Angola’s economic and social infrastructure was devastated by 27 years of civil war. Since 2002, Angola’s health system has faced immense challenges and currently only a small proportion of the population has access to healthcare. Despite its size and wealth of natural resources, it has some of the highest levels of under-five mortality and poverty in sub-Saharan Africa.
The drop in global oil prices in 2014, has been very negative for national revenue which remains heavily dependent on the export. The oil price drop impacted many national budgets leaving the Ministry of Health (MoH) underfunded and reliant on aid and support. Angola remains a challenging context for INGOs to work in. However, in 2002, MENTOR set up a partnership with the MoH and has since been working to address the challenges posed by malaria, the most common cause of death in Angola. In 2012, the work was extended to tackle the huge burden of neglected tropical diseases (NTDs) through an integrated NTD programme which started to integrate WASH activities in 2015.
Neglected Tropical Diseases (NTDs)
Every year, millions suffer from devastating, yet preventable NTDs such as soil-transmitted helminthiases (STH), schistosomiasis (SCH), lymphatic filariasis and onchocerciasis. These diseases are often associated with inadequate water supplies, poor sanitation and hygiene, and are often found in the poorest areas. NTDs lead to increased poverty and even poorer health, hindering socio-economic development on a massive scale. However, many NTDs can be prevented and treated relatively easily through the mass administration of donated drugs.
Building on results from the successful malaria programmes in Angola from 2002 to date, MENTOR in partnership with the End Fund began supporting, the implementation of school and community-based mass drug administration (MDA) to treat (STH) and (SCH) in six Angolan provinces: Huambo, Uige, Zaire, Bie, Kuando Kubando and Kwanza Sul. In 2016, MENTOR started delivering community-based MDAs to prevent and treat onchocerciasis and lymphatic filariasis in disease prevalent municipalities in Uige, and Kuando Kubango, and also supporting Bie where high levels of onchocerciasis, including cases causing blindness were detected during mapping. During 2018, MENTOR supported the distribution of 4.4 million treatments for the four NTDs across the six provinces. This brings the total treatments delivered to over 14 million since 2013. From 2019 MENTOR will also support capacity building in Bengo.
Basic sanitation and access to clean water are essential to halt some NTD transmission cycles. Yet the results from surveys performed amongst students between April and June 2015 clearly show that these basic sanitation improvements are severely lacking:
- 71% had no access to improved water supply.
- 57% defecated in the bush rather than in latrines.
- 83% in Huambo and Uige had no hand-washing facilities at school.
- 93% in Zaire had no hand-washing facilities at school.
School WASHE programmes were successfully set up in Huambo, Zaire and Uige as part of an integrated approach to NTD control since June 2015. The WASHE programme encompasses work on hygiene practices among school children, waste management and equipment for making tippy-taps (basic sanitation installation for hand washing). The programme provides WASH equipment and trains teachers in techniques to improve school-based hygiene and hand-washing in 2,034 schools across the three provinces and also has a more focused approach supporting over 500 schools; working intensively with the Ministry of Education structures and frameworks to ensure sustainability. The teachers’ enthusiasm for the training programme has been very motivating for the trainers and MENTOR.
MENTOR operates as an official partner to the Provincial Health Department in all provinces and has supported WHO-funded disease mapping in 2015 and 2016 as well as current ongoing efforts to map remaining provinces for SCH and STH.
The entire Angolan population is at risk for malaria. According to estimates published in the 2018 WHO World Malaria Report, Angola saw at least 3.8 million malaria cases and 16,000 malaria-related deaths in 2017. Malaria in Angola accounts for 35% of mortality in children and 40% of pre-natal mortality (National Health Development Plan 2013). The four southern provinces bordering Namibia have highly seasonal transmission and are prone to epidemics, while in the north transmission extends throughout the year.
Under the USAID funded Health For All Program, MENTOR has been working with PSI across the northern provinces of Zaire and Uige, providing a strong platform for sustainable outcomes in malaria case management. MENTOR has been training and supporting health workers to diagnose and treat malaria cases more effectively, and improving the ability of laboratories to diagnose malaria. MENTOR is also supporting the training of the ADECOS programme (community development workers) in malaria detection and treatment by delivering training programmes to selected municipalities in Zaire.
In Southern Angola MENTOR has been directly delivering projects along the southern border with Namibia and Zambia focusing on Kuando Kubango and Kunene in partnership with Elimination 8 (Global Fund and other donors) to support southern African countries in reaching their malaria elimination targets. In partnership with ADPP, MENTOR has been providing malaria expertise as well as direct testing and treatment of suspected cases of malaria through specific screening points placed along the border between Angola and Namibia. During 2018, MENTOR supported the testing of over 80,000 people and treatment of 25,000 positive cases in Kuando Kubango.
During 2018 – 2019, MENTOR delivered an indoor residual spray (IRS) campaign in houses along the southern border to prevent the spread of malaria during the 2019 season. IRS involves spraying the interior walls of human and animal shelters with insecticide to ensure 6-9 months of malarial mosquito control as well as other household insects. Over 18,000 households have been reached.
The Way Forward
As the Angolan health infrastructure adapts in order to cope with the effects of economic changes caused by the oil crisis, MENTOR remains at the forefront of control activities for neglected tropical diseases and malaria, implementing strategies that involve stakeholders from local to national level. Fundamentally, MENTOR is working with national level actors to influence policy changes and the implementation of recommended strategies for NTDs, malaria, school hygiene and WASHE.
MENTOR will continue to work to reduce the disease burden of the vulnerable populations in the provinces where it operates, and to seek opportunities and new partnerships to help improve health outcomes for the most excluded populations.
Last updated 04/07/2019