Angola

Malaria burden

Angola is among the ten countries with the highest number of malaria cases and deaths (3% of the global cases and deaths).1  Between 2015 and 2018, there was a 14% increase in malaria cases from 200 to 228 cases per 1000 of the at risk population. Deaths however fell by 8% from 0.47 to 0.43 per 1000 of the population at risk to 0.43 per 1000 of the population at risk.

Five provinces especially noted increases in malaria cases and malaria-related deaths between December 2017 and March 2018.2 Due to the increase in malaria cases, the Ministry of Health initiated rapid assessments in the provinces with the highest burden.2 

Severe malaria data

According to data from the National Malaria Control Programme (NMCP), 8% of all reported yearly malaria cases in 2017 were severe malaria.2 

Severe malaria case management

The country’s national treatment guidelines recommend that the first-line treatment for severe malaria is intravenous (IV) artesunate, with intramuscular (IM) artemether as second-line treatment, and quinine IV as third-line treatment.3 However, due to limited availability, and unfamiliarity of health providers, with injectable artesunate and artemether, quinine IV is the treatment most often administered.3 This may have contributed to an increase in malaria-related deaths in several provinces.3

The goal of the government is to encourage the NMCP to develop a plan for scaling up the use of artesunate products. For the pre-referral treatment of severe malaria, country’s guidelines recommend artesunate rectal capsules for all ages (including adults) even though this is contrary to WHO guidelines, which specify that pre-referral artesunate rectal capsules should be restricted to children under the age of six.

The Ministry of Health requested US$4.9 million in funding from the Global Fund to purchase injectable artesunate, artemether and quinine (for pregnant women in their first trimester).2

Commodity stock outs

Stock outs are often reported at municipality and health centre levels, even though this was not the case at the central level (national or provincial).3 

Integrated Community Case Management (iCCM)

World Vision, a principal recipient under the Global Fund 2016-2018 grant, is implementing the integrated community case management (iCCM) strategy in 18 municipalities within six provinces. The USAID President’s Malaria Initiative (PMI) also commenced the implementation of iCCM in an additional 4 municipalities of 2 provinces at the end of 2017.2

Cross-border initiatives

An elevated burden of severe malaria has been experienced in the areas along Angola’s borders with the Democratic Republic of Congo and Zambia. To address this issue, two cross-border initiatives were introduced with government funding from Angola and Namibia: the Trans-Kunene Malaria Initiative in 2011 and the Trans-Zambezi Malaria Initiative in 2013.3,4 

The healthcare system in Angola consists of three levels:2

  • The first level includes health centers and posts, municipal hospitals, nursing stations and doctors' offices; 
  • the secondary level consists of general and monovalent hospitals; 
  • and the tertiary level consists of central hospitals and specialized hospitals.

As of 2016, there were 2775 public health facilities: 1,675 health posts, 431 health centers, 75 maternal and child health centers, 166 municipal hospitals, 25 provincial hospitals, 1,2 central/national hospitals, 24 specialized health centers, and 28 non-classified health facilities.3

As of 2016, government contribution to the healthcare budget was about 60% (about 50 million). ,  This however declined significantly in 2017 to less than 10 million and represented under a third of the total healthcare budget.4

Malaria case admissions and deaths

Photo: World Malaria Report 2018

Malaria case distribution in Angola

Photo: World Malaria Report 2018

Severe malaria policy and practice

National treatment guidelines
Recommendation Treatment
Strong Injectable artesunate (IV or IM)
Alternative Intramuscular artemether
Alternative Injectable quinine

*Since artesunate and artemether are often not available, injectable quinine continues to be the most commonly used treatment for severe malaria nationwide. 

Recommendation Pre-Referral
Alternative Rectal artesunate
Alternative Intramuscular artesunate
Alternative Intramuscular artemether
Alternative Intramuscular quinine

* A broad spectrum antibiotic should also be associated

Sources of health financing

Photo: World Malaria Report 2018 - Angola country profile