DRUG SHORTAGES CRIPPLE ANGOLA’S HEALTH SERVICE
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 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. 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. 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 centres 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 decisionmaking 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 11pm. 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.