Un-Stuck in the Mud

Angola distributes anti-malaria supplies despite challenging terrain

Octávio Longuenza is not one to shy away from tough jobs. He spends up to three months living and working underground in the diamond mines in Angola’s Lunda-sul Province, followed by three months aboveground working other jobs, including as a driver to deliver malaria supplies to communities in Lunda-sul. Octávio’s willingness to get his hands dirty is a welcome trait when it comes to driving delivery trucks around Angola during the rainy malaria season.

In the 16 years since Angola became one of the first U.S. President's Malaria Initiative's (PMI) partner countries, malaria deaths have and the incidence of malaria cases has decreased by 25%. However, challenges remain. In 2019, nearly 24 percent (7 million) of Angolans contracted malaria and 13.6 thousand died from this preventable and curable disease. In Lunda-sul Province, Octávio’s home on the country’s eastern border, each fall when the rainy season begins, the standing water leads to spikes in malaria cases and the roads throughout the province become a muddy mess.

In February 2021, heavy rains in Malanje and Lunda-sul provinces in Angola left many health facilities cut off from the provincial warehouses, right in the middle of malaria season, leaving them low on supplies. Many of the provinces’ facilities are in remote areas and don’t have the infrastructure to store malaria test kits, medicines, or long-lasting insecticide-treated nets (LLINS) for longer than two to three months.

Under the coordination of the Provincial Malaria Control Program (PMCP), with funding from PMI and in collaboration with the Municipal Directorates of Health, the USAID Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM) project developed a plan to deliver the products.

The project first assessed which roads were washed out and which remained accessible and ensured they had vehicles equipped with four-wheel drive and knowledgeable drivers to navigate what would certainly be bumpy, muddy terrain. Having worked with Octávio in the past, the project knew his dynamic personality and collaborative nature would make him the perfect person for this rainy-day job.

Well-equipped pick-up trucks set out from the provincial warehouses determined to deliver the malaria supplies to the health facilities within 10 days. The trucks carried waterproof tarps for rainy driving, supplies to release the trucks from the mud if they got stuck, and food and water for the drivers as they traveled over long stretches of back roads. Octávio and his fellow drivers would be navigating roads with muddy potholes the size of small ponds, occasionally making the trucks bounce so hard the riders’ teeth would chatter.

Even before their first delivery, the Lunda-sul pick-up truck could no longer resist the suction of the sticky red mud. Thankfully, the delivery team had anticipated this. Octávio and GHSC-PSM Malaria Technical Advisor Paulino Mbundo jumped into action. Barefoot to avoid losing their shoes, the pair dug a path in front of each wheel, then laid wooden planks to help the truck regain traction. Three hours later, they were finally on their way again.

I am happy to know that patients are able to go to their consultation and have treatment for free. Muddy roads, holes everywhere and rain does not matter. We all have a sense of happiness to see our duty accomplished, which is saving lives.”
 Délcio Alberto Fernando Serafim
GHSC-PSM, Provincial Malaria Supply Chain Advisor, Malanje

Deliveries to the next 16 health facilities in Lunda-sul continued to face expected weather delays. When Octávio and Paulino arrived at empty health facilities that had closed for the day, they knew they would be spending the night in the nearest town, watching over their precious cargo. Because many of the health facilities are in regions that aren’t connected to telephone lines and health technicians don’t often carry cell phones due to poor signals, the delivery teams couldn’t always contact the health technicians in advance. They would simply show up to try again the next day. Despite these delays, the team finally completed their deliveries fourteen days after they’d set out. The Malanje delivery team faced similar roadblocks. Ten days after starting out, they had completed their trip.

Despite long days driving over rough roads, manual labor to keep the trucks on solid ground, and frequent rescheduling with health staff, Octávio and the rest of the delivery teams distributed all the malaria rapid diagnostic tests (mRDTs), anti-malarial medicines, and LLINs to 32 of 36 health facilities in Malanje Province and 45 of 59 health facilities in Lunda-sul Province, improving the availability of antimalarial supplies and ensuring patients receive the care they need. Although the eighteen remaining facilities in these provinces remained inaccessible, GHSC-PSM coordinated additional deliveries a few weeks later to guarantee the availability of malaria commodities at these health facilities.