The mental health care system for children and adolescents in Mozambique: a systematic review and health system analysis

BackgroundMozambique faces climate-related disasters, armed conflict, and structural poverty that affect the mental health of its nearly 18 million children and adolescents. Despite recent policy progress, the health system remains under-resourced and lacks a comprehensive assessment of child and adolescent mental health care.MethodsIn this systematic review, we synthesized health indicators, qualitative evidence, and regulatory policy on child and adolescent mental health care in Mozambique. We searched PubMed, Web of Science, CINAHL, PsycInfo, Google Scholar, African Index Medicus, university and journal catalogues, and governmental and international agency repositories from inception to November 2025. Data analysis followed a best-fit framework synthesis using the WHO`s health-system building blocks.ResultsWe included 99 documents (46 academic articles, 14 policy or legislative texts, and 34 governmental or international agency reports). Mozambique operates a community-based, stepped-care health system; however, programmes for child and adolescent mental health remain limited mainly to HIV-related psychosocial support and epilepsy care. Fewer than 5% of all people experiencing mental health conditions receive treatment. Human resources are critically insufficient, with only 0.01 psychiatrists per 100,000 population, and service delivery relies heavily on mid-level Psychiatric Technicians. Although the policy framework is well appraised, implementation is constrained by weak institutional capacity, chronic underfinancing, and strong dependence on donor initiatives. Despite pledging to the 2001 Abuja Health Declaration to allocate 15% of the state budget to healthcare, Mozambique's actual allocations remain below this target and lack a dedicated mental health budget line. Epidemiological data are sparse, and national information systems lack disaggregated indicators for child mental health. Social determinants highlight substantial vulnerability: in 2022, 41.3% of children and adolescents were multidimensionally poor.DiscussionDespite establishing key foundational frameworks for child and adolescent mental health, service development remains in early stages. Implementation is hampered by limited institutional capacity, lack of dedicated funding, and a critical shortage of specialized workforce. This pattern mirrors broader post-colonial sub-Saharan African contexts, where international agencies have historically driven mental health service development and research capacity.