Along Mozambique’s Indian Ocean coast, where Inharrime District meets the sea in Inhambane Province, health care decisions have long meant impossible choices. Families scattered across this coastal region—connected by dusty roads that wind between lagoons and villages—have had to choose between paying for medical tests or putting bread on the table.
But change has a way of rewriting even the most entrenched realities.
Once a district where patients with diabetes and high blood pressure needed to travel hours away for basic care, Inharrime has quietly evolved into a place that can appropriately manage these noncommunicable diseases (NCDs). Inharrime now has its own local health centers, where diagnostic equipment sits ready for use and where trained health workers confidently handle conditions that previously required expensive referrals to distant hospitals.
In May 2025, this rural district became the destination for a delegation comprising representatives from PATH, Sanofi’s Global Health Unit, and the Mozambique Ministry of Health (MISAU). They had come to witness firsthand how an 18-month partnership resulted in diabetes and hypertension care reaching rural communities.
When basic noncommunicable disease care was inaccessible
The delegation’s visit would reveal just how dramatic this shift had been. Before the partnership began, the reality for people with diabetes and hypertension in Inharrime was stark.
Members of the visiting delegation from PATH, Sanofi’s Global Health Unit, and the Mozambique Ministry of Health during their May 2025 field visit. Photo: PATH/Biut Chilaúle
Lili Zavala, a diabetes patient, faced a choice that thousands of others knew well. “We had no choice but to do tests outside the health center,” she told the visiting delegation. “That’s 60 meticais for each test at a private pharmacy”—equivalent to almost one US dollar, and nearly a full day’s earnings for many rural families, money that had to be weighed against every other basic need.
“We had no choice but to do tests outside the health center. That’s 60 meticais for each test at a private pharmacy”— Lili Zavala, Inharamwe District resident
Lili’s words captured a reality faced across rural Mozambique: NCDs don’t just damage health in low-income communities—they destroy livelihoods. The ongoing costs of managing diabetes or hypertension can quickly bankrupt families already living on the edge, creating a deadly cycle where poverty prevents proper care and inadequate care worsens both health and economic outcomes.
The challenge extended beyond individual patients.
Across the district, health workers at the primary health care level had inadequate training to screen for and manage these conditions properly. Basic diagnostic tools—digital blood pressure monitors, glucometers for blood sugar testing, and the test strips needed to operate them—weren’t available at health centers. The inevitable result: Patients with complications regularly presented at the primary health care level and then transferred to the provincial hospital, creating expensive journeys for families and overwhelming higher-level facilities.
The partnership: Three organizations, one vision
Recognizing that sustainable change requires collaborative expertise, the government of Mozambique, through MISAU, partnered with Sanofi’s Global Health Unit through PATH in 2024 to launch the Supporting Noncommunicable Disease Care in Mozambique project—a focused 18-month initiative to strengthen primary health care capacity for NCD management in Inhambane Province.
MISAU maintained leadership and decision-making authority, providing the essential policy framework and institutional commitment to guide the initiative. Sanofi’s Global Health Unit contributed funding and valuable technical expertise from its global diabetes and hypertension management experience. PATH Mozambique served as the implementing partner, bringing its vast technical knowledge and proven experience in health system strengthening and high-quality primary health care service delivery.
Building capacity where it matters most
The partnership’s strategy centered on systematic capacity development rather than quick fixes. Comprehensive training packages, specifically designed for primary health care providers managing hypertension and diabetes in resource-constrained settings, were developed and deployed.
The implementation was methodical, with 32 master trainers being trained at national, provincial, and district levels across all 14 districts of Inhambane Province and intensive support focused on 37 frontline health providers in three high-volume facilities in Inharrime District (the main district health center at Inharrime Sede and two peripheral centers at Chacane and Chongola).
“Now we can test for blood glucose here, collect our medication here, and go home”— Lili Zavala
The project also enabled these facilities to acquire the diagnostic equipment and clinical job aids necessary for effective screening and ongoing patient management at the primary care level while operationalizing MISAU’s “hypertension screening corners” initiative.
What the visiting delegation saw
When the May 2025 delegation arrived in Inharrime, they found a health care landscape that had been fundamentally transformed.
Dr. Olga Hobjana, Inharrime District Chief Medical Officer, who had championed the changes, delivered news that perfectly captured the project’s impact. “I don’t remember the last time I had to transfer a patient with diabetes or hypertension to the provincial hospital due to complications,” she told the visitors. “All patients we are managing in the district are within acceptable parameters.”
The data supported Dr. Hobjana’s assessment. Health workers’ knowledge of diabetes and hypertension screening and management had increased by 32 percent. Two-thirds of trained frontline providers reported feeling fully confident in delivering NCD care. After three rounds of post-training mentoring visits, despite facing multiple system-level constraints on a daily basis, 69 percent achieved desired quality scores for NCD service delivery.
“I don’t remember the last time I had to transfer a patient with diabetes or hypertension to the provincial hospital due to complications”— Dr. Olga Hobjana, Inharrime District Chief Medical Officer
But statistics only tell part of the story. The delegation heard directly from patients whose lives had been changed by improved access to care. Lili Zavala’s testimony was compelling. “Now we can test for blood glucose here, collect our medication here, and go home,” she said. “That’s 60 meticais we save for each test—money we now spend on bread.”
Lili’s words represent a fundamental shift—from health care as a financial burden to health care as an accessible community resource. Across Inharrime, patients are no longer choosing between medical care and necessities.
Health workers at the Inharrime Health Center shared their experiences delivering improved noncommunicable disease care within their own communities. Photo: PATH/Biut Chilaúle
Leading change
Dr. Hobjana exemplifies the local leadership that made transformation possible, coordinating her teams and ensuring systematic implementation of new protocols. The 37 trained frontline health workers—nurses, clinical officers, and community health workers—became the backbone of change, applying new skills with confidence and dedication. And patients like Lili Zavala, willing to share their experiences, provided the human impact testimony that validates the partnership’s approach.
For Pepe Sefike, Access Lead for Africa at Sanofi’s Global Health Unit, the field visit provided direct evidence of what strategic partnerships can achieve. “Congratulations to the team on the excellent work. The impact on patients’ lives is truly remarkable. Your dedication is commendable, and hopefully, the work will continue with the support of institutional and other partners.”
“Congratulations to the team on the excellent work. The impact on patients’ lives is truly remarkable. Your dedication is commendable, and hopefully, the work will continue with the support of institutional and other partners”— Pepe Sefike, Access Lead for Africa at Sanofi’s Global Health Unit
Sanofi’s investment enabled not just immediate improvements but also a sustainable model of care delivery that could be replicated elsewhere. The company witnessed proof that pharmaceutical expertise, combined with local leadership and implementation support, creates lasting change in communities that need it most.
A public-private partnership best practice
The Inharrime District success demonstrates key principles for effective public-private collaboration. Local leadership proved essential—Mozambican health officials maintained decision-making authority while international partners provided targeted support. Comprehensive capacity development, rather than equipment-only interventions, created sustainable change. Focusing on primary health care strengthening addressed fundamental access barriers while building overall system resilience.
Visiting delegation members from PATH, Sanofi’s Global Health Unit, and the Mozambique Ministry of Health at the Inhambane Provincial Health Directorate during their May 2025 field visit. Photo: PATH/Biut Chilaúle
Most importantly, the partnership measured success not simply by activity counts or resource deployment but through patient outcomes and experiences.
As the 18-month project concluded, the evidence of success was overwhelming. The question was how to build this foundation to reach more communities and save more lives.
The model developed in Inhambane Province offers a template for addressing NCD challenges across sub-Saharan Africa and beyond. It demonstrates that high-quality diabetes and hypertension care can be delivered effectively in rural, underresourced settings through strategic partnerships, systematic capacity-building, and sustained commitment to local ownership.
Dr. Hobjana continues her work with enhanced capabilities and confidence.
Lili Zavala manages her diabetes with dignity and reduced financial stress.
