By the end of the civil war in 2002, one million Angolans died, 4.5 million were internally displaced, and another 450,000 fled the country. The decimation of infrastructure and public services during the war created serious development challenges, particularly poor public health.
Today, Angola continues to struggle to improve child and maternal mortality rates which are among the highest in the world: almost 1 in 5 children dies before the fifth birthday, and the maternal mortality rate is 610 deaths per 100,000 live births. A high fertility rate of 5.8 births per woman places pressure on an already struggling health system to keep up with the growing population’s needs. Malaria is widespread and the number one killer in the country. HIV/AIDS rates are relatively low, presenting an opportunity to avert the devastating consequences of widespread disease seen in other southern African countries.
Angola’s National Health Development Plan (Plano Nacional de Desenvolvimento de Saúde) 2012-2025, sets strategic goals and priorities for the health sector for the short, medium and long term. High level health objectives to be achieved by 2025 include: reducing malaria morbidity in the general population from 21 to 12 percent, and maintaining or reducing HIV/AIDS prevalence at 2 percent, tripling the number of doctors per 10,000 citizens (from 1 to 3), substantially improving birth attendance by qualified staff (from 49 percent to 70 percent), and exponentially increasing family planning services (from 6 percent to 45 percent).
U.S. assistance targets major improvements in health through sustainable approaches and increased country ownership. We partner with the Government of the Republic of Angola (GRA) and other stakeholders to support the development of an integrated, comprehensive, and sustainable health system and a strong workforce capable of providing quality health services to all Angolans. USAID works directly with authorities to address endemic threats from malaria and HIV/AIDS. Through the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI), USAID supports the Ministry of Health to develop, strengthen, and sustain health systems to reduce the spread of malaria and HIV/AIDS and other communicable diseases. U.S. assistance enhances Angola’s ownership by increasing capacity within the GRA and among community and civil society organizations. In addition to providing integrated prevention, care, and treatment for malaria and HIV/AIDS, USAID strengthens universal access to high-quality voluntary family planning services and reproductive health care. The total health-related funding provided yearly by USAID represents one percent of all health spending in Angola, thus the GRA does not rely on USAID to finance its core health program. However, the Ministry of Health and other sub-national institutions rely heavily on USAID as one of the few bilateral partners providing capacity building and long-term technical assistance toward the implementation of the government’s health and development strategy.
Since 2005, USAID, through the PMI, has reduced malaria-related child death rates in Angola by 42 percent. USAID achieved this success through the provision of bed nets, training of healthcare workers in efficiently using malaria diagnosis and treatment kits, and the distribution of anti-malarial medications. PMI currently supports malaria control activities in Cuanza Norte, Lunda Norte, Lunda Sul, Malanje, Uige, and Zaire provinces. USAID also develops the local capacity of Angola’s National Malaria Control Program through training and technical assistance to achieve the goals set out in the Angola National Malaria Strategic Plan.
As part of the PEPFAR, USAID supports the GRA to meet the World Health Organization (WHO)’s 90-90-90 strategy by 2020: 90 percent of all people living with HIV know their HIV status, 90 percent of all people with diagnosed HIV infection receive sustained antiretroviral therapy, and 90 percent of all people receiving antiretroviral therapy obtain viral suppression through technical assistance at the national, provincial, health facility, and community levels. In 2019, the PEPFAR program in Angola shifted its HIV programming to focus on a family-focused prevention of mother-to-child transmission (PMTCT) in four provinces. The country’s First Lady recently signed the African Union-sponsored Born Free to Shine Initiative and is a vocal advocate for improving HIV care in Angola. Her advocacy increased the National Institute for the Fight against HIV/AIDS’ focus and commitment to PMTCT.
USAID provides targeted technical assistance to ensure the effective quantification, planning, and distribution of key HIV commodities from the national to the sub-national levels. At the subnational level, USAID focuses on inventory management, pharmacy management, and monitoring to limit stock-outs of commodities and ensure effective antiretroviral therapy dispensing as part of Angolan PMTCT program.
Maternal and Child Health
USAID works with the Angolan MoH to achieve better health for mothers and children through polio surveillance. Angola remained polio-free for 8 years (2011-2019), but unfortunately several confirmed vaccine-derived polio cases were diagnosed in recent months in the provinces of Lunda Norte and Huila. The outbreak has since spread to 9 other provinces. In October 2019, USAID provided $2.7 million for operational support for polio campaigns for the outbreak response through WHO/Angola. USAID will also continue to provide technical and financial assistance to the MoH for increased routine immunizations and polio surveillance through WHO/Angola.
Maternal and Child Health Family Planning and Reproductive Health
Angola has one of the world’s highest maternal mortality rates. One in seventy women faces a risk of dying during pregnancy or childbirth. USAID supports the Ministry of Health’s (MOH) primary goal of reducing maternal and child mortality by increasing access to family planning (FP) information, services, and commodities. USAID’s assistance support the development and implementation of MoH international standard FP/RH policies and protocols, expansion of MoH capacity to provide FP service models, and contraceptive availability. USAID also supports the MoH’s efforts to increase demand for FP/RH services through the development and dissemination of messages on healthy timing and spacing of pregnancies. In collaboration with the World Bank, UNICEF and UNFPA, and in coordination with the Angola National Statistics Institute, USAID is supporting the MoH to design and implement its second ever Demographic Health Survey. The Survey will provide updated demographic and health indicators, including fertility, mortality indicators (maternal, child and adolescent), HIV/AIDS prevalence, malaria prevalence, and child anemia and nutrition status. USAID also works closely with UNFPA to support the MoH’s recent commitment to the FP 2020 global initiative, and advocates for increased country financial resources to implement sustainable FP programs that will produce a lasting change.