Monday, March 26, 2018

Angola's healthcare emergency

Apart from a few packs of medicine and plastic jars, the shelves at the Okanautoni health centre in southern Angola are bare and lack basic drugs for saving lives. The clinic has no first-line tuberculosis drugs, no antiretrovirals for HIV, no general antibiotics and just three anti-malarial pills.  At the clinic, plastic gloves, syringes, and disinfectant are in short supply. There's no running water and the only electricity is from a generator that runs sporadically. At night, births are guided by the light of a cell phone. If something goes wrong, patients are driven for two hours down bumpy bush tracks to the nearest hospitals in Chiulo or Xangongo – where conditions too can be precarious.
Okanautoni in Angola is remote but the provincial director for health says clinics without drugs are no exception. "The public health system is losing credibility," said Mendes Esteves at his office in the sleepy provincial capital Ondjiva.
"We ask for medicine but they don't send us anything," said nurse Penitencia Goreti, 33, who said she had repeatedly asked for fresh stock from the municipal government. "The situation is getting worse," she said, as a child, blurry-eyed with malaria, lay on the floor nearby.
Provincial health director Esteves said the sick were starting to shun health centres because they didn't expect them to have any medicine. He said he hoped a batch of first-line TB drugs would come in the next few months, but deliveries had failed to show up before. "We will see," he said with a sigh.
In the one-road town of Chiulo, Cunene, basic medication regularly runs out at the hospital. While Reuters visited wards the last tablets of a vital antibiotic were handed out. The hospital struggles without mains electricity and has a generator that cuts out at 11 p.m. Water is pumped from a dry river bed but ageing equipment often fails. In July, the hospital diagnosed cases of multi-drug-resistant tuberculosis but medication to treat it did not arrive until four months later, despite increasingly desperate requests. For such emergencies, the hospital is supposed to have a small budget of its own to buy drugs, but clinical director Ivo Makonga described the money as a "fiction". Payment, which is centrally controlled in Luanda, takes more than eight months to be processed if at all, meaning suppliers increasingly refuse to accept orders,
In the capital Luanda, ranked the most expensive city in the world for expatriate workers and home to a luxury-loving Angolan elite, public hospitals are similarly stretched. At Cacuaco hospital on the capital's outskirts, two doctors see 400 to 700 patients per day. The hospital suffers power outages, there is no functioning X-ray machine and only the most basic medication. Anti-malarial drugs frequently run out. 
"We just have so many cases, it's never enough," one nurse said as hundreds waited in the humid heat under broken fans. 
Poorer residents in Luanda frequently say they have to pay for medication that should be free at public hospitals. The cost means patients often cut their treatment short, increasing the risk of resistant strains developing.
In 2018, the government committed 4 percent of government expenditure to health, down from 4.3 percent in 2017. By comparison, South Africa spent about 14 percent on health in 2015 and Kenya 6 percent, according to WHO data. According to one former government source, the Ministry of Health has estimated that half the drugs it buys do not reach their intended destination.
Diseases that should be disappearing after more than 15 years of peace are spreading. Tuberculosis has been declining worldwide but in Angola the incidence of TB rose 16 percent from 2002 to 2016, according to the World Health Organization (WHO).
Angola suffered the world's worst yellow fever epidemic in a generation in 2016 with about 4,000 suspected cases and 380 deaths, and the country is now in the grip of a malaria outbreak with more than 300,000 cases so far this year.
International health workers say the country is leaving itself open to further outbreaks, with some warning of cholera spreading from neighbouring Democratic Republic of Congo and others of a potentially devastating epidemic like ebola - a strain of which struck Angola in 2005.

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