Author name: CSAUDE Mozambique

A major milestone reached in 2025, transforming care for stable ART patients In the past, during rainy seasons like the one we are experiencing now, Ruquina Cunfersso would go days, weeks, or even months without being able to collect the medicines that allow her to live a healthy, active life and care for her two children. Today, six-month antiretroviral therapy (ART) dispensation at 100 health facilities in Zambézia has transformed treatment access for stable patients, like Ruquina, especially when roads flood and families are busiest with farm work. Ruquina learned that she was living with HIV in 2009, after seeking care because she felt unwell. The diagnosis was difficult to accept—made even harder when her late husband refused treatment. She stayed in care because she wanted to remain healthy for her children—and to keep working to provide for them. During the rainy season, however, which coincided with the most intensive period of work on her field, it was very difficult to get to the nearest health facility of Macuse, located about 20 kilometers away from her plot. As a result, she experienced long interruptions in treatment, causing her viral load to fluctuate and weaken her overall health.  Photo: Ruquina Cunfersso receives her medication for the next six months from Clinical Officer Cremilde Macuelia at Macuse Health Center, one of the 100 health facilities in Zambézia offering this life-changing treatment option with support from C-Saúde. Photographer: Solina Ribeiro A 40-years old farmer and seller of chilled water and fried snacks, Ruquina enrolled in the six-month ART dispensation model in October 2025 and no longer worries that access roads to the health facility will be cut off by the rains, which in Zambézia typically last from October to March each year. Six-month ART distribution reduces the time spent traveling and waiting in queues (and therefore productive time lost), in addition to transportation costs. The benefits of dispensing antiretroviral medicines twice a year (rather than monthly or quarterly) extend to providers and health facilities as well, reflected in more effective management of time and other resources (including pharmacy stock), more human-centered care, and retention on ART, ultimately reducing the national health system’s dependence on external funding. Crimilde Macuelia, a Clinical Officer, explains that with the introduction of six-month ART distribution, “very important changes have been observed in the functioning of Macuse Health Center.” Among the most impactful changes, Crimilde highlights a significant reduction in long queues, improved patient follow-up, and an increase in the number of patients retained in HIV care and treatment. “When queues are reduced, counselling improves,” she adds, “and follow-up becomes more targeted.” As a recipient of these services, Ruquina confirms: “Six-month ART dispensation has brought many improvements to my health and much greater peace of mind. I can now organize my family life, my farm work, and my business without the pressure of having to go to the health facility every month,” she says. With stable access to medication, Ruquina now feels strong, healthy, and “very beautiful”.Ruquina is one of more than 127,000 people living with HIV who were active on ART and enrolled in six-month ART distribution at one of the 100 health facilities across Zambézia that offer this delivery model. C-Saúde, with funding from the United States Government, supported the provincial health services to expand six-month ART distribution through financial and technical inputs for facility readiness assessments, training and mentoring of 557 providers, and ongoing support for antiretroviral drug management within pharmacies.    This success story is made possible by the generous support of the United States Government.  

“Now I immediately know if my treatment is working. That gives me strength to keep going.” — Filomena Vili, person living with HIV, Quelimane, Zambézia   Lúcio Assis, a Clinical Officer at the 24 de Julho Health Center, consulting the viral load results of Filomena Vili, using the Clinical Summary app on his phone. The Clinical Summary app is a secure, mobile application directly linked to the health facility´s Electronic Patient Tracking System, allowing clinicians to access patient information including viral load results during clinical consultations. For many years, Mozambique’s health system faced major challenges in managing and providing timely access to essential laboratory results, such as viral load, that are crucial for the clinical follow-up of people living with HIV. The process was slow and manual: results generated in the Laboratory Information System (DISA) had to be printed and handed over to the clinicians or entered one by one into the Electronic Patient Tracking System (SESP). Typing errors, missing information, and long waiting times were part of the daily routine. Filomena Vili recalls the days when she had to return to the health facility multiple times just to get her viral load result. “Sometimes I would come back three times, and still there was no result,” she says. Today, things have changed. As soon as her sample is collected, it is entered in the DISA system and once processed at a referral laboratory, the clinical officer at her facility can immediately see the result directly on his phone. To transform this reality, the Ministry of Health of Mozambique, with support from the U.S. Government and CDC, in partnership with C-Saúde Health Information Systems team and other implementing partners, invested in innovative digital interoperability solutions. The automatic connection between DISA and SESP now allows laboratory results to be transmitted electronically and instantly to each patient’s medical record, generating the e-Lab, an electronic laboratory form. Today, once a test is completed at the referral laboratory, usually hundreds of miles away from the health facility, clinicians can access the results in real time. “Before, we used to wait for days; now, on the same day, I can counsel the patient and make clinical decisions based on up-to-date information,” explains Lúcio Assis, a Clinical Officer at 24 de Julho Health Center. The impact is visible: waiting times from sample collection to receiving the results have been reduced from weeks to days, strengthening the quality of care provided. Data quality and integrity have also improved thanks to the employment of applications that use global standards, such as HL7, which prevent duplication and enable the correction of identified discrepancies. The integration with SESP also makes it possible to track each result and ensure that no information is lost. In Quelimane, Lúcio adds: “Interoperability has completely changed our work. Today, we treat people with more confidence—we know the system is working with us, not against us.” More than just a technological advancement, this integration represents a strategic step toward achieving the 95-95-95 targets: ensuring that 95% of people living with HIV know their status, 95% are on treatment, and 95% achieve viral suppression. Initially launched in Zambézia Province with 144 synchronized health facilities, the interoperability platform has now expanded to cover all provinces across the country with more than 500 health facilities implementing the system, and a million plus viral load results transmitted to SESP in the past 12 months. C-Saúde’s interoperability team has been instrumental in the design and development of the solution, along with technical support to clinical implementing partners throughout the country to implement the solution. The DISA–SESP interoperability stands as a symbol of collaboration and vision—a collective achievement of the Ministry of Health, C-Saúde, the U.S. Government, dedicated health professionals, and every person on antiretroviral treatment, who now receives their results at the right time. . Elton Januário, a Biological Samples Data Clerk at the 24 de Julho Health Center, entering data regarding newly collected samples into the Laboratory DISA system. As soon as the samples are processed at the referral laboratory the results are available at clinicians’ phones.

“With C-Saúde’s technical support, we were able to turn our vision of a unified health information system into a clear, actionable strategy one that truly reflects Mozambique’s priorities.” Eliazardo Muchave, Health Information Department – Ministry of Health (MOH) in Mozambique. Over the years, PEPFAR through its local implementing partner C-Saúde has developed and brought deep technical expertise in HIV data systems to Mozambique’s health sector. Among other stakeholders, C-Saúde supported the development of MOH’s cohesive, nationwide Health Information Systems (HIS) Strategy to guide all future digital investments. Drawing on lessons learned from earlier HIV platforms that improved patient tracking and reporting, C-Saúde contributed to MOH-led high-level workshops and technical working groups with multiple stakeholders to define the country’s strategic priorities. As the strategy crystallized, MOH’s Planning and Cooperation Directorate (DPC) signed a Memorandum of Understanding (MoU) with C-Saúde. This agreement unlocked the allocation of fifteen embedded specialists’ software developers, business analysts, and health-informatics experts who now work side by side with Health Information Department (DIS) staff at MOH headquarters. MOH´s vision through this support is to design the Health Information System – Electronic Medical Record (SIS-RME), intended for deployment in both hospitals and health facilities, integrating essential modules such as HIV, maternal and child health, triage, outpatient clinical consultations, prescriptions, lab tests, inpatient admissions, and automated reporting. The team’s mandate is clear: while focusing on the HIV module, ensure the system is grounded in frontline realities, technically sound, and fully aligned with the needs of health facilities, from small rural health centers to referral hospitals. Together, the joint team has mapped existing workflows, identified critical data gaps, and set practical milestones for system interoperability, infrastructure upgrades, and user training. C-Saúde’s experience with PEPFAR-funded HIV systems is proving invaluable: guiding sessions on requirement gathering, patient-identifier integration, systems interoperability, real-time dashboards, and governance mechanisms. Additionally, C-Saúde specialists are mentoring DIS staff in agile requirement gathering and system administration, ensuring that Mozambique’s MOH builds lasting in-house capacity to maintain and evolve the platform long after launch. As one Eliazardo Muchave from MOH’s DIS observed: “This support is not only accelerating solution delivery but also strengthening institutions, creating autonomy, and elevating data-driven decision quality.” Looking ahead, the roll-out of SIS-RME slated for 2025, will include a Unique patient identifier strategy to eliminate duplicate records and streamline patient management. The system will be gradually enhanced to provide near-real-time dashboards for policymakers, automate routine reports, and embed continuous learning modules for health workers laying the foundation for an integrated, efficient, and sustainable digital health ecosystem. By anchoring the HIS strategy in participatory design, MoU-backed collaboration, and a deeply embedded technical team, Mozambique is building on PEPFAR’s work in the area of HIV to craft a digital health roadmap that will strengthen decision-making, optimize resources, and ultimately improve care for its citizens.

“The Six-Month Dispensation model came at the right time. Now, I can spend more time on my farm and don’t have to explain so often why I go to the hospital.”— Arlindo Nalili, patient at 17 de Setembro Health Facility In the heart of Zambézia Province, many families confront the daily reality of living with HIV while striving to maintain their livelihoods amid scarce resources. Until late 2024, clinically stable patients typically returned to health facilities every one to three months for antiretroviral therapy (ART) refills – a rhythm that imposed long journeys, lost wages, and the quiet toll of stigma in tight-knit communities. At that time, only seven health facilities in the province had begun implementing Six-Monthly Medication Dispensation (6MMD), which reduces routine clinical visits from as many as twelve per year to just two. This simple yet transformative change provided patients like Manuel Albano the freedom to focus on their families, farms, and futures rather than spending considerable amounts of time waiting to receive clinical services at busy health facilities. But scaling it across a province as large and varied as Zambézia demanded buy-in from national, provincial, and district managers, nurses and pharmacy technicians, data clerks, and community advocates alike. Acknowledging the potential, the Ministry of Health approved a coordinated expansion strategy in October 2024. Led by the Zambézia Province Health Directorate (DPSZ) with support from C-Saúde, district health officers and C-Saúde mentors organized intensive workshops on the 6MMD guidelines, paired with hands-on exercises in updating master cards and using the patient-tracking database to flag eligible clients. Weekly virtual check-ins and monthly in-person supervisory visits provided troubleshooting and encouragement, while data managers helped facilities generate automatic reports on uptake rates and stock levels, enabling rapid course corrections whenever bottlenecks emerged. Community engagement proved equally vital. At the 17 de Setembro Health Facility in Quelimane, a multisectoral task force comprising local activists, traditional leaders, and clinic staff hosted interactive health talks, where patients asked questions, shared concerns, and heard testimonials from early adopters. Posters and radio spots in local languages and Portuguese emphasized that six-monthly medication refills were not a reduction in care but a recognition of patients’ stability, granting them autonomy and dignity. In the rural Mocubela Sede Health Facility, community health committees invited patients to “come with a friend” during enrollment days, pairing newcomers with peers who had already experienced the convenience of longer dispensing intervals. Between October 2024 and June 2025, these efforts bore fruit. The number of supported facilities surged from seven to 37, covering most of the province’s districts. Province-wide coverage of 6MMD among eligible clients nearly doubled, from nine percent at baseline to 20 percent by the end of the reporting period, by which time more than 79,000 clients were enrolled in 6MMD. At 17 de Setembro, more than 72% of eligible patients opted in as workflows shifted to accommodate dedicated ART pick-up days and data clerks ensured accurate enrollment tracking. Even in Mocubela Sede, where infrastructure challenges once loomed large, 70% of stable patients now enjoy six-monthly medication refills. The impact extended beyond the numbers. Nurses reported a smoother outpatient flow, with fewer ART pickups per clinic day, allowing them to provide more focused counseling for newly enrolled or complex patients. Pharmacy technicians, once pressed by constant dispensing demands, found time to conduct inventory reconciliations and provide adherence support. Patients described feeling less like clinic visitors and more like empowered partners in their own care, able to sow fields, attend market days, and participate in community events without the dilemma of frequent hospital trips. Looking ahead, provincial health authorities and C-Saúde, through CDC/PEPFAR support, are committed to improving access to six-monthly drug dispensation in all supported health facilities that meet the necessary structural and staffing criteria by December 2025. Plans include scaling up mobile supervision and technical support teams to reach the most remote sites, integrating real-time performance dashboards at the district level, and deepening partnerships with community networks to sustain demand and address emerging patient concerns. For patients like Manuel Albano, who can now tend to his crops without the monthly trek to the clinic, six-monthly drug dispensation is more than a program, it is a gateway to normalcy, productivity, and hope. As Mozambique continues its journey toward epidemic control, differentiated service delivery approaches such as this offer a blueprint for balancing clinical rigor with human dignity, transforming the way HIV care is delivered across rural landscapes and urban centers alike. Health providers at 17 de Setembro Health Facility, conducting a technical review of the clinical eligibility criteria for the Six-Monthly Drug Dispensation (6MMD), reinforcing the implementation of differentiated care based on data, national protocols and collaborative decision-making.

“The new system has simplified my daily tasks. I can now swiftly obtain information that would take hours to obtain using a manual process. For example, I can extract monthly reports and use the dashboard that facilitates verification of the main performance indicators. It is easy to check patient history and monitor adherence to treatment.” Rafique Eduardo, pharmacy technician supported by Ariel in Cabo Delgado province. Rafique Eduardo is one of the hundreds of users of iDMED, which is the pharmacy information system developed by Centro pela Saúde Global (C-Saúde) in partnership with the Ministry of Health. The development and roll-out of the system has been supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the United States Centers for Disease Control and Prevention (CDC). iDMED is currently in use at 356 health facilities throughout Mozambique. For years, the PEPFAR supported health facilities in Mozambique had been using a desktop-based electronic pharmacy system primarily used for antiretroviral (ARV) drug dispensing. The previous system while a lifeline for antiretrovirals relied on local installations, and outdated technology, hindering expansion and interoperability. Recognizing these weaknesses, the Ministry of Health, PEPFAR and C-Saúde joined forces to design iDMED, the Intelligent Medication Dispensing System. The new platform was built from the ground up as a secure, web-based solution capable of managing every essential medication, not just ARVs. By leveraging modern frameworks Vue.js on the front end, Spring Boot on the back end, RESTful APIs for seamless communication, and OpenHIM for national interoperability C-Saúde developers created a system that supports both online and offline operations, ensuring that even the most isolated health posts never lose access to critical information and functionalities. Rollout followed a deliberately phased approach, beginning in lower-volume clinics where data migration and staff training could be closely supervised. During each pilot phase, pharmacy and clinical teams provided real-time feedback on usability, allowing the technical team to refine workflows before extending the platform to busier facilities. This careful, people-centered strategy meant services never skipped a beat; health workers transitioned smoothly, armed with hands-on training and the confidence that patient care would improve rather than be interrupted. The results have been nothing short of transformative. Real-time registration and automated stock management improved, while digital records guard against transcription errors, elevating both clinical decision-making and patient safety. Whenever a network outage occurs, clinics simply switch to offline mode, maintaining full functionality until their connection returns. And because updates occur automatically through the web interface, system maintenance improved dramatically freeing IT resources for other vital tasks. Perhaps most importantly, iDMED’s integration with electronic patient tracking system (based in OpenMRS) offers a comprehensive view of each patient’s journey, smoothing referrals and underpinning data-driven policy decisions at every level of the health system.“We can track stock movements in real time and respond instantly to shortages. Even in our busiest centers, where the system sometimes slows briefly, the overall efficiency gains have revolutionized how we deliver care,” explains Dário Osmel Victor Gabriel, an ICAP-supported user in Nampula province. “Stock management has dramatically improved, facilitating the production of reports required by the Ministry of Health” adds Kátia Zacarias Chissano a pharmacy technician in Namacata health facility in Zambezia province while she is preparing her monthly inventory report. PEPFAR support in Namacata health facility has transitioned to the provincial health authorities of Zambézia and iDMED is essential in the provision of accurate reports. C-Saúde is a Mozambican association and serves as the central partner of PEPFAR for Health Information Systems (HIS) in Mozambique. Under the strategic guidance of CDC, C-Saúde supports the Government of Mozambique and PEPFAR partners in developing, strengthening, implementing, and supporting HIS, with the ultimate goal of achieving control of the HIV epidemic.      

In Mozambique, where tuberculosis remains a critical public health challenge among children, the story of Eva Evaristo, a 2-year-old girl from Namacurra in Zambézia province demonstrates the effective application of innovative diagnostic and treatment approaches under the PEPFAR-supported National Tuberculosis Control Program.Eva’s journey began when her mother, Mrs. Goi Luís, noticed that Eva was running a persistent fever and losing weight. An initial visit to the Naciaia health facility produced inconclusive results, prompting Mrs. Goi to seek further evaluation at the Namacurra sede health facility. There, considering Eva’s family history her grandmother was being treated for tuberculosis the healthcare team raised the possibility that the young girl might also have contracted the disease. Confirmation came through an unconventional test: a stool sample. Diagnosing tuberculosis in children is particularly challenging due to the difficulty they face in providing sputum samples. In response, the National Tuberculosis Control Program, in collaboration with C-Saúde and with PEPFAR funding, introduced an alternative diagnostic approach using stool samples. Despite initial reservations, Mrs. Goi understood the importance of the test and, with the help of the health team, was able to collect the sample. The result, days later, confirmed what everyone feared: Eva had tuberculosis. Mrs. Goi recalled, “It was a shock to learn that my daughter had the same disease as my mother. But at the same time, I was relieved to know that there was a cure.”Following the diagnosis, Eva commenced tuberculosis medication. Mrs. Goi observed early changes in her daughter’s condition, explaining, “At first, I received medication for a month, and I soon noticed improvements. My daughter was more energetic, her eyes began to shine again, and her appetite returned.” Alongside medication, Eva’s treatment plan included nutritional and psychological support. These integrated services were crucial given the challenges Mrs. Goi faced in managing the long-distance travel to health facilities and the ongoing risk of reinfection within the household.Reflecting on the difficulties she encountered during this period, Mrs. Goi stated, “It was hard, but as a mother, nothing stopped me from giving my best for my daughter. I knew that the cure was within our reach, and I had to fight for it.” After several months of consistent treatment and follow-up, Eva’s condition improved markedly Her recovery was evidenced by her renewed energy and a return to normal activities, attesting to the success of both the medication regimen and the novel diagnostic strategy. Mrs. Goi expressed her relief and gratitude: “Now, my daughter is cured and healthy. She is a girl full of joy. As a mother, I feel immense happiness seeing her well again. “Eva’s illustrates the tangible benefits of adopting stool-based diagnostic methods for pediatric tuberculosis. Between January and December 2024, the implementation of stool diagnosis resulted in a significant increase in the number of confirmed diagnoses: from 8 TB identified cases in 126 samples collected among children in the first quarter of fiscal year 2025 to 54 cases identified in 485 samples in the fourth quarter. This change not only saved Eva’s life but also influenced her grandmother, who found motivation in her granddaughter’s recovery to continue her own treatment. “It is essential for communities to share experiences like ours so that people know that tuberculosis is curable,” says Mrs. Goi, emphasizing the importance of awareness. Now, Eva’s next step is to ensure she is not reinfected, and Mrs. Goi is committed to following all prevention guidelines. Eva’s story is a beacon of hope, an example of the positive impact that early diagnosis and appropriate treatment can have on a child’s life. The innovation of stool-based diagnosis, supported by C-Saúde through PEPFAR funds, is a crucial tool in the fight against tuberculosis. Eva’s journey reminds us that healing and hope are within reach when we seek the right care and work together for the health and well-being of our communities. Eva Evaristo, sitting on her mother’s lap, serves as a reminder that new beginnings are always possible. “Eva’s treatment was a success. Looking back, I realize how this experience has made me stronger. The most important thing was to follow all the guidance from the health providers. My daughter is well now, and I am grateful for everything we learned in this process.” Mrs. Goi