• strengthening leadership and management at the national, provincial, and district levels to improve primary health care access and services;
   
• overall management oversight of the national malaria control program;
   
• overall management assistance to child survival programs and administrative support to promote the country's Integrated Management of Childhood Illnesses (IMCI) program.

Several public health consultants from Brazil have been members of the team providing technical assistance in leadership development to Mozambican health managers, an example of knowledge transfer between front-line practitioners in the developing world. The project also draws upon M&L's experience with public sector health services improvements in Brazil and Egypt.

Strengthening the health system by improving management and leadership
M&L is working with national level managers and with managers in selected provinces and districts to improve health services Mozambicans have a successful legacy of applying and adapting established MSH tools, such as MOST (Management for Organizational Sustainability, renamed "MOSTambique") and the Financial Management Assessment Tool to the work of national and provincial health directorates.

Mozambican health officials have shown a commitment to improving the quality of their leadership. Eighty-seven MOH managers representing all four ministry directorates have participated in M&L's leadership development process. The Minister and the Vice-Minister of Health were among the top managers who took part in leadership exercises.

Twenty-one managers volunteered and were trained as facilitators to lead work groups that will apply new practices and skills to the task of developing and implementing annual operational plans. One four-day workshop included a special focus on managing human resources in the face of the HIV/AIDS epidemic. M&L is also providing assistance to improve provincial strategic planning.

MOH staff worked with M&L to design a monitoring and evaluation methodology that will produce an accurate picture of health results and outcomes. M&L worked with directorates to collect and analyze baseline measures of organizational climate. Draft reports suggest that work group climate and operations need to be improved to effect higher employee performance.

Malaria management
Mozambique's National Malaria Control Program (NMCP) is aimed at reducing the morbidity and mortality caused by malaria in vulnerable groups: women of child bearing age, children under five, and socially disadvantaged individuals. Malaria control is co-financed by the MOH and several different donors including WHO, UNICEF, the Global Fund, and USAID.

M&L plays a key technical role in the development of an adequate data collection and information management system to support public health personnel in making sound decisions in regard to malaria control. M&L also has a key role in overseeing the management of USAID funds for the malaria control program, providing technical assistance in financial management, logistics, and administration. We are providing logistics support to many activities, including surveillance and emergency preparedness measures, training and supervision of clinical and laboratory staff, and youth-run community based education programs in three districts M&L helped organize a National Malaria Awareness Day in November 2003. Event organizers secured special radio and television coverage about malaria prevention and distributed posters, pamphlets, and t-shirts.

The MOH carries out design, implementation and monitoring of NMCP activities directly. M&L ensures that malaria control efforts that are carried out with multiple donor partners are well-supervised and coordinated.

Child Survival
Mozambique's Integrated Management of Childhood Illnesses (IMCI) Program has an overall objective to improve the quality of childcare in the health system, leading to the reduction of morbidity and mortality of neonates, infants and children. M&L supports the development of management systems and educational materials for training medical and paramedical staff in IMCI. M&L also ensures USAID funds for IMCI are managed in accordance with USAID rules and regulations.