|
 Hours from the nearest town in Cunene province, the clinic has no
first-line tuberculosis drugs, no antiretrovirals for HIV, no
general antibiotics and just three anti-malarial pills.
Okanautoni 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.
João Lourenço, Angola's first new president in 38 years, has vowed
to tackle corruption, attract foreign investment and improve public
services such as healthcare, which the government acknowledges
suffers from a lack of doctors and medication.
Crippled by 27 years of civil war, healthcare improved after the
conflict ended in 2002 as the oil-fueled economy surged and new
hospitals and clinics were built. But experts say the country failed
to develop a robust system for buying and distributing medicines, or
training doctors and nurses.
When the price of oil tumbled in 2014, the economy stalled and the
government slashed spending, exposing cracks in the public health
service and leaving the population at risk.
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
neighboring Democratic Republic of Congo and others of a potentially
devastating epidemic like ebola - a strain of which struck Angola in
2005.
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.
'NEVER ENOUGH'
At the clinic in Okanautoni, 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.
"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 centers 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.
Nearly 1,000 km away 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.
[to top of second column] |
The Ministry of Health did not respond to requests for comment on
the state of the healthcare system. It provided data showing 304,410
cases of malaria had been reported in Angola between Jan. and Feb.
4, with 984 deaths.
After a tour of the northern Zaire province, Health Minister Silvia
Lutucuta, said the lack of drugs was being addressed.
"We can't come here and affirm that we have resolved all the
medication problems, but the basics and essentials for the
functioning of centers is there," local media quoted her saying.
RED TAPE AND DELAYS
However, senior medical professionals working in the system said the
situation had got worse since Lourenço's new government was
appointed. They described severe delays in decision-making and
project approvals since Lutucuta took charge in October.
They said the response to the malaria outbreak had been hamstrung by
increased red tape, which slowed the distribution of preventative
measures such as mosquito nets.
Most sources spoke on condition of anonymity due to the sensitivity
of the issues.
They described flaws in the way drugs, that are not supplied by
international agencies, are procured and distributed.
Sources said purchases at the local level were not in enough bulk to
secure competitive prices while the central procurement system,
known as CECOMA, lacked the information and budget to keep the
system fully supplied. Drugs also often go missing, they said.
According to one former government source, the Ministry of Health
has estimated that half the drugs it buys do not reach their
intended destination.
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.
Chiulo receives assistance from the Italian charity Medici con
L'Africa (CUAMM), which has worked there since 2000. Laura Villosio,
a wiry indefatigable doctor from northern Italy, said the water and
drugs situation had deteriorated since she first worked in Chiulo a
decade ago.
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, Makonga said.
The lack of drugs means Emilio Txikussa faces a bleak future. Five
years old, he weighs just over 10 kg, his eyes sunken and belly
swollen with severe malnutrition.
He also has HIV and tuberculosis.
For now, the doctor is pleased that he has put on 300 grammes after
three days on therapeutic milk. With a big smile she asks if he is
feeling better. Beaming, she asks again.
"Tell the doctor, yes," his father urges. "Say yes ... say yes."
Emilio only stares.
(Reporting by Stephen Eisenhammer; editing by David Clarke)
[© 2018 Thomson Reuters. All rights
reserved.] Copyright 2018 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
Thompson Reuters is solely responsible for this content. |
