MISAU, COLLAPSE OF MINISTER USSENE HILÁRIO ISSE: CONTRACT PROGRAM FOR THE DETERIORATION OF HEALTH AND MEDICINE CODIFICATION

Paulo Vilanculo"

Mozambique's new Minister of Health enters the governmental spotlight in a bleak context, facing headwinds within a deeply fragile system. While political speeches promise structural reforms and advances in the "quality of healthcare," the reality in the corridors of the country's hospitals reveals a disturbing truth: cyclical strikes, exhausted professionals, lack of medicines, absence of basic supplies, piled-up hospital waste, and a continuously eroding professional morale. The recent proposal for "drug coding," presented as an attempt to improve stock management and drug distribution, raises questions. Is this just another technocratic smokescreen to hide the system's desperation? Or a palliative measure that ignores the deep roots of the health crisis afflicting Mozambicans? How does the Minister feel when a simple rural health unit lacks even the most basic instruments to stop bleeding?

In recent years, the Ministry of Health has become a minefield of tensions between professionals and the government. Successive strikes by doctors, nurses, and diagnostic technicians, not out of whim but due to exhaustion, have been a constant. These professionals, considered "front-line soldiers," work in undignified conditions, where vocation is no longer enough, amidst inadequate salaries, non-existent subsidies, frozen career paths, and a complete lack of recognition that has fueled silent revolt in wards and consultation rooms. Now, the appointment of the new minister was seen by some as an attempt to revitalize a sector in a state of coma. The precariousness of basic health services exposes the vulnerability of a system that should protect lives, but which, on the ground, struggles to ensure even the minimum conditions of dignity for patients. According to television reports, the Morrumbala District Hospital has been facing a food supply crisis for inpatients for months, forcing those dependent on care to rely on the solidarity of others or to leave the hospital to seek food outside the facilities. The situation reaches dramatic proportions in district and rural hospitals, where the lack of resources is even more glaring.

In many units, women in labor continue to give birth on the floor, without anesthesia or dignified assistance. Obsolete X-ray equipment, health centers without potable water or electricity, and ambulances that function only through "goodwill" are a portrait of a country that insists on postponing its commitment to public health. As an example, the Beira Central Hospital announced on January 13, 2026, that all Gynecology and Obstetrics services would cease operating at that hospital. The Beira Central Hospital (HCB) announced the suspension of all Gynecology and Obstetrics services at that health unit, as part of an ongoing internal reorganization process. Information dated February 9, 2026, from the District Health, Women and Social Action Service (SDSMAS), reports that the operating block of the Manhiça district hospital is closed due to a shortage of hygiene and cleaning materials, rendering the operating block of the Manhiça District Hospital in Maputo province inoperable. The SDSMAS has made an urgent request for support to restore minimum operating conditions. The document reveals that the lack of release of financial quotas in the e-Sistafe system prevents the acquisition of essential products, also affecting the Xinavane Rural Hospital. Without clean linens for the operating block, patients have been transferred to Maputo Central Hospital.

"How is it possible that a simple rural health unit lacks basic instruments to stop a hemorrhage?"(sociologist Pedrito Cambrão)

This question doesn't concern the individual level of the Minister of Health because it's not merely a matter of feeling; it concerns institutional awareness and seeks accountability. The Minister may feel embarrassed, and that's human. But feeling indignant would be legitimate. What is expected of a head of the Health Ministry is not just feeling, but action. In a country where the majority of the population depends exclusively on the public health system, the absence of minimum resources to save a life is not an administrative detail, but a cruel exposure of structural fragility. Because governing, especially in the area of ​​health, means acknowledging that every material failure can cost a life. When a health post lacks sterile compresses, gloves, serums, or even simple suture material, the problem ceases to be technical and becomes moral and political. In a rural center, the lack of the minimum to control a hemorrhage means that what is at stake is not just the efficiency of management, but the State's real commitment to the fundamental right to life. The general perception is that, once again, the solution sought is superficial.

It's not enough to reorganize codes and digitize medications. A national emergency plan is needed to restore the dignity of public health. A plan that prioritizes human beings, both those who care and those who need care. The minister may cite budgetary constraints, delays in the release of funds, or logistical difficulties. But, faced with a life at risk, bureaucratic justifications sound like deafening silence. Before codes and digital platforms, it is necessary to ensure water, oxygen, serum, in short, human dignity in hospitals. If the system cannot guarantee the basics, any technological or administrative reform loses relevance and becomes mere rhetoric in the face of real blood spilled where care should be. The Mozambican people deserve clean hospitals, accessible medications, valued professionals, and a State that understands that health is not a favor, it is a right. Medication coding may be a useful tool, but it will never replace the political will to confront structural problems with courage, transparency, and social commitment.

"Are we under a kleptocratic regime, a power structure controlled by cartels of thieves?"(sociologist Pedrito Cambrão)

It is legitimate to question whether there are organized networks of genuine informal cartels that exploit the weaknesses of the system. But asserting the existence of kleptocratic management requires proof. This paradox does not arise by chance. This unease cannot be ignored due to the concrete fact that revolts public opinion, which points to profound flaws in the system of control, storage, and distribution of the pharmaceutical supply chain. Popular indignation does not stem from conspiracy theories; it arises from the concrete experience of suffering. When a citizen is informed that there are no antibiotics in the health unit, but finds the same product for sale at speculative prices on the street corner, institutional trust crumbles. And trust, in public health, is as vital as the medication itself. The persistence of this phenomenon reveals a State with serious deficits in control and supervision.

"A responsible state must hold people accountable..."(sociologist Pedrito Cambrão)

The reference to sociologist Cambraio is pertinent. When a medication disappears from a hospital pharmacy and reappears in the informal market, there are only three possible explanations: internal diversion, serious failure of oversight, or administrative collapse. In any case, it is a matter of institutional responsibility, and responsibility implies accountability. A responsible state must hold people accountable. It is not enough to open formal inquiries that end in silent reports. Corruption in healthcare is not just an economic crime; it is social violence. Each diverted box of medication can mean a life lost.

A transparent investigation with clear consequences for those involved in embezzlement or collusion schemes is necessary. The minister's challenge is not only technical, but also ethical and political. Combating the parallel market for medicines requires rigorous audits, effective digital traceability, whistleblower protection, continuous monitoring, and swift punishment. Without this, any reform will be perceived as cosmetic. If there is no exemplary accountability, institutional silence will be interpreted as complicity. Until then, the new head of the Ministry of Health will continue to row against a turbulent sea, where hope drowns every day in waiting rooms, dark corridors, and endless queues for minimally humane treatment.

2025/12/3