How community-based care drives Angola’s progress against TB
March 30, 2023
Cristina João Pedro visited a clinic in Gabela, Angola because she felt weak and was having trouble conceiving a second child, which prompted her visit. The nurse saw Cristina’s condition and suspected she might have tuberculosis (TB).
Cristina had TB. She took prescribed medicines but stopped when she ran out and her cough subsided. When she settled in Waku Kungo, a nearby town, her condition worsened. Cristina consulted an herbal healer, who also suggested she had TB. With her health declining, Cristina went to the government-run hospital in Gabela.
"I went for an X-ray and when they told me I was very sick, I came home and started to cry. It was then that I realized that it is a very serious disease,” said Cristina.
TB is the world’s second deadliest infectious disease. Yet TB services remain out of reach for many people. Limited health education, inadequate health services and healthcare costs leave many patients undiagnosed and without treatment. Treatment can take several months, increasing the risk of death, spreading TB or drug resistance if not completed.
Community-based TB services are important in smaller towns like Gabela, where vulnerable people may be unable to afford travel expenses for health services further away. Photos: UNDP Angola
Angola ranks among countries with the most TB cases per year. TB remains the third leading cause of death among people aged 15-49. Health service coverage is low, especially among lower income people in rural areas, with 60% of TB services located in Luanda, the capital. In 2020, GeneXpert machines used to detect TB were diverted for COVID-19 testing, which met urgent needs during the pandemic but may have contributed to limiting TB case reporting.
But Angola is seeing progress. In 2022, the Government of Angola, UNDP and Global Fund partnership to fight TB reached 95% of its target for case reporting, a significant indication that patients are being found. Among those cases, 80% were cured of TB.
Progress meant supporting patients like Cristina, who had limited awareness of TB and felt stigmatized for her diagnosis. Through Development Aid from People to People (ADPP), a local non-governmental organization, UNDP supports community-based TB services in Kwanza Sul, where Cristina lives, and Benguela, a neighbouring province.
ADPP works closely with underserved communities to support community health workers, who educate people about TB. The health workers challenge stigma and misconceptions associated with the disease, which can delay diagnosis and disrupt treatment adherence.
They also provide patient screening, contact tracing and referrals. They live in the community and are a vital link between patients and health facilities. After diagnosis, they conduct home visits and advise caregivers and patients on effective treatment and prevention.
Patients are referred to local health facilities where they can access TB testing and free medications after being diagnosed. Photos: UNDP Angola
Back at the hospital in Gabela, Cristina received another prescription for TB medicines, which were not yet available for free. She found sustained treatment unaffordable, even with her husband’s financial support. Looking for free medicines, she returned to the hospital, where she met Josefa Pinheiro Segunda Jaime, a local community health worker.
“As soon as the medication was finished, I went back to the hospital and that's when I met Josefa, who looked at my prescription. She told me that at the hospital they now give the medicines for free and with her help it was no longer necessary for me to buy the medication,” Cristina recalled.
Community health workers deliver TB medications and conduct home visits to support patients during their treatment. Photos: UNDP Angola
Cristina was cured of TB last year. With support from Josefa, Cristina committed to daily treatment.
“We set a day for me to visit her home and I told her that I would accompany her treatment until the end. I supported her by taking medicines to her house and making constant visits,” said Josefa regarding Cristina’s case.
“I didn't have any difficulty in helping her fight the disease, because there was access to medication, she is responsible and her husband helped with everything,” she added.
Josefa strengthens Angola’s fight against TB by providing health education and tailored patient care. Her work is coordinated with Celestina de Carvalho Fortuna, who manages eight other community health workers in the Amboím area. Celestina provides training and operational support and serves as the liaison between local hospitals and the community health workers.
“The best way to deal with TB here in our municipality is through IEC, which is information, education and communication. Because if we communicate properly, we can not only prevent the individual case, but we educate the whole community,” said Celestina.
Celestina and Josefa are essential for reaching vulnerable people who might not have easily accessible TB services. Their support helps destigmatize TB and ensures coordination with community leaders and nearby health facilities to encourage TB testing and patient support after diagnosis.
Over several months, TB patients are encouraged to complete their treatment and practice prevention methods like opening windows and not sharing eating utensils. Photos: UNDP Angola
For Cristina, this tailored care proved essential after multiple attempts to complete TB treatment on her own. She credits Josefa for educating her about TB. Cristina now educates others about TB in her community.
“With Josefa’s and my husband's help I felt safer. Having two people close to me was very good. If I didn't have that support, I don't know what would become of me. Now I also help others, give them advice, explain how things are and what this disease is like. People react well when I share that information about TB,” Cristina remarked.
The Government of Angola, UNDP and the Global Fund are working to defeat HIV, TB and malaria and achieve a more equitable, healthier and sustainable future. Together, the three partners are building a stronger and more resilient health system that can withstand health challenges and provide life-saving health services in the future.
In strengthening community-based health services, this TB programme leaves lasting contributions to Angola’s efforts to promote good health and wellbeing, and related Sustainable Development Goals.
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