Angola: Providing care where huge gaps remain

MSF's work in Angola has changed dramatically as a result of the modest progress that has been made in various areas.

The population's nutritional situation is also improving. Yet despite these developments, 70 percent of the population remains without basic health care. Angola also has one of the world's highest child mortality rates - one in four children dies before turning five.

MSF's work in Angola has changed dramatically as a result of the modest progress that has been made in various areas. While teams continue to support Angolan health authorities' efforts to provide basic health services, more and more responsibility is being transferred back to local authorities.

Today MSF is focusing on helping those with malaria, sleeping sickness, tuberculosis (TB) and most recently, HIV/AIDS, all diseases that receive little attention. In 2005 MSF also provided emergency assistance when the country was confronted with an outbreak of the deadly Marburg virus (see box).

Treating those with malaria

As in many sub-Saharan countries, malaria is Angola's number one killer disease, with the heaviest toll among children under five. More than half of all primary health care consultations involve malaria. In Kuito, MSF runs a pediatric malaria-treatment center that admits as many as 750 children a month during the annual six-month malaria peak.

In addition, a large number of health posts located in the provinces of Bie, Bengo, Lunda Norte, Malanje, Cuanza Sul, Moxico, Huambo, Cuanda Cubango, Huila and Uige carry out thousands of malaria consultations each month with the support of MSF, which provides drugs, rapid-testing kits and regular supervision and training. In June 2005, in Caala, a city in Huambo province, MSF transferred its support of 13 health posts - along with a six-month supply of medicines and rapid testing kits - to the ministry of health.

Screening for sleeping sickness

Virtually eliminated in the 1960s, sleeping sickness is making a vengeful comeback in Angola and other parts of Africa. Existing treatments for this fatal, parasitic disease are old, toxic and unsuited for resource-poor settings. MSF operated a sleeping sickness project in Caxito, the capital of Bengo province, and in Camabatela, a municipality in Cuanza Norte province. In addition to admitting patients, MSF conducted active screening campaigns to identify and treat new patients, mostly in remote areas. MSF screened more than 8,000 people and treated a total of 163 patients in 2004.

In the first half of 2005, the team screened 3,000 people and treated 23 for the disease. In mid-2005, due to lower-than-expected incidence, MSF handed over activities to the ministry of health and other collaborating partners.

TB and HIV/AIDS increases

TB is a major public health problem in Angola. According to national agencies, the number of reported TB cases increased almost threefold, from approximately 11,500 to more than 31,000, from 1999 to 2002. MSF cares for TB patients in Bie, Lunda Norte, Cuanza Sul, Moxico, Malanje and Huila provinces with more than 1,300 people under treatment.

Angola is at a critical point in its fight against the HIV/AIDS epidemic. While UNAIDS estimated adult prevalence at 3.9 percent at the end of 2003, there is evidence of a growing number of HIV-positive pregnant women and the prevalence could rapidly increase once transportation routes reopen. MSF is now integrating HIV/AIDS care within its TB projects in Malanje, Bie and Huila provinces because of increasing numbers of patients with both illnesses.

Caring for the most vulnerable

Today MSF conducts a variety of primary health care activities - supporting health facilities and operating mobile clinics - in Malanje, Bie, Moxico, Cuanza Norte, Cuanza Sul, Lunda Norte, Huila and Uige provinces. The main illnesses treated continue to be malaria, respiratory tract infections and diarrhea. In April 2005, MSF's primary health care activities in Cuando Cubango and Zaire provinces were handed over to the ministry of health after 5 and 10 years, respectively.

MSF has supported hospitals in the towns of Mavinga and Menongue, Cuando Cubango province; Camacupa, Bie province; and Luau, Moxico province. During 2005, MSF handed over responsibility for these projects to local authorities.

MSF provides water and sanitation facilities in Moxico, Bie and Cuando Cubango provinces. Teams in Luau, Moxico province provided assistance to refugees from the Democratic Republic of the Congo and Zambia by carrying out screenings and consultations, health education and water and sanitation services until September 2005, when these activities were transferred to government authorities.

MSF has worked in Angola since 1983.