Background:

Mozambique: situated in southern Africa Borders countries: South Africa, Swaziland,

Tanzania, Malawi, Zambia and Zimbabwe. Total area: 801,590 sq Km 11 provinces and 133 districts Population: 16,099,246 (July 2002 est.) 72% of the population live in rural areas illiteracy: 60.5% of population

Mozambique

Capital: Maputo Pop:+- 2 millions

Health Status

Population growth rate: 1.13% Birth rate 36.41 births/1,000 population Death rate 25.13 deaths/1,000 population Infant mortality: 138.55 deaths/1,000 live

births Life exp at birth:tot population: 35.46 years

female: 34.65 years; male: 36.25 years

Socio, historic & political context 1458 – 1975: Colonial period

June 25th, 1975 - Independence 1975 – 1992: civil war destroyed most of

the infrastructures (mostly health, education & tele and communications) Trained people left the country; 5 doctors!!! Peace aggreement signed

1992 .... National reconstruction (after war, floods, ....)

ICTs: Maputo

50% of the ICTs and related technologies are located in Maputo;

Survey: 3:1000 and 2: 10000 inhabitants share a computer and use internet respectively;

Challenges

How implementation is related with communication practices?

What can we do about it?

Health system hierarchy

Community (US)

Province (DPS)

District (DDS)

MISAUNational

Health dataPlans and resources

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Health district: Xai-Xai

Health Information System (HIS) information flows between levels: paper-

based (forms reports) data are collected at health facilities from

communities, aggregated and collated at district levels

communication did not always follow a fixed pattern

communications depended on many external conditions, often out of control of the health officers responsible for communication

HIS

The information collected at facility levels and handle at district level consists basically of aggregating the forms from the health facilities into district forms, which are then submitted to the province.

Lack of skill and training of the personnel of the district health data are not kept in a systematic way on a health facility basis.

HIS

Because of these problems of communications, the weekly and monthly health reports were sent to the upper levels very late

Local people showed little motivation and commitment to communicate with the upper levels

HISP

Mozambique in 1999 Eduardo Mondlane University & MISAU

Pilot districts: located in remote rural areas with relatively good infrastructure

Actions: Research Training seminars

Communication at different levels Health unit health district

Health district province

Province MoH (MISAU)

Counter networks Castells

Globalization and Marginalization Exclusion vs Inclusion

Health Information

Information & Communication Technology

System Develeopment context & implementation The culture of communication Nature of work practices Methods/processes of communication Constraints to communication Experience with new ICTs How can new ICTs be integrated

effectively into work practices at various levels

Resistance to technology ….. question of identity?

Expectations ...

Assessment of current constraints to communication between district and provincial levels in HIS, and how these can be made more effective.

Theoretical model to help understand the interaction between ICT and communication practices in the health districts.

Help to produce social change on the ground in terms of improved information management in the district health system in Mozambique (???)