Primary Health Care Programme

The major thrust of the Health Programme is three-fold: (1) increase vaccination coverage rates; (2) promote health care at district and community level through the Bamako Initiative; (3) build capacities at national, district and community levels. In reproductive health, UNICEF plays a complimentary role to UNFPA. UNICEF is a member of the thematic group UNAIDS, which undertakes joint programming in the fight against HIV/AIDS. Following completion of the household survey on micronutrient deficiencies, UNICEF has resumed its support to the Ministry of Health with Vitamin A supplements, benefiting children under five and women at the post-natal stage.

Capacity building is an important component of the Programme. In 2000, training was provided to health authorities and youth in the areas of immunisation management, HIV/AIDS and breast-feeding.

Immunization is the oldest component. The programme is implemented through a combination of fixed (hospitals, health centers) and mobile services. UNICEF and WHO have long supported the mobile vaccination team with vaccines, cold chain and other logistical support. A national vaccination survey commissioned by the Ministry of Health in 1998, UNICEF and WHO showed show slightly dropping coverage rates for most antigens, with measles coverage dropping to 59 %. However, most coverage rates still compare very favorably with other sub-Saharan countries. In 1999, an accelerated measles campaign was carried out by the health authorities supported by WHO, UNICEF, UNFPA and UNDP, immunizing over 90 % of children between 9 months and 14 years old. This year, UNICEF and Who will again support a new vaccination coverage survey. In 2000, UNICEF continued to procure vaccines, immunization materials and equipment for a total of $ 38,000. Another important development is the participation of the Health Sector in the Global Alliance for Vaccines and Immunization (GAVI), an initiative by WHO and UNICEF, with an initial funding of $ 750 million by the Bill and Melinda Gates Foundation. Several donor governments have expressed interest in participating. GAVI is an opportunity to reinforce the immunization programme through the introduction of new vaccines such as Hepatitis B.

Presently, the Ministry is elaborating a medium term Plan of Action. The Ministry has actively endorsed Roll Back Malaria. Meanwhile, the United States, Taiwan and Portugal have sent technical teams to assess the malaria situation. In September, these teams will link with the other donors, including UNICEF and WHO, in order to establish a concerted plan of action.

The Bamako Initiative is now a well-accepted approach to primary health care. The strategy aims to involve communities in managing their own primary health care based on a cost recovery scheme. UNICEF continued to focus its efforts on the district of Lemba, supporting the construcution of six health posts. In addition, Nuova Fronteira has activities in water, environmental sanitation and education in several communities of that district. Zatona/Adil is UNICEF´s partner in training local health committees and in general, in the promotion of a better understanding and acceptance of the strategy by the communities. In the districts of Agua Grande, Cantagalo and the island of Principe, BI is being applied on a pilot basis.

Some constraints to be overcome in BI are: weak financial management on the part of health committees, poor pay of health workers and irrational use of drugs.

In reproductive health, UNICEF completed its support to the central maternity with the procurement of materials. Traditional birth attendants were provided with kits. The challenge is to link reproductive health to the Bamako Initiative and integrated child disease management. A technical WHO mission came to prepare the terms of reference for a comprehensive evaluation of the National Reproductive Health Programme, in which UNICEF will be a full partner.

At present, the National Institute for Statistics and UNICEF are conducting a Multiple Indicator Cluster Survey at household level. The Survey is mostly directed to health indicators. Its results will be published at the end of December and its data will serve as input to the End of Decade Review by the Secretary General in September 2001. The Survey is expected to contribute substantially to national social planning. The findings are certain to be reinforced by the upcoming Census in 2001.

Most HIV/AIDS interventions are channeled through the United Nations theme group UNAIDS. UNAIDS has established a technical group, which plays an advisory role to the Heads of Agencies. In 1999, UNICEF supported the Programa Nacional de Luta contra SIDA with the realisation of radio programming and screening of films at schools. The UN agencies have commissioned a survey on HIV/AIDS prevalence, to begin in September 2000. The results of the survey will form the basis of a national plan of action.

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