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Santos Simione


Discussing the impact of the Global Gag Rule in Mozambique

Santos Simione is the executive director of Amodefa, our associated clinic in Mozambique. He discusses the consequences of the global gag rule and what it means for sexual and reproductive healthcare ...

Santos Simione is the executive director of Amodefa, our associated clinic in Mozambique. He discusses the consequences of the global gag rule and what it means for sexual and reproductive healthcare in the community.

What is the the financial impact on Amodefa of the US withdrawal of funds?

Santos: The impact of the US withdrawal of funds, will be $2 million – 60% of our budget.

How will this impact the people involved in US funded projects?

Santos: People involved in US projects: 130 jobs (staff) will need to be cut – not including  the activistas or peer-educators who are part of those projects. To give an examples, two weeks ago we had to close 9 clinics in Gaza Province, there were 33 staff involved and 600 activistas and peer educators at the community level.

And in terms of the families you help?

Santos: We estimate half million people across their HIB, TB, malaria and family planning projects will be affected. The focus is more on HIV and TB and malaria, because we never used funds from US for any programme related to abortion or prevention care.


Staff and volunteers remain dedicated and determined as the impact of the GGR takes effect

The continuation of many vital health services Amodefa offers in Mozambique are under threat following the reintroduction of the Global Gag Rule by the US Administration. The Global Gag Rule, or Mexico City Policy as it is formally known, stops US aid to all health programmes run by organisations who perform or counsel on abortion.

The decision, which will deprive Amodefa of $2 million, 60% of its budget, will have devastating consequences for the fight against HIV in Mozambique, where an estimated 12% of the country’s nearly 30 million population are living with the virus.

Photography © IPPF/Grant Lee Neuenburg
Talking about the impact of the Global Gag Rule, Executive Director of Amodefa, the Mozambican Association for Family Development, Santos Simione says, “We estimate half million people across our HIV, tuberculosis, malaria and family planning projects will be affected."
A client being tested for HIV.
 21-year old Jenny Marcelino* and her three-year old son wait for free counselling, tests and treatment at the Amodefa clinic in Maputo.
Palmira Enoque Tembe, 54, is HIV positive. She lives on the outskirts of Maputo with her two sons (also HIV positive) and four grandchildren. Amodefa volunteers visit three times a week and a nurse once a week who provide medication, food and therapy to the family.
Albertina Machaieie has been working with HIV patients for Amodefa for 38 years and is their longest serving nurse. Albertina now heads up Amodefa’s home care programme which provides medical, nutritional and emotional support to HIV positive patients living in the poorest suburbs of Maputo. longest serving nurse. “I’m going to work forever,” she says. “I like helping people, that’s why I do this job.”
Palmira Enoque Tembe with Albertina Machaieie. “Amodefa counsels me through the difficulties in life,” Palmira says. “They help counsel me though my problems, my thoughts and worries. Sometimes I don’t know what to do when things get out of control, but Amodefa helps me through.”
12 year old orphan Antonio Junior Xirindza* who is HIV positive, was almost given up as as lost cause. He has gained a new lease on life following Amodefa’s intervention. His health has improved rapidly and he is gaining weight. He is well enough now to attend school regularly and is already thinking about the future; when he grows up he wants to be a fireman. “I am happy about life here,” he says, shyly.
18 year old Yuran Nhaquila* gets a HIV test at the Amodefa clinic in Maputo.
Nurse Julia Suzette Mulambo* administers hormonal contraceptive injection to Eleria Horacio Mabucule.
Aida Carlos Cossa, 17, is a student at the Armando Emilio Guebuza secondary school in Maputo. She has come to Amodefa’s clinic for free counselling at the “Tua Cena” at Armando Emilio Guebuza School in Maputo. “This is better than a hospital – it’s close, it’s private, I feel comfortable,” says Aida Carlos Cossa.
A fresh delivery of bikes for staff and volunteers to use to reach local communities sit piled in a store room. The programmes that use these to deliver services will cease to operate as the funding stops.
Nurse Julia Suzette Mulambo* gives family planning counselling and treatment to 16-year old student Eleria Horacio Mabucule, at the Amodefa clinic in Boane, in southern Mozambique.
At the Armando Emilio Guebuza secondary school in Maputo Amodefa has set up a sexual and reproductive health clinic to provide access to services including contraception. Known locally as the 'Tua Cena' project, the clinic aims to increase access to quality services and information on safe abortion, STIs and HIV, relationships.
Cacilda Antonio Nimaco, is responsible for transporting HIV and TB tests from the local communities to the lab. Amodefa's TB programme is under threat; the programme, which has been running just over a year, identifies and treats patients with tuberculosis, some living more than 80 km from the nearest health centres. “I like the programme because it helps a lot of families,” she says. “There are lots of families who are sick, but can’t reach healthcare – people who can’t leave their homes.”
Cacilda Antonio Nimaco picks up a TB sample in rural Ribaue District, Nampula Province, Mozambique.
A free HIV test is administered in a village that has just registered eight new cases of TB. TB is prevalent in Mozambique with an estimated 12.5% infection rate. Communities will be abandoned just as the success of the treatments, and the effects of educating communities about HIV and TB, is breaking fear and stigma around the diseases.
Amodefa staff work late into the evening in Nampula’s local communities. Maria Teresa de Fátima and her team have been testing for HIV and TB. “If the US cuts this off, it’s going to implode. This is finished, you can’t imagine what will happen. If we could bring Trump here to come and see this, if he could see the work we are doing, maybe he would change his mind.”



HIV and STIs

Why is it so important to Amodefa not to sign the GAG rule?

Santos: It's important to us not  to sign the GAG rule because it is related to human rights, it’s related to human dignity. It’s related to saving the lives of people. That’s why we won’t sign it.

What was your role in helping push for the abortion law in Mozambique?

Santos: Amodefa was part of a civil society coalition on this issue. Form the beginning Amodefa was involved in lobbying the government to help this law, using different stakeholders. 

What will be the impact of the health clinics closing, particularly on young girls and girls in school?

Santos: First impact, especially on young people, is that most likely the number of unplanned pregnancies will increase. Secondly, those that seek abortion  won’t have the information about which facilities to use, they will resort to unsafe abortion methods and as a consequence of that, we expect many people will die. The other angle is that, because organisations likes AMODEFA provide services across a wide spectrum from HIV to tuberculosis to malaria, and so on, they will stop doing this, there will be a big pressure on government facilities, because with our week we are also trying to complement what the government is going, so the pressure on government facilities is going to increase. In some cases we go into very rural areas, 50 km away from the health centre, and bring samples. If we stop this the most vulnerable, the poorest people will be most affected. It will tough on the whole country."

IPPF refuse to sign the Global Gage Rule and will continue to provide sexual and reproductive healthcare that includes abortion and abortion related healthcare.



HIV and STIs