2006年-世界发展银行全球_Capacity_Assessment_of_the_Ministry_of_Health_of_the_Republic_of_Angola_34页_435kb

Capacity Assessment of the Ministry of Health of the Republic of Angola (June 2006)

Core Content

This document presents a comprehensive capacity assessment of the Ministry of Health (MOH) of Angola, conducted in March 2006 by João Carlos Blasques de Oliveira M.D. The assessment focuses on the strengths, weaknesses, and opportunities of the health sector, with an emphasis on the MOH's ability to implement health policies, manage resources, and coordinate with international partners and local stakeholders.

Main Points

1. Strengths and Weaknesses of the Health Sector

2. Key Health Indicators (2003)

3. Health Status and Vital Statistics

• The health status of Angola is among the worst in the world.
• Maternal mortality ratio (MMR) increased from 600 in 1992 to 1,700 in 2003.
• Under-five mortality rate is 250 per 1,000 live births, and infant mortality rate is 150 per 1,000 live births.
• Main causes of death among children: malaria, diarrhea, respiratory infections, anemia, measles, and malnutrition.
• Contraceptive use is low (6%), with only 4.5% using modern methods.
• High fertility rates (7.0) and early sexual activity among girls (13–15 years) contribute to poor reproductive health outcomes.

4. Epidemiological Situation

• Angola faces a high burden of infectious and parasitic diseases, including malaria, tuberculosis (TB), and HIV/AIDS.
• Malaria is the leading cause of outpatient visits and deaths, with 3–5 episodes per person annually.
• Diarrhea and TB are also significant contributors to mortality and morbidity.
• HIV/AIDS is a growing epidemic, especially in Luanda and Cunene provinces, with prevalence rates above 10% in some areas.
• TB and HIV are closely linked, with 19% of TB cases being HIV-positive.
• Low awareness and high stigma around HIV/AIDS contribute to continued transmission.

5. Analytical Work by Other Partners

• EU-PASS Study (Copayment Scheme):

  • Assessed the efficiency and equity of the health service payment system.
  • Found that the cost recovery rate was only 4.1% of total costs.
  • Identified inefficiencies in procurement and pricing, leading to higher costs.

• USAID Health Sector Assessment:

  • Evaluated the health system to improve the impact of health projects.
  • Helped conceptualize key issues and improve the integration of health system interventions with technical programs.

• Global Fund/UNDP Institutional Diagnosis:

  • Focused on strengthening the MOH's institutional capacity.
  • Recommended improving leadership, participatory management, and administrative processes.

6. Organization of the Health System

• The health system is primarily public, managed by the MOH, and organized in three levels:
  • Primary Level: Health posts, health centers, and municipal hospitals.
  • Secondary Level: Provincial hospitals providing specialized services.
  • Tertiary Level: National specialized hospitals.
• A military health subsystem exists, with a central hospital and regional facilities.
• The private sector includes:
  • Small networks in oil regions.
  • Expanding NGO and church-controlled facilities.
  • For-profit urban services with variable quality.
  • Traditional health systems with unregulated practices.

7. Recommendations

• Integration at Provincial and Municipal Levels: Ensure program integration and establish national coordination mechanisms.
• Strengthen HMIS: Support the development and use of health management information systems for disease surveillance and management.
• Improve Human Resources: Train and develop capacity in health statistics, management, and planning.
• Revise Training Curricula: Enhance the quality of training for nurses and other health professionals.
• Develop New Incentives: Encourage health professionals to work in provinces and municipalities.
• Accelerate Drug Policy Approval: Improve the regulation and forecasting of drug procurement.
• Enhance Forecasting and Procurement Processes: Provide training and technical assistance to the MOH.
• Support Provincial Planning: Strengthen the capacity of provinces to coordinate health infrastructure planning.
• Resume Health Promoter Training: Implement a new framework for training community health promoters.
• Expand Health Infrastructure: Improve access to services in rural and remote areas.

Key Information

• Angola has a young population (50% under 15, 93% under 50), with high fertility rates and low contraceptive prevalence.
• The health system is still weak, with 60% of the population having poor access to care.
• The country has a high incidence of malaria, diarrhea, and TB, with significant challenges in disease surveillance and logistics.
• HIV/AIDS is a growing public health concern, with high prevalence in certain regions and limited awareness.
• The MOH has made progress in decentralization and budget allocation, but lacks the capacity to effectively manage and implement health programs.
• International donors and NGOs have played a significant role in supporting the health sector, particularly in infrastructure and service delivery.

Conclusion

The health sector in Angola faces numerous challenges, including weak institutional capacity, inefficient resource management, and inadequate service delivery in rural areas. Despite progress in decentralization and increased funding, there is a need for stronger coordination, improved training, and better policy implementation to address these issues and improve public health outcomes. The integration of health programs, development of a robust HMIS, and enhanced human resources are critical to achieving these goals.