A/HRC/42/43/Add.2 67. Although officials from the National Institute for Social Action visit communities on paydays, there is no opportunity for an effective and immediate complaint and grievance redress, since the human and other resources are focused on the processing of payments. Their offices are located in provincial capitals, which are inaccessible for the vast majority of older persons and there is no comprehensive management information system, making it impossible to record complaints or review them at a higher administrative level.30 F. Care 68. The right to health remains unrealized for many of the most marginalized older women and men. Health insurance is only available to those in formal employment. 69. Health services in Mozambique are provided at the primary level by health posts and health centres. In 2011, the national health system had approximately 1,400 health units distributed across the country; first level or basic health centres account for 1,314 of those units. Less than 60 per cent of the population had access to those basic health services and the average distance to a health unit is about 10 km. 70. The remainder of the population is covered by alternative support networks, such as traditional healers, community health agents, elementary agents and traditional birth attendants, who constitute a central component of the primary health-care system. Traditional healers are often the first recourse for people facing a health emergency. In addition, a very small part of the population is covered by private health care, mainly concentrated in the big cities.31 71. Older persons are entitled to free inpatient admittance in general and central public hospitals as well as free outpatient services. They are also legally exempt from paying for most medication at health centres. That is administered upon presentation of a valid national identification card. It appears that exemption is not always honoured, but that older persons are often asked to pay for services and that medicines, especially adequate medication for conditions faced by older persons such as chronic and non-communicable diseases, are often not available at all or in very limited quantities only at public health services, forcing older persons to obtain medicine from private pharmacies. 32 They may also have recourse to traditional medicines, which are widely used. 72. Older persons, particularly those with limited mobility and little family support, also face significant expenses in order to reach health facilities. The costs of transport are especially high for people in rural communities and those needing a carer to accompany them to a health facility. There is also a noticeable disparity in access to health services between rural and urban areas. Older persons living in rural areas face larger distances, particularly in cases where more specialized health care is required, and have more limited transport options. 73. Most Mozambican households, particularly those in rural areas, are composed of extended families, where two or three generations live together, care for each other and, when needed, pay the health and education costs of household members. Support from family, friends and neighbours may also include material support for the payment of medication. Older persons, particularly women, rely heavily on their daughters-in-law to provide them with support and care. Faith- and community-based organizations have a central supporting role, but coverage is patchy and often ad hoc, as they lack the infrastructure, human resources and secure funding to provide such services.33 30 31 32 33 12 Ibid. See Ministério de Saúde Plano Estratégico do Sector de Saúde (PESS) para 2014–2019 (September 2013), available from www.medbox.org/plano-estrategico-do-sector-da-saude-pess-20142019/preview?q=. HelpAge International, “The right to health in old age: unavailable, inaccessible and unacceptable” (August 2011). Divina de Fátima dos Santos, Flamínia Manzano and Moreira Lodovici “Pessoas idosas em Moçambique: com a palavra de Teresinha da Silva”, Kairós Gerontologia, vol. 14, No. 6 (December 2011).