Angola

Project Dates: May 2012 – December 2016

[click to enlarge]

Background

Angola has a population of 18 million, a fertility rate of 5.8 births per woman, and a maternal mortality ratio of 1,400 per 100,000 live births. With frequent stock-outs of antimalarial and other commodities, there was a need to improve the availability of and access to these lifesaving commodities. Angola’s 2012–2025 health sector development plan aims to promote universal access to health care and ensure equity in care.

Malaria accounted for an estimated 60% of hospital admissions, 35% of overall mortality in children under five, and 25% of maternal mortality in Angola. The prevalence of HIV in Angola in 2010 was estimated at 2% (224,000 people).

An assessment of the Angola supply chain system recommended improvement in warehouse management processes, human resource capacity, updating of operating procedures, and implementation of key performance indicators at the Central Procurement Agency for Medicines and Medical Supplies (CECOMA). The National Directorate for Medicines and Equipment (DNME) faced challenges in building a  database that could be used to determine the  types of medicines to be registered. In line with the Government of Angola’s health goals, USAID/Angola’s objective is to improve health service delivery through systems strengthening and partnerships with local organizations.

The USAID funded SIAPS implemented interventions under the leadership of the Ministry of Health (MOH) and in collaboration with local partners. Interventions focused on enhancing governance, capacity building, information for decision making, and pharmaceutical service delivery.

Selected Activities 

Developing a Pharmaceutical Product Registration Policy: SIAPS supported the DNME to set up a new Medicines Regulatory Unit to regulate and  guide product registration. The DNME has developed and disseminated advocacy and policy briefs to initiate the process fo establishing a National Drug Regulatory Authority (Situation Analysis: Introducing Pharmaceutical Product Registration Policy in Angola).

Workshop with key CECOMA warehouse staff for development of Standard Operating Procedures (SOPs). Photo credit: SIAPS/Angola [click to enlarge]

Enhancing the Capacity of CECOMA: To achieve uninterrupted access to commodities, SIAPS supported CECOMA to improve its warehouse management processes, update its procedures, and improve its human resource capacity. In addition, security for sensitive products in the CECOMA warehouse has been enhanced by enforcing rigorous stock monitoring and storage organization in the controlled areas. SIAPS also provided technical assistance to CECOMA in developing the procurement plan (Plano de Compras da CECOMA) and procurement procedure manual (Manual de procedimentos aquisies – CECOMA).

 

Financing for Pharmaceutical Supply Strengthening: SIAPS supported the MOH to develop its first comprehensive national supply chain strategy for health commodities. The document identifies and prioritizes issues and strategic objectives in the pharmaceutical supply chain system.

Improvement of Pharmaceutical Service Delivery: SIAPS worked closely with the National Reproductive Health Program, CECOMA, United Nations Population Fund (UNFPA), and Pathfinder to conduct regular physical inventories at the national level and prepare forecasting and distribution plans.  SIAPS supported the HIV and AIDS Control Program (INLS) and DPS Luanda in improving pharmaceutical management and dispensing of HIV/AIDS, tuberculosis, and opportunistic infection commodities at nine PEPFAR-focus health facilities in Luanda. This included monitoring stock, preparing emergency orders, and developing an HIV/AIDS pharmaceutical management manual.  By adapting SIAPS training materials, United Nations Development Program (UNDP) collaborated with INLS in rolling out the training to the rest of the country

Twenty provincial technical staff were trained as trainers in pharmaceutical management. They used their facilitation skills and adapted curricula and materials to roll out the trainings to municipal-level staff In addition, 90 municipal technical staff were trained as trainers in pharmaceutical management, and 31 final-year pharmacy students were trained in pharmaceutical management.

Results

Over the past five years, Angola has achieved sustainable improvements in its supply chain management system through capacity building of institutions and individuals across key health systems, and improved the availability and use of selected public health commodities.

General System Improvements

  • Key supply chain and regulatory considerations informed the 2012–2025 National Health Development Plan, national strategic plans, and national annual plans
  • Coordination of pharmaceutical logistics systems has improved, and supply chain managers hold regular meetings for joint planning and information sharing among public health programs

Improved Pharmaceutical Management of Malaria Commodities

  • Malaria Trends in Huambo Province from 2004 to 2014 [click to enlarge]

    Regularly monitored stock using PPMRm, a stock monitoring tool, and frequent EUV visits.
  • Redistributed antimalarial products from provinces that have excess of stock to those that have shortages
  • Established and capacitated the national quantification technical working group for malaria health commodities to improve stakeholder involvement and coordination in forecasting and supply planning
  • Provided technical assistance to the national malaria control program to facilitate receipt and monitor the distribution and monthly stock status of USAID/PMI-funded commodities

Improved Pharmaceutical Management of HIV/AIDS Commodities

  • Established and capacitated the national quantification technical working group for HIV/AIDS commodities to improve stakeholder involvement and coordination in forecasting and supply planning
  • Assisted the INLS to design a stock monitoring tool and inform the country procurement plan for HIV/AIDS commodities
  • Implemented new LMIS forms in six provinces and three national hospitals to improve data quality and completeness to inform key pharmaceutical management decisions
  • Helped improve the availability of HIV/AIDS and related commodities in PEPFAR-focus health facilities in Luanda.

Project Legacy 

The SIAPS pharmaceutical systems strengthening approach aligned with USAID’s global health goals and with USAID/Angola’s goal of ensuring health services delivery. SIAPS has played a key role in helping Angola strengthen the pharmaceutical system through technical assistance for achieving a sustainable supply of locally trained pharmaceutical personnel, better stock monitoring of pharmaceuticals at health facilities, and better management and use of pharmaceutical information for decision making.

However, more needs to be done to improve the quality of service delivery to patients. Additional technical assistance is needed to design strategies for achieving universal access to medicines, and the MOH needs to foster collaboration with local stakeholders to leverage and share resources and synergize pharmaceutical management improvement efforts.  SIAPS has contributed to Angola’s efforts to mitigate the spread of HIV/AIDS and reach the goals of achieving an AIDS-free generation, eliminate malaria, and end preventable maternal and child deaths by ensuring the continuous availability, appropriate management, and rational use of related health commodities.

Left to right: DNME Director Dra. Katiza Mhula Mangueira opened the SIAPS end of project event. Joining her were SIAPS Deputy Director for Country Programs Dr. David Mabirizi; Angola MOH Secretary of State Dr. Eleutério Hivilikwa; US Ambassador to Angola Helen LaLime; and US Embassy/Angola General Development Officer Paul McDermott. Photo credit: SIAPS/Angola [click to enlarge]

SIAPS/Angola ended on December 31, 2016, and a closeout event on September 13, 2016, was facilitated by senior government officials, representatives of MOH organizations, and representatives of USAID and SIAPS.  The keynote address was delivered by US Ambassador to Angola Helen LaLime, and DNME Director Dra. Katiza Mangueira made closing remarks.

Resources