reduction through support to activities aimed at people living with AIDS and children infected by AIDS;
and (4) Focus on the Development Corridors.

Beyond the health sector, the Ministries of Education and Youth have developed and are currently
implementing programmes to equip young people in- and out-of-school with information and life skills
to protect themselves and facilitate their access to youth-friendly health services. The Ministry of
Social Action, through their sectoral plan on HIV/AIDS, have finalised their strategies for the care and
protection of children made vulnerable by HIV/AIDS and implementation is underway in collaboration
with NGOs and community based organisations.

Child Labour
Following a rapid assessment carried out in 2000, a national strategy on child labour was elaborated
and approved by the Consultative Council of the Ministry of Labour which set the stage for a national
seminar on child labour in which a draft plan of action to address the worst forms of child labour was
drawn up. UNICEF is working to support the development of legislation on child domestic labour, as it
was one of the three worst forms of child labour identified.

Landmines
The government created the National De-mining Institute to co-ordinate all mine actions and mine
awareness campaigns in the country and this institution has now developed a 5 year plan of action to
address landmines in Mozambique.

4. Resources

HIV / AIDS
The National Strategic Plan remains largely unfunded. According to the revised budget presented by
the National AIDS Council in 2000, the implementation of the National Strategic Plan is costed at
$253 Million for the period of 2001-2003. However, these figures do not reflect key new interventions,
such as Home Based Care; ARV treatment, PMTC, and others which were not included at the time of
the formulation of the NSP in 1999. Over USD 100 million were pledged by donors in December 2000
but very little has been disbursed. The AIDS Common Fund, launched in Nov. 2001, aims to pool
additional external funds primarily to support CVOs. Procedures and systems for the management of
the funds are been established but pledged donor funds have yet to be disbursed. Funding for the
sectoral plans on HIV/AIDS are also limited. Mozambique is preparing a funding proposal for the
Global Fund (2nd round) and has also officially requested a World Bank loan to address HIV/AIDS.

Child Labour
UNICEF is currently finding the dissemination of the findings of the rapid assessment and the draft
national plan of actions, as well as the development of legislation and action in the area of child
domestic work. However, few other bilateral and multilateral partners are involved in this area.

Landmines
Landmines awareness campaigns have been supported by UNICEF through Handicap International
who has been the co-ordinating institution in the area of mine awareness. This responsibility was late
2000 handed over to the IND. Currently, IND have not been able to fill the vacuum created by
Handicap international in co-ordinating the area of landmine risk awareness and education.

5. Key Challenges
HIV / AIDS
 Level of awareness and life skills development: strategies to develop increased knowledge and
    skills to address and cope with the issues relating to HIV/AIDS, and supported by shifts in social


Page 19 of 20
    and economic relations between men and women. This may be increasingly difficult during the
    drought period, as more immediate concerns are likely to draw attention away from this issue.
   Stigma: characterised by silence, fear, discrimination and denial, stigma is a major factor fueling
    the spread of HIV/AIDS in Mozambique. A new legislation was passed to protect HIV positive
    workers from dissemination in the workplace, but there are still no clearly articulated strategies to
    address this important issue, although there is recognition of the potential role of PLWAs and
    religious organisations.
   Access of Children Affected by HIV/AIDS to Basic Social Services: Strategies to ensure the care
    and protection of orphans and other children made vulnerable by HIV/AIDS need to be better
    articulated and implemented. Many of these children lack food, shelter, medical care, school fees,
    protection from neglect and abuse, economic support and emotional care. Many find themselves
    at high risk of HIV infections due to their living conditions. These children may suffer increased
    discrimination as a result of the additional pressures placed on communities by the drought. Many
    find themselves at high risk of HIV infections due to their living conditions.

Child Labour
 Finalise the draft National Plan of Action, ensure multi-sectoral participation and action for its
    implementation in all parts of the country.

Landmines
 Building the capacity of IND and its partners in the area of mine risk education and awareness,
   and strengthening local NGOs to build on the work already done in the country in this area.


6. Government / UN Response to Current Situation

Louise I am not sure about what to write here …. The rapid assessment will more clearly identify what
needs to be done, but key would be that any intervention needs to take into consideration vulnerable
groups and their capacity, and would need to address rights violations if they are directly related to the
drought (i.e. increased exploitative child labour, prostitution etc.)., strengthening work in the area of
OVCs and HIV/AIDS …

Assessment and Monitoring
From 4th – 30th June 2002, a series of assessments will be carried out in the districts identified as
being worst affected in terms of food security. These will collect data on critical household status due
to the drought.

Assistance Provided by UN
WHO is already providing financial and technical support to Sofala, Gaza, Manica and Tete
particularly in Counselling and Voluntary Testing, Home Based Care and treatment of opportunistic
infections. In the above named provinces WHO supports training of district health staff, provision of
drugs and supervision.

Youth friendly health services?


Expected Areas of Intervention




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