Structural readiness of health facilities in Mozambique: how is Mozambique positioned to deliver nutrition-specific interventions to women and children?

Abstract

Background The health sector is essential in delivering high-quality nutrition interventions to women and children in low and middle-income countries, and Mozambique is no exception. Still, the quality and readiness of health services to deliver nutritional services have yet to be comprehensively mapped across the country. We assessed the accessibility and readiness of health facilities to deliver maternal and child nutrition services in Mozambique. Methods Using multiple data sources within a geographic information system (GIS) environment, we calculated facility readiness to deliver nutritional services, population access to health facilities, and health facilities ready to deliver nutrition services. Data from Mozambique’s 2018 Service Availability and Readiness Assessment (SARA) was used to calculate readiness scores for each facility in the country. We used geospatial data from the ´WorldPop´ initiative to estimate the proportion of people in Mozambique within 10 kilometers of a ready facility. For each province and the country as a whole, we calculated the proportion of people with access to a ready facility for maternal and child nutrition interventions. Results At the national level, 29.1% and 37.3% of the population were within 10 kilometers of a facility ready to deliver all maternal and child nutrition services, respectively. Pregnancy growth monitoring (73.8%) and vitamin A supplementation (72.4%) were the most available interventions to the population. In contrast, anemia testing/iron supplementation (45.1%) was the least available nutritional intervention. The Center (30.5%) and North (26.9%) regions of Mozambique had much lower coverage than the South region (71.7%) across the maternal and child nutrition interventions. Nampula (14.9%) and Zambézia (17.9%) provinces were the least ready to deliver maternal nutrition services while Nampula (20.4%) and Cabo Delgado (21.2%) provinces were the least ready to deliver nutrition services to children. Conclusions To achieve high coverage of nutrition interventions, facilities need a full suite of commodities and equipment. Currently, too many facilities in Mozambique have only some of these supplies, meaning that only a minority of the children and pregnant women will receive effective nutrition services when they need them. Multi-sectoral efforts, including those outside the health system, are necessary to improve nutrition in Mozambique.