Jully 2019, Maputo Province, Mozambique, Measles and Rubella Virus Isolation_Serology Laboratory_INS_Mozambique

A research undertaken by the Observatório do Cidadão para Saúde (OCS) in various health units in the Mozambican capital of Maputo found that Covid-19 tests are out of stock.

Owing to that, health personnel choose to test patients who show severe symptoms of the disease, which means that there are people who return home without having the test, even after requesting it.

The only health unit that was still testing last week was the José Macamo General Hospital. Maputo Central Hospital (HCM), the country’s largest hospital, and the Mavalane, Chamanculo Polana Caniço hospitals were managing the last stocks of tests.

“Yesterday, I was at the Maputo Central Hospital because I have symptoms similar to those that are mentioned as those of a person with coronavirus. However, I was advised to come to the José Macamo General Hospital, for lack of tests at the HCM. Today, I came here and they are telling me that it is not necessary to test and I was prescribed flu medication. Now, I don’t know if I have Covid-19 and if I am, I’m spreading the disease”, said Manuel Gudo in a conversation with our team at the HCM.

However, with the increase in the number of Covid-19 cases in the country, and in Maputo in particular, even the José Macamo General Hospital is also beginning to reel from the scarcity of Covid-19 tests.

Other users confirmed that it is not enough to have Covid-19 symptoms to be tested, there are other criteria that are not public, which is causing great indignation among citizens who go to health facilities for testing.

Also not tested for Covid-19 was Rosa Cuna, even though she had symptoms associated with the disease. Cuna said she did not understand the testing criteria, because when asked if she had been in contact with someone with Covid-19, she replied that she did not know, which resulted in the test not being done.

“Every day we hear on television that anyone who develops coronavirus symptoms should head to the nearest health facility to take the test and, as such, I came here to Chamanculo Hospital and they tell me that there is no need for testing. Exactly, what’s going on? ” she questioned.

A different scenario in the private sector

The same does not seem to be happening in the private sector, where despite long queues, tests have been carried out. However, prices are steep to the majority of the disadvantaged population. In response to the business opportunities created by the pandemic, almost all health units in the private sector have the conditions created to carry out tests, and most of the patients undergoing testing are sent by companies in case of suspected Covid-19.

In these private sector health units, the cost of testing varies between 1,000 (about $13.29 at today’s exchange rate) to 5,000 meticais, which is not easy for a large part of the population, who live on less than a dollar a day and depend on daily sales to support themselves. As such, tests in the public sector, which are “free”, are the alternative for this population group.

Information on social networks point to the existence of companies offering home testing services at a cost ranging from 6,500 meticais to 7,500 meticais, an unbearable cost for a majority of Mozambicans.

But if the public sector does not test users only with Covid-19 symptoms, what about those who are declared recovered after 14 days even if they still have symptoms, suggesting the need for a new test to ensure that the patient no longer has Covid-19? These patients are discharged and return to family life without getting confirmation that they are already negative. Now, around the world and in Mozambique, in particular, many asymptomatic patients (such as the footballer Cristiano Ronaldo) tested positive for Covid-19, even after having spent 15 days in treatment.

This situation of automatically sending people into normal coexistence can be dangerous for the public health and for the containment of the pandemic, as many Mozambicans may still be infected and thus be a factor in the spread of the disease.

It is our opinion that the contact tracing and monitoring services for patients in a confinement regime is not doing are not being used effectively in order to prevent citizens who tested positive for Covid-19 from making decisions about their health without proper health monitoring.

There seems to be a contradiction between what health authorities say to the press about the availability of tests in public health facilities and the reality found by citizens who go to health facilities looking for Covid-19 testing services.

Findings

The research showed that in addition to the lack of tests, the inclusion criteria for testing in public health units are not clear, which results in discrimination and encourages corruption.

We also found that patients who tested positive for Covid-19 and are in a confinement regime are not receiving follow-up services from the health sector, which may contribute to the failure of the country’s response to the rapid expansion of community transmission.

The third finding is related to the lack of information about where the testing centres are located and how they are organised, so much so that some health units do not seem organised to deal with the avalanche of citizens with Covid-19 symptoms who seek testing and post-testing check-up services, which in a way contributes to widespread panic and resortig to self-medication which is a danger to citizens.

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