It is day 2 of the field visit of the annual joint review and I am sitting sweating in a dingy hotel room with no functioning air-con, but with a most fantastic sea view. I've attached a shot of the beach just to make you jealous...
I am writing up the outcome of the day's visit to two health facilities in Gaza province, the first, the Provincial hospital in Xai Xai, which was ranked the best hospital in Mozambique by the Ministry of Health in 2004, 2007 and last year in 2008. The hospital proved to be an excellent bench mark against which to judge other health facilities.
I am part of a team of 9 people, from the Ministry of Health and from development partners who are evaluating one of 3 provinces which are being used to assess the performance of the health sector in 2008. This joint annual assessment process is the way by which both the government and its development partners, particularly those donors who are providing support directly to the health sector budget, judge whether both Mozambican donor country tax payers' money is being well spent.
The team are looking at 4 areas: financial management; pharmaceutical management; monitoring and evaluation, including doing a data verification on statistics collected on anti-retroviral drug coverage; and, the area I am responsible for, environmental health.
I've attached a couple of pictures which show the team walking towards the extremely clean and well run Xai Xai Provincial Hospital. Whilst we were on our inspection there however, the heavens opened and the picture of the Patrice Lumumba health centre which we visited in the afternoon, shows the deluge of mud and water that greeted us. The picture shows our team leader, Julio Langa avoiding the water to enter the facility.
Environmental health is a focus of the annual review this year as the Ministry of Health made it one of the 5 priority areas for 2008. Although health services in Mozambique have been improving over recent years, some of the major causes of ill health, such as access to clean drinking water and sanitation, along with levels knowledge of good hygiene behaviours is limited in some parts of the country.
The significant outbreak of cholera in Zimbabwe has received much attention, but Mozambique also has an endemic cholera problem and 2008 saw higher levels of cholera than normal - in part due to the heavy rains which increase the risk of drinking water being contaminated with sewage.
Its only day 2 of the annual review, but it is apparent that huge strides have been made to improve environmental health in Gaza. The two facilities visited so far are clean and have good procedures in place for maintaining a clean hospital environment and reducing the infection risk. There also appear to have been significant efforts made with the communities to increase the collection of rubbish in streets and increase the number of households that have a latrine. In spite of these efforts however, 2008 was a year in which there was a significant increase in the number of diarrhoea cases and in cholera cases. This just serves to demonstrate that the types of changes needed to improve some of the determinants of health, such as clean water and sanitation require long term investments. It is also clear that the Ministry of Health will not achieve improvements working alone, and a significant effort has been put in to increasing collaboration between various departments at central, provincial and district level in order to improve public health.
I was impressed by the facilities seen today. But let's see what the next couple of days bring, as we move further away from the provincial capital Xai Xai.