Estimating the cost for obstetric fistula repair in hospitals of Mozambique: a low-income country.

BACKGROUND: Obstetric fistula is incident and prevalent in low-income countries. Globally, about 100,000 women develop fistula annually. In Mozambique, more than 2,000 fistulas are reported annually. A national strategy to combat obstetric fistula has been implemented in Mozambique from 2012-2020. This strategy is under review, making it opportune to generate evidence that reflects the course of the strategy implemented to subsidize/optimize the definition of priorities of the new strategy to achieve universal health coverage. In Mozambique, information on the costs incurred to treat fistula is scarce. This study aims to estimate the mean unit cost of repair/treatment of simple and complex obstetric fistula in Mozambique. METHODS: We carried out a retrospective evaluation, from the provider's perspective, using the Ingredient and Stepdown approaches. The mean unit cost was obtained by the sum of individual and shared ingredients to treat fistula. Cost dimensions included Direct Medical Costs (personnel, drugs, and supplies), Overhead and Capital Costs (administration and capital assets' costs, respectively). The average exchange rate was USD 1 = MZN 61.47. Data were collected in secondary, tertiary, and quaternary hospitals of Zambézia and Nampula provinces in 2021. Costs borne by patients and their families and loss of productivity were not included. RESULTS: The mean cost for Simple Obstetric Fistula repair was MZN 14,937.21 (USD 243) and Complex Obstetric Fistula was MZN 21,145.68 (USD 344) per person operated. Regardless of the type of fistula, the repair cost was MZN 18,072.18 (USD 294). CONCLUSION: Without neglecting that prevention is better than plasty, the results show feasible levels of fistula repair costs for mobilization of funds. For the estimated 2,000 fistulas reported annually, the government needs an average MZN 36,144,360 (USD 588,000).

The Use of Research for Health Systems Policy Development and Implementation in Mozambique: A Descriptive Study.

Health policy and systems research (HPSR) is generating an increasing amount of evidence in Mozambique, where implementation of a wide range of public health policies and interventions, and innovative technologies and solutions, is underway. We used qualitative methods to explore the relationship between HPSR and policy development and implementation in Mozambique. We conducted a literature review and in-depth interviews with researchers, experts, and policy makers. Through our analysis, we assessed barriers to the use of research evidence in the development and implementation of national health policies and identified potential opportunities to improve evidence use in this context.We found an increasing number of research institutions producing solid scientific evidence in the country, with activities in health in general and health systems specifically. There is also a growing trend for decision makers and policy makers to use the results of research during the design, formulation, and implementation of health policies. Most HPSR conducted in Mozambique is funded by international donors and focused on research questions of international interest. Therefore, research generated in Mozambique does not always address questions that are relevant to the local health system development agenda.While Mozambique has a lot of "gray literature" outlets, few of its publications support the translation of research evidence into policy. Much of the evidence generated in country is disseminated through project reports and briefings, not peer-reviewed literature. Furthermore, when the research evidence generated is not locally relevant, results may be published only in English and in scientific articles, instead of in formats useful to Mozambican policy makers-to the detriment of national-level understanding and use. We recommend that research institutions and policy makers in Mozambique collaborate on developing a platform that consolidates HPSR, making it more accessible and useful to policy makers.

Access to and use of preventive intermittent treatment for Malaria during pregnancy: A qualitative study in the Chókwè district, Southern Mozambique.

BACKGROUND: Malaria remains a significant health problem in Mozambique, particularly in the case of pregnant women and children less than five years old. Intermittent preventive treatment with sulfadoxine-pyrimethamine (IPT-SP) is recommended for preventing malaria in pregnancy (MiP). Despite the widespread use and cost-effectiveness of IPTp-SP, coverage remains low. In this study, we explored factors limiting access to and use of IPTp-SP in a rural part of Mozambique. METHODS AND FINDINGS: We performed a qualitative study using semi-structured interviews to collect data from 46 pregnant women and four health workers in Chókwè, a rural area of southern Mozambique. Data were transcribed, translated where appropriate, manually coded, and the content analyzed according to key themes. The women interviewed were not aware of the risks of MiP or the benefits of its prevention. Delays in accessing antenatal care, irregular attendance of visits, and insufficient time for proper antenatal care counselling by health workers were driving factors for inadequate IPTp delivery. CONCLUSIONS: Pregnant women face substantial barriers in terms of optimal IPTp-SP uptake. Health system barriers and poor awareness of the risks and consequences of MiP and of the measures available for its prevention were identified as the main factors influencing access to and use of IPTp-SP. Implementation of MiP prevention strategies must be improved through intensive community health education and increased access to other sources of information. Better communication between health workers and ANC clients and better knowledge of national ANC and IPTp policies are important.