Countries must be capable of describing and monitoring their people's health and well-being needs to try to understand and address them. As set out in the Sustainable Development Goals (SDG) of the Agenda 2030 adopted by the United Nations, there is a need to invest in health information systems to progress towards equity in this field.

Research involving UPF has assessed health inequalities in Mozambique according to the 27 indicators included in the third SDG: Good Health and Well Being for All at All Ages. This is the first such work conducted in sub-Saharan Africa, and it may serve as a model to provide a detailed overview of the existing information gaps in the national health systems of low-income countries.

This is the first such work conducted in sub-Saharan Africa.

The study, published recently in the journal Globalization and Health, within the framework of a project funded by Medicus Mundi and the Spanish Agency for International Development Cooperation (AECID), has been conducted by researchers of the Research Group on Health Inequalities GREDS-EMCONET (Alba Llop-Gironés, PhD in Public Health at UPF, as first author; pre-doctoral researcher Lucinda Cash-Gibson, and Joan Benach, full professor of the Department of Political and Social Sciences and Group director), together with researchers from the National Health Institute of the Ministry of Health of Mozambique (Sergio Chicumbe), the National Statistics Institute of Mozambique (Elisio Mazive), and Medicus Mundi Mediterrània (Francesc Álvarez and Ivan Zahinos).

This article is part of a collection that aims to shed light on intersectoral actions for health and has been funded by the WHO’s Alliance for Health Policy and Systems Research.

“There are important information gaps in Mozambique’s current national health information system which prevent it from being able to comprehensively measure and monitor health equity”, the researchers state. Their analysis has highlighted the suitability of research on health and the need for it to be directed and managed internally, in line with national priorities.

Other aspects identified as being key are to have the ability to define the set of determinants and specific indicators that match the health and well-being needs of the people of each country; make adequate investment in the field of technical capabilities and human resources to address health inequalities; and address the political challenges to support transparency in the decision making process and accountability.

“Comprehensive national health information systems are essential public health needs, as their absence not only hides the health equity gap within these low-income countries, but also limits national capacity to effectively inform local interventions and action towards achieving health equity and to advance the study of the social determinants of health”, the study authors assert.

Insufficient information on health inequalities and obtained mostly through external funding

The research, which analysed data sources of the health information system in Mozambique, followed a methodology of the World Health Organization to assess the available information for each of the 27 indicators included in the third of the SDGs. It identified and selected the relevant data sources (eight in total) available in the country's health system, which included institution-based and population-based data sources.

For each data source identified, the researchers also noted its funding source (domestic or foreign) and the time period of new available information (of the 17 indicators with information, only one updates data on a weekly basis). These indicators were scored on a three-point scale (1, information available; 2, need for more information; and 3, information gap).  In addition, for each indicator they estimated the national average inequality score.

None of the 27 indicators contained complete information on all seven demographic and socioeconomic variables considered.

The results found that, of all 27 indicators, 7 bear information with nationally funded data sources, 10 with data sources externally funded, and ten indicators either lack information or were not applicable for the study issue. None of the 27 indicators contained complete information from all seven demographic and socioeconomic variables considered (equity stratifiers): fifteen had some information and nine did not have any.

“Our results show that the most complete information to monitor health equity in Mozambique is related to maternal and child health programmes which are often external-donor-funded programmes. We have found a lack of routine health information able to capture health and mortality trends differentiating social groups and geographical area. This may have hindered progress in strengthening the capacity of the national health system to achieve equity in health”, they conclude.

Reference article: Alba Llop-Gironés, Lucinda Cash-Gibson, SergioChicumbe, Francesc Álvarez, Ivan Zahinos, Elisio Mazive and Joan Benach (December 2019). “Health equity monitoring is essential in public health: lessons from Mozambique”. Globalization and Health.