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. 
 
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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) 
 
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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