The results in context

Mozambique has vast water resources but its infrastructure and management capacity are often insufficient. Mozambique has set an ambitious target for universal coverage of water by 2030, whereas only around 50% of the population currently has access to safe drinking water. The Netherlands supports two government institutions that are responsible for access to drinking water and sanitation. The 2019 cyclones damaged many installations that needed to be repaired. As a consequence, fewer people were provided with new water connections than initially planned. Full recovery of public infrastructure in a climate resilient way (‘building back better’) will take a couple of years.

Mozambique is among the 10 countries in the world with the highest percentage of population exposed to water risks. Flooding and droughts occur frequently and the country is heavily dependent on water resources from neighbouring countries. Through the Netherlands’ support to the regional water board in the Zambezi Valley, more people benefited from better management of water resources.

The results in context

Agriculture is a critical pillar of the Mozambican economy, employing 80% of the labour force and contributing more than a quarter of GDP. Extremely high levels of chronic malnutrition affect almost one in two children under the age of five; a frightening figure. The overwhelming majority of producers are smallholder farmers. Through various programmes, the Netherlands supports these farmers in increasing their productivity and resilience to climate change. Cyclones Idai and Kenneth occurred during a critical harvest period, wiping out the food stocks of thousands of families and leaving many without the prospect of another full harvest until April 2020.

The Dutch government therefore made additional funds available for early recovery and cash transfers to the most vulnerable households, to ensure they had access to a nutritious diet. Apart from destroying food crops, the cyclones also destroyed various means of production, including irrigation structures, machinery and equipment. The long-term effects will continue to be felt throughout the country, since the central region of Mozambique that was hit by cyclone Idai is the country’s breadbasket.

The results in context

Although some progress has been made, many SRHR indicators in Mozambique reveal a deplorable situation, which was further exacerbated by the cyclones. Thousands of women and girls were in urgent need of sexual and reproductive health care. In co-operation with UNFPA, 500,000 beneficiaries received life-saving emergency SRHR services (clinical equipment, medicines, supplies).

HIV prevalence is still at 13.2%. In 2019, more than 1.2 million people living with HIV accessed treatment but 30% of these stopped after 12 months. Only 65% of pregnant women and 70% of children continued taking their medicines after one year. Homosexuality is not illegal but Lesbian, Gay, Bisexual and Transgender (LGBT) organisations are not yet able to register. Abortions are also not illegal but this is not widely known.

Dutch support to the United Nations Population Fund (UNFPA) and Population Services International (PSI) empowers young people with knowledge and skills. PSI, in co-operation with the Ministry of Health, trained staff and equipped 15 health centres to provide safe abortions. Support to the World Bank’s Global Financing Facility (GFF) strengthens the primary health care system, especially in catering for women and girls.

Regional SRHR/HIV programme in Southern Africa

Southern Africa remains the epicentre of the AIDS epidemic in the world. However, other SRHR indicators are also appalling and some groups are more deprived than others.

In the regional SRHR/HIV programme, the Netherlands focuses on empowering the most vulnerable groups: young people, including those living with HIV, girls, migrants, LGBT groups, people who use drugs and sex workers. And it is working. Peer educators, change agents and Community Adolescents Treatment Supporters (CATS) are making a difference.

For example, due to the engagement of CATS in the READY+ programme, almost 90% more young people living with HIV were reached (18,431 compared to 10,000 in 2018). Health providers became more motivated and better equipped to provide care to this specific group. The partnerships between the implementing partners and the various Ministries of Health were key to this success.

As part of a more integrated approach, SRHR interventions are linked with providing economic opportunities. Beneficiaries of our SRHR/HIV programmes are invited to enrol in technical and vocational training provided by Young Africa (the ‘Skills2Live’ programme). Young Africa, a network of centre-based and mobile training facilities, works closely with the private sector and caters to large groups of young people, including young people with disabilities. At the end of the course, the graduates are empowered to find employment or start their own business.

Evaluation of the ‘Hands Off!’ programme for sex workers shows that this regional programme has been successful in decreasing violence against sex workers. This success is based on building a strong sex worker movement by enhancing their awareness of human rights, setting up rapid emergency response systems and turning the police into an ally.

Despite the hostile political environment towards migrants in the region, the International Organisation for Migration (IOM) and implementing partners were able to reach more than 170,000 migrants with SRHR information and almost 19,000 received SRHR services. Child marriages were discouraged and traditional leaders were mobilised to send more than 100 child mothers back to school after delivery.

Changes in the legal environment in favour of migrants and key populations require endurance and time. The IOM advocates for SRHR rights at the regional Migration Dialogues for Southern Africa (MIDSA) and managed to include HIV and health issues in the SADC Regional Migration Policy Framework.

UNDP conducts Legal Environmental Assessments (LEAs) aiming at a more favourable legal environment for sexual minorities, sex workers and drug users; an environment that promotes SRHR and encourages access to HIV prevention, care and support. LEAs have been undertaken in five countries and recommendations for reforms have been formulated. However, legal reforms take time and depend on the commitment of politicians, legal advisors and civil society actors.