Throughout their civil war, the Mozambican government continued to repair and build health facilities. During the first five years of major RENAMO activities (starting in 1982), 822 health units were destroyed by RENAMO while 567 were reconstructed by FRELIMO. FRELIMO was, in a very real sense, racing to build health facilities faster than they could be destroyed or forced to close. The struggle between the destruction and wartime reconstruction of the health system is apparent in the number of health facilities in Mozambique during almost a decade of war, shown in Figure 3.2. Before the start of major RENAMO operations in 1982, the rapid expansion of the health system that started in the pre-war era continued to increase the number of health facilities in the country. However, after 1982 the total number of each type of health facility stayed the same or decreased as RENAMO attacks and collateral damage took their toll on the health system.
Along with continuing to construct the health system, the government maintained a vigorous medical education program during the war. From 1976 to 1985, the Mozambican government trained thousands of health workers, including 569 medical aids, 818 midwives and maternal/child health nurses, 2181 nurses, 268 preventative medicine workers, 486 pharmaceutical personnel, 406 laboratory personnel, 76 health administrators, 384 specialized nurses, and 1,402 village health workers. In addition, around the same time 6,242 paramedical workers were trained. The training of these health workers represented a significant cost for the wartime government. The result of this training program during the first years of the war was that the number of health workers in semi-rural and rural areas increased from 8,163 to 10,593 between 1980 and 1984. While the number of health workers in these areas likely decreased as RENAMO stepped up its attacks after 1982, the numbers demonstrate the high priority the FRELIMO government gave the operations of the health system. In addition to training new health workers, the government invested in the improvement of its existing personnel. After the civil war made it impossible to train enough new health workers to provide child and maternal health, the Ministry Of Health started new education and training programs for the country’s existing health workers, including training medical technicians to conduct emergency obstetric surgeries and educating traditional birth attendants.
Christopher R. Albon is a political science Ph.D. specializing in armed conflict, public health, human security, and health diplomacy.