Medical education and other activities in Mozambique Joep M.A. Lange Department of Global Health Academic Medical Center, University of Amsterdam & PharmAccess Foundation Amsterdam Institute for Global Health & Development

Centro de Investigado de Doenças Infecciosas (Research Center of Infectious diseases of UCM CIDI) Collaboration UCM, FHI, AIGHD Approx. 25 staff: PI, physicians, research nurses, community outreach specialists, quality assurance-, data management- and administrative staff, laboratory manager and technicians HIV incidence studies PROMPT trial: HIV/TB (EDCTP)

PROMPT trial To determine in a randomized-controlled trial whether TB treatment in HIV-infected patients with CD4<50 cells/µl and BMI<18 who do not have verifiable or suspected pulmonary TB at the time of ART initiation prevents early mortality, by comparing the death rate during the first 6 months among patients started on ART only with that among patients started on anti-TB treatment followed after 1-2 weeks by ART.

9 Students Health Care Plan MOZAMBIQUE PharmAccess Foundation cw December 2010

10 UEM aims to improve access to quality health services for students and staff by introducing and progressively expanding an affordable and sustainable health insurance scheme for these target groups. UEM has asked PAI technical assistance in realizing this ambition. Background

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12 Financing Delivery Alternative model: a virtuous circle of health care Demand Out-of-pocket Access to health care Ownership Solidarity Supply Quality Efficiency/cost Risk/ investment Data IFHA 50 mln HIF Dutch gov 100 mln MCF 2 mln User premium contributions 2-3 mln Patient Empowerment Willingness to pay USAID 20 mln World Bank 5 mln

13 G20-SME award for Medical Credit Fund

14 Target population & Package coverage Phase 1: students staff members in Maputo Phase 2: 800 students and staff in Vilanculous 500 students and staff in Quelimane 300 students and staff in Chibuto students and staff in Inhambane The demand of an affordable quality basic health care package for UEM has resulted in a coverage with primary and secondary outpatient benefits and (limited) in-patient benefits Benefits Primary outpatient benefits: available unlimited: at Campus Clinic (90%) of services Benefits Secondary outpatient benefits: available unlimited but only on referral by the member’s registered healthcare provider (military hospital) after pre-authorization Inpatient benefits: Available at referral after pre-authorization and limited to health insurance package Health insurance package: Essential drug list medication, laboratory tests and radiology tests

15 Budget lines Program design support through PharmAccess: now HIF Funding for T.A. Amsterdam dinner / DGO through MCF: asset funding Campus Health Center UEM: loan for construction of Campus Health Center UEM: 1 $ mln budget for premium support (staff premiums and approx. 200 students, not able to pay the premium) Students UEM (17.000) students: $ 7.50 p month (through increased tuition fee) Peer funding students insured with HollandZorg by ENO Mozambique Ministry of Health: HR support and vertical program support

RNE HIV program HIV prevention and treatment package local personnel Dutch embassies

ORIO Dutch Government funding for the building of 2 district hospitals in Sofala Province (Beira and Marromeu) Co-funding Government of Mozambique

North Star Technical support to establish Roadside Wellness (RWCs) at disease “hotspots” along the major transport corridors in sub- Saharan Africa and other low ‐ income areas The networks offer a package of prevention and treatment services for high ‐ impact diseases related to mobility including information, education, basic health services, treatment for STIs, HIV counseling and testing, and medical referrals.

19 The PharmAccess approach to investments in local health provision development Need-based - construction &/ or upgradingtailor made to local needs Integration - simultaneous investments in ‘hard ware’ (physical facilities) & ‘soft ware’ (effective & efficient operation of the facilities) Performance-based - structural measurement of output, results & (health) impact

Potential for collaboration with MEPI Postgraduate medical education UEM – CEM: integrate/align programs Research: joint projects in the different sites Research training Health financing: supporting medical and paramedical graduates through MCF, IFHA