Minimum Health and Nutrition Care Package
(MH&NCP)
For the Newly Accessible Populations
Ministry of Health - Angola
Emergency and Humanitarian Action
WORLD HEALTH ORGANIZATION
UNICEF
UNFPA
ANGOLA
June 2002
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1-Problem addressed
With recent peace events in the country, the populations encounter themselves in the
post-conflict gap between the end of the hostilities and the beginning of reconstruction.
The total number of vulnerable population is estimated in around 2,000,000, and is
consisting of four main groups.
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IDPs prior to January 2002, around four million;
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Newly accessible populations, around 2 million people, many on the move
coming out from the bush; many of them trying to access provincial towns; and
refugees spontaneously returning from neighboring countries. The number is
expected to grow due to increased access and freedom of movement;
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800,000 in the newly accessible areas have been found in critical need;
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80.000 soldiers and their family members, expected 220,000 people, in
‘quartering areas’, established under the auspices of the 4 April 2002
Memorandum of Understanding, currently spread in 39 locations around the
country
Based on recent assessments, most newly accessible population is in appalling or critical
condition and requires emergency life-saving assistance and longer-term support in health
and nutrition sector.
2- Objective
o 1st PHASE (6 months): To stabilize the population of the newly accessible areas
and QFAs by reducing morbidity and mortality due to malnutrition and
communicable diseases.
o 2ndPHASE (7-18 months): To improve the health system in order to provide
diagnosis, treatment and epidemiological surveillance related to all the most
prevalent communicable diseases and malnutrition of populations in the newly
accessible areas.
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3-Strategy
The humanitarian assistance in health and nutrition sector will be carried out through the
provision of a “Minimum Health and Nutrition Care Package” (MH&NCP) to the
targeted populations.
4- Targeted beneficiaries
All the vulnerable identified population in newly accessible areas and quartering family
areas. Around two million is the estimated population.
5- Components of the “Minimum Health and Nutrition Care Package
1st PHASE (6 months):
1-
Immunization:
o Against Polio for all children under 5;
o Measles for all children from 6 months to 15 years; and
o Tetanus Toxoid for all pregnant and in fertile age women.
2-
Common diseases surveillance and treatment for:
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3-
Malaria;
Acute Respiratory Infections (ARI)
Acute Diarrhea Diseases (ADD)
Scabies.
Malaria prophylaxis of all pregnant women.
Anemia prophylaxis with Ferrous and Folic Acid to all pregnant women.
HIV/AIDS/STIs:
o Condoms, together with educational activities for their distribution and use.
o Health Education on prevention of HIV/AIDS and STIs.
o Screening and syndromic case management of STIs.
4-
Nutrition:
o Screening nutritional in children under 5 years.
o Supplementary feeding to malnourished under-5 children and for pregnant and
lactating women.
o Referral of children in need to the reference Therapeutic Feeding Center
o Vit A to children from 6 to 59 months
o Iodized salt distribution ensured
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5-
Deworming:
o Albendazol 400 mg or, alternatively, Mebendazol 500 mg, unique doses, in
children up to 15 years it will be provided together with measles vaccination.
6-
Trypanosomiasis:
o Screening of Trypanosomiasis cases, in the 8 endemic provinces, using a
syndromic case management and referral for lab confirmation and treatment to the
provincial capital towns.
7-
Registration of all health providers from the previously held UNITA areas
o Organization of health providers concerning the provision of the minimum
package and their re-insertion in the national health system.
8-
Referral of severe cases to a higher level:
o Medical evacuation of the severe cases that need to be referred at a more complex
level.
2nd PHASE: In addition to the components of the first phase, in the period from 7th
month to 18th month the following components will be added:
1. Vaccination of all other vaccine-preventable diseases (BCG, DPT, Yellow fever, etc),
where possible through routine immunization.
2. Trypanosomiasis:
o Screening of Trypanosomiasis cases, in the 8 endemic provinces, using a syndromic
case management and referral for lab confirmation and treatment to the provincial
capital towns.
3. Traditional Birth Attendances (TBAs):
o Registration of all TBAs available in the different identified areas.
o Training of the TBAs.
o Provision of the clean delivery package to the trained TBAs
4. Tuberculosis and Lepra:
o Screening of TB and Lepra cases using a syndromic approach and referral for
diagnosis and treatment to the nearest health center.
5. IEC on HIV/AIDS and STIs
6. Provision of Impregnated Mosquito Nets and Tse-Tse Traps for the Fight against
Vectors’ diseases
7. Referral operations:
o Identification of the reference health unit where treatment (drugs and medical
supplies) is available.
o Medical evacuation of the cases that cannot be treated.
o Ensure the transportation of the evacuated patients.
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6- SUPPLIES.
In order to implement the above-mentioned activities, a kit of medical supplies –
Minimum Essential Drug Package, designed for 10,000 inhabitants during 3 months – is
going to be provided through mobile teams and fix posts.
The kit comprises of the following items:
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Chloroquine phosphate 150 mg base
2 boxes x 1,000 tablets
Co-trimoxazole 400 mg+80 mg scored
2 boxes x 1,000 tablets
Ferrous Sulphate 200 mg/folic acid 0,25 mg
2 boxes x 1,000 tablets
Mebendazol 100 mg
2 boxes x 500 tablets
Albendazol 400 mg
10 boxes x 500 tablets
Oral Rehydration salts for 1000 ml water
2 boxes x 100 SAC
Paracetamol 100 and 500 mg
1 box x 1,000 tablets
Sulphadoxine/pyrimethamin 500 mg/25 mg
3 boxes x 100 tablets
Benzathine Benzyl-penicillin 2,4 units 1 dose
2 boxes x 50 VLS
Erythromycin 500 mg tablets
2 boxes x 1,000 tablets
Doxycycline 100 mg tablets
2 boxes x 1,000 tablets
Amoxicillin 500 mg tablets
3 boxes x 1,000 tablets
Benzyl Benzoate lotion 25 % application
100 bottles x 1 lts.
Pvp iodine 10 % solution
10 bottles x 200 ml.
Vit A 200,000 iu (retinol)
4 boxes x 1,000 CAP
Metronidazole 250 mg tablets
2 boxes x 1,000 tablets
Condoms (120 gross)
3 boxes x 7,200 units
Thermometers
10 units
Syringes of 2, 5 and 10 ml with corresponding needles
500 units
7-OPERAZIONALIZATION:
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A national Task Force at the National Institute of Public Health, MoH will be
constitute with two main tasks:
1.
Organize and update a data base on the newly accessible areas and the FQAs
with will collect and consolidate information on integrated surveillance, logistics,
availability of human and material resources, movement of the population and operations
related to the medical supplies (all information will be coordinated with FAAs and fed
into the National Surveillance Center of MoH based at the National Institute of Public
Health).
2.
Assist the Provincial “health task forces” in planning, supervision including
monitoring, of the implementation of the MH&NCP in the newly accessible areas and in
the Family Quartering Areas (FQAs), taking into account resources existing at the
provincial level including local and international NGOs.
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The national based task force will be composed by the Ministry of Health (1 General
Coordinator of the task force, 1 Emergency Coordinator; 1 Epidemiological Surveillance
Coordinator; 1 Nutrition Coordinator and 1 PAV Coordinator); and the Health Services
of the Angolan Armed Forces (2 Medical Officers); WHO (2 International staff; 2
National Officers); UNICEF (1 National staff), UNFPA (1 Officer) and OCHA (1
Officer).
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At the provincial level, task forces for the medical provision are already carrying
out assessment, planning, implementation and monitoring medical assistance in the newly
accessible areas and QFAs.
The main strategies adopted in the provision of the MH&NCP will be:
1- Fixed Health Posts and
2- Mobile Health Teams.
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A crosscutting issue to be implemented for all items included in the “MH&NCP”
is capacity building at the provincial and national level, especially targeting the health
providers from the previously UNITA held areas.
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The Kits’ transport to the provincial capital is to be organized through WFP, the
Ministry of Administration and Territory, or Private flight.
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In the provinces, the kits will be temporally stored at WFP, UNICEF or Health
Delegation’s warehouses, until be transferred either to the new areas previously under
UNITA, or the QFAs.
In order to implement the same basic supplies, the health kits have been harmonized
between MINSA, UNICEF and WHO.
In addition to “10 Kits MINSA-UNICEF” or “1 New Emergency Health Kit” (NEHK-98
WHO-boxes 1 to 13), the following medicaments and medical supplies are going to be
procured in order to use the same instruments for 10,000 populations during 3 months:
» Albendazol 400 mg 10 boxes x 500 tablets.
» Sulphadoxine/pyrimethamin 500mg/25mg (Fansidar) 3 boxes x 100 tablets
» Amoxicillin 500 mg 3 boxes x 1,000 tablets
» Vit A 200,000 iu (retinol) 4 boxes x 1000 CAP
» Thermometers 10 units
» Condoms 3 pack of 7,200 each
» 1 SUB KIT 5 (STIs drugs)(UNFPA sub Kit from the Reproductive Health Kit)
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Implementation’ Strategy
» Establish an operational health post in each newly accessible population and QFAs with
capacity to manage the “MH&NCP”.
» Identify and possibly recruit four- (4) health basic technician in each mentioned health
post and train them in the “MH&NCP “ management. The Health Provincial Delegation
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(MINSA) will carry out this task, the FAA’s health personnel with assistance from WHO,
UNICEF, and/or NGOs working in the identified area.
» Identify and recruit health personnel and constitute mobile health teams when fix posts
are not available and logistics allow quick movement from the provincial capital town to
the new or QFA areas and vice versa.
» Identify and recruit, among the population, volunteers to work like health promoters for
Health Education within the community.
In Newly accessible and QFA areas, Registration and Health and Nutrition Rapid
Assessment will be carried out during Phase 1.
8- COST IMPLICATIONS (Only related to Phase 1 - approximately 6 months since
May 2002)
8.1 Summary of cost for supplementary feeding programmes for 24,000 beneficiaries and
provision of therapeutic feeding for 6,000 children.
Supplementary feeding programmes
Partial
Setting up of 20 Supplementary Feeding Centres (SFC)
178,324
Running Cost of 20 SFCs for 6 months
456,400
Training of 45 Staff
Total Cost USD
65,400
Staff for SFCs for 6 months
186,000
Breastfeeding Promotion
41,800
Monitoring and Evaluation
34,200
Total
962,124
Support for therapeutic feeding
Therapeutic food for 6,000 malnourished children
196,644
Running material for 6,000 malnourished children
42,588
Equipment for 6 TFCs
21,707
Total
260,939
Grand Total USD
1,223,063
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8.2 Summary of cost for the Health Sector for 2,000,000 populations in the first phase (6
months)
USD
Minimum essential drugs package
1,600,000
Internal transport, storage and handling
185,800
Training on Management of the MH&NCP through the country
352,000
Training of Traditional Birth Attendants (TBA)
130,000
Training of local health worker for the new accessible areas
152,000
Transportation and trainers’ per diem
96,000
Emergency IEC
120,000
National Task Force
2 International staff x 6 months USD 150,000
3 national staff x 6 months……….USD 45,000
3 consultants part time x 3 months USD 45,000
Equipment for national task for….USD 80,000
Supervision and monitoring field .USD 36,000
Secretary and driver………………USD 15,000
392,000
Toyota Land Cruiser’ car…………USD 21,000
Provincial Task Force
Supervision and Movil Team…… USD 45,000
Provincial transportation………... USD 90,000
135,000
Total
3,162,800
Total Nutrition Component – Phase 1 (6 months)
1,223,063 USD
Total Medical Component – Phase 1 (6 months)
3,162,800 USD
Total Costs of Health & Nutrition components in
4,385,863 USD
PSC Costs (6 per cent) ……………………….…:
263,151 USD
TOTAL MN&HCP PROJET COSTS………… 4,649,014
Note: At present, available resources covered by the implementing entities comprise of:
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MINSA: 600 kits for health post; UNFPA: 35 kits of STD drugs (sub kit 5)
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UNICEF: 400 kits for health center and 200 kits for health post
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WHO: WHO: 10 kits NEHK-98; 1 International Consultant and 1 National Consultant
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