Angola was implementing a national program for the Integrated Management of Acute Malnutrition (IMAM). The IMAM program has had a history of challenges affecting the quality-of-service delivery leading to poor program performance. Some of the challenges include:
Furthermore, there is no systematic way of identifying, prioritizing and addressing bottlenecks to access coverage and quality of care of the IMAM program.
n addition, in May 2019, an initial bottleneck analysis (BNA) of the national Severe Acute Malnutrition (SAM) programme was conducted. Data was collected in 18 provinces during a 2-month period. Although the BNA has the potential to provide an evidence-based indication as to where the SAM programme requires reform, the analysis was not finalized due to the limited time. Therefore, the identification of the root causes and relevant solutions was not performed. Despite this, supply chain challenges were identified as a critical inhibiting factor for the SAM program.
The focus of the Tech RRT support was to finalize the May 2019 BNA analysis and to directly support the scale-up of quality Community Management of Acute Malnutrition (CMAM) services at the national level with a strong focus in the drought-affected areas, to be delivered through the health system in order to meet the increasing needs of the affected populations.
A persistent nutrition crisis caused by cyclic drought and flooding had affected the southern provinces of Angola in recent years. Notably, the 2018-19 rainy season received the lowest seasonal rainfall since the early 1980s. Delayed and erratic rains resulted in reduced crop cultivation and loss of livestock as well as diminishing the availability of water for human consumption. According to the Integrated Food Security Phase Classification (IPC) conducted in July 2019 in the provinces of Cuando Cubango, Cunene, and Huila, it was estimated that 421,127 families were acutely food insecure. The most recent Demographic and Health Survey (DHS) in 2015-2016 reported the highest prevalence of Global Acute Malnutrition (GAM) per Weight for Height (WHZ) in Cunene Province (10.5%) while somewhat lower in Huila Province (4.6%).
In order to generate more evidence and mobilize resources for increased investment in response to the impacts of drought, up-to-date and reliable data on the prevalence of acute and chronic malnutrition in the most affected provinces were needed.
Given the lack of existing expertise to implement SMART surveys in-country, UNICEF Angola requested the Tech RRT to support the implementation of two SMART surveys in the drought-affected Provinces of Huila and Cunene. On 24 November 2019, the Tech RRT Assessment Advisor was deployed to Luanda, Angola.
UNICEF Angola and WFP Angola
In 2020-2021, Southern Angola experienced one of the worst climate shocks. High temperatures due to poor rainfall and persistent drought caused severe hunger and malnutrition in many parts of the region. The central provinces of Benguela and Huambo received less than 40% of their average rainfall in the period from December to February 2021. The nutrition data from the Multiple-Indicator Cluster and Health Survey (MICS) 2015/16 showed that the prevalence of acute malnutrition in Benguela and Huambo was at 4.6% and 6.0% respectively which was likely to worsen because of drought. WFP visited the two regions and assessed that the harvest losses for corn and beans were 90-100% a serious compromise to the nutrition status of the population. Worse still, health facilities had limited human and equipment capacity to mitigate malnutrition. On the other hand, COVID- 19 further exacerbated the situation due to less purchasing power and insufficient acquisition of food on the markets.
To gather more evidence for advocacy to mitigate the impact of drought, up-to-date data was needed to capture the nutrition situation in the affected province. UNICEF and WFP requested Tech RRT support to implement SMART surveys in Angola.