Numerous paths lead to Health: Projects of Swiss Organisations

Community Health Projects in Sofala Province

Von Denise Caviezel & Ignacio Packer / Stiftung Terre des hommes

A set of various and flexible communication channels at different levels were put in place to improve or create an “interface” between the rationality of health services and of the population. By developing the interface, Tdh provided the opportunity to take health closer to the doorstep of the people and to encourage members of the community to see themselves as active collaborators in promotion and preventive health. This approach aimed to increase the community development process that ensures that health activities are run taking into consideration the social problems that people face every day.

It has been documented that real dialogue, real interaction between the health care providers and the people increases autonomy and self help.

The family, and by extension, the community, are the oldest institutions in provision of health to their members. Promoting alimentary habits, health in general, preventing nutrition problems, preventing illness are age-old human concerns and certainly not the prerogative of the health professional.

While the rationality of the health service is based on an analysis of the suffering caused by health problems and the possibility to reduce this suffering by health care or health promotion, the logic of the people’s readiness to influence their health is within a different value system. Improving the nutritional status of the family is not always the priority. The people will not accept that the efforts required for improving health modifies their priority setting based on values they consider more important.

The project paid a lot of attention in the implementation of an “interface” between the rationality of the people and the rationality of the health workers in the Mother and Child Health Projects run by Tdh in Sofala district between 1993 and 2002. Special emphasis is given to the nutritional activities.

Though the project capitalisation in May 2002 questions the lack of sustainability of the interface, it clearly acknowledges the results and impacts.

When planning the health service, the capacity for communication with the target population should certainly be foreseen. But one should keep in mind that the domain of interaction between the rationality of health services and of the population is made of a set of various and flexible communication channels at different levels.
The interface cannot be reduced to village workers, or to health committees, or to superficial contacts with the elderly of the village or when the health activities are dispensed. It cannot be restricted to one level. In this case, it covered: the household, village and leadership structures, peripheral health post, mobile team and district headquarters.

If developed simultaneously at the interface between the health service and the people, participation and rationalisation can contribute to equity and self-reliance in balance with effectiveness and efficiency. If minimum resources (community referral system and up-grading of quality of services) are secured, participation and rationalisation also contribute to sustainability.

The project has to some degree shown the dynamics involved in behavioural change as regards breastfeeding practices when the interface of rationalization between health service and the population is appropriately employed. The shift from the extreme practice of early introduction of solid foods in the diet of infants to the midway position of predominant breastfeeding can be considered a position of compromise between age old tradition and customs and the concept of exclusive breastfeeding as being promoted by the health system.

Pays, région: Mozambique, Sofala

Secteur: Santé

Période, durée: 1993 to May 2002 reported below.
Project on going with new phase May 2003 to December 2004.

Since 1993 and the current project phase (May 2003 to December 2004), the Terre des hommes Foundation has been involved in both emergency and development projects in the province of Sofala in Central Mozambique.

1993 to 1995 was immediate post war period in Mozambique, and the Tdh delivered emergency medical aid to the districts of Muanza and Cheringoma. Tdh also delivered emergency medical aid to the districts of Buzi and Machanga severely affected by floods in 2000.

From 1997 to 2000, Tdh implemented in the districts of Muanza and Cheringoma the “Child Survival Project” which aimed to increase demand for essential maternal and child health services and improve the effectiveness of child health services.

In 2001, Tdh reinforced the project with the implementation of the Health Services Delivery Support project in the 5 districts with a total population of 580.000 (of which 110.000 infants and children less than 5 years of age). The project has nine specific, which can be divided in into three broad categories (1) reproductive health; (2) child survival and (3) institutional capacity building.

Organisation suisse: Fondation Terre des hommes

Site web de l‘organisation:

Tdh Delegation in Mozambique
CP.3054, Zona Macuti, Beira, Mozambique
Tel. 00258 3 31 26 36; Fax 00258 3 31 24 11;
Former Tdh Mozambique delegate, Dr Abimbola;
Tdh desk manager, Denise Caviezel ;
Tdh head of programme department, Ignacio Packer;

Capitalisation document available (13 pages): Authors : Ignacio Packer, head of Programme Department II and Dr. Abimbola, Tdh delegate in Mozambique as an output to the valuable analysis of the participants of « Nutrition capitalisation workshop » held in Beira on 9-10 and 13 May 2002.