Angola
Tuberculosis (TB) is a major public health problem in Angola. According to the World
Health Organization’s (WHO’s) Global Tuberculosis Control Report 2009, the number of
new sputum smear positive (SS+) cases notified increased almost threefold, from
approximately 7,379 to more than 21,422, between 1999 and 2007. WHO estimated
that there were 48,777 new TB cases in 2007. Between 2002 and 2007, DOTS (the
internationally recommended strategy for TB control) coverage increased from 43 to
63 percent, according to WHO.1 National data show that in 2008 the total new SS+
cases notified was estimated at 22,562, what corresponds to an increase in case
detection of nearly 5 percent from 2007.2 Treatment success rates were between 68
and 74 percent between 2002 and 2005, and national data for 2007 show that the
success rate is still within that range, still below the WHO target of 85 percent.
Angola established the National Program for the Control of Tuberculosis (NPCT) in
1981. However, nearly three decades of civil war have displaced 35 percent of the
population, destroyed 70 percent of the country’s health facilities, and left a substantial
proportion of the population vulnerable to TB. An analysis by the Ministry of Health
(MOH) in 2007 found that the national program was implemented in only 8.6 percent
of health units.3 In addition, TB drugs are in irregular supply, and 40 percent of clinics
have experienced stockouts. Although drugs may be available in Luanda, the country
has yet to develop internal transport and distribution mechanisms.
By the end of 2009, the NPCT aims to strengthen case detection and treatment
capacity in 11 provinces that are home to about 75 percent of the country’s population.
Fewer than 1,000 cases of multidrug-resistant (MDR) TB have been detected in Angola;
however, the actual prevalence is not known. In 2008, a nationwide study was
conducted at the Micobacteriogical Laboratory of the National Institute of Public
Health to provide more accurate information on the situation. Results are not yet
available.4 Also unclear is the actual number of TB patients who are HIV positive.
While the 2008 WHO report provides an estimate of TB-HIV co-infection, national
data on HIV prevalence among TB patients show a range from 2.8 (Cabinda), to 15.6
percent (Benguela Province), and 6 percent in the province of Luanda.
USAID Approach and Key Activities
In fiscal year 2008, USAID provided $400,000 for TB in Angola. USAID collaborates
with the NPCT through the Essential Health Services Program (EHSP). Those partners
work closely with local TB partners, and municipal and provincial TB authorities. The
overall objective of USAID support is to establish a strong foundation for the DOTS
strategy to reduce incidence and morbidity and mortality from TB in 11 provinces of
Angola. To implement this strategy, USAID supports the following activities:1
- Training provincial teams and managers on supervision, monitoring, and
management
- Strengthening TB surveillance
- Improving data management and monitoring of DOTS through the
establishment and modification of information systems
- Training health workers and provincial supervisors in the area of TB-HIV/AIDS
co-infection, including voluntary counseling and testing (CT), and opening CT
services at DOTS centers
- Promoting coordination activities among all partners
- Implementing community-based DOTS activities, training community volunteers on TB prevention, and increasing the
awareness of community leaders and organizations on TB
- Supporting the NPCT to update and improve clinical guidelines and TB-HIV/AIDS co-infection guidelines
- Developing the chapter on TB-HIV/AIDS co-infection for the National TB Manual
USAID Program Achievements
As of the second year of funding, USAID has achieved the following:
- Strengthened the health system through technical assistance (TA) to the MOH and NPCT, specifically in the areas of
laboratory diagnosis and clinical TB treatment, and established USAID as a strong working partner of NPCT
- Certified a total of 30 Master Trainers (MTs) by the Huambo Provincial Health Director on an integrated curricula with TB
- Helped develop the first Scientific Symposium in Huambo, which was attended by 1,030 health professionals
- Supported five TB clinics to incorporate CT into their routine procedures: a total of 56 percent of registered TB
patients tested for HIV, from an initial 10 percent
- Supported an alliance of indigenous faith-based partners to improve TB control and prevention in the community
- Facilitated the training of 246 community health volunteers (trained by MTs) who have further developed a total of 926
education and prevention activities, in which a total of 14,359 people have participated
Case Detection and Treatment Success Rates Under DOTS
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Source: Global Tuberculosis Control WHO Report 2009. These numbers differ from those reported by the Angola Ministry of Health. Data for case detection in 2007 are not shown due to large differences in the value reported by the Ministry of Health and WHO. |
Partnerships
The Global Fund to Fight AIDS, Tuberculosis and Malaria and WHO are the major multilateral partners working with Angola’s
MOH in TB prevention and control. Many nongovernmental organizations, including Collègues Universitaires Aspirants et
Médecins Missionnaires CUAMM (Italy) and the U.S. CDC are also working on TB and TB/HIV activities. Doctors Without
Borders is also involved in supporting TB programs. In 2004, the World Bank approved a five-year, $21 million grant to the
government for a multisector approach that aims to reduce the impact of HIV/AIDS, TB, and malaria. The Global Fund began a
Round 4 grant for $10.9 million in 2005, which will end in 2009, for reducing the burden of TB,
1 WHO 2009 Country profile
2 Informative document on NTB Program: 20th Health Consultative Council, Huambo, March 2009
3 Summary of Strategic Plan of the National TB Control Program, Ministry of Health, Luanda, 2008
4 WHO Anti-TB Drug Resistance report, 2008
August 2009
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