Securing the Future: Reimagining Tuberculosis Financing and Health System Sustainability in Mozambique

Background: Tuberculosis (TB) remains a major health challenge in Mozambique, which continues to rank among the top 30 high-burden countries for TB, TB/HIV co-infection, and drug-resistant TB (DR-TB). Despite efforts to align with the World Health Organization’s End TB Strategy, Mozambique faces significant obstacles, including chronic underfunding, overreliance on external donors, and persistent systemic inefficiencies. The recent reduction in international donor support, notably from USAID, further jeopardizes progress toward the 2030 targets. Methods: A narrative literature review was conducted, synthesizing peer-reviewed articles, policy documents, and grey literature published between 2000 and 2024. Databases searched included PubMed, Scopus, Web of Science, and Google Scholar, alongside institutional reports from WHO, the Global Fund, and Mozambique’s Ministry of Health. Studies were included if they discussed health financing, TB control, or donor dependency in Mozambique. Results: Mozambique allocates only 6% - 9% of its national budget to health, far below the 15% Abuja Declaration target. Donors fund over half of TB program activities, leaving services vulnerable to external shocks. Inefficient resource allocation, fragmented TB/HIV services, substantial patient out-of-pocket costs, and limited private sector integration further weaken TB control efforts. Nevertheless, opportunities exist: progressive tax reforms, innovative financing mechanisms, digital health solutions, and strengthened social protection could improve sustainability. Strengthened public-private partnerships and phased donor transition plans are critical to ensuring service continuity. Conclusion: Mozambique stands at a pivotal moment. Without urgent reforms in domestic financing, service integration, and system efficiency, the country risks reversing two decades of TB progress. Achieving the End TB Strategy targets by 2030 remains possible but will require bold political commitment, strategic investment, and a decisive shift toward sustainable, country-led health financing.