Africa, Development & Aid, Headlines, Health, Poverty & SDGs

Ramping up Malaria Prevention in Angola

Louise Redvers

LUANDA, Apr 30 2010 (IPS) - Crouched on an upturned plastic box, Eva Angelino bounces 11-month old Odelina on her knee, trying to stop her crying. Mother and daughter are waiting in line outside a public health centre not far from the city centre of Angola’s capital Luanda.

“You have to be very patient here,” sighed 24-year-old Eva. “I was here yesterday from 8 am to after 2 pm waiting to get a malaria test for us both and then they told us we would have to come back again today.

“They only have one microscope to do the tests so that’s why it takes so long.”

If Odelina’s test is positive, it will be the third time she’s had malaria in her short life, her mother explains, resigned to the hold the disease has on Angola and its people.

“What’s important is that you get the medicine in time,” she said, “Then it’s ok, but if you don’t get it quickly, then you have problems.”

There are estimated to be just over three million cases of malaria each year in Angola which has a population of just 17 million.

This is a low level compared to other African countries like Mozambique, where there are an estimated 7.4 million cases a year or the more than 11 million cases annually in Tanzania.

But no-one is really sure of the exact numbers of malaria cases in Angola due to weaknesses in reporting systems.

Waiting across the road from the health centre while his wife and son crammed into the queue inside, Ricardo Barros, told IPS that malaria was just part of everyday life for most people.

“I’ve grown up with malaria, it was part of my childhood. I can’t remember how many times I’ve been infected,” the 30-year-old said. “It’s killing a lot of people and we need to find a way of reducing it.”

Pointing at the heaps of litter nearby, unemployed Barros said: “The government needs to do more to invest in places like this, to improve conditions to get rid of the litter and stop all this dirty water lying around, then I think we will see less malaria.”

Large amounts of money are however already being spent on fighting malaria in Angola.

The Portuguese-speaking country, which emerged from a 27-year civil war in 2002, is one of 15 countries benefiting from the President’s malaria Initiative (PMI), a five-year, $1.2 billion programme led by the U.S. Agency for International Development (USAID) and implemented together with the Centers for Disease Control and Prevention (CDC).

The cash is being spent on training health workers in the correct use of artemisinin-based combination therapy (ACT – often referred to by the brand name Coartem) and in laboratory diagnosis procedures, as well as indoor residual spraying and the free distribution of mosquito nets.

The Global Fund to fight HIV/AIDS, Tuberculosis, and Malaria also allocates large sums to anti-malaria initiatives in Angola, with the money split between the World Health Organisation (WHO), the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP) and U.S. healthcare organisation PSI (Population Services International).

Improving the system Population Service International’s Nana Frimpong said that in the past stockpiles of artemisinin-based combination therapy had been left in warehouses and not given out, another symptom of lacking capacity, he said, which was a further reason for the deep economic burden of a disease like malaria in Angola. “When you have just one person in a company who knows, for example how to do the books at the end of the month, and he or she is off sick with malaria, it creates problems for the firm,” he explained. “And then you have the financial impact on the sufferer themselves if they cannot work and take money to their families, and so the economic burden of malaria in Angola is significant.” The Angolan ministry of health has a policy of dispensing free ACT at public health centres, but these are not always available as Eva Angelino knows to her own personal cost. “Sometimes they have the medicine here and we get it free, but last time they ran out so we had to go to a pharmacy and pay for it,” she said. A prescription can be as much as 2,500 Kwanzas, $25 U.S. “You can pay less if you buy it from the women on the street,” she added, “They only charge around 500 Kwanzas (five dollars) but you don’t know if it is ok to use so I don’t like to take the risk.” Angelino is luckier than most because she lives within a few kilometres of a public health centre. But the public health network serves less than half the population, others turning to expensive private clinics which have sprung up to fill the gap. And in rural areas, there have been cases of public health staff charging patients for ACT medicine instead of giving it out free. UNICEF’s Kone Vanormelingen said: “Sometimes there are capacity issues and perhaps when you have people who have been working for months without receiving salaries, it can lead to problems. “But this is all part of a process of Angola’s health services growing and improving. It will take time.”

Dr Kone Vanormelingen, UNICEF representative in Angola, believes good progress is being made in the country’s fight against the disease, which is financed in partnership with the Angolan government and ministry of health.

He said Angolan malaria statistics were unreliable, especially because as services have improved, so has reporting. But through monitoring “indicators” such as distribution of bed nets and medication, pre-emptive treatment of pregnant women and indoor residual spraying, a positive pattern was emerging.

“International evidence has shown that with 80 percent coverage with mosquito nets and treatment of cases with combination therapy, then morbidity (number of cases) is reduced by 50 percent and mortality by 20 percent,” he explained.

Dr Vanormelingen said that during 2008 and 2009 UNICEF had distributed 2.5 million mosquito nets. This year the organisation has given out 500,000, with 300,000 more to go.

He added that the latest studies showed that close to one fifth of pregnant women and children under five were reported to be using insecticide-treated nets. But while the net distribution scheme has been a major step forward, not everyone with a net is using it, according to Nana Frimpong, PSI’s Angola country director.

He said focus studies had revealed some people didn’t sleep under the nets because they thought it would make them too hot. Others simply didn’t know how to hang them up properly.

“Knowing this,” Frimpong explained, “We now make sure we give net-hanging demonstrations when we distribute the nets because there is no point in people having nets in their homes if they don’t use them.”

But Frimpong feels things are moving in the right direction.

“We were in Cunene last week in the south of Angola and they told us that in one municipality there no-one had died of malaria in the last three months.

“This is a start and a move in the right direction,” he said.

Outside the health centre in Luanda, people continue to wait patiently for their turn.