1. 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

2. Mozambique Capital: Maputo Pop:+- 2 millions

3. 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

4. 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,....)

5. 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;

6. Challenges How implementation is related with communication practices? What can we do about it?

7. Health system hierarchy Community (US) Province (DPS) District (DDS) MISAU National Health dataPlans and resources Health Information System

8. Health district: Xai-Xai

9. 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

10. 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.

11. 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

12. HISP Mozambique in 1999  Eduardo Mondlane University & MISAU Pilot districts: located in remote rural areas with relatively good infrastructure Actions:  Research  Training seminars

13. Communication at different levels Health unit  health district Health district  province Province  MoH (MISAU)

14. Counter networks  Castells Globalization and Marginalization  Exclusion vs Inclusion Health Information Information & Communication Technology

15. 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?

16. 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 (???)