Poverty and HIV/AIDS are stubborn challenges in development, especially in Sub-Sahara Africa. Mozambique is one of the least developed countries in the world, ranking 117 out 193 countries. With a population of 27 million people, 79% live in rural areas and are dependent on subsistence agriculture. Literacy rate is 56%, poverty stands at 55%, HIV prevalence is 16%, vitamin A deficiency is 40% and life expectancy is just 53 years.
The country also has one of the worst doctor-patient ratios in the world. According to the Ministry of Health, there is 1 doctor for every 25,000 people. Health services are poor and over stretched due to limited resources.
Poverty often leads people to risky behavior that will affect health, such as HIV/AIDS. Poverty is also a risk factor for certain cancers, particularly those causally linked to infections, such as hepatitis B, and HIV. The percentage of the world’s cancer cases and deaths that occur in developing countries is rising.
Poor health reduces productivity, draws the individual and family into deeper poverty and eventually shortens life. Therefore, good health is vital to combating poverty. For people living with HIV/AIDS, access to health services is critical.
PORENet (Poverty Reduction Network) is a local NGO based in Chimoio, Manica province. The province is in the central region of Mozambique, where the economic corridor (Beira Corridor) links the port of Beira and inland countries of Malawi, Zambia, Zimbabwe and Botswana.
The NGO works with other network organizations including Shingirirai (PLWHA), RENSIDA (network of organizations for PLWHA), CCM (Council of Churches in Mozambique), YPM (Youth Parliament in Mozambique) and UAPCD (Union of Associations for People with Disabilities). The organization uses a rights-based approach to eradication of poverty because poverty is a consequence of denial or violation of one’s rights (the equality of conditions and treatment). People living in poverty are often treated as less than human, are denied the very material and philosophical basis that allows them to flourish as human beings with a sense of self-worth, which results in them being locked in a deepening cycle of poverty.
PORENet believes that palliative care is a more achievable and affordable alternative to disease-modifying treatment for HIV/AIDS and cancer in poor settings such as in Mozambique. Insufficient access to care for both cancer and AIDS patients makes palliative care the only humane and feasible response in many contexts. Patients and families with access to palliative care are able to spend fewer days in intensive care, lower medical costs, reduce malnutrition, extend productive lives, mitigate poverty and improve quality of life.
In Mozambique palliative care is relatively new. The government is committed to fulfilling Article 12 of the International Covenant on Economic, social and Cultural Rights (ICESCR) on the right to health. This means that the state has an obligation to ensure that essential medicines for pain control are available and affordable to all.
A policy to integrate palliative care into the broader health services was developed in 2012 with assistance from the African Palliative Care Association. However, this policy has not been widely disseminated to health care providers, government officials, patients, and caregivers. Training on palliative care has yet to cascade to home based care givers. Prescriptions for opioids are still done by doctors only. Many patients who need these services, in many cases, have financial and social barriers, long distances and transport costs that prevent them from accessing treatment.
In June 2014, PORENet conducted a national training workshop in Chimoio to equip participants with advocacy skills for support to access to palliative care, which was sponsored and facilitated by SAFAIDS-Harare and APCA-Uganda respectively. The workshop was attended by representatives from MOPCA (Mozambique Palliative Care Association), provincial Department of Health, pastors, community leaders, disabled, nurses and care givers from 15 organizations. This collaborative effort provided a rich reservoir of appropriate skills on which to draw from in order to meet new challenges.
An advocacy campaign meeting to support access to palliative care was held in July with 15 participants from the same diverse partnerships. Eventually, at least 8 PaCaH champions will be identified who will catalyze a community of practices in promoting palliative care and HIV literacy and advocacy at local and national levels. The next phases include participating in a regional forum of PaCaH champions and hosting demand creation community dialogues on palliative care and HIV services.
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