Abstract

PIP: This report describes the current status of maternal and child health care (MCH) in Mozambique and was prepared by an American nurse-midwife, hired by the Mozambique government as an instructor for the country's nurse-midwife training program. The socialistic government, under its international cooperates program, hires advisors and instructors to help implement the nation's many health, education, and economic development programs. In 1975, when the country was granted independence, the health care system was grossly inadequate. During the colonial period, the health system was oriented toward providing care for the white, urban population rather than for the country's largely rural population. Prefessional jobs were reserved for Portuguese nationals, and Africans were not allowed to attend the nationhs medical schools. When independence was obtained, all but 50 of the nation's 600 physicians left the country. The development of MCH services is given a high priority by the current government. It is estimated that currently 35% of the all children born in the country die before they reach the age of 5 years. The maternal mortality rate is estimated to be 300/100,000. Efforts to improve health conditions are hindered by a lack of trained personnel, money, and medical equipment and supplies and by an inadequate transportation network. Despite these obstacles, progress in the provision of MCH services is being made. MCH units are being established throughout the country. These units are generally operated by trained nurse-midwives. A national nurse-midwife training program is conducted at the National Health Science Institutes in Quelimane. Trainees must be at least 18 years of age and have 6 or more years or primary schooling. The 2 1/2-year training program is intensive and students receive practical experience by working at an adjacent provincial hospital. Upon graduation, most assume the responsibility for operating a rural MCH unit. They are expected to provide services for a large population and to do so with little or no medical backup and minimal equipment and supplies. As part of their training, they learn how to prioritize health care and how to recruit community volunteers to help run the unit. The rural MCH units provide prenatal services, including high risk pregnancy referrals, nutritional counseling, and treatment for parasites and anemia. Many of the nurse-midwives operate well child clinics. These clinics provide immunization and chloroquinization services and treatments for parasites and anemia for children under the age of 5 years. Nutritional counseling is provided for the mothers of the children. Growth charts are used to identify malnourished children in need of hospital care. The midwives encourage breastfeeding. Recently a family planning component was added to the MCH program. Oral contraceptive, IUDs, foam, and condoms are provided. The program stresses the use of contraception for spacing rather than for limiting child births. Infertility is common among the rural women, and some midwives provide limited infertility counseling and evaluation. 30% of the country's deliveries are now performed in maternity units. These units range from hospital facilities to small, minimally equipped rural units. In most rural units, the deliveries are performed by nurse-midwives without medical assistance. Given the poor health status of rural women, pregnancy complications are common, and the units are too inadequately equipped and staffed to cope effectively with these complications. As a result, maternal morbidity and mortality is high. The majority of the country's deliveries are still performed at home by untrained traditional birth attendants. No effort is being made to train the traditional birth attendants or to bring them into the national health care system.