Angola

History of leprosy in Angola

During the fifteenth to eighteenth centuries leprosy spread through Africa downwards from the East.

Christian missionaries opened Angola’s leprosy colonies towards the end of Portuguese colonial rule. For example Dondi leprosarium in Huambo province was started in 1940 and in 1946 a leprosarium was established in Jamba in Benguela province. 

The Serviço de Combate à Lepra (Leprosy Combat Service) was started in 1958 by the Government of Angola, comprised of leprosaria and leprosy settlements where people affected by leprosy were living. Some of these were being cared for by the Evangelical and Catholic Missions, but their technical supervision passed to the government program. In the same year the Angolan Government opened its first Government leprosarium in Cazombo in the province of Moxico. 

15,280 cases of leprosy were recorded in 1973 in a total of 20 leprosy villages. Dapsone monotherapy was the only treatment.

The Portuguese left Angola in 1974 when three main parties agreed to establish a transitional government, however civil war soon broke out. This caused wide scale destruction of the health network, the deterioration of socio-economic structures and huge movements of the population which undermined capacities to detect and treat diseases such as leprosy. Churches continued to play a vital role in the provision of leprosy services during the civil war – ILEP Members AIFO and ALM were providing leprosy care through their health institutions and programmes in ten church-related projects.

Up until 1975 people affected by leprosy were seen in fixed Health Units and visited by Mobile Brigades.

In 1983 the National Leprosy and Tuberculosis Control Program was created. 

The National Program (PCNL) began to implement multi-drug therapy in 1994 in a few provinces and was available in all provinces by 1998.

Migration to larger cities such as Huila, Luanda and Benguela from 1997 meant that they became the focus for leprosy control activities and contained 40% of known leprosy cases in the country.

In 1998 the Nucleo Consultivo da Lepra was established from representatives of the Ministry of Health, the Leprosy Program, a representative from the Ministry of Social Affairs, and representatives of interested churches and non-governmental organisations. A couple of years later the Nucleo Consultivo invited membership from members of the World Health Organization and non-governmental organisations with an interest in prevention of disabilities.

The leprosy situation was unknown in half of the municipalities of Angola in 2000.

By 2001 a plan to intensify anti-leprosy activities was adopted and leprosy control work had been integrated with tuberculosis programs in several areas. In remoter areas military staff were helping with the diagnosis and treatment of leprosy.

In April 2002 a peace agreement was signed ending the civil war. In that year India, Brazil, Nepal, Mozambique, Madagascar and Angola accounted for 90% of leprosy cases around the globe. Rebuilding and reconstruction began.

During that year, 80% of government health workers at the municipal health centres were trained in tuberculosis and leprosy.

The main strategies of the National Leprosy Control Program for the period 2003-2005 were to:

• facilitate the ownership of all areas of the program by the Government through integration of leprosy services into Primary Health Care (PHC);
• make the staff of Health Units responsible for the care of all patients, not only those with leprosy;
• transform leprosaria into health units for general care; and
• create a network of all partners working towards realisation of the National Program.  

A report of the Angolan Ministry of Health in 2004 reported that multi-drug therapy was available at 85% of its health centres. Prevention of disability services were being integrated with drug provision.

Angola reached less than one case of leprosy per 10,000 inhabitants by the end of 2005, although pockets of high endemicity remained such as in Bengo, Kuando, Kubango, Kuanza Sul, Lunda Sul, Moxico and Uíge. The technical knowledge of health workers remained low and negative stigma of leprosy persisted in some communities.

In 2006 the Ministry of Health stated its wish to continue reducing the number of cases of leprosy in Angola by working with its national and international partners.

Today anti-leprosy work in Luanda is integrated into the general health service, but in the provinces there are still some vertical staff at some health centres who deal only with people affected by leprosy.