Resumen de Social determinants of health and the health system of mozambique: Towards a comprehensive analysis of health inequalities
The present thesis aims to give a critical overview of the health care and health inequalities for the Mozambican case. The thesis is divided into four articles, two of them are quantitative articles analysing data from the Mozambican household budget survey, while the other two articles employ different methodologies: a systematic review and data source mapping. Findings show that in Mozambique, despite the overall health status has improved over time, women, children, elders and the population living in rural areas of the country are left behind in the progress to attain better health. Structural factors are the major drivers of health inequalities and people’s access to basic services and material conditions, although crucial, are not the main causes of health inequalities in Mozambique. Another key finding is that a comprehensive view of the health system based in primary health care is fundamental for addressing health care inequalities. In Sub-Saharan Africa, the access to and quality of primary health care is mainly determined by the social position, rather than by the need, and health care inequalities persist over time. These results allow drawing conclusions for the improvement of the equity in the access to quality care in Mozambique. In the country, 70% of Mozambicans use healthcare services when having a health need, and despite there are no differences in the direct payments for the public sector visits, significant socio-economic and geographical inequalities were found for women and men in the access to and quality of care received. Finally, this thesis highlights the important information gaps that exists in the national health information system to monitor health equity in Mozambique.
