Mozambique has one of the lowest provider to patient ratios in the world with 3 physicians and 21 nurses per 100,000 population (WHO 2007). The lack of human resources is also felt in other sectors of the health care system in areas such as laboratory, M&E, management, and pharmacy. In Mozambique, higher education can take the form of universities, superior training institutions and pre-service training institutions. The MOH oversees the work of 13 pre-service institutions that produce clinical officers, nurses, laboratorians, auxiliary health care workers, and pharmacists. In addition, the MOH oversees superior institutions where the goal is to prepare graduates for work in line with that of university graduates. The Ministry of Education oversees 4 medical schools (3 government and 1 private). One of these medical schools has been in operation since the mid-70s and the other two began in the last 2

years. The private medical school began educating students in 2000. In the past few years, there has been a small but growing number of private superior education institutions. The superior institutions provide much needed education in areas such as public health, nurses, surgical technicians, hospital administrators, dentistry, pharmacy, and laboratory. Regardless of whether the university-based medical programs or superior institutions are public or private, most are in need of additional resources in order to accomplish their mission. Resources needed include: scholarships for students; faculty preparation; additional faculty; curricula re-design or updating; equipment and books; student fees for transportation and accommodation to their practicum site; and salary support for field supervisors. The focus of this new implementing mechanism would be on developing sustainable locally maintained health services and strengthening of the higher education institutions, whether private or government. Strengthening of these institutions will be done through revision of curricula, as needed; faculty development (technical and increased teaching skills capacity); purchase of teaching and reference materials, clinical equipment for practicums and minor renovations; salaries for part time classroom and field supervisors; student transportation and accommodation to practicum sites; provision of scholarships; and improving the teaching skills of classroom and field faculty. Other donor support is provided primarily via technical assistance and some scholarship support.

The mechanism is linked to Goal 3 of the Partnership Framework: strengthen the Mozambican health system, including human resources for health and social welfare in key areas to support HIV prevention, care and treatment goals. The benchmarks would be number of new health workers graduating by cadre, number of inhabitants per doctor and clinical technician and number of new social worker graduates.

The cross cutting program is human resources for health given the emphasis on the development of new health professionals. The geographic coverage is national and target populations are faculty and students at university based medical schools and superior learning institutions.

This activity is cost-efficient because it will fund local medical schools and superior institutions directly rather than through an international partner. The aim is that as the local institutions gain experience managing funds and programs, the USG direct funding to them can increase compared to that provided through international partners.

This new implementing mechanism has a list of measurable outcomes for both medical schools and superior training institutions and will be described in the budget code narrative for the first year of the cooperative agreement once awarded.

There is a huge lack of health workers at the superior and medium level across cadres and supporting

medical schools and superior training institutions helps to address this lack. This cooperative agreement

offers two tracks for funding: university-based medical programs and superior education institutions.

Although all the medical schools have changed their name to Faculty of Health Sciences therefore

including physicians, nurses, laboratory technicians, nutritionists and dentistry, the emphasis will be on

medical student education. The second track, superior training institutions, is open to courses that

support the health sector such as nursing, laboratory, pharmacy, nutrition, dentistry and hospital

administration. The activities under this budget code include strengthening of their faculty's capacity to

teach, hiring additional faculty in order to offer more courses, developing new curricula, purchasing

additional or new equipment and didactic materials, and providing resources to support local

transportation for clinical rotations of students. There are linkages across human resources for health and

service delivery as development of more health workers who are current in their knowledge and skills is

beneficial to the country. These are leveraged activities as there are other donors such as WHO, Tropical

Medicine Institute at Antwerp, UCLA, and University of West Virginia who are supporting specific

activities at the medical schools in Mozambique. There is limited donor support for the superior training

institutions primarily focused on surgical technicians.