JOHANNESBURG, 7 Jun 2005 (IRIN) - Angola has made "limited progress" in improving the country's health network since the devastating 27-year civil war ended three years ago, according to a new report by the UK Department for International Development (DFID).
Progress in implementing new health sector projects funded by UN agencies and other donors has been affected by poor capacity, noted the report on a case study by researcher Suzanne Fustukian of DFID's Health Systems Resource Centre.
Less than 30 percent of the population has access to adequate healthcare, the study found.
During the war, health services in government-controlled areas were run with the support of Cuban medical staff, but since 2002 the government has slowly been brought into alignment with current global aid instruments and is preparing an interim Poverty Reduction Strategy Paper. However, low budget priority continues to be given to the development of social services, according to Fustukian.
A mid-term review of the Consolidated Appeal Process (CAP) for 2004 noted that underfunding of planning and technical support for the health ministry was undermining the government's ability to tackle the delivery challenges. It also found that general underfunding of NGOs had hampered interventions in municipalities, where government capacity and human resources were still limited.
The Angolan government's accountability was another issue affecting funding. Fustukian noted that "... a stand-off continues to exist, with donors setting a condition of greater transparency regarding revenues and expenditure in the government's own programmes before committing assistance".
Other factors in the government's failure to deliver were identified as: a low-priority commitment to social sector "or even broader development policy", and a lack of political will and policy-making.
A social fund - Fundo de Apoio Social (FAS I) - was initiated in 1994, with support from the World Bank, to improve basic services in the sectors of education, health and water supply. "FAS I was perceived to be critical in strengthening social capital, community-level democracy and knowledge sharing, which had positive spin-offs for the community-level projects," Fustukian pointed out.
However, it was found that FAS I projects had failed to reach the poorest communities: most of them were urban-based, as rural areas were still inaccessible; few women were found to have benefited; coverage had been affected by the insecurity still prevalent in many provinces; the dislocation of families; and reliance of households on short-term coping strategies.
FAS III, launched in 2003, laid more emphasis on community-driven development, which Fustukian considered a "potentially important feature".
"In conflict-affected societies, social capital is often seriously eroded - for example, through continuing forced migration and destruction of kinship and community networks. In order to build community capacity to take on wide-ranging community-based service projects, rebuilding social capital becomes an important feature," she commented.
Donors and international NGOs, on the other hand, have concentrated on specific sectors or geographic areas, with disease-specific, non-integrated approaches. Consequently, services have remained fragmented, according to Fustukian. Poor engagement by the central government and civil society has also contributed to this fragmentation.
The renewed outbreak of war between the Angolan government and the rebel movement, UNITA, at the end of 1998 resulted in the withdrawal of most donor programmes from the country, except for those funding humanitarian assistance in the more secure areas.
"The return to war on both occasions, in 1992 and again in 1998, found the international community unprepared. Most had shifted their programming in Angola from humanitarian assistance to reconstruction and longer-term development programming; as a result, staff experienced in relief were involved in emergencies elsewhere," the study commented.
However, Fustukian said the involvement of NGOs and international donors in community-driven development initiatives, such as FAS, have helped to capacitate local government and civil society "in how to communicate and to collaborate on planning and delivering essential services."
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