In Mozambique, like in most areas of the developing world, vital statistics, when existing, are weak and unreliable. In these areas, a considerable number of the births, deaths and migrations are missed or improperly registered, impeding the assessment of the true demographic dynamics of the population. Small area projects may more accurately measure cause-specific HIV morbidity and mortality in these settings.

Currently, Mozambique has one Health Demographic Surveillance Site (HDSS) in Manhiça, Maputo Province and a second HDSS site in development in Chokwé, Gaza Province. The Chokwé site has not yet initiated activities due to delays in receiving initial PEPFAR funding.

This implementing mechanism will fund second year operating costs and core data collection activities for the Chokwe site. Strengthening of this HDSS will allow improved calculations of health statistics needed for decision making, monitoring and evaluation of programs and interventions, including mortality due to HIV. By creating a sample frame and providing longitudinal follow up of a well-defined population, it will also create a platform for public health evaluations.

The site is housed at Chokwé Rural Hospital, a Ministry of Health facility, and will be run in close collaboration with the National Institute of Health, MOH. Chokwé will soon be expanding its research and health service provision activities at the district level. HIV incidence and behavioral studies began in early 2009, several clinical trials on Malaria, HIV, tuberculosis (TB) and co-infections are also planned to initiate in 2010. Clinical surveillance for several infectious and non-infectious diseases is going to be established at Chokwé rural Hospital and the network of health centers and other facilities in the district. In addition, Chokwé district is currently targeted with several large health interventions, covering areas like malaria, TB, reproductive health, and health system strengthening. The impact of these interventions can ultimately be better monitored through their impact on mortality, which in turn can be monitored through a HDSS.

Creation of the HDSS site in Chokwé will also build human resource capacity in public health and clinical research by providing an environment for training Mozambican Government demographers, epidemiologists, and clinicians on morbidity and mortality surveillance methods.

This activity includes a portion of costs for the second year of operations. The Health Demographic

Surveillance Site (HDSS) is expected to be co-funded by other donors starting in the second year.

Primary activities include payment of continuing salaries for a demographer, data entry personnel, and

field staff, maintenance and fuel for vehicles used for fieldwork, and purchasing office consumables

including questionnaire production. Data collection instruments will be developed in accordance with

international standards, such as the World Health Organization (WHO) approved Core Verbal Autopsy

Procedures. Field staff will visit all communities in the catchment area on a quarterly basis to count births,

deaths, and in and out migrations of residents. They will complete verbal autopsy interviews for all

deaths, which will be used to create cause of death indicators. Assignment of a unique identifier to every

resident will allow measurement of health care utilization.

Development of the HDSS will allow routine mortality surveillance, including estimation of cause-specific

mortality rates. Specific clinical trials or other research projects will be funded separately and must seek

appropriate ethical reviews prior to initiation.

Through participation in the HDSS, Mozambican professionals will have the opportunity to learn

demographic and epidemiology skills necessary for implementing monitoring and evaluation, and disease

surveillance systems. Further, the HDSS in Chokwé will not only provide a solid basis for the

implementation of the centers research agenda but will also result in an impact in the health status of the

population of the district.