Currently, at least three-quarters of a million people are internally displaced in Mozambique due to armed conflict that erupted in the northern province of Cabo Delgado beginning in 2017.
Climate change and resulting extreme weather events compounded with this civil unrest have left Mozambique in a state of flux and investigating an important question: how does a country address the health needs of its citizens on the move?
With support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC), ICAP in Mozambique supports the delivery of comprehensive HIV and tuberculosis (TB) prevention, care, and treatment services in Nampula province, which has the highest number of internally displaced people (IDP) from Cabo Delgado. Mirroring the movement of its citizens, the ICAP team maps and allocates mobile brigades and clinics to camps dedicated to serving IDP. Mentor mothers, religious and community leaders, and other ICAP lay staff support identification and referral of IDP to these health services. At the IDP camp in Meconta, a district in northeastern Nampula, ICAP also supports allocation of vital medical supplies.
“In terms of vulnerability and exclusion, internally displaced people have some of the most inconsistent access to health services,” said Monica Negrete, ICAP clinical director in Mozambique. “When someone flees their home, they leave everything behind. They are focusing on surviving while enduring situations they have never experienced before. They may wait to seek services only until their health issue becomes severe, so it’s important that systems take the responsibility of prioritizing health for them.”
In Nampula alone, in December of 2021, there were nearly 69,000 IDP, over half of them children. ICAP established mobile brigades, operating with at least one clinical officer, maternal-child health (MCH) nurse, lay counselor, extended program of immunization (EPI) technician, and a driver, to serve both IDP and other vulnerable populations, such as miners and prisoners in the region. The program provides services including HIV testing, early infant diagnosis, TB screening and treatment, and COVID-19 testing, as well as initiation and continuation of pre-exposure prophylaxis (PrEP) and antiretroviral treatment (ART). Condom distribution, psychosocial support, STI screening and treatment, outpatient consultation and MCH services are also offered by the mobile brigades.
In 2021, 11,185 people were screened for TB at the mobile clinics or brigades in Mozambique, of which, 26 screened positive. Of the 3,795 individuals who initiated TB preventive treatment (TPT), 3,093 completed the TPT cycle. In one year, through mobile clinics and mobile brigades, 70,686 outpatient general consultations were conducted, 25,062 people living with HIV sought HIV treatment services, and 3,881 initiated PrEP. Of 478 pregnant women living with HIV, 475 initiated ART.
“While it would be ideal to establish permanent health facilities in these areas, we know that there is a need for a rapid response to this population’s immediate needs,” said Eduarda Pimentel De Gusmao, ICAP country director in Mozambique. “Our goal is to continue to work in close collaboration with local leadership to identify locations with high concentration of IDP and adapt and implement service delivery models that respond to their needs and challenges, ensuring access to comprehensive and quality health services.”
ICAP has devoted major efforts to monitoring continuation of care – especially for those who have initiated lifesaving HIV or TB treatment – but for families who continue to be mobile, maintaining treatment and care is a major challenge. Negrete noted that continuation of care for IDP is an area that all health providers must continuously work to improve.
“Families are constantly on the move and there are limited ways to communicate with them and know where they are headed next, much less where they will be accessing health services in the future,” Negrete said. “While electronic databases are helpful, they aren’t foolproof. In the coming months, we want to evaluate more ways to increase demand and ensure continuation of care through such methods as communication through community leaders and local media, and further training for health care workers to reduce stigma and improve IDP identification both at health facilities and community activities.”
“For those who are staying with host families rather than the IDP camps,” Negrete added, “we also want to better understand their current conditions and create more of a demand for them to approach a health facility, as the mobile brigades can more easily serve IDP camps or new settlements than IDPs hosted at individual homes. We could consider doing this by increasing advocacy, further strengthening coordination with other stakeholders and government institutions working in the province and improving IDP patient referral systems within Nampula and the neighboring Cabo Delgado province.”
Given how critical a factor mobility is in HIV and infectious disease acquisition, ICAP is heading a number of projects aimed at addressing the health needs of mobile populations around the world. In Uganda, for example, ICAP is leading the first Refugee Population-based HIV Impact Assessment (RUPHIA), which offers household-based HIV counselling and testing for refugees.
A major global health organization that has been improving public health in countries around the world for nearly two decades, ICAP works to transform the health of populations through innovation, science, and global collaboration. Based at Columbia Mailman School of Public Health, ICAP has projects in more than 30 countries and is working side-by-side with ministries of health and local governmental, non-governmental, academic, and community partners to confront some of the world’s greatest health challenges. Through evidence-informed programs, meaningful research, tailored technical assistance, effective training and education programs, and rigorous surveillance to measure and evaluate the impact of public health interventions, ICAP aims to realize a global vision of healthy people, empowered communities, and thriving societies.