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Cablegate: Health Minister Commits to Pepfar Goals

VZCZCXRO2645
RR RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHTO #1081/01 2790510
ZNR UUUUU ZZH
R 060510Z OCT 09
FM AMEMBASSY MAPUTO
TO RUEHC/SECSTATE WASHDC 0807
INFO RUCNSAD/SOUTHERN AFRICAN DEVELOPMENT COMMUNITY
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHDC

UNCLAS SECTION 01 OF 02 MAPUTO 001081

SENSITIVE
SIPDIS

STATE PLEASE PASS TO OGAC

E.O. 12958: N/A
TAGS: PREL PGOV EAID KHIV SOCI MZ
SUBJECT: HEALTH MINISTER COMMITS TO PEPFAR GOALS

REF: 08 MAPUTO 729

1. (SBU) SUMMARY: The Charge met with the Minister of
Health (MISAU) Dr. Ivo Garrido recently to discuss his
Ministry's involvement in a Partnership Framework for
HIV/AIDS programming over the next five years including
priority policy issues. MISAU is the key ministry in the
Mozambique response to HIV/AIDS and a sizable percentage of
USG PEPFAR resources are used to support and build capacity
of the public health system. The Minister expressed his
appreciation of USG assistance and noted he was especially
pleased by President Obama's Ghana speech and general
approach to reinforcing health systems rather than taking a
single disease approach. The Minister stated that the USG is
listening to the needs of African Ministers of Health. END
SUMMARY.

--------------------------------------------- ---
CHARGE ENGAGES GARRIDO ON PARTNERSHIP FRAMEWORK
--------------------------------------------- ---

2. (SBU) Mozambique is faced with daunting health
challenges, including a HIV/AIDS national prevalence rate of
16 percent. The health care delivery system was severely
damaged during its civil war (1977-1992) and is very slowly
recovering. The PEPFAR program (since 2003) accounts for the
largest foreign investment in the health sector. The Charge
recently met with the Minister of Health (MISAU) Dr. Ivo
Garrido to discuss the Ministry's participation in the
development of the proposed bilateral Partnership Framework
between the U.S. and the Government of Mozambique (GRM) to
guide the President's Emergency Plan for HIV Relief
2009-2013. The Charge was accompanied by the CDC Country
Director, USAID Deputy Director and USAID HIV/AIDS Team Lead.
MISAU is the key ministry in the Mozambique response to
HIV/AIDS and has jurisdiction over all health programs in the
public health system. Minister Garrido has also demonstrated
leadership in HIV/AIDS prevention programming.

3. (SBU) The Charge reviewed the progress thus far in
developing the Mozambique PEPFAR Partnership Framework and
its focus on five goals: (a) reduce new HIV infections; (b)
strengthen the multi-sectoral HIV response; (c) strengthen
the Mozambican health system, including human resources in
key areas to support HIV prevention, treatment and care
goals; (d) improve access to quality HIV treatment services
for adults and children; and, (e) ensure care and support for
adults and children infected or affected by HIV in
communities and through health systems. The discussion then
focused on key policy issues associated with achieving those
goals.

---------------------------------------------
GARRIDO: MALE CIRCUMCISION NOT A MAGIC BULLET
---------------------------------------------

4. (SBU) Garrido stated that male circumcision (MC) is not
a "magic bullet" and shared his belief that MC should be part
of a package of prevention services, but would not agree to
develop a vertical MC program and would not develop MC
programs similar to those in Swaziland or Botswana. He
stated there are pressing obstetrical and other emergency
surgical needs and that MC should be part of increasing the
country's surgical response not a parallel service. He
mentioned he has two major concerns about MC: (1) feasibility
and (2) risk compensation, noting that any scale-up of MC has
to be accompanied by very careful messaging. Also, he
expressed concern about creating demand for MC that the
Ministry would be incapable of meeting. In addition, he
mentioned that differences between ethnic groups and their
views on this issue that will have to be considered.
Finally, he highlighted that MC is not the top prevention
priority; however, he believes MC is part of a comprehensive
prevention package and should be in the framework.

---------------------------------------
WORK PERMITS TO SUPPORT PEPFAR PROGRAMS
---------------------------------------

5. (SBU) Garrido stated that MISAU would work to facilitate
the work permit process for foreigners coming to Mozambique
in support of PEPFAR goals, but could not guarantee work
permits for expatriate staff who are health professionals
(e.g., those providing services directly to support MISAU
such as nurses and doctors). Garrido also indicated that
MISAU will not assist other non-health project staff. (Note:
Work permits are issued by the Ministry of Labor and the
applications require supporting letters from other relevant

MAPUTO 00001081 002 OF 002


ministries. End Note)

----------------------------------
EXPANSION OF THE HEALTH WORK FORCE
----------------------------------

6. (SBU) Although currently PEPFAR-funded programs support
lay social workers to assist with clinic-based HIV counseling
and psycho-social support services, Garrido stated that MISAU
will not be able to absorb this cadre into its work force.
Moreover, he said that MISAU is constrained by internal
Government of Mozambique (GRM) policies that do not allow for
sufficient expansion of its work force.

-------------------------
ARV NEEDS A MAJOR CONCERN
-------------------------

7. (SBU) Future ARV procurement is a major concern for
Garrido. Future ARV availability to the public sector is
largely linked to the uncertain outcome of the Global Fund
(GF) Round 9 HIV/AIDS application. Garrido expressed his
disappointment in working with the GF, highlighting the
complex regulations and problems with GF disbursements in
Mozambique. He suggested that GF should have someone in
Mozambique to help MISAU with the GF system and expressed
openness to external support to improve the flow of GF
resources, noting that the GRM does not need to manage the GF
money directly. Additionally, he referenced a letter he sent
to the GF Director to express his concern about $49 million
that has been held up in 2009 (Note: No GF funds were
disbursed to Mozambique in 2009.)

---------------------------
USG RELATIONS HAVE IMPROVED
---------------------------

8. (SBU) Garrido thanked the USG for its assistance and
stated that working relations with the USG has improved,
noting that the USG approach to build capacity and systems is
greatly needed and appreciated by the GRM. Garrido said he
was very pleased by President Obama's speech from Ghana and
his approach to reinforce the needs of the health systems
rather than a single-disease approach resonated with the
Minister. In 2007, the African Ministers of Health requested
a more comprehensive approach to USG assistance with health
programming; Garrido stated that the USG is now showing
sensitivity to this issue.

--------------------------------------------- ------
COMMENT: IMPROVED RELATIONSHIP WITH HEALTH MINISTER
--------------------------------------------- ------

9. (SBU) Garrido's recognition of the shift in PEPFAR
fuQing at post to fund system strengthening was a positive
demonstration of improved communication and alignment with
MISAU in USG programming. On the key policy issues outlined
in the draft Partnership Framework, Garrido repeated previous
positions, but agreed to leave the proposed wording in the
agreement intact. Garrido holds a privileged place among
current GRM Ministers as a technical expert respected for his
contributions to health services more than his role in the
ruling FRELIMO party. His surprise visits to health
facilities and hospitals meant to identify problems are
widely publicized as apparently effective in improving
services, which has made him popular among the Mozambican
public. His autocratic style within MISAU, however, and his
micro-management of programs, has sometimes created difficult
working conditions. Nonetheless, Garrido is likely to
continue in his post with the new government and has been
rumored to be in the running for other high-level positions.
ROTH

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