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Letter from the Prime Minister of the Republic of Mozambique, Dr. Pascoal 
Mocumbi, to the People's Health Assembly    4 December 2000

Read By Dr. Martinho Dregdge

Dear Mr. Balasubramian,

In the first place, I would like to thank you for inviting me to 
participate in the People's Health Assembly, in Bangladesh from 4th to 8th 
December. I was preparing to come and contribute to the initiative, which 
will bring a ray of hope to all those who are 'excluded' from today's 
globalisation process.

Unfortunately, I must remain in Mozambique in order to fulfil my 
obligations in relation to the parliamentary session currently underway, 
which requires my presence on exactly the same dates as those of the 
People's Health Assembly. I would have liked to have been able to share my 
concerns and thoughts personally.

In my country, when we won national independence, in 1975 we successfully 
launched a people's health initiative, based on primary health care for 
all, as an integral part of our national development programme. 
Unfortunately, we were unable to continue our integrated rural development 
programme, because we were struck a by man-made disaster.

The war ended in 1992, and since then we have begun to rebuild. With our 
southern African neighbours and partners, now free from apartheid and 
colonialism, we are building the Southern Africa Development Community, SADEC.

The challenge we face, and which I believe confronts all the peoples of 
developing countries and beyond is: what is the role of the State in social 
development in the context of the prevailing ideology of globalisation?

In countries such as mine, where 70% of the population lives below the 
absolute poverty line and where maternal and perinatal mortality ratios are 
extremely high, the State must assume the responsibility of guaranteeing 
access to healthcare. Nonetheless, thought must be given to how to ensure 
that the health systems are sustainable, if there is not or has not been 
community participation in its design and operation.

In our experience, community empowerment is a key guarantee of sustainability.

Community involvement in the health system creates better empathy between 
health technicians and members of the community. Furthermore, knowledge of 
local culture and traditional customs is essential to the proper 
functioning of the health system, particularly in rural areas.

The community must see the health or school unit as a public property, in 
relation to which it has the right to know who it is serving, how it does 
it and how to preserve it so that it can continue to work for community 
development.

It must be said that there is an intrinsic relation between health, poverty 
and economic development. The reality is that the greater the level of 
economic development, the more resources can be allocated to improving 
health services. However, if a worker is not healthy, for example, 
suffering from Malaria - an endemic disease in our countries- his or her 
contribution to economic development will be minimal. Thus expenditure on 
health is an investment in human capital just as much as expenditure on 
education and supplying potable water.

As a result of the reform process on which many countries have embarked, 
there appears to be a lack of clarity as to the role of the State in 
ensuring  the minimum basic conditions that will enable society and 
citizens to do the rest for themselves. Our poverty frequently means that 
various matters are seen as public; part of the common good: health is one 
of them. But here we must find a balance that will define the frontiers of 
State and community responsibilities. The community must be participatory 
actor in the health system that is designed for it and directed towards it; 
there must be an interaction between the community and the State unless we 
want the community to be a mere receptacle for what the State decides. 
Major emphasis must therefore be given to preventive and primary health 
care, because community education in these areas will contribute both to 
more active public participation and to reducing expenditure at the level 
of health systems.

The national and international health systems must be rethought in such as 
a way to empower communities as national level, aiming to establish 
stimulating and beneficial partnerships between civil society, NGOs, and 
the State itself. Decisions on what should be done and how cannot be 
hostages to political party agendas. At international level, reforms in the 
UN system, the WHO and so on must be introduced. How can citizens' voices 
make themselves heard at that level, and how can their contributions help 
to achieve an effective system that corresponds to the real concerns of the 
communities?

Peace is a precondition for social and economic progress.

With reference to the African continent, we must struggle to bring all the 
conflicts to an end, and to strengthen Africa's presence on the 
international stage.

We must recognise that the industrialised countries are also having 
difficulties in managing their health services. Rocketing costs are forcing 
them to rethink their systems, but we cannot allow the principle of health 
for all to be placed in jeopardy.

Once again, I wish the People's Health Assembly every success. Through you, 
I send my best wishes to all the participants.

Yours sincerely

Dr. Pascoal Mocumbi
Prime Minister of the Republic of Mozambique


Pam Zinkin                              tel:44 (0)20 7609 1005
pamzinkin at gn.apc.org            fax:44 (0)20 7700 2699
45 Anson Road
London N7 OAR
UK
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