MATALA, 14 May 2010 (IRIN) - After more than a decade of volunteer work in Angola's rural Matala district in the southern province of Huila, a Finnish doctor is seeing maternal mortality rates gradually come down in a country where about one in every 70 women dies in childbirth.

Since 1998 Birgitta Long has spent three months each year working as a volunteer in a run-down clinic handicapped by staff and skills shortages, and which battles to source emergency medicines, but she sees the growing queue of women coming for medical help as a step in the right direction.

The causes of maternal deaths - of which about 80 percent are preventable - range from haemorrhaging (25 percent), anaemia (13 percent) and tropical diseases like malaria (39 percent). Angola's three-decade civil war, which ended in 2002, established a routine of shunning clinics in favour of home births, but reversing this trend is seen as crucial.

When Long arrived 12 years ago, about 500 women delivered babies at the municipal clinics annually, but this has climbed to about 3,000 out of an estimated 9,000 to 10,000 births in the district each year. "It still means that more than two-thirds [of births] are taking place at home," she told IRIN.

The rehabilitation of road infrastructure by Chinese, Brazilian and Portuguese construction companies is making for a more comprehensive public transport system, and "takes the bumps out of the road", Long said, whereas before the rutted surfaces made the journey for a woman being transported with a ruptured uterus "horribly painful".

"Uterus ruptures are much more common [than fistula, when a hole develops between either the rectum and vagina or the bladder and the vagina] - women can die from it. They don't die from fistula, they just suffer."

Thin healthcare resources

Long pointed out that reproductive health in the continent's largest producer of oil remained at a low ebb. Although the need is great, a state-of-the-art, 77-bed Chinese-built hospital few kilometres from the clinic is yet to be opened, and is a bleak reminder that nurturing medical skills and personnel lags the development of health infrastructure.

Angola's oil and diamond wealth portrays it as a middle-income country with a gross domestic product (GDP) per capita of about US$4,000, but in reality 63 percent of the 18 million people survive on $1.75 or less day.

The country has one of the world's highest maternal mortality rates, life expectancy is 42 years, and 35 percent of children are chronically malnourished; it also has the dubious distinction of being the world's last stronghold of urban polio.

The hospital was scheduled to come into service in late 2009, but the access road has not been built, electricity and water supplies are not connected, and training courses for using the medical equipment have yet to begin, but the most pressing requirement is staff.

Eight Cuban doctors will work at the hospital - boosting to nine the number of doctors serving the 230,000 people in the area - but the hospital will draw heavily on the district's available staff, to the detriment of existing clinics. The hospital requires 248 personnel, including theatre nurses and laboratory technicians, but there are only 44 medical staff available in the district.

"I am very concerned with the situation - we will not be able to run the hospital adequately, as we don't have enough staff," Daniel Cambungula, the Matala municipality's director of health, told IRIN.

The hospital may be a glimpse of Angola's future and a grand gesture by one of the world's fastest growing economies - even during the oil-slump year of 2009 the national budget reached $34 billion - but donors and the government are opening up a second front for the improvement of maternal health.

A second front

At a clinic in Lubango, capital of Huila Province, Katrine Jumba, 23, waits in line for a vaccination for her second child, a three month-old boy. She told IRIN that friends had died giving birth, so she was aware of the risks associated with childbirth but, "Thank God, everything was okay. I was a little bit afraid because of the pain [of labour], but that's normal."

Because her home is near the clinic, "friends and family members who are pregnant come and stay with me [in their final months of pregnancy]. Some come from more than 100 kilometres away [to give birth at the clinic]."

The Lubango clinic is part of a strategy led by the government and supported by the UN Children's Fund (UNICEF), the World Health Organization (WHO) and the UN Population Fund (UNFPA) to revitalize the provision of basic healthcare at existing health facilities in 16 municipalities, covering 23 percent of Angola's 18 million people.

The initiative provides routine immunization, antenatal and childhood care, access to safe water, and the distribution of free insecticide-impregnated mosquito nets. One of the province's three nursing training colleges, which together produce 120 graduates each year, is adjacent to the clinic.

UNICEF's country representative, Koen Vanormelingen, described the revitalization of clinics as "leading from behind", and said the government was committed to replicating the revitalization projects in another 54 municipalities, bringing essential healthcare coverage to about 70 percent of the population.

Lubango, which was largely untouched by the civil war, was a "low-hanging fruit" for resuscitating health services said Joao Neves, of UNICEF's Huila project office, which covers the neighbouring municipalities of Matala, Kaluquembe and Caconda.

On average, Angolan women will have seven pregnancies; half of all births are by women younger than 18, and seven percent are by girls aged between 12 and 14 years, but no stigma is attached to teenage pregnancy.

Source http://www.irinnews.org/