With Global Fund financing, UNDP supports community-based health services in Angola to fight TB. Photo: UNDP Angola

With Global Fund financing, UNDP supports community-based health services in Angola to fight TB. Photo: UNDP Angola

 

When Cristina João Pedro visited a clinic in Gabela, Angola, tuberculosis was far from her mind. She felt weak and was having trouble conceiving a second child, which prompted her visit. The nurse saw Cristina’s condition and conducted a TB test. Cristina had TB. She took prescribed medicines but stopped when she ran out and her cough subsided. When she settled in Waku Kungo, a nearby town, her condition worsened. Cristina consulted an herbal healer, who also suggested she had TB. With her health declining, Cristina went to the hospital in Gabela. "I went for an X-ray and when they told me I was very sick, I came home and started to cry. It was then that I realized that it is a very serious disease,” said Cristina.

Community health workers provide TB services to underserved populations to encourage TB testing and treatment. Photo: UNDP Angola

Community health workers provide TB services to underserved populations to encourage TB testing and treatment. Photo: UNDP Angola

TB is the world’s second deadliest infectious disease. Yet TB services remain out of reach for many people. Limited health education, inadequate health services and healthcare costs leave many patients undiagnosed and without treatment. Treatment takes months, increasing the risk of death, spreading TB or drug resistance if not completed. 

Community-based TB services are important in smaller towns like Gabela, where vulnerable people may be unable to afford travel expenses for health services further away. Photos: UNDP Angola

Community-based TB services are important in smaller towns like Gabela, where vulnerable people may be unable to afford travel expenses for health services further away. Photos: UNDP Angola

Angola ranks among countries with the most TB cases per year. TB remains the third leading cause of death among people aged 15-49. Health service coverage is low, especially among lower income people in rural areas, with 60% of TB services located in Luanda, the capital. In 2020, GeneXpert machines used to detect TB were diverted for COVID-19 testing, which further limited TB case reporting.

But Angola is seeing progress. In 2022, the UNDP-supported Global Fund TB programme reached 95% of its target for case reporting, a key indication that patients are being found. Among those cases, 80% were cured of TB.

Community health workers educate people about TB to destigmatize the disease and encourage people with TB symptoms to get tested. Photo: UNDP Angola

Community health workers educate people about TB to destigmatize the disease and encourage people with TB symptoms to get tested. Photo: UNDP Angola

Progress meant supporting patients like Cristina, who had limited awareness of TB and felt stigmatized for her diagnosis. ADPP Angola and the UNDP supports community-based TB services in Kwanza Sul, where Cristina lives, and Benguela, a neighbouring province. 

ADPP works closely with underserved communities to support community health workers, who educate people about TB. The health workers challenge stigma and misconceptions associated with the disease, which can delay diagnosis and disrupt treatment adherence.  They also provide patient screening, contact tracing and referrals. They live in the community and are a vital link between patients and health facilities. After diagnosis, they conduct home visits and advise caregivers and patients on effective treatment and prevention.

Patients are referred to local health facilities where they can access TB testing and free medications after being diagnosed. Photos: UNDP Angola

Patients are referred to local health facilities where they can access TB testing and free medications after being diagnosed. Photos: UNDP Angola

Back at the hospital in Gabela, Cristina received another prescription for TB medicines, which were not yet available for free. She found sustained treatment unaffordable, even with her husband’s financial support. Looking for free medicines, she returned to the hospital, where she met Josefa Pinheiro Segunda Jaime, a local community health worker.

“As soon as the medication was finished, I went back to the hospital and that's when I met Josefa, who looked at my prescription. She told me that at the hospital they now give the medicines for free and with her help it was no longer necessary for me to buy the medication,” Cristina recalled.

Community health workers deliver TB medications and conduct home visits to support patients during their treatment. Photos: UNDP Angola

Community health workers deliver TB medications and conduct home visits to support patients during their treatment. Photos: UNDP Angola

Cristina was cured of TB last year. With personalized support from Josefa, Cristina committed to daily treatment. 

“We set a day for me to visit her home and I told her that I would accompany her treatment until the end. I supported her by taking medicines to her house and making constant visits,” said Josefa regarding Cristina’s case. “I didn't have any difficulty in helping her fight the disease, because there was no lack of medication, she is responsible and her husband helped with everything,” she added.

Each community health worker is supported by a district supervisor, who liaises with health facilities to ensure patients receive follow-up care. Photo: UNDP Angola

Each community health worker is supported by a district supervisor, who liaises with health facilities to ensure patients receive follow-up care. Photo: UNDP Angola

Josefa strengthens Angola’s fight against TB by providing health education and personalized patient care. Her work is coordinated with Celestina de Carvalho Fortuna, who manages eight other community health workers in the Amboím area. Celestina provides training and operational support and serves as the liaison between local hospitals and the community health workers.
“The best way to deal with TB here in our municipality is to do IEC. Which is information, education and communication. Because if we communicate properly, we are not only preventing the individual case, but we are educating the whole community,” said Celestina.

Celestina and Josefa are essential for reaching vulnerable people who might not have easily accessible TB services. Their support helps destigmatize TB and ensures coordination with community leaders and nearby health facilities to encourage TB testing and patient support after diagnosis.

Over several months, TB patients are encouraged to complete their treatment and practice prevention methods like opening windows and not sharing eating utensils. Photos: UNDP Angola

Over several months, TB patients are encouraged to complete their treatment and practice prevention methods like opening windows and not sharing eating utensils. Photos: UNDP Angola

For Cristina, this personalized care proved essential after multiple attempts to complete TB treatment on her own. She credits Josefa for educating her about TB. Cristina now educates others about TB in her community.

“With Josefa’s and my husband's help I felt safer. Having two people close to me was very good. If I didn't have that support, I don't know what would become of me. Now I also help others, give them advice, explain how things are and what this disease is like. People react well when I share that information about TB,” Cristina remarked.

Community-based TB services are a key component to strengthening Angola’s health system and provide a vital link between vulnerable patients and health facilities. Photos: UNDP Angola

Community-based TB services are a key component to strengthening Angola’s health system and provide a vital link between vulnerable patients and health facilities. Photos: UNDP Angola

The Government of Angola, UNDP and the Global Fund are working to defeat HIV, TB and malaria and achieve a more equitable, healthier and sustainable future. Together, the three partners are building a stronger and more resilient health system that can withstand health challenges and provide life-saving health services in the future. 

In strengthening community-based health services, this TB programme leaves lasting contributions to Angola’s efforts to promote good health and wellbeing, economic transformation and climate action to achieve the Sustainable Development Goals.

 

 

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Article on Angop, Benguela, 9 November 2022

The abandonment rate in the treatment of patients with tuberculosis has dropped to six percent this year in Benguela province, as a result of the innovative community screening project by the NGO ADPP Angola, which started in July 2021.

The community project for the prevention of tuberculosis, which also includes HIV/AIDS and malaria, is being implemented by the NGO ADPP Angola, with funding from the Global Fund that covers the provinces of Benguela and Cuanza Sul up to June 2024

Speaking to the press, at the end of a visit today by the Secretary of State for Public Health, Carlos Alberto Pinto de Sousa, to a tuberculosis diagnosis center in Benguela, the director of the Provincial Health Office, António Cabinda, highlighted that, in 2021, the dropout rate was 11 percent. The reason for the drop to 6% is the ADPP Angola programme, which consists of the monthly distribution of a basic food basket, mainly for the 108 patients with multidrug resistant tuberculosis (MDR-TB) currently being controlled, which has helped them to continue their medication.

“Many of the patients are needy and have been abandoning their medication due to lack of food,” he said, rejoicing in the results of the partnership with ADPP. The food support to patients motivates them not to abandon the treatment, aiming to control tuberculosis. In addition, many patients resumed medication thanks to another follow-up project, also carried out by ADPP, through which a health agent carries out community screening and brings patients to the units.

Despite the five thousand cases of tuberculosis registered from January to October this year in the province, Benguela has one of the most complete diagnostic networks in the country, with 30 units that carry out the diagnosis of Koch's bacillus.

The Secretary of State for Public Health advocated for ADPP’s continued monitoring of patients by Community Health Agents (ADECOS), for better control of cases and a reduction of the chain of community transmission. For Carlos Alberto Pinto de Sousa, this intervention is an asset and should be replicated, as it helps significantly to improve access to quality care for patients and reinforces the prevention component. As for the provinces not covered by this project, Carlos Alberto Pinto de Sousa commented that they are served by a Ministry of Health national program to fight tuberculosis, from prevention to treatment.

According to the inter-provincial coordinator of the ADPP Angola project, Andrew Pamuchigere, 600 tuberculosis patients are being followed up in the municipalities of Benguela, Lobito, Catumbela and Baía Farta, with plans to extend the program to the remaining six municipalities in the interior of the province. Andrew Pamuchigere pointed out that the country is committed to the 90-90-90 goals, which aim at diagnosing 90% of possible cases of tuberculosis.

Read the article in Portuguese here:

https://www.angop.ao/noticias/saude/benguela-reduz-para-seis-por-cento-taxa-de-abandono-no-tratamento-da-tuberculose/

Skærmbillede 2022 12 16 kl. 10.12.11

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Levando experiência, informação e conhecimento sobre as medidas de prevenção e combate da malária por meio dos Projectos de Controlo Comunitário da Malária, financiado pela ExxomMobil.

Projectados para atender professores e alunos do ensino primário, os Projectos de Controlo Comunitário da malária, desempenham um papel importante, sobretudo, como veículo promotor de mudança de comportamento por meio da transmissão de conhecimentos aos professores e posteriormente aos alunos. 

 O Professor Domingos Luís colocado na escola primaria nº116, no município do Soyo ao apresentar o resumo das suas actividades relactivamente a luta contra a malária confirmou o alcance dos objectivos do projecto ao afirmar “…Actualmente, vemos nossos alunos a dedicarem-se mas nas aulas, principalmente as que têm como tema, a malária, como erradica-lo, o que devemos fazer para combater e como prevenir...” O Projectos de Controlo Comunitário de combate a malária trabalha com os professores primários para que no final de cada aula, os alunos partilhem com o seu agregado familiar os conteúdos leccionados. Este é um de muitos exemplos partilhado pelos professores das escolas primárias selecionadas pelo projecto.

Actualmente estabelecidas em 4 províncias, Uige, Zaire, Malanje e Cuanza Norte, o Projecto de Controlo Comunitário da malária, tem como abordagens a difusão de mensagens chave de saúde, através da distribuição de panfletos, palestras, exibição de peças teatrais, entre outros instrumentos utilizados pelos agentes comunitário de saúde no processo de mobilização e capacitação da comunidade, para fornecer às comunidades informações, competências e confiança para ganhar o controlo sobre as decisões relacionadas com combate a malária. Outro testemunho vem da direcção geral do Hospital municipal do Cacuso província de Malenje.

 “…Tenho de agradecer ao Projecto TCE de tudo quanto tem feito principalmente pela mobilização aos utentes a aderência as consultas, porque no passado recebíamos os doentes já em casos terminais, hoje existe grande mudança de comportamento aos nossos utentes, com maior relevância na prevenção da Malaria, como se prevenir e o uso correto do mosquiteiros. Aos doentes com VIH/TB aqueles que têm abandonado o tratamento, todas estas graças ao esforço do Projecto pelo seu acompanhamento ao tratamento…” Cecília Mateus Domingos Sebastião Diretora geral do Hospital Municipal da saúde de Cacuso.

Enquanto continuamos a nos precaver da COVID-19, a ADPP Angola através dos projectos de Controlo Comunitário continuam reafirmar o seu compromisso de dar seu contributo, individual e colectivo, no combate a malária, para longo prazo contribuir para eliminação da malaria uma das principais causas de morte em Angola. 

Malnutrition was in focus at the Integrated Community Project in Gambos, Huíla Province, where health workers attended training on 6 December. 

Júlio Madaleno, Provincial Public Health Supervisor, Adilson Nascimento Pedro, Provincial Malnutrition Supervisor, and João Câncio Zau Sancha, Head of Gambos Municipal Public Health, provided the training, which will help save lives and improve the health of the most vulnerable.

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