Few pregnant women access medical services

Despite the fact that Angola has one of the world's highest infant and maternal mortality rates, few pregnant women are accessing the available medical services. The maternal mortality rate in Angola is 1,000 deaths per 100,000 births, while the mortality rate for infants reaches 250 per 1,000 births. Only Sierra Leone and Nigeria have infant mortality rates worse than Angola's. Catarina de Conceicao, 16, lives with her family in a settlement 45 minutes by road from bustling centre of the capital, Luanda. The houses in the settlement lack a supply of clean water, sanitation and electricity. Most of the residents survive on meagre incomes from selling salt, sugarcane or fish. Many suffer from malnutrition or diseases caused by poor living conditions. De Conceicao is six months pregnant with her first child. She is one of several women visited by a team of officials from the ministry of health, a group of young activists called Gira Jovem and the NGO, Management Sciences for Health (MSH. They are all trying to convince pregnant women to go for pre-natal consultations at the health centre in Cacuaco, a 15 minute drive away, to give them health guidance and make sure they take vitamins and anti-malaria medication. But the women tend to ignore their advice because of financial problems, the workload at home or ignorance. A community mobilisation advisor for MSH, Hirondina Cucubica, asked about visits to the doctor. Pregnant women are supposed to visit the health centre once a month, but De Conceicao's last visit was in January, and she couldn't find the medicine she had been given. Prompting Cucubica to remark that "you should not need to search for your pills. If you don't know where they are, I'm sure you're not taking them". Although the medical services are free, the women have to pay the nurses. "Sometimes the nurses charge 50 kwanzas (US $0.7), sometimes 100 (US $0.14)", De Conceicao's neighbour said. With the added cost of the journey, she believes it is better to stay at home. Only 45 percent of the births in Angola are attended by trained personnel. According to Cucubica, the nurses are often poorly trained. "And when there is a huge line of women waiting outside, they tend to rush through or skip many of the important messages. This makes it hard for the women to understand the need for check-ups," she said. Not all the blame should be put on health institutions. "Many of the problems are probably due to a lack of education. The concept of taking medicine as prevention is hard for the people to comprehend," said Clara Gamiz de Luna, coordinator of health NGO Medicos del Mundo. HEALTH SERVICES NEED TO BE UPGRADED However, the quality of the services provided by the health institutions needed to be improved. At the health centre in Cacuaco, the two doctors employed by the municipality spend most of their days clearing paperwork, while hundreds of women queue outside. They bring sick children, wait for vaccinations or pre-natal consultations, and seek treatment for many other ailments. IRIN visited the centre and witnessed pregnant women, wanting to check in, jostle each other in the crowded reception area. Then wait on small wooden benches, sit on the ground or stand in the hot sun until their name was called, which could take an entire day. The health centre, though clean and fairly spacious, lacks some necessities. "We have electricity," said Margarida Cambinda, head of public health at the centre. "But this morning it went out. And we don't have a generator." Complicated pregnancies are sent to the larger hospitals in Luanda, as the clinic is unable to handle them, but transporting patients is sometimes difficult. "We have an ambulance, but it is quite old," Cambinda explained. "It is not very reliable - one week it works, the other it doesn't. When it doesn't work we have to send the women with a candongeiro or a taxi," she explained. Angola's health system was left in tatters by the country's 27-year civil war. After two years of peace, medical institutions are still struggling to provide adequate treatment. Malaria is considered the single largest cause of child death. And the country has the third-highest child mortality rate in the world, with one in every four children likely to die before reaching the age of five.