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A mobile rural ambulance in Mozambique. Credit: Mozambique health ministry<\/p>\n
Barbara Fazenda, 49, has done it all over the years \u2013 attending emergency births, treating babies with flu, counselling fearful teenage mothers who are unaware that the sting of the vaccine needle helps so much more than it hurts<\/p>\n
\u201cIt\u2019s a juggling act,\u201d says Fazenda, a midwife based in Gurue, one of the most deprived rural districts of Zambezia, the central Mozambique province. She is employed by the Mozambique Health Ministry and serves assisted by two community health workers at a rural health post \u2013 a makeshift two-room satellite clinic located 49 km from the better-equipped Centro de Sa\u00fade de Guru\u00e9<\/p>\n
Her building has no obstetrics room, no pharmacist, no doctor on call and no standby ambulance \u2013 yet a line of a dozen of vulnerable mothers come in every week looking for help<\/p>\n
\u201cThis is the load on the shoulders of us midwives in rural Gurue. In remote locations, we are the nurse, doctor, vaccinators, therapist for an underfunded primary healthcare system\u201d<\/p>\n
She says the so-called \u201cestrat\u00e9gia de porta \u00fanica<\/a>\u201d, or single-door policy, is a model born out of an necessity, not necessarily design. Mozambique has a dire shortage of trained health workers of all stripes, with just 0.2 physicians<\/a> and 0.94 nurses and midwives<\/a> per 1,000 patients. That density falls well below the World Health Organization\u2019s guideline rates, which estimate 2.5 medical staff per 1,000 as a minimum<\/a> for adequate primary health coverage.<\/p>\n In practice, it means that in many remote rural outposts, just one trained health technician, usually a midwife like Fazenda, does it all. \u201cA few times we even pay out of pocket for a critically ill baby to be sent to the city or Guru\u00e9 Rural Hospital \u2013 and when the baby returns healthier, the mothers thanks us with a live chicken gift. We can\u2019t really take gifts from the poor,\u201d she says. Poverty touches everything she sees, she explains, from educational levels to nutritional deficiencies<\/a> and immune vulnerability.<\/p>\n Fazenda is a deeply religious woman, who says selflessness is her \u201centire identity and calling\u201d. She graduated as a midwife at Beira Central Hospital 15 years ago, and worked in the port city for ten years before she relocated to Gurue, her district of origin. Her goal was to \u201cserve my community\u201d, and to do that, she spurned more lucrative employment with healthcare NGOs<\/p>\n \u201cHowever, apart from being a critical vaccinator and nurse of last resort in my community, the city-based NGOs make me the first port of call to gauge the community\u2019s status each time they visit my village for healthcare surveys,\u201d she says<\/p>\n As peripheral as they often are geographically, Fazenda and her colleagues are also located right at the heart of a global campaign<\/p>\n After years of disruption to immunisation due to the COVID-19 pandemic, conflict and an apparently rolling sequence of extreme weather crises, the \u201cBig Catch-up\u201d is a multi-country push to patch up a dangerously frayed immunisation safety net. Mozambique\u2019s progress<\/a> under the campaign has been encouraging. But Maria Louren\u00e7o , leader of the Mozambican Order of Nurses, suggests the story being told about the country\u2019s successes unduly relegates figures like Fazenda to a supporting role<\/a>.<\/p>\n \u201cThe big global positive headlines about immunisation milestones tend to dwell on cold chain logistics, data, vaccine shipments, big donor commitments. The rural \u2018do-it-all\u2019 health technicians, they are the persons actually doing the immunisation on babies under candlelight in districts where there is no electricity \u2013 after a day of delivering an emergency baby whose due date was not known. They are hardly celebrated, and that\u2019s unfair,\u201d she says.<\/p>\n Una Bishi, 35, is a midwife at Mundonguara Centro De Sa\u00fade Rural II, a deprived rural health outpost in a two-roomed shanty some 1,200 km from Maputo<\/p>\n Her day rarely follows a predictable to-do list. \u201cIt can begin with a long talk with a mum who has never heard of the malaria vaccine. I always tell my clients that I\u2019m basically a midwife \u2013 but they call me everything \u2013 doctor, therapist, vaccinator \u2013 because a lot of the rural mums here have never seen a doctor or therapist in their lifetime,\u201d she says<\/p>\n![\"A](\"https:\/\/lumeamara.online\/wp-content\/uploads\/2026\/08\/A_nurse_mans_a_rural_health_outpost_h2.jpg\")
Peripheral, but critical<\/h3>\n
![\"A](\"https:\/\/www.gavi.org\/sites\/default\/files\/vaccineswork\/2026\/body\/A_mozambique_nurse_h2.jpg\")
\u201cA literal walking hospital\u201d<\/h3>\n
![\"Una](\"https:\/\/www.gavi.org\/sites\/default\/files\/vaccineswork\/2026\/body\/Una_Bishi_h2.jpg\")