International Medical Corps : Angola relief and rehabilitation -- structural redevelopment of health services in rural Angola : grant no. AOT-0003-G-00-2077[-00] -- final report

IMC efforts focused on training village health workers (VHWs) and vaccinators for the Expanded Program of Immunization (EPI). IMC designed a 16-week training program for VHWs, which, in a historic first, incorporated health workers politically affiliated with both MPLA (Popular Movement for the Liberation of Angola) and UNITA (National Union for the Total Independence of Angola). The program was implemented in Luena and Menongue and included both classroom instruction and practical exercises at local health posts. A total of 95 students participated. Unfortunately, the program was interrupted when renewed civil unrest following the September 1992 election forced IMC expatriate staff to evacuate. However, despite the absence of expatriate staff, IMC-trained health workers continued a variety of primary health operations, including patient diagnosis and referral, growth monitoring, and promotion of preventive care through community fora on such topics as breastfeeding and water and sanitation. Training of EPI vaccinators was also implemented in Luena and Menongue and was provided to 46 individuals associated with MPLA and UNITA. This program also was interrupted by civil unrest. Nonetheless, between July and December 1992 several vaccination campaigns were carried out, reaching 6,395 women and children in Luena (July-September), 5,600 women and children (including 4,800 children under age 6) in Menongue (October), and another 894 women and children in Luena (October, December). By November 4, 1992, all expatriate staff had been evacuated to Namibia, but they were able to maintain daily radio contact with Angolan staff in Luena (until January 11, 1993) and sporadic contact with staff in Menongue (until early December 1992). Even after the loss of radio contact, IMC-trained Ministry of Health (MOH) vaccination teams used vaccines and syringes provided by the Angolan Red Cross to continue EPI activities among the estimated 70,000 displaced persons in Luena. The forced evacuation provided IMC staff a unique opportunity to meet as a group, share ideas, and discuss technical issues; establishment of a standardized primary health care curriculum was a significant outcome of these meetings. In January 1993, UNDP officials tried to visit Luena, but their plane was fired upon during descent and rushed when it departed an hour later. IMC expatriate staff finally revisited Luena on March 1, 1993 and found all equipment at the IMC compound safely under lock and key; the cold chain had evidently not been compromised -- reflecting the value of IMC's training and the high degree of self-sustainability incorporated into project design. Plans to visit Menongue (where drug supplies had been exhausted at the time of evacuation) were thwarted because the town was reportedly under siege. In March 1993, the Mission asked its grantees to submit proposals detailing what activities could still be completed under their grants. Since IMC had already begun efforts to redevelop Angola's health infrastructure, it submitted a proposal to evaluate MOH health systems and provide support and training to national and provincial EPI administrators. However, USAID decided that the civil crisis made reprogramming of funds infeasible.