Citizens demand for better public health service delivery

Every day women and children die due to poor health service delivery in Mozambique. Unaware of their rights and entitlements young mothers are often not educated or empowered enough to demand acceptable quality mother and child health services and accountability within the public health sector. This intervention will engage citizens and civil society organizations with a focus on women and children, to monitor and advocate for the improvement of these services in selected Districts of Cabo Delgado and Niassa Provinces.

Country/region Topic Period Budget
Cabo Delgado and Niassa Province
Primary health care
01.04.2013 - 30.04.2019
CHF 3'483'557

The public sector in Mozambique is the most important health services provider, through its National Health Services Network-SNS. In the past years, the country has made huge strides in improving the lives of its citizens and in generating growth, but many challenges remain affecting the health sector, such as:

- Low quality of services provided, including lack of medicines and incorrect lab testing

- Illegitimate charge of medicines to users

- Lack or weak accountability in policy formulation, resources allocation and its management

- Poor working environment for health staff (including salaries and hygiene in the health facilities)

Most of these challenges can be addressed with the active participation and dialogue between Civil Society and service providers at the local level. Civil Society Organizations in Mozambique are becoming stronger with increasing capacity to influence politics. This positive development is, however, mostly limited to the Maputo area.

Civil Society Organizations at provincial and district level are still relatively weak with little capacity to influence the political agenda and to engage in the policy dialogue at their levels.

The latest Mozambique Demographic and Household Survey-DHS 2011 reveals that while Child survival in Mozambique is improving, maternal mortality ratio re­mained with 408 maternal deaths for every 100,000 live births the same high level in 2011 as it was in 2003. Data also indicate that literacy rates for women aged 15-49 in Niassa and Cabo Delgado are 32% and 25% respectively, against 66% and 45% for men in the same provinces, respectively. Furthermore, the two provinces have high rates of early marriages for young girls (Niassa 25%; Cabo Delgado 30% compared to around 10% in Southern Provinces). 

The two provinces show that on average, only 16% of the men believe that their participation in community monitoring of services would positively influence services provided against the even lower average of 14% for women; 80% of the sample from the 12 targeted districts are unaware of at least 7 of the 9 rights of patients elaborated by the Ministry of Health - women with lower average then men. Only 10% of the health posts have complaint mechanisms in place; and there is a general dissatisfaction of waiting time and staff presence of the people ampled at health posts.


Contribute to improve health status of the target population through empowerment of citizens that claim for accountability and transparency in public spending and better quality of service delivery.

Target groups
  • Citizens with special focus on women and children; Health service providers at local and national level
  •  Local Civil Society Organizations of 12 districts in Niassa and Cabo Delgado provinces
Medium-term outcomes

The strategic objective is to engage citizens and civil society organizations to monitor and advocate for better quality services in 12 selected districts.

  • Citizens are informed and empowered to act and claim better quality health service delivery
  • Citizens and Civil Society Organizations interventions that hold health service providers accountable in the selected 12 districts are increased.
  • Improved evidence-based advocacy to influence national/macro level health policies

The project will utilize an innovative range of participatory actions and mechanisms combined with enhanced space and opportunity for citizen/civil society engagement with the state. Tools such as community score cards, expenditure tracking surveys and public hearings will empower citizens and emphasize a solid evidence base and direct dialogue and negotiation with government counterparts.


Achieved results:  




  • Individuals and communities are reached with appropriate means/media and with relevant information
  • At least one mechanism established for Citizens to claim and interact with service providers at district level
  • Reports on user’s perception of the quality of health service delivery produced and discussed at local and national level
  • Reports on expenditure tracking of district health development budget produced and discussed at different levels
  • Frontline staff/service providers and service users agree on action to address identified service issues
  • At least 2 policy briefs produced and disseminated annually (based on evidence from 12 Districts) to Government, Civil Society Organizations and ordinary citizens



    Results from previous phases:  

    • Baseline & Community mapping conducted,
    • Formative research completed and
    • Operational & Monitoring tools developed
    • Main insights from the Inception phase include that:
    • Effective women empowerment can be achieved through quality contribution by women to community dialogue and not just in terms of numbers of women participating.
    • Already existing information, communication and education mechanisms and platforms should be capitalized in effective citizen engagement and monitoring of service provision.
    • Power authority and gender dynamics should be better understood and addressed as they vary from community to community and they influence greatly the achievement of expected results and ensuring sustainability.

    Directorate/federal office responsible SDC
    Credit area Development cooperation
    Project partners Contract partner
    International or foreign Non-Governmental Organization

    Implementing partner
    Local Non-profit Organisation

    Other partners
    • Niassa Provincial Health Directorate, Cabo Delgado Provincial Health Directorate and Community Based Organizations
    • Consortium led by N’weti - Comunicação para Saúde,also composed by CIP - Centro de Integridade Pública and, CESC - Centro de Aprendizagem e Capacitação da SociedadeCivil.


    Coordination with other projects and actors
    • SDC projects: Wiwanana Foundation, Local Governance Monitoring Initiative, Cabo Delgado Health
    • Other: Concern Universal social accountability project (World Bank) being implemented in two of the project districts and other emerging government & health initiatives such as the citizen engagement fund (DFID).
    Budget Current phase Swiss budget CHF   3'483'557 Swiss disbursement to date CHF   3'234'158
    Project phases Phase 1 01.04.2013 - 30.04.2019   (Current phase)