Differentiated Service Delivery in Mozambique
Percent of health facilities providing less-intensive DSD models. Of the 630 ART facilities in the country with electronic medical records systems (covering 84% of all people on ART), all 630 have enrolled at least 10% of eligible recipients of care into less-intensive models. Source: October 2021 CQUIN DSD Dashboard staging
% In Less-Intensive
Percent of people on ART who are enrolled in less-intensive DSD models. In a sample covering 84% of all people on ART, 81% have been enrolled in at least one less-intensive model. Source: National electronic medical records data, end June 2021
# of Less-Intensive
Number of less-intensive DSD models designed for people doing well on ART. Less-intensive models include: Multi-Month Drug Dispensation (3MMD or 6MMD), Fast Track, One-Stop Model for Adolescent and Youth Friendly Services, Extended Hours Model, Private Pharmacy Drug Dispensation, Facility-Based Adherence Clubs, Community Drug Dispensation, and Community ART Groups. Source: October 2021 CQUIN data report
Number of groups for whom less-intensive DSD models have been designed and implemented. Differentiated ART models are available for adults who are doing well on ART and eligible adolescents, as well as adults with co-morbidities, men, and pregnant or breastfeeding women. Source: October 2021 CQUIN DSD Dashboard staging
Differentiated Service Delivery Implementation in Mozambique
Mozambique has been a member of the CQUIN learning network since 2017. Since joining the network, the country has rolled out multiple initiatives to scale up differentiated service delivery (DSD). While recipients of care are not currently engaged in the strategic planning of DSD-related activities, they are heavily involved in implementation, demand creation, and ongoing discussions regarding the quality of DSD services.
In September 2019, Mozambique’s Ministry of Health (MOH) rolled out new monitoring and evaluation (M&E) tools to accelerate collection of DSD information, using a master-card and electronic patient tracking system to collect DSD-specific data at the patient level. Additionally, Mozambique’s MOH created definitions for quality standards for less-intensive DSD models and developed a supervision form to evaluate the quality of DSD services including assessment of eligibility, prophylaxis, lab tests, clinical appointments, and drug pickups.
Currently, ten models of antiretroviral (ART) services are available in Mozambique—six less-intensive DSD models and four more-intensive models, including the conventional model and one-stop-shops for antenatal care, services for the prevention of mother to child transmission, as well as TB/HIV and youth-friendly adolescent services. The six less-intensive models include:
- Two facility-based individual models: three-month multi-month scripting (MMS); and the appointment spacing model.
- One facility-based group model: adherence clubs.
- One community-based individual model: integrated mobile brigades with community ART refills.
- Two community-based group models: community support and adherence groups; and the family group model.
Community engagement and quality improvement (QI) are central to Mozambique’s DSD priorities. In 2017, a CQUIN-supported south-to-south learning exchange led a team from Mozambique to observe Malawi’s teen clubs, resulting in the addition of teen clubs for ART refills to Mozambique’s national DSD guidelines. Mozambique’s MOH developed a QI framework to enhance the quality of HIV services, including DSD, based on assessment of clinical performance standards and the development of improvement plans for weak performance areas. The framework has guided health managers and providers in the implementation of a standardized approach to QI and has enabled health facilities to implement different QI-DSD activities. Mozambique has actively participated in the CoP, and contributed to the co-creation of CQUIN’s DSD quality framework.
Mozambique is also a member of CQUIN’s virtual monitoring and evaluation (M&E) community of practice, a forum where experts share resources, tools, and best practices to enhance national M&E programs for DSD.
As Mozambique continues to improve and diversify DSD models, MOH focus remains on demand creation and effective community engagement strategies to ensure all eligible recipients of care have the option to enroll in the model of their choice. Moving forward, increasing the diversity of models and improving quality standards are central to this goal.
Visit ICAP’s website for a broader portfolio of work in CQUIN network countries.
Photo: Jake Price. A community-based ART program in Nicoadala District, Mozambique.