Table 2.

Alignment of Mozambique’s legal/regulatory framework with WHO retention guidelines

WHO recommendation	Mozambique’s relevant laws/regulations	Alignment (Yes/Partial/ No)
(A: Education; B: Regulatory; C: Financial; D: Personal/Professional Support)
A1. Use targeted admission policies to enroll students with a rural background in education programs for various health disciplines, in order to increase the likelihood of graduates choosing to practice in rural areas	Do not target rural students, although Decree 47/2003  creating Higher Institute of Health Sciences allows it to  add admission criteria not contrary to law	Partial
A2. Locate health professional schools, campuses, and family medicine residency programs outside of capitals and other major cities as graduates of these schools and programs are more likely to work in rural areas	Ministerial Diploma 98/87 created health science institutes  in four capitals and allowed Ministry of Health to create  additional ones according to need Most provinces now  have these institutes	Partial
A3. Expose undergraduate students of various health disciplines to rural community experiences and clinical rotations as these can have a positive influence on attracting and recruiting health workers to rural areas	Ministry of Health regulations (2009 and 2012) support  rural and community participation internships	Partial
A4. Revise undergraduate and postgraduate curricula to include rural health topics so as to enhance the competencies of health professionals working in rural areas, and thereby increase job satisfaction and retention	Ministry of Health regulations (2009 and 2012) support  rural internships as part of health science institutes’  curricula	Partial
A5. Design continuing education and professional development programs that meet the needs of rural health workers and that are accessible from where they live and work	EGFAE and REGFAE require continuing education but  lack explicit attention to rural needs and accessibility.  However, the Ministry of Health approved a Continuing  Education Strategy in 2011 with attention to rural health  workers	No
B1. Introduce and regulate enhanced scopes of practice in rural and remote areas to increase the potential for job satisfaction	SCR in Article 7 notes that workers may be given duties not  explicitly in their broad scopes of practice	Partial
B2. Introduce different types of health workers with appropriate training and regulation for rural practice	SCR established job titles or occupations including ones  often deployed in rural practice, such as clinical officers  (técnicos de medicina), surgical technicians, and lower  and mid-level nurses.	Yes
B3. Ensure compulsory service requirements in rural and remote areas are accompanied with appropriate support and incentives	Ministerial Diploma 56/85 requires all technical-  professional health careers (for example, medicine,  nursing, laboratory) to complete 2 years of compulsory  service, albeit not specified whether rural. Those with  good performance evaluations are then brought into the  public service	Partial
B4. Provide scholarships, bursaries, or other education subsidies with enforceable agreements of return of service in rural or remote areas	Ministerial Diploma 98/87 requires return of service to the  State equivalent in duration to the length of training at a  governmental health sciences institute	Partial
C1. Use a combination of fiscally sustainable financial incentives, such as hardship allowances, grants for housing, free transportation, paid vacations, and so on, sufficient enough to outweigh the opportunity costs associated with working in rural areas, as perceived by health workers	REGFAE lists multiple financial incentives for employees  and contractors including supplements and special  bonuses tied to base pay, hardship/isolation pay, locality  pay, vacation, performance bonus, funeral expenses, and  several others	Yes
D1. Improve living conditions for health workers and their families and invest in infrastructure and services	None found	No
D2. Provide a good and safe working environment	EGFAE states all public servants have a right to workplace  hygiene and security	Yes
D3. Identify and implement appropriate outreach activities to facilitate cooperation between health workers from better served areas and those in underserved areas	None found	No
D4. Develop and support career development programs and provide senior posts in rural areas	EGFAE Article 42 states all public servants have a right to  continuing education, career development, fair  evaluation, and so on	Yes
D5. Support the development of professional networks, rural health professional associations, rural health journals, and so on	None found	No
D6. Adopt public recognition measures	REGFAE contains many public recognition measures  which supervisors can take	Yes