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. Despite its size and wealth of natural resources and minerals, it has some of the highest levels of under five mortality and poverty in sub Saharan Africa.
The decrease in global oil prices has been very negative for national revenue which remains heavily dependent on the export. This impacted all national budgets leaving the underfunded Ministry of Health (MoH) 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 suffering and death in Angola. In 2012, the work was extended to tackle the huge burden of neglected tropical diseases (NTDs) through integrated WASHE NTD programme.
Neglected Tropical Diseases (NTDs)
Every year, millions suffer from devastating, yet preventable, NTDs such as soil-transmitted helminthiases, schistosomiasis, lymphatic filariasis and onchocerciasis. These diseases are often associated with the inadequate water supplies, sanitation and hygiene 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 now supports the implementation of school and community based mass drug administration in six Angolan provinces: Huambo, Uige, Zaire, Bie, Kuando Kubando and Kwanza Sul. In addition during 2019 MENTOR will support capacity building in three further Provinces of Bengo, Benguela and Kwanza Norte to enable further scale up of MDA good practice.
Basic sanitation and access to clean water are necessities, yet the results of surveys performed amongst students between April and June 2015 clearly show that these necessities 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 with support from The END Fund. 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 has developed initially providing WASH equipment and training teachers in techniques to improve school based hygiene and hand-washing in 2034 schools across the three provinces. The teachers’ enthusiasm for the training programme has been very motivating for the trainers and MENTOR, and a more focused approach supports over 500 schools working intensively with Ministry of Education structures and framework to ensure sustainability.
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 and currently ongoing efforts to map remaining Provinces for Schistosomiasis and STH.
In 2016, MENTOR started delivering community based mass drug administrations (MDAs) to prevent and treat onchocerciasis and lymphatic filariasis in disease prevalent Municipalities in Uige, and Kuando Kubango and supporting Bie where high levels of onchocerciasis including cases causing blindness were detected during mapping.
During 2018 MENTOR distributed 4.4 million treatments for the four NTDs across the six Provinces. This brings the total treatments delivered with MENTOR’s support in Angola to almost 13 million since 2012.
The entire Angolan population is at risk for malaria. According to estimates published in the 2017 WHO World Malaria Report, Angola saw at least 3.5 million malaria cases and 12,000 malaria-related deaths in 2016. Malaria in Angola accounts for 35% of mortality in children, 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, where in the north transmission extends throughout the year.
Under the USAID funded Health For All Programme 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 and support of the ADECO programme (community development workers) in Malaria detection and treatment delivering training programmes to selected Municipalities in Zaire.
In Southern Angola MENTOR has been directly delivering projects across the southern border with Namibia and Zambia focusing on Kuando Kubango to support Elimination 8’s efforts (Global Fund and other donors) to support countries reach their Malaria elimination targets. In partnership with ADPP and Angolan based NGO, MENTOR has been providing malaria expertise as well as direct test and treatment of suspected cases of malaria. During 2018 MENTOR nurses tested over 80,000 people treating 25,000 positive cases in Kuando Kubango.
MENTOR has delivered Indoor Residual Spray Campaign in houses along the Southern Border to prevent the spread of Malaria during the 2019 season. Over 20,000 households have been reached in the challenging terrain of the area. MENTOR are also delivering an entomology study across this area providing much needed research to better understand the mosquito behaviour in the area and enable the selection of the most effective tools to target and prevent future epidemics in this area.
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 implementation of recommended strategies in 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 15/02/2019