The Informal Health Economy: A Working Paper on Non-State Maternal Care in Urban Mozambique

In urban Mozambique, a substantial portion of maternal healthcare is delivered by a complex informal health economy operating outside the formal state system. This sector includes unlicensed providers, traditional birth attendants, and informal medicine sellers, and functions with minimal regulatory oversight. This working paper aims to map and characterise the non-state maternal care sector in two major Mozambican cities. Its objectives are to describe the provider landscape, their practices, the reasons for their utilisation, and to analyse the implications for maternal health policy and outcomes. The paper synthesises findings from a qualitative, ethnographic study. Data were collected via semi-structured interviews and observational fieldwork with informal healthcare providers and their clients, and analysed using a thematic framework approach. Preliminary analysis identifies accessibility and affordability as primary drivers of client choice, with informal providers frequently serving as the first point of contact. A notable proportion of consultations for antenatal concerns and minor ailments were reported to occur within this informal sector. The informal health economy is an entrenched and integral component of the urban maternal healthcare landscape in Mozambique. It fills gaps left by the formal system but presents significant challenges related to quality of care and regulation. Policy should shift from marginalisation towards structured engagement. Recommended actions include exploring mechanisms for basic training, supervision, and the creation of formal referral pathways between informal providers and the state health system to improve care coherence. informal health sector, maternal health, urban Africa, Mozambique, non-state providers, healthcare access This working paper provides a detailed conceptual mapping of the informal maternal care economy in urban Mozambique, establishing a foundation for future empirical research and pragmatic policy dialogue on integrating non-state actors into national health strategies.