CHAPTER 3: CONTEXT AND METHODOLOGY
3.2 The Context: Mozambique
Mozambique is one of two Portuguese-speaking countries in Southern Africa. It is situated to the South of Tanzania; East of Malawi, Zambia, and Zimbabwe; and North-East of South Africa and Swaziland. Mozambique is administratively divided into 10 provinces namely Cabo Delgado, Niassa and Nampula provinces in the North; Zambezia, Tete, Manica and Sofala provinces in the Centre and, finally Inhambane, Gaza and Maputo provinces in the South. Maputo City is the capital city of Mozambique and is regarded as the 11th province. Mozambique is a relatively large country constituting almost 799 380 square kilometers of land area.
Mozambique is the third most populous country in Southern Africa. Since the 1950s the population of Mozambique increased from 5.7 million in 1950 to 20.2 million in 2007 (National Institute of Statistics, 2000; 2009). The population of Mozambique is relatively youthful. Almost half of the population (47 percent) is aged 0-14 (National Institute of Statistics, 2009). According to the 2007 census 10.4 million of the population are females (52 percent) and 9.7 million are males (48 percent). In addition, according to the 2007 census, the majority of the population, 70 percent, lives in rural areas compared with 30 percent which lives in urban areas. Furthermore,
the 2007 national census data indicate that the Central region is the most populated with about 43 percent of the nationwide population, followed by the Nothern region with 34 percent and, at the bottom, the South region with about 23 percent (National Institute of Statistics, 2009).
Mozambique has been enjoying a peaceful and stable political environment since the end of 16 years of “civil war” in 1992, which pitted the Government of the Republic of Mozambique and the armed rebel movement, RENAMO, heavily backed by the apartheid government of South Africa. Thereafter, a democratic electoral process was established. In 1994, the country held its first general election, which was won by FRELIMO, the ruling party from the time Mozambique gained its independence from Portugal. The country has so far held four successful general elections in 1994, 1999, 2004 and 2009. All the elections held were deemed free and fair by the international community and the country has been hailed for its commitment to democracy and peace.
Mozambique has been experiencing steady economic growth after the end of the “civil war” in 1992. The Gross Domestic Product (GDP) per capita increased on average by 10 percent between 1996 and 2000. However, Mozambique is still considered one of the poorest countries in the world. Available data suggest that 54.1 percent of Mozambique’s population live below the poverty line (Ministry of Finance, 2001). Poverty is more prevalent in rural areas (70 percent) than the urban areas, although urban poverty has also become a matter of concern. For instance, the incidence of poverty in rural areas is 55.3 percent compared to 51.5 percent in urban areas.
Maputo city is the least poor province with only 47.8 percent of its population living below the poverty line while Sofala province is the poorest province in the country with about 88 percent falling below the poverty line (Ministry of Finance, 2001). In aggregated terms, recent data on the levels of poverty in Mozambique do not indicate significant improvement. In fact, the third round of the family budject national survey (IOF08) indicates that the national average of poverty in Mozambique has not change since the last survey (IAF02). Thus, 54.7 percent of Mozambique’s population was found below the poverty line (Ministry of Planning and Development, 2010). The incidence of poverty is still higher in rural areas with 56.9 percent compared with urban areas with 49.7 percent (Ministry of Planning and Development, 2010).
The 2007 census indicates that almost half of the Mozambique’s population (50.4 percent) is illiterate (National Institute of Statistics; 2009). The level of illiteracy is much higher among women than in men. According to the National Institute of Statistics (2009) the rate of illiteracy is higher among women (64.25 percent) than men (34.6 percent). On the other hand, the rate of literacy is much higher in urban areas than rural areas. Only 21.6 percent of women living in rural areas are literate compared with 64.9 percent in urban areas. This imbalance in education obviously has serious implications for gender relations.
In common with other Southern African countries, Mozambique also faces a severe HIV/AIDS pandemic (Whiteside, 1998; UNAIDS, 2008; Ministry of Health, 2004; 2008). The past two decades has experienced a steady and growing increase in the levels of HIV infections. Some researchers argue that the presence of foreign troops (principally Zimbabweans) in the central region, and the return of refugees from neighbouring hard hit countries (particularly South Africa and Zimbabwe) after the end of war was a major factor contributing to the increase in HIV prevalence in Mozambique (Karlyn, 2005). The most recent prevalence data estimates that 16 percent of sexually active adults aged 15 to 49 years in Mozambique, that is, 1.6 million people are HIV positive (Ministry of Health, 2008). This prevalence rate is the same as that was reported in the 2004 Epidemiological Surveillance which may suggest some signs of stabilization of the epidemic (Ministry of Health, 2008). Nevertheless, the 2007 Epidemiological Surveillance data shows important changes in the rates of HIV prevalence, both at regional and provincial levels.
At regional level, the most significant change in Mozambique’s HIV/AIDS epidemic pattern is that the South region, namely Maputo city, Maputo province, Gaza and Inhambane provinces, is the most hard hit region with a HIV/AIDS prevalence rate of 21 percent followed by the Central region with 18 percent and lastly the Northern region with 9 percent (National Institute of Statistics, 2009). At provincial level, what is noteworthy is that all the southern provinces have shown increasing trends in HIV/AIDS prevalence rates compared with other provinces of the country, except the Zambezi province which also showed some increase. Thus, in Maputo province the HIV prevalence rate increased from 22 percent in 2004 to 26 percent in 2007. In
Gaza province the prevalence rate increased from 25 percent in 2004 to 27 percent in 2007.
Similarly in Inhambane province the prevalence rate increased from 10 percent in 2004 to 12 percent in 2007 (Ministry of Health, 2008)
According to some estimates, the size of Mozambique’s population, without HIV/AIDS would have been about 18.9 million in 2004, but because of AIDS, it is estimated that the population size might have fallen to 18.6 million. It is predicted that, in the absence of HIV, Mozambique would have a population of 21.8 million by 2010, but due to HIV/AIDS the population size is projected to increase to only 20.6 million (National Institute of Statistics, 2004). The high level of mortality among the 15-49 years is likely to alter the structure of the population and is also likely to slow population growth (Whiteside, 1998; Whiteside and Sunter, 2000). The estimated annual population growth rate was projected to slow or even to decline due to high levels of mortality (UNAIDS, 2002). The most recent census suggests that the population of Mozambique increased at a rate of 2.3 percent (National Institute of Statistics, 2009).
The most immediate consequence of the AIDS epidemic is the rapid increase in morbidity and mortality. It is estimated that in the past 20 years, Mozambique has lost almost 855 000 people to HIV/AIDS (National Institute of Statistics, 2008). The number of HIV/AIDS related deaths increased from 63 571 in 2002 to 81 247 in 2004 and is expected to reach 97 975 by 2010 (National Institute of Statistics, 2008). The highest mortality rates are concentrated in the Central region of the country, with 67 percent of total deaths followed by the Southern region with about 21 percent of total deaths (National Institute of Statistics, 2008). In 2007, the population census found that Malaria and HIV/AIDS were the leading causes of death (National Institute of Statistics, 2009).
Orphanhood is one of the most dramatic outcomes of HIV/AIDS. The most recent data indicates that the number of AIDS orphans rose from 172 311 in 2002 to 557 531 in 2010 (National Institute of Statistics, 2008). On the other hand, one of the most visible effects of HIV/AIDS is the increase in the number of sick people. The number of new AIDS patients in health facilities has increased from 83 000 in 2003 to 109 000 in 2004, and is projected to soar to 178 000 cases
in 2010, unless measures are taken to reduce this impact (National Institute of Statistics, 2004).
The health sector is under huge strain as it is not equipped to cope with the epidemic.