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Sidas Support to the Health Sector in Angola 1977–2006

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Sidas Support to the Health Sector in Angola 1977–2006 Healthy Support? Healthy Support? Sidas Support to the Health Sector in Angola 1977–2006 Healthy Support? Sida Support to the Health Sector in Angola 1977–2006 Sidas Support to the Health Angola is emerging from decades of war with an infrastructure in ruins and some of the worst health indicators in the world. Sweden has Sector in Angola 1977–2006 supported the health sector in Angola since independence in 1975 up until 2006, when the last development cooperation programmes were Kajsa Pehrsson phased-out. This study describes Swedish health support over 30 Lillemor Andersson-Brolin years and the motives behind it. It also analyzes to what extent Staffan Salmonsson development cooperation efforts have contributed to improved health in Angola. Sida Evaluation 07/50 SWEDISH INTERNATIONAL DEVELOPMENT COOPERATION AGENCY Department for Democracy and Social Development Address: SE-105 25 Stockholm, Sweden. Visiting address: Valhallavägen 199, Stockholm. Tel: +46 8 698 50 00. Fax: +46 8 20 88 64. E-mail: [email protected] www.sida.se Sida EVALUATION 07/50 Healthy Support? Sida’s Support to the Health Sector in Angola 1977–2006 Kajsa Pehrsson Lillemor Andersson-Brolin Staffan Salmonsson Sida EVALUATION 07/50 This report is part of Sida Evaluations, a series comprising evaluations of Swedish development assistance. Sida’s other series concerned with evaluations, Sida Studies in Evaluation, concerns methodologically oriented studies commissioned by Sida. Both series are administered by the Department for Evaluation and Internal Audit, an independent department reporting directly to Sida’s Board of Directors. This publication can be downloaded/ordered from: http://www.sida.se/publications Authors: Kajsa Pehrsson, Lillemor Andersson-Brolin, Staffan Salmonsson. The views and interpretations expressed in this report are the authors’ and do not necessarily refl ect those of the Swedish International Development Cooperation Agency, Sida. Sida Evaluation 07/50 Commissioned by Sida, Department for Democracy and Social Development Copyright: Sida and the authors Registration No.: 2005-003541 Date of Final Report: November 2007 Printed by Edita Communication, 2008 Art. no. Sida40853en ISBN 978-91-586-8192-7 ISSN 1401— 0402 SWEDISH INTERNATIONAL DEVELOPMENT COOPERATION AGENCY Address: SE-105 25 Stockholm, Sweden. Offi ce: Valhallavägen 199, Stockholm Telephone: +46 (0)8-698 50 00. Telefax: +46 (0)8-20 88 64 E-mail: [email protected]. Homepage: http://www.sida.se Preface The Swedish support to the Health Sector in Angola started soon after An- gola’s independence in 1975. Some three decades later it was the last Sida Programme to be phased out, in March 2006. The total amount disbursed during these years was MSEK 667 and included support to primary health care, infectious diseases programmes, essential drugs, and maternal- and child health. During most of this time Angola has been ravaged by a devastating civil war. The confl ict led to the displacement of almost one third of the population, the overcrowding of the capital Lu- anda and unbearable human suffering. This study analyzes the motives and methods of the Swedish cooperation and lessons learnt from supporting the health sector over such a long period of time and under diffi cult conditions. Angola has some of the worst health indicators in the world, with alarm- ingly high maternal- and child mortality rates. There are a number of con- tributing factors, but the main one has no doubt been the war. It has never been possible to implement the health programmes to their full extent due to the confl ict. The cooperation would also have benefi tted from more preparatory studies when designing the support and more systematic learning and follow-up from the studies and evaluations actually carried out. Sidas initially defi ned objective to help build a nationwide Public Health system was never achieved. Nevertheless some important components of such a system have developed and are working effi ciently. A number of the programmes that have received support from Sida are still performing more or less according to plans. An- other positive development is in the area of institutional capacity, where various institutions involved in the Angolan-Swedish cooperation have been strengthened. This study was initiated by Sida’s Health Division at the Department for Democracy and Social Development in cooperation with the Embassy of Sweden in Luanda and carried out by the Institute of Public Management (IPM). It was later complemented by an evaluation of the last agreement in the Angolan health sector 2004–2006 entitled “Phasing-out Swedish Health Support in Luanda, Angola” (Sida Evaluation 2008:03). iii Anders Molin Head of Health Division Department for Democracy and Social Development Sida Table of Contents Acknowledgements ................................................................ 9 Executive summary .............................................................. 11 Introduction ........................................................................ 19 The study .........................................................................................19 Method and material .......................................................................20 Background to the Swedish-Angolan cooperation ................... 22 When Angola was put on the map ..................................................22 A political support – the solidarity movement and the government ..............................23 Did Angola get peace? ....................................................................26 Part 1: The start ................................................................. 29 The prelude – fi rst request about health support ............................29 The MPLA congress – planning for health after Independence ....30 What to support within the health sector? .......................................30 The fi rst agreement .........................................................................31 Expectations unfulfilled ......................................................... 33 Gap between budget and disbursement .........................................33 Attempts to bridge the gap ..............................................................34 Better spending of aid money ..........................................................35 Confl icting views and interests ........................................................35 Modifications of the support ..................................................38 Inconsistencies left without analysis .................................................38 Maternal health added ....................................................................40 Conditions formulated – but optimism remains .............................41 Striving for improved coordination ................................................42 Reorientations ..................................................................................44 Reduced support to training and planning ......................................45 Angola and Sweden on different lines .....................................46 Angola’s proposal .............................................................................46 A critical analysis – Sida identifi es constraints ................................46 MoH’s self-criticism ........................................................................47 v The outcome: Focus on maternal health in Luanda ..................49 Concentration to the Luanda province ..........................................49 The Programme outsourced to consultant ......................................49 Explicit requirements of “services in return” ..................................50 Obstacles identifi ed .........................................................................51 … and children’s health added ........................................................52 More rigorous conditions ................................................................53 Systematic follow-up ........................................................................53 Questioning sustainability ................................................................56 The basis of development cooperation reconsidered ...............57 New strategies required ...................................................................57 Humanitarian assistance – a short-time solution .............................58 “Business as usual” despite obvious strains ......................................59 Preparations for a long-term development agreement ...................59 Thorough knowledge emphasized ...................................................60 A new turn .......................................................................................61 Audits and frozen disbursements .....................................................61 Last agreement – sustainability in focus .........................................62 Tendencies in 2006 ..........................................................................64 Part 2: The Angolan point of view ......................................... 65 Angolan voices – the evaluation 1991 .............................................65 Recommendations for future development .....................................66 Part 3: Angolan and Swedish views on the programmes ..........68 Essential drugs .................................................................................68 Extended Programme of Immunization .........................................72 Health education .............................................................................77
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