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.