The implementation of the Primary Health Care Strengthening Program, which is directly linked to the investment case, has exceeded most of its targets (Table 1).1 In December 2018, the Ministry of Economy and Finance reported a 9 percent ratio of domestic health expenditures to total domestic government expenditures, putting it on track to achieve the 2021 commitment of 9.5 percent. The government also committed to increasing health expenditures for the 42 prioritized districts from US$0 in 2017 to US$9 million by 2019 and US$36 million by 2021, but this target was not met the first year.
Increases in primary health care and community health staffing have also been demonstrated: the targeted number of trained and active community health workers was 3,390 in 2018, with a goal of 8,800 by 2022. The target for the first year was met, with training for 5,363 community health workers already completed. The targeted number of technical health personnel assigned to the primary health care network was 14,344 in 2018 (from a baseline of 11,970 in 2017) and has a goal of reaching 17,662 by 2022.
Efforts toward the systemic recording and use of data have also improved. To facilitate progress in tracking the implementation of the investment case, and in response to significant challenges in monitoring activities at the subnational level, the government and its partners are developing a national dashboard with jointly agreed-upon indicators. In the meantime, quality-of-care scorecards for health centers and hospitals have been piloted and will be scaled. Also, vital statistics registration, which is a key focus area of the investment case, has improved, with the share of facilities using the Data Management Module (MGDH) to record cause of death rising from 70 to 100 percent among hospitals and from 0 to 50 percent among health facilities.
Lastly, many of the RMNCAH-N indicators and targets set forth in the Primary Health Care Strengthening Program for 2018 have been achieved or exceeded (Table 1). The share of births that occurred in health facilities reached 80 percent, a number that exceeded the 2018 goals. Nutrition goals for 2018 focused mostly on training key nutrition personnel and rolling out the Nutrition Intervention Package (NIP) in the eight highest-burden provinces: these goals were also achieved. Between 2017 and December 2018, 3,609,078 additional children received basic nutrition services. To improve sexual and reproductive health outcomes, Mozambique has placed a high priority on reducing the unmet need for family planning and increasing access to modern contraceptives. To monitor utilization of this service, Mozambique uses “couple years of protection” (CYPs), and on this indicator saw a 26 percent increase in 2018 compared to the previous year, exceeding national goals.