Strengthening the Mangunde Hospital for Health Improvement of Women and Children

Project location: MOZAMBIQUE, Chibabava
Project start date: December 2014 - Project end date: December 2015
Project number: 2014-025
Beneficiary: Fundación Promoción Social de la Cultura (FPSC)


The project aims at achieving immediate action in favor of people of Chibabava District (Southern Region of Sofala), Mozambique, who live in situation of extreme social and economic hardship, by the strength of primary health services.
In the Sofala Region, as well as in the rest of the Country, the quality of healthcare delivery is low. A very central problem is the lack of adequate infrastructure and equipment as well as competent manpower. Preventable diseases such as malaria, pneumonia, typhoid, diarrhea and measles are still causing people to die prematurely. Children below 5 years are the major consumers of health services and they need to have assistance and medication available throughout the year.
More in depth, the action is focused on the Hospital of the Mangunde Mission, the most structured of the fourth Comboni missions managed by “Esmabama” association. It is 300 Km away from Beira in the internal savanna, in a rural territory located on the shore of a river and often hit by flooding and hurricanes.
The Hospital is the biggest and better equipped in the territory. It provides prenatal care, vaccinations, maternity ward, blood tests and general care to the neighboring communities. It is particularly focused on HIV treatment and prevention of vertical transmission: the main problems that affect the population of the area and that the doctors seem to be dealing with are HIV treatment (around 100 people start HIV treatment each year, with an adhesion of 96%), severe cases of malaria and malnutrition, and wounds by crocodile bites.
The Hospital serves an area of 150-200 km radius. There are no streets or cars, and people have to come to the hospital by walking. They have ca 40 kids born there every 6  month. Most of the women, who come to deliver their babies, are HIV negative. However, about 2-3 children per month are born HIV positive.
Doctors and community assistants must deal with daily problems typical of the countryside in Mozambique which affect their action a lot. In particular:
-the low nutritional level of the local population, because of low-protein diet, which brings to serious food crises during prolonged drought and greatly complicates the clinical picture of the chronically patients;
-the high rate of malnutrition in early childhood, often due to the precarious conditions of the mothers; -the high rate of HIV / AIDS (around 50% in the Area);
-the lack of public transport combined with the poor condition of transitability (especially in the rainy season) which often make patients to arrive to the hospital in critical condition;
-the cultural resistance that still brings people to prefer, in case of illness, the sorcerer of the village to conventional medicine (although an improvement can be stressed since 2009, thanks to a specific program).
Moreover, being the Mission quite isolated and far from the city, it is not reached by an electric line yet. Electricity is produced by an oil generator (the main expense of the Mission so far), and solar panels. The generators supply three hours of electricity per day to illuminate the dormitories, to produce bread in the bakery and to pump water from the river or wells, mainly for irrigation. The majority of buildings in the Mission (dormitories, teacher's houses etc) don't have tap water. The hospital of Mangunde is however provided with electricity all day long, mainly for preservation of blood samples.

The action aims at addressing primary health services in an area (Chibabava District)
- 96% of the population (around 100,000 inhabitants) live in houses built with wooden poles, mud and straw;
-A large part of population is composed of women and children as the heads of the families usually work as miners in South Africa.

Within this context, the Mangunde Health Center is crucial for the local population: it provides assistance to approximately 30,000 people per year, of which about 60% are women. That’s why Esmabama is strongly committed to ensure its functionality.
The project is in line with Nando Peretti Foundation’s goals as it supports:
 -people who live in situation of extreme social and economic hardship, with particular attention to women and children;
-the strength of primary health services through immediate action.

The project received a grant from the Nando Peretti Foundation. Its overall goal is to improve the health conditions of the population of Chibabava District by strengthening the Mangunde Hospital, the most structured health center of the Area.
The objective will be achieved through 2 specific actions:
1) the rationalization of the water supply system;
2) the supply of medical equipment for the first aid whose construction ended in 2013.
The rationalization of the water supply will be achieved through the improvement and expansion of the existing system. In the last five years, the extraordinary growth of the Health Center, both in terms of infrastructure and human resources, was not linked to an adjustment of the distribution system and the lack or scarcity of water deeply affects the quality of services offered by its personnel, however qualified it may be.
Currently, the various departments of the health center receive water from separate systems fed by the same well, through pipes which are unsuitable for relatively long distances (up to 200 meters). These pipelines cause bottlenecks and blockages, significantly reducing water pressure: this phenomenon is particularly pronounced in older facilities where the pipes are worn out.
The result is that the current system of hospital delivery is not efficient, due to significant losses and waste along the way and does not guarantee the constant spillage of water from the taps installed at the hospital and homes, seriously distressing the ordinary functioning of the hospital, the services offered to patients, and the daily lives of people involved. Moreover, at the end of last year a new first aid was built by the aim of improving the services offered to the local population. The improvement process, however, will occur only to the extent that the property is furnished and stocked with medical and health care of good quality. In this first phase of opening basic furniture and equipment are strongly needed.
Therefore, the activities proposed by this project are the following:
1)A new primary system will be installed to feed the various relevant infrastructure using, wherever possible, the ramifications (secondary system) that already exist.
By this aim, a tower of about 6 meters will be built on which a tank of 5,000 liters will be placed and fed by the existing well. The tank will be then connected to a system of pipes suitable for transporting water for a maximum distance of about 200 meters without excessive loss of pressure. Then, the existing secondary systems will be checked to see if and where a repair or replacement is needed, before they are connected to the primary system.
2)Supply of basic medical equipment and furniture for the new first aid: 5 bottles of oxygen with the respective regulators and gauges, 8 stethoscopes, 3 sphygmomanometers, 3 suction pumps, 5 drip supports, 3 wheelchairs, 2 electronic scales, 2 refrigerators; 3 hospital beds, 7 regular beds with mattresses, 30 pillows, 30 sheets, 7 tables with towel rails, 4 trays, 5 foot baskets, 5 hospital chairs, 5 desks with chairs, 4 cabinets.

The project will adopt the following operational procedures and methodology: FPSC will be in charge of monitoring the proper execution of the activities and will be responsible towards Nando Peretti Foundation; Esmabama association will be the operative partner responsible of the activities on the ground.
 In particular:
 -the procurement activities will be carried out by the logistics sector in accordance with the internal procedures which ensure the supply of materials, goods and services to the best conditions in the local market;
-the transport of materials will be made by Esmabama itself allowing a significant cost saving;
 -the construction will be executed by Esmabama’s expert team who has got twenty year experience in the matter. This will ensure a good level of quality and a substantial cost savings.
-the equipment will be installed by the staff of the District Directorate of Health and the Hospital itself. No training session on the use of the equipment is needed as the personnel of the Health Center is already skilled on the issue.

The project outcomes will be the following:
 1)A new system of water supply installed. This will improve the hygienic conditions of the Hospital, of the neighboring dwellings and it will strength the quality of health services provided to almost 30,000 patients who annually require assistance;
2)Medical equipment for the first aid of the Hospital supplied. This will enhance the quality of services provided to patients by medical and paramedical staff, as it will greatly improve the ability to diagnose and cure.
3)Basic furniture for the new first aid of the Hospital supplied. This will increase the perception of the patients about the quality of service and it likely will result in an increase in the number of patients received annually from the Health Center.
All the activities will bring multiplier effects in terms of quality of the services provided by the Hospital, number of patients and improvement in the health and hygienic conditions of the interested environment.

Fundación Promoción Social de la Cultura (FPSC)
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