A new partnership for PCI in Mozambique: our role in shifting NCD care into primary care

PCI is pleased to be partnering with one of Mozambique’s most established healthcare leaders, Professor Ana Mocumbi, Head of Non-Communicable Disease (NCD) Research at the Mozambique Institute for Health Education and Research. The partnership will test how strengthening primary care systems and upskilling health professionals in NCD care provision can improve outcomes for patients with diabetes and at risk of heart disease and stroke.  As well as being a practising Cardiologist and our project partner, Professor Mocumbi currently leads the Mozambique NCDI Poverty Commission which recently hosted a conference on Non-Communicable Diseases and Injuries in Southern Africa – a Dialogue on Science Implementation and Policy.

Dr. David Mazza, PCI’s clinical lead, reflects on his recent visit to Mozambique to attend the NCD conference and meet our project partners.

As a family medicine doctor attending the conference amongst a majority of public health and clinical specialists, I was mindful of the role that Primary Care International occupies within the complex system of organisations working to tackle the global burden of NCDs. Delegates included academics, public health specialists and Ministry of Health representatives. Presentations and discussions described initiatives to address NCD care through global advocacy and policy implementation to influence fiscal, behavioural, environmental and socio-economic risk factors. At Primary Care International, we focus on another vital link in the chain – primary healthcare systems. We train and equip primary care teams to apply evidence-based, cost effective guidance to improve NCD care at the community level.  

After 16 years of civil war, the country has seen relative political stability, and economic growth over the past 20 years.  During this time, Mozambique has made some progress in the provision of primary healthcare, including halving its infant mortality rates.  However, the growing epidemic of NCDs is resulting in a double burden of disease. As conference delegates reported, this is an area of healthcare that is currently under-resourced in Mozambique, in spite of causing some 18,000 deaths per year.  Our funder, Letshego Holdings Ltd have been pioneering in supporting work that tests primary healthcare solutions to tackle NCDs in emerging markets, including Mozambique.

And so, as part of PCI’s Letshego funded Healthcare Innovation Project, I headed from the conference in downtown Maputo, the capital of Mozambique, with its impressive historic buildings, along streets lined with modern steel and glass blocks to the much poorer outskirts of the city. This area is home to Mavalane Hospital with whom PCI is piloting a practical NCD care project. The hospital serves some 800,000 people who are among the poorest living in the city. Here, the dedicated clinicians face multiple challenges in managing the large numbers of patients who attend the out-patient and emergency departments with acute health problems every day.

The pressures are intensified when trying to provide care for people with chronic, ongoing conditions (known as Non-Communicable Diseases, or NCDs) such as raised blood pressure (Hypertension) and Diabetes.  And yet the impact of these conditions is clear to observe. Stroke, a consequence of hypertension, is common. One senior clinician talked about the frustration of seeing at least two people every week with diabetic foot disease, requiring amputation – “but we can prevent this condition”. Only a minority of those people with diabetes in the population are seen in the hospital diabetes clinics because it does not have the capacity to see many more. And the majority remain undiagnosed. Even for those patients who do attend the clinic, the problems continue. Important medications for the management of diabetes and other NCDs are often out of stock in the pharmacy. For those who can afford it, they may try to buy the medication from private pharmacies and I heard of one diabetic patient who drives to South Africa to buy the vital medication there. However, these options are not possible for the majority of patients, with severe consequences for themselves and their family dependents. Clinicians shared with me their frustrations at not being able to provide the care which they know will improve their patients’ quality of life and life expectancy.

Dr Ana Mocumbi, in her role as Head of NCD Research at the Institute for Health Education and Research is partnering with PCI to pilot a project to improve Diabetes and Hypertension care for the population served by Mavalane Hospital. The model moves the bulk of NCD care away from the hospital and into the primary care health centres. This will provide a more local service for patients and avoids overwhelming the already busy hospital departments, as well as diagnosing and treating them as early as possible in the disease before symptoms take them to hospital.

 PCI’s role will be to work closely with Dr Mocumbi and her team to create guidelines for managing these conditions and relevant training materials for health professionals. PCI will also train clinicians to be NCD trainers, who will then be a resource for sustaining the workforce going forward – often called ‘cascaded training’. In addition, the project will consider the operational elements in the wider primary healthcare system which are required to deliver a successful NCD care service, including consideration of how such issues of medication supply can be addressed.

Dr Mocumbi’s ambition for the NCD care project is to demonstrate, “good ethical practice as a model for the Ministry of Health in Mozambique.”  PCI is delighted to be a partner in such a timely and ambitious project.


Photo credit: Amy McLaughlin / Partners In Health