Author name: CSAUDE Mozambique

“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 social barriers 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 representatives 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 patients. 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 representatives, 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 patients 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 active protagonists 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 ties 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) with support from 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 worked together 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 lead institution supporting PEPFAR for Health Information Systems (HIS) in Mozambique. Under the strategic guidance of CDC, C-Saúde supports the Government of Mozambique and PEPFAR-supported institutions 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, with support from C-Saúde and funding from PEPFAR, 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 mental health 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 

“Being where I am today means a lot to me. Programs funded by the United States Government (USG) were like a school and a bridge that helped me to get to where I am today.” says Santos Mucelo, currently serving as the Laboratory Mentor for Corromana health facility at Molumbo district. Corromana health facility is one of the health facilities that graduated from receiving technical support from a USG-funded International NGO to the Provincial Health Authorities and local Association Centro pela Saúde Global (C-Saúde). Based at Molumbo district capital, Santos Mucelo is the District Laboratory Chief and his own career has followed a similar trajectory as the support provided to Corromana health facility. Born in Mocuba, Zambézia province, Santos Mucelo joined to the Instituto de Ciencias de Saúde de Quelimane in 2015 and completed his Government of Mozambique (GoM)-funded mid-level academic in 2017 training graduating as Laboratory Technician. He passed the pre-employment GoM tests, but due to GoM budget limitations he couldn’t start working. His case was and continues to be similar to hundreds of health professionals across Mozambique, who although they have the necessary skills they cannot provide their services at health facilities that face shortages of qualified health professionals. It was in this context that, at the end of 2018, the USG-funded International NGO Friends in Global Health (FGH) provided a sub-agreement to Zambézia Provincial Health Authorities for hiring mid-level health professionals throughout the province. Santos was one of these professionals and started working at rural Molumbo district as a Laboratory technician, focusing on HIV-related laboratory work. “My initial experience was very good. I didn’t expect to have this opportunity.” recalls Santos. USG enabled him to step into the professional environment, apply his academic knowledge, and begin a promising career journey. But the start wasn’t without hurdles. Working in the field brought practical and emotional challenges, while also providing invaluable lessons. “It was my first contact with patients on the front lines, and life in the field wasn’t easy. However, this experience taught me a great deal about teamwork and how to cope with adversity.” Santos participated in USG-funded technical trainings and received mentoring that significantly broadened his skills. “I learned a lot, and I’m still learning. These trainings and regular mentoring were vital to my growth and continue to directly influence my work.” In 2020, Santos reached a milestone in his career when he was finally absorbed into the GoM payroll. He continued growing and today, as a District Laboratory Chief in Molumbo, he oversees teams and ensures the quality of services provided across all health facilities in the district. In October 2024, with the USG funding through the Centers for Disease Control and Prevention (CDC), C-Saúde initiated the implementation of the Avante Saúde program. C-Saúde assists provincial health authorities in various districts and Molumbo is one of them – Santos did not miss the opportunity: “I want to continue improving the public health system. I will keep applying everything I’ve learned.” says Santos, who is now one of the mentors of the graduated sites. Santos’s progression—from unemployment, to being hired by GoM through the support of an international NGO, to joining the government’s payroll, and ultimately becoming a mentor to other GoM providers—demonstrates the transformative power of USG programs. Santos is not an exception, but rather one of the 91 health professionals at leadership positions in Zambézia province, who were once supported by USG-funded sub-agreements. C-Saúde works with these leaders, ensuring that they seize the opportunity to retribute the technical support they once received and that they continue to build capacity of the public health system in Zambézia province.