Assessment of reproductive health for IDPs Angola

Angola is located in southwestern Africa; it borders Namibia, Zambia, Democratic Republic of Congo and Congo-Brazzaville. Angola gained its independence from Portugal in 1975, and has been embroiled in armed conflict ever since, resulting in the dislocation of a large proportion of the population. The U.S. Committee for Refugees estimated that approximately 340,000 Angolans were refugees in neighboring countries at the end of 1999. Many more have become internally displaced within the country's borders. The number of IDPs is now estimated to be between 3.8 and 4 million, or approximately one third the total population of 12.6 million.
Angola has a wealth of natural resources, including oil and diamonds. The United States imports approximately 8% of its oil from Angola - this is more than it imports from Kuwait. Unfortunately, those resources are fueling the war rather than benefiting the Angolan population.

Currently, the two major parties involved in the conflict are the Angolan Government/Movement for the Popular Liberation of Angola (MPLA) Party and the National Union for the Total Independence of Angola (UNITA). Technically the government controls all of the provincial capitals and 80% of the municipalities. UNITA, however, is still very active throughout the country, particularly in areas that are not dominated by the government. In general, the ongoing conflict between the two factions causes constant and often volatile insecurity. This has added to the logistical challenges of humanitarian assistance.

One of the horrific consequences of the war is the huge number of landmines planted throughout Angola. Angola is estimated to have more landmines than any country in the world - every kind imaginable, including those placed above ground that are painted in bright colors to entice children to play with them. The devastating effect of landmines in Angola cannot be stressed strongly enough. It is estimated that one in 400 Angolans has suffered a landmine accident. Landmines blanket the countryside making it impossible in many regions for people to cultivate food or raise livestock. This has created a dependency on the World Food Program (WFP) for food deliveries by air.

The Angolan Ministry for Social Assistance and Reinsertion (MINARS) is the government agency responsible for the IDPs in Angola. MINARS works closely with other government branches, as well as with the UN Office for the Coordination of Humanitarian Affairs (OCHA), other UN agencies and international NGOs. The UN agencies and international NGOs provide financial and technical support to many of the government services. During our visit, many spoke of an increasing donor fatigue in Angola and a real concern about who would fill in the gaps if these agencies leave.

General Health Services/Conditions

UNICEF considers Angola to be "the worst place in the world to be a child," based on the extremely high rates of morbidity and mortality among children under the age of five.

The Angolan government spends less than 2% of its national budget on healthcare, and after years of neglect, the health system is in shambles. The government has committed to increasing its health budget from 2% to 5.5% but the increase has yet to take effect and while a sign of progress, does not come close to meeting the country's actual need for health services. The system includes basic levels of care and services. A health post offers primary care services, a health center has more advanced care, and hospitals are where people are referred for specialized care and surgery. During our visit, healthcare facilities at all levels were inadequately staffed and lacked basic equipment and supplies.

Due to the war, many people have not been able to complete their education, and trained medical health personnel are in short supply. Many doctors have left the country, and others have relocated to the capital Luanda in order to make more money in private practice. As a result, provincial hospitals have a very difficult time hiring and retaining doctors. In one hospital we visited, an Angolan doctor had just been hired, but before his arrival, there had been no doctor in the entire province. In another hospital, the only doctors were expatriate doctors employed by an NGO. There are also shortages of trained midwives and other health personnel. During our visit, many NGOs cited the lack of trained and qualified health staff as a barrier to implementation of quality services.

The shortage of medical equipment and supplies is also a severe problem. Health care workers at every healthcare facility we visited complained of drug stock-outs and lack of equipment. The facilities that had any medicines or equipment were being sponsored or supported by NGOs and were not relying on the government health system for procurement.

In theory, health care should be accessible and affordable for all Angolans, but the reality is quite different. Because government staff are so underpaid, many government health workers do not come to work or try to charge fees for their services. NGOs are only able to work in stable and secure areas, so there are large parts of the country where people are dependent on the government or UNITA for services that may or may not be available. Almost all health facilities in the four provincial capitals that we visited are supported or run exclusively by international NGOs. A major concern of the NGOs and some of the health providers is what will happen if these NGOs pull out of Angola.

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