Angola

Angola: Municipal development assessment - health priorities

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A municipal health needs assessment was conducted by a Boston University Doctor of Public Health student to fulfill an academic practicum requirement. Data were collected in Luanda and the municipality of Cuango, Angola during the period of September 20 through October 20, 2007. The following is an abbreviated version of the results of the assessment. Please send inquires for references and other information to janeskijs@hotmail.com.

Considering its year-round malaria transmission, the proximity of hemorrhagic disease outbreaks, including Ebola and Marburg, a lack of HIV/AIDS services and an HIV prevalence higher than 10% amongst people seeking voluntary counseling and testing (VCT), the municipality of Cuango may be considered an infectious disease 'hot spot' in both Angola and the region. The consequences of a weak health infrastructure on the health status of the local population are compounded by a lack of economic opportunity, the chronic immigration and deportation of foreign nationals (most originating in the Democratic Republic of Congo - DRC) seeking opportunity from the diamond trade, and restrictions on trade and movement. The eventual closure of private sector social welfare programs and possible conflict over diamond mining turf between locals and foreign nationals upon the departure of mining companies could lead to further disintegration of the condition of the local population.

The Cuango population lacks basic services required of a population to maintain minimum health standards. No adequate improved water supply and electricity are available in the municipality. Refuse lines the streets leading up to the entrance of the municipal administration building. Provincial level data reveals that diseases related to water and poor hygiene to be the second most frequent cause of illness after malaria. Although malaria is transmitted year-round and accounts for 93% percent of reported deaths, very little appears to have been done to protect the population beyond the distribution of mosquito nets. Apart from mining company HIV/AIDS services within company clinics, available to a select few, no HIV/AIDS services have been provided to the population. At the time of the assessment, no public HIV/AIDS counseling and testing had ever been implemented in the municipality. According to the Cafunfo hospital, the municipal HIV/AIDS program will not be operational until an HIV/AIDS medical director is hired. Although under-equipped and understaffed, the Cafunfo hospital is functioning not only as the municipal hospital but also as a regional health center. A lack of health services in neighboring municipalities attracts people to the hospital on a regular basis.

As recently as September 2007, an outbreak of Ebola was reported 21 kilometers north of Lunda Norte. Experts predict another Marburg outbreak in Angola following the devastating outbreak in Uíge and others in the region. The regular movement of foreign nationals to and from the DRC combined with poor living conditions and a weak health infrastructure could lead to a hemorrhagic outbreak. Regardless of these risk factors, the municipality has no emergency plan or containment facilities prepared to address the threat of a hemorrhagic disease outbreak.

The special health risks of the municipality of Cuango warrant the unique attention of the Government of Angola (GoA) and the international community similar to that which has been given to other areas of the country. The province of Cunene, for example, received a great deal of attention from the GoA and investment from the international community when the 2004 ANC prevalence study revealed an HIV prevalence in Cunene greater than three times that of the capital Luanda. The Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and Doctors without Borders (MSF), and other international organizations rushed to the province of Uíge in 2005 to combat the largest outbreak of Marburg disease ever recorded. Similarly, the GoA and partners strengthened Angola's efforts to combat polio when a 1999 outbreak in Luanda involving over 1000 reported cases threatened to spread the disease regionally.

In the absence of effective efforts to address the health needs of Cuango, the poor health status of the population of Cuango could continue to decline and serve as an embarrassment to the Government of Angola and the companies that have been mining Cuango, especially when services provided by mining operations will seize upon the departure of diamond mining companies. If is not already, Cuango could serve as a distribution center for the spread of HIV/AIDS, cholera, and other infectious diseases regionally and could someday provide another hemorrhagic disease outbreak experiment within the borders of Angola.