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Angola Health System Assessment 2010

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Angola Health System Assessment 2010 ANGOLA HEALTH SYSTEM ASSESSMENT 2010 July 2010 This publication was produced for review by the United States Agency for International Development. It was prepared by Catherine Connor (Abt Associates Inc.), Denise Averbug (Abt Associates Inc.) and Maria Miralles (International Relief and Development) for the Health Systems 20/20 project. Mission The Health Systems 20/20 cooperative agreement, funded by the U.S. Agency for International Development (USAID) for the period 2006-2011, helps USAID-supported countries address health system barriers to the use of life-saving priority health services. Health Systems 20/20 works to strengthen health systems through integrated approaches to improving financing, governance, and operations, and building sustainable capacity of local institutions. July 2010 For additional copies of this report, please email [email protected] or visit our website at www.healthsystems2020.org Cooperative Agreement No.: GHS-A-00-06-00010-00 Submitted to: Robert Emrey, CTO Health Systems Division Office of Health, Infectious Disease and Nutrition Bureau for Global Health United States Agency for International Development Recommended Citation: Connor, Catherine, Denise Averbug, and Maria Miralles. July 2010. Angola Health System Assessment 2010. Bethesda, MD: Health Systems 20/20, Abt Associates Inc. Abt Associates Inc. I 4550 Montgomery Avenue I Suite 800 North I Bethesda, Maryland 20814 I P: 301.347.5000 I F: 301.913.9061 I www.healthsystems2020.org I www.abtassociates.com In collaboration with: I Aga Khan Foundation I Bitrán y Asociados I BRAC University I Broad Branch Associates I Deloitte Consulting, LLP I Forum One Communications I RTI International I Training Resources Group I Tulane University School of Public Health and Tropical Medicine 2 CONTENTS ANGOLA HEALTH SYSTEM ASSESSMENT 2010 DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government ABSTRACT The Health Systems 20/20 Project fielded a three-person team to conduct a rapid assessment of the Angolan health system to inform USAID/Angola’s new health sector strategy for 2011-2015 and provide recommendations for the Angolan Ministry of Health (MINSA) that is launching a new district health strategy. This assessment updates a similar assessment done in 2005. Since 2005, the Angolan health system has realized progress in health financing, human resources, information systems, governance, and service delivery, facilitated by continued peace, political stability, rapid economic growth, and major investments in infrastructure such as roads, water, and housing. Although prevalence of underweight children and fertility have declined significantly, key indicators such as infant and under-five mortality, maternal mortality and HIV prevalence appear stagnant are still high compared to regional averages. Health sector stakeholders are benefiting from the availability of new data from health surveys, studies, and slight improvements in the routine facility and epidemiological surveillance systems. Government health financing continues to be relatively low at 5 percent of total public expenditures, but is more equitable and effective as public spending on primary health care tripled. Access to health services rose slightly but is still less than half the population. MINSA is demonstrating political commitment to improve access to health services and equity through its district health strategy, which has the explicit support of major partners such as the European Union, World Bank, and UN agencies. As implementation begins in earnest, the district health strategy crystallizes specific challenges facing MINSA and its partners: funding of non-labor recurrent costs, consistent supply of essential medical products, integration of vertical programs at the district level, how to extend access, how to reach communities, and donor coordination. ABSTRACT V CONTENTS Abstract.......................................................................................... v Acronyms.................................................................................... xiii Acknowledgments..................................................................... xvii Executive Summary................................................................... xix 1. Background.............................................................................. 1 2. Country Overview................................................................... 3 2.1 General ................................................................................................ 3 2.2 Health 4 2.2.1 Health Status.......................................................................... 4 2.2.2 Health System ........................................................................ 6 3. Methodology ............................................................................ 9 3.1 Framework for the Health Systems Assessment Approach........ 9 3.2 Phase 1: Document Review and Interviews.................................10 3.3 Phase 2: In-Country ......................................................................... 10 4. Technical Modules................................................................. 13 4.1 Governance....................................................................................... 13 4.1.1 Overview .............................................................................. 14 4.1.2 Decentralization and District Revitalization.................... 16 4.1.3 Voice...................................................................................... 17 4.1.4 Responsiveness .................................................................... 18 4.1.5 Technical Oversight ............................................................ 18 4.1.6 Service Delivery................................................................... 19 4.1.7 Information, Reporting, and Advocacy.............................19 4.1.8 Directives, Oversight, and Resources..............................20 4.1.9 Donors and Donor Coordination....................................20 4.1.10 Summary............................................................................... 21 4.2 Health Financing ............................................................................... 23 4.2.1 Overview .............................................................................. 23 4.2.2 Resource Mobilization........................................................ 24 4.2.3 Resource Pooling and Allocation......................................26 4.2.4 Purchasing............................................................................. 29 4.2.5 The Budgetary Process....................................................... 30 CONTENTS VII 4.2.6 Resource Flows and Management ....................................31 4.2.7 Summary of Findings: Financing.........................................36 4.3 Human Resources............................................................................ 37 4.3.1 Human Resources Data...................................................... 38 4.3.2 Distribution of Health Care Professionals ......................40 4.3.3 Presence of a Human Resources Information System (WHO 2009)........................................................................ 41 4.3.4 Human Resources Planning................................................ 42 4.3.5 Job Classification System and Job Descriptions.............. 42 4.3.6 Compensation and Benefits...............................................44 4.3.7 Hiring Process and Licensing Requirements ...................44 4.3.8 Health Worker Training and Supervision........................45 4.3.9 Summary of Findings: Human Resources.........................46 4.4 Medical Products Management....................................................... 47 4.4.1 Overview .............................................................................. 47 4.4.2 Managing Selection .............................................................. 48 4.4.3 Procurement ........................................................................ 49 4.4.4 Storage, Distribution, and Logistics..................................51 4.4.5 Rational Use ......................................................................... 54 4.4.6 Summary of Findings: Medical Products...........................54 4.5 Health Information Systems ...........................................................59 4.5.1 Overview .............................................................................. 59 4.5.2 HIS Regulations and Policies..............................................60 4.5.3 HIS Components................................................................. 60 4.5.4 A Single Health Information System.................................64 4.5.5 Data Quality......................................................................... 65 4.5.6 Data Analysis and Use ........................................................65 4.5.7 Summary of Findings: Health Information System.......... 66 4.6 Service Delivery................................................................................ 67 4.6.1 Organization of MINSA and Service Delivery................. 67 4.6.2 Health Facilities.................................................................... 70 4.6.3 Services Provided ................................................................ 72 4.6.4 Coverage..............................................................................
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