UNICEF Angola Situation Report February 2002 (Also available at: www.unicef.org/emerg, www.angonet.org, www.gro.unicef.org & www.reliefweb.int) Highlights: • Death of UNITA’s leader Jonas Savimbi during combat in Moxico province. • Security situation still precarious with several attacks reported in Benguela, Bie, Huambo, Malanje and Moxico provinces. • Humanitarian situation remains alarming with over 30,000 new internally displaced persons reported in February: over 80% of new IDPs are children and women (see latest map on internal displacement in January 2002). • Planning of polio and measles immunization days in Moxico province. • Poor funding of humanitarian activities: UNICEF urgently needs US$ 6.3 million to provide emergency assistance to displaced and resident children in the fields of nutrition rehabilitation, immunization, protection, and access to water and sanitation for the next 6 months. A – Health and Nutrition Polio Eradication Following reported cases of polio among Angolan children in Zambia, UNICEF, WHO and the national EPI are preparing a co-ordinated vaccination campaign with Zambian authorities to immunize children along the common areas of the border. UNICEF supported the preparation with access assessment tools, including the preparation of maps at communal level. In addition to polio vaccination, measles vaccination and vitamin A supplementation will be given to accessible children in Moxico, Kuando Kubango, Lunda Norte and Lunda Sul provinces. UNICEF provided a significant amount of Vitamin A doses, vaccines and related materials (cold chain, vaccination cards and syringes) to the local health authorities. Access to children remains the main constraint to eradicate polio in Angola. As indicated in the map below, out of 31 communes in Moxico provinces only 8 could be reached during last year’s first round NIDs. The national EPI, WHO and UNICEF provided training in immunization techniques to future trainers of military personnel, as the army will be instrumental in the forthcoming campaign to reach children in areas currently not accessible. It is expected that the army will itself vaccinate 90,000 children and MoH personnel an additional 100,000 children in all municipalities of Moxico province. Moxico province: communes accessed during the first round of the 2001 NIDs Luau Caianda Camanongue Kavungo Luacano Lovua Luena Leua Liangongo Lago-Dilolo Kameia Alto Zambeze Calunda Cagumbe/Kachipoque Lucusse Mucondo Kaquengue Lutuai Lumbala Luvuei Cassamba Tempue Lutembo Luchazes Sessa Lumbala-Nguimbo Mussuma Muie Cangombe Ninda Chiume Communes reached Communes reached with FAA/Police support Commune reached from DRC Communes not reached A technical and epidemiological criterion for prioritising municipalities for polio eradication was also established in close co-ordination with the national EPI Programme and WHO. Following this criterion, 20 municipalities were selected from the existing 164 to hold sub-national immunization days in May 2002. Immunization Measles cases continue to be reported from several provinces including areas with new IDPs, such as Luanda, Cunene, Caconda in Huila, and Camacupa in Bie. During the reporting period, UNICEF supported measles vaccination campaigns in IDPs camps in Caconda and Luena with the aim to curb the number of susceptible children. In conjunction with the national EPI programme UNICEF is finalising the planning of large-scale measles vaccination interventions and vitamin A distribution that will be conducted with ECHO financial support in Malanje, Uige, Huambo, Huila, Benguela, Bie, and Luanda provinces. A methodology for evaluating and monitoring six key areas in routine immunisation was developed and tested. It includes the cold chain, logistics, information system, and safe injection practices. This tool is based in a set of six critical indicators each of which must qualify in 5 grades. The first evaluation was done at national level and is going to be expanded to other levels of the health system. Upgrading of the EPI information system was the target of several efforts that included the redesign of some registration forms such as the monthly report form. A graphic to monitor the monthly coverage of vaccinations was elaborated and the Child Immunisation Card was completely redesigned to facilitate caretakers’ educational work. A pre-test of this card revealed a very positive acceptance of the new design, both from the mothers and by the health personnel. Malaria A total of 35,500 mosquito nets and a corresponding quantity of insecticide was distributed to Benguela, Huambo, Huila, Malanje and Zaire provinces and to the IDP Camp of Boa Esperança in Porto Quipiri, Bengo province. In response to an invitation from the Provincial Government of Cabinda, UNICEF presented a rapid evaluation of the Provincial Prevention and Malaria Control Programme. Main findings of the evaluation were: • A very good level of partnership was reached involving the National Malaria Control Programme (NMCP), Cabinda Gulf Oil Company, ESCOM, a Portuguese institution assisting the province in Health management and UNICEF; • Since the implementation of the Programme in Cabinda, the Provincial Government and partners have acquired 21,300 mosquito nets and insecticide. About 8,950 nets have been distributed to 2,984 families. UNICEF participated with 5,060 nets; • Base-line studies have been performed by the NMCP, including entomology, parasitology and epidemiology; • An Information, Education and Communication Campaign is on-going since last year and involves the JULU theatre group in training local groups with UNICEF support. A team composed of two trainers in Impregnation Techniques for Nets and other materials and one UNICEF staff travelled to Luena to facilitate the first workshop on impregnation of mosquito nets, where 25 staff of the provincial delegation of health, NGOs and the Lutheran and Catholic churches participated. Essential Drugs Responding to the emergency caused by the arrival of about 10,000 new IDP to Camacupa from Umpulo and Ringoma in Bie Province, UNICEF provided 3 Essential Drugs Kits, enough for at least two months of medical care. Nutrition Therapeutic Feeding Centers (TFCs) admission data was consolidated until December 2001 and presented to the nutrition sub-group network meeting held at the Direcção Nacional de Saude Publica. December corresponds to the early hungry season that typically starts in November and ends in April. Comparing the total admissions of 2000 and 2001 the situation seems stable with 2,263 admissions in December 2000 against 2,276 in December 2001. Nevertheless the analysis by provinces showed that the situation has changed among provinces over the last three years. # admissions Admissions to TFCs by Province 1500 1000 500 0 Bengo Bie K-Kub Huambo Huila Malanje M oxico U ige Dec-99 416 556 68 1366 86 910 159 170 Dec-00 506 291 63 864 240 77 235 Dec-01 474 658 385 542 35 169 This year Bie and Huila provinces are facing serious nutritional emergencies. In December 2001 Bie had 126% more admissions that in December 2000. In Huila Province in December 2000 there were no TFCs operating while in the same month in 2001, due to the nutritional conditions of new IDPs, ACH open a TFC in Caconda and MSF-Spain one in Matala, Huila Province. A nutritional survey carried out by ACH in January in Caconda showed a Global Acute Malnutrition of 20.7% and severe malnutrition of 5% among IDPs. In Matala the NNP team with UNICEF support started a nutrition survey in the last week of February. In order to plan nutrition interventions to benefit new IDPs expected in Cacula and Hoche municipalities in Huila province, a training plan for three local nutrition staff was prepared. This training will start with the self training module on severe malnutrition under tutorial assistance of UNICEF medical staff, followed by a 10-day on the job training in Catumbela’s TFC. Another 12 health workers will be trained on nutrition surveillance, screening and prevention of severe malnutrition. The NNP, assisted by the nutritionist from CRS, carried out the 2nd round of monitoring visits to nutrition rehabilitation centres implementing the National Protocols. The full accomplishment of the task required is not easily implemented by the MoH structures (Paediatric hospital Luanda, TFCs in Caxito and Menongue). However, the implementation of the recording system and the regular visits allow for more accurate identification of problems. In the Provincial Hospital of Huambo the work is facilitated by the full collaboration of the ICRC. B- Water and Sanitation In view of the emergency situation in Moxico province, UNICEF conducted a technical assessment visit and developed Terms of Reference to launch a bid for the rehabilitation of 2 major water supply systems in 2 IDPs camps (Sangondo and Camanongue). In addition, water and sanitation equipment was dispatch to Luena. It is since long known that the IDP camps Sangondo, Camanongue and Luchases are in urgent need of an intervention to improve the water supply and sanitation situation. However, lack of funds in the area of Water and Sanitation are seriously hampering the ability to make such life saving interventions in these camps. UNICEF together with the LWF, DPA and DPS held training in Moxico for 15 staff members on water disinfection by means of chlorine (preparation of the main solution to be used at household level). In Menongue, Kuando Kubango province, the main focus of UNICEF continues to be a major rehabilitation and construction work of the water supply system in Pandera, Tomas and Saprinho bairros to benefit approximately 25,000 people. The social mobilisation sub-sector started a working plan to inform the communities and involve the communities in addressing several issues, such as the river water intake protection (laundry washing and cattle watering to be done down stream), operation and maintenance issues, hygiene and sanitation promotion. In Luanda the NGO NOVOMUNDO began implementation of water trucks desinfection, under an agreement with DNA/UNICEF and MSF-Belgium support, that will hand over all activities to NOVOMUNDO including training and assessing the NGO’s capacity.