As at March 2005 palliative care in the country was non-existent.

The health repercussions of the AIDS epidemic have been the impetus for introducing care to the chronically ill in Mozambique. The Ministry of Health (MOH) introduced regulations in 2002 to standardise and monitor home based care for people living with HIV/AIDS and other chronic illnesses. Although the MOH does not implement or finance this care, policies have been established to guide practice and to supervise and coordinate implementing partners. Education, patient care and counselling are prioritised in the programme and a palliative care component is included. The home based care policies form part of an integrated approach to a national expansion in health care.²

Family Health International (FHI) defines home and community based care (HCBC) as “the provision of care and support that endeavours to meet the nursing and psychosocial needs of persons with chronic illnesses and their family members in their home environment”.³ While HCBC delivers patient care in the home environment, palliative care is an approach that attends to the needs of patients and families affected by a life threatening illness in a variety of settings including the home, hospice, hospital, clinic and community.

During 2004, there were 47 HBC programs operating in all but one of the provinces in the country, serving 17,790 people. All HBC programmes are run by non- governmental organisations (NGOs) or community based organisations (CBOs).

In a 5 year programme supported by the Global Fund from 2004, HIV/AIDS related programmes are to be scaled up. Palliative care is not mentioned in the agreement although the provision of antiretroviral therapy (ART) forms part of the continuum of care for people living with HIV/AIDS. Salient points include the following:

• The proposal aims to reduce the spread of HIV/AIDS in Mozambique and mitigate the impact of HIV/AIDS among those already infected through the provision of a comprehensive programme of prevention, care and support.

• The proposal builds on existing community, government and non-governmental organisation activities.

• Targeted interventions include community and school based programs, peer education, establishment of youth friendly services, training of health care workers, institutional and technical support to youth associations, community, condom promotion/distribution, support to PLWA and orphans, non-governmental organisation strengthening, increased access to home care based services.

• 50 Voluntary Counselling and Testing (VCT) centres are to be established within 5 years

• 56 day clinics are to be established to treat 56,000 HIV infected patients for opportunistic infections.

• Antiretroviral therapies will be provided in 22 clinics to 20,000 patients.

• Treatment for sexually transmitted infections will be implemented.

• Interventions to prevent mother to child transmission (PMTCT) will include administering 20 000 newborns with nevirapine.⁴