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Health and Livelihoods in Rural Angola: a Participatory Research Project

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Health and Livelihoods in Rural Angola: a Participatory Research Project Health and Livelihoods in Rural Angola: a Participatory Research Project Laura Habgood An Oxfam Working Paper ©OxfamGB 1998 ISBN 0 85598 391 4 A catalogue record for this publication is available from the British Library. All rights reserved. Reproduction, copy, transmission, or translation of any part of this publication may be made only under the following conditions: • with the prior written permission of the publisher; or • with a licence from the Copyright Licensing Agency Ltd., 90 Tottenham Court Road, London W1P 9HE, UK, or from another national licensing agency; or • for quotation in a review of the work; or • under the terms set out below. This publication is copyright, but may be reproduced by any method without fee for teaching purposes, but not for resale. Formal permission is required for all such uses, but normally will be granted immediately. For copying in any other circumstances, or for re-use in other publications, or for translation or adaptation, prior written permission must be obtained from the publisher, and a fee may be payable. Available from the following agents: for the USA: Stylus Publishing LLC, PO Box 605, Herndon, VA 20172-0605; tel 800 232 0223; fax 703 661 1501; email [email protected] for Canada: Fernwood Books Ltd., PO Box 9409, Stn. A, Halifax, Nova Scotia B3K 5S3; tel 902 422 3302; fax 902 422 3179; email [email protected] for Southern Africa: David Philip Publishers, PO Box 23408, Claremont, Cape Town 7735, South Africa; tel. +27 (0)21 64 4136; fax +27 (0)21 64 3358; email [email protected] for Australia: Bushbooks, PO Box 1958, Gosford, NSW 2250, Australia; tel. 02 4323 3274; fax 02 9212 2468; email [email protected] For the rest of the world, contact Oxfam Publishing, 274 Banbury Road, Oxford OX2 7DZ, UK. tel +44 (0)1865 311311; fax +44 (0)1865 313925; email [email protected] Published by Oxfam GB, 274 Banbury Road, Oxford OX2 7DZ, UK Printed by Oxfam Print Unit Oxfam GB is registered as a charity, no. 202918, and is a member of Oxfam International. This book converted to digital file in 2010 Contents Abbreviations / Glossary 4 Part Three: Conclusions and recommendations Preface 5 3.1 Health-related behaviour and the Introduction 6 use of health services within the sociocultural context of Ganda 42 Map of Ganda Municipality 8 3.2 Preventive health priorities of the communities and their most vulnerable members 44 Part One: Methodology 3.3 The development of appropriate 1.1 Background 9 methodological tools and health- 1.2 Study design and organisation 9 status indicators 44 1.3 Study area, sample, and sources 13 3.4 Recommendations to Oxfam concerning programme direction 1.4 Methods and tools 15 and initiatives in Benguela Province 45 1.5 Analysis and interpretation 18 3.5 General recommendations for 1.6 External and internal factors working in communities 47 influencing the methodology 19 1.7 Influences on findings 20 Appendices 1. Population survey 49 Part Two: Findings and discussion 2. Participatory methods and tools used 52 2.1 History of Ganda 22 3. Example of a drawing used as a discussion 2.2 Social structures 23 starter by research assistants 60 2.3 Health-service providers 24 4. Causes of malnutrition — 2.4 Sociocultural factors 27 interview guide and diagram 61 2.5 Health beliefs 30 5. Map of Ganda district 63 2.6 Health-related behaviours 32 6. Health-service providers in Ganda 64 2.7 Why do people make 7. Research-project schedule based the choices they do? 37 on intermediate objectives 69 2.8 Health needs 40 Notes 70 Abbreviations / Glossary ACF Accion Contra Fome adobe mud (Action Against Hunger) agimdente locally brewed alcohol CVA Cruz Vermelha de Angola amigos chegados good family friends (Angolan Red Cross) bairro a neighbourhood comprising DMPMF Delegagao Municipal para several residential zones Promogao e Desenvolvimento batuque. drum da Mulher e Familia cabewgrande traditional illness (a merger of UNITA's and the (potentially fatal bleeding occurs from MPLA's women's organisations) the mouth and nose) 1CRC International Committee of the comunidade familiar family compound Red Cross desenrascar to scrape around for food IESA Igreja Evangelica de Angola kandonga parallel market (Evangelical church) kanjango extended family grouping MINSA Ministerio da Saiide de Republica kimbanda common term for any health de Angola (Ministry of Health of practitioner; the Umbundu equivalent is the Republic of Angola) otchimbanda MPLA Movimento Popular de Libertacao lavra land distant from a river de Angola (Popular Movement for makulu used to describe illness caused by worms the Liberation of Angola muhongo traditional pregnancy NGO Non-Government organisation naca land bordering a river OMA Organizagao das Mulheres de Angola olondele ancestors (the MPLA's Angolan Women's olusongo scarification Organisation) ondjango village or neighbourhood meeting place UNICEF United Nations Children's Fund otchitenlid 'lack of rains, then hunger' (Umbundu) UNITA Uniao Nacional para a pdssaro Portuguese for 'bird'; used to describe Independencia Total de Angola an illness of childhood with symptoms of (National Union for the Total convulsions Independence of Angola) planalto in-land plateau/central highlands quimbo traditional village quintal compound santa/o female/male traditional practitioner (spiritualist) seculo bairro elder or vice-soba soba traditional chief, highest authority in a bairro; sometimes appointed by the Administration tensdo de gota. the adult version of pdssaro vanumuso tiny devil people which appear in dreams to attack the dreamer walunguka a person with a particular capacity to understand and share an experience of life Preface Angola appears to be emerging from years of Oxfam wanted to focus on the beliefs and social disruption, during which the people least perspectives of Ganda's communities, rather responsible for prolonging the conflict have than to review health-service provision from the been most affected by the poverty that results provider side. In doing so, Oxfam also sought to from war. Planners developing basic social ser- gain experience in information-gathering at vices face a situation marked by high levels of community level. poverty-related morbidity and mortality among This work is the result of the combined efforts populations returning to their homelands; of several people: those who had the oppor- scarce resources; and a lack of information to tunity and privilege of getting to know some of guide decision-making. the many Angolans who will continue to look for The Oxfam country programme in Angola, ways of coping with an uncertain future, and with several years' experience in working to friends and colleagues for whom such a life is meet people's emergency and long-term needs 'normal'. Thank you, Virgilio Joya, Filomena for water and sanitation, has been leading a Rosalina, Hilaria Katumbo, Marion O'Reilly, recent shift in approach to community develop- Vincent Koch, Maria Catarina, Ana-Maria, ment in the country. This approach aims to help Manuel Joca, Gustavo Manuel, Paulo Job, people identify and manage their problems, as Avelino Rufino, Padre Adriano, Maria-Augusta well as to cultivate a culture of information- Peixote, Gabriela Da Silva, Dona Maria Luisa, sharing among programme staff. The 1997 Manuel Gonga, Isabel Nimba, Aidan McQuade, research project in Ganda which is the subject of Kate Home, Maria Emilia Barradas, Odete this paper grew out of the need to gain a better Antonio, Fernanda Antonieta S de Carvalho, insight into the lives of rural people with whom and the people of Ganda. Oxfam worked, particularly into their health 1 behaviour, and use of existing health services. Laura Habgood, 1997 Introduction Angola is a country devastated by many years of based approach, for example by using parti- war. Those health and development indicators cipatory problem-definition techniques. If a that exist reveal human suffering on a scale development initiative is to grow within the nearly unparalleled world-wide,2 which cynically community which it aims to benefit, it must also mocks Angola's potential to become one of be located within the community's reality. Africa's richest nations by virtue of its vast natural Problems cannot be defined without informa- resources. As a stable future seems possible, and tion. The challenge is to develop tools (and society moves slowly from a state of conflict to experience in their use) to gather and understand one of rehabilitation and recovery, the attention rural people's vast traditional and local know- of international and local development organi- ledge, and to consider such knowledge at all sations has begun to focus on plans for inte- levels and stages of programme development. grated rural programmes. Because of insecure Health-related information too often consists conditions and difficult access, previous develop- only of formal service-providers' reports or ment initiatives have been confined to coastal official sources. The limitations of relying on and urban areas, whose population increased such sources in the municipalities of Angola's rapidly as a result of large-scale war-induced interior, where the health-care infrastructure displacement from the interior.3 The current barely functions, became evident in discussions 5 population distribution within the country is with health-service providers and in a review of unrelated to available natural resources or the written records. They revealed the lack of any basic social-service infrastructure. Moreover, coherent or meaningful system of information further population movements are anticipated as management at either community or facility people return to their places of origin. Planners level. A reliable health-information system (HIS) is a basic requirement for the planning and deve- lack experience and knowledge of rural 6 people's lives, whether settled or displaced. In lopment of health programmes and services. It addition, they lack the information necessary to is based on appropriate data-collection and data- guide programme development— although they processing methods, followed by interpretation know that the war caused high levels of rural and analysis.
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