Overview
Angola’s healthcare and welfare system is inadequate to fulfil the needs of the population. It has not adapted to the growth of the population, the evolution of medicine and public health, the pace of technology and innovation, or research and development.
The healthcare sector in Angola is comprised of public and private service providers. Public hospitals serve almost 60 percent of the Angolan population, and access is free-of-charge, but the quality of care is not perceived by the public to be particularly good. Private clinics are expensive. Consequently, the best healthcare service is found abroad, and middle–to upper-income families travel abroad for complex medical interventions. Regardless of affordability, treatment at public institutions is of inconsistent quality of care and with poor customer service.
For acute diseases requiring travel abroad for treatment, the expenses associated with consultations, examinations, procedures, surgeries, hospital/clinic admission, lodging, and meals for accompanying family members, is challenging for most Angolans. Most patients would need an insurance policy for such expenses. Such insurance plans are expensive, and most of those who benefit from this insurance are limited by their employee benefit and compensation plans.
Angola’s healthcare system has a shortage of medical professionals and skilled practitioners. The insufficient number of trained nurses and technical staff are not always working in their fields of expertise. The very few physicians are limited in their capacity to do outreach to the population, compounding the challenges related to delivery of quality services. Medical societies have limited financial resources to assist in the capacity building of their members.
Nurses and doctors staged a strike in early 2022, demanding improved working conditions and more secure work environments, an increased workforce, and improved compensation and benefits. They noted that the means to accomplish their mission of saving lives is hindered by limited resources.
The Angolan healthcare sector is very centralized in the Ministry of Health (MOH). Decision making is highly concentrated with a few prominent figures, which creates barriers to opening the market, a major challenge to private companies wishing to pursue business opportunities in Angola. Feedback from some American businesspeople in the healthcare sector has suggested a lack of consistent and timely responsiveness to queries by the MOH, making it more difficult to establish a presence in Angola, which may influence decisions on whether to continue to focus on the market or invest efforts and resources in other countries where the environment is more friendly.
Healthcare availability in Angola is supposed to be universal, but even with the various stakeholders active in the sector - the Ministry of Health, the Ministry of Defense, the police (Ministry of Interior), and the private and civil society sectors, many Angolans continue to go unserved.
National Healthcare Plan
Despite the government’s initiatives, Angola’s national healthcare system is not on par with the standards of global healthcare systems. It has limitations in resources: a shortage of medical professionals and skills as described above, exacerbated by poor infrastructure, insufficient availability of medical services, and inadequate budget.
Angola has approximately 1.01 inpatient beds per 1,000 inhabitants. The World Health Organization (WHO) recommends three beds per 1,000 inhabitants, and the African Union recommends at least two beds per 1,000 people as the minimum across Sub-Saharan Africa. Angola, with its population estimated at 36 million in 2023 has approximately 14,000 physicians, or 0.3 physicians per 1,000 inhabitants, and 39,000 nurses or 1.1 per 1,000 inhabitants. There are around of 3,000 health facilities in Angola.
Angola’s 2012 – 2025 National Plan for Health Development (PNDS) outlines government priorities. These include: 1) rehabilitating and expanding public healthcare infrastructure and capacity, especially for rural and underserved urban populations, 2) expanding healthcare professional training, and 3) disease prevention.
Feedback from private sector healthcare companies suggest that an updated PNDS plan which spans Angola’s healthcare needs over a 10–20-year period would give product and service providers a clearer vision of potential market opportunities, and better address Angola’s needs. Accurate statistics and comprehensive data would allow for detailed healthcare investment forecasting, including population growth; and distribution of population by gender, age, education level, and geographical area; infrastructure needs (number of hospitals, number of beds, equipment, and medical devices); as well as financial models, logistics needs including human resources (capacity, competencies, skills) needed to execute and operationalize the plan. Additional information on the operational level would allow for proper planning and management of healthcare facilities.
Human Resource Development
Angola’s healthcare system would benefit from a restructuring of human capital to better address the country’s patient care needs. There is a need to address the understaffing of hospitals, by increasing the number of qualified personnel with the attributes, knowledge, abilities, skills, experience, education, and training to sustain and strengthen the system.
Some 2,000-3,000 additional trained healthcare providers in the workforce are needed. According to the WHO, Angola has a major gap in the number of health care professionals who are qualified and able to address the needs of the populace.
Some health practitioners leave Angola because the knowledge, experience, and skills they have acquired, often abroad, are not entirely utilized in Angola. Hence, some leave the healthcare profession. Highly trained physicians and surgeons often decide to depart the country to practice elsewhere. Others leave the public sector to work in the private sector. Understaffing at hospitals and the lack of healthcare specialties lead to medical professionals being overworked, negatively impacting their performance.
Doctors and nurses do not receive competitive salaries. Most do not have minimally adequate basic housing and living conditions, or efficient transportation services. The absence of these basic needs demotivates healthcare practitioners and negatively affects their enthusiasm in working in the sector, as well as their ability to provide quality services. Development of talent acquisition and medical professional retention plans could mitigate their dissatisfaction and inefficiencies.
Infrastructure
Angolan healthcare infrastructure is outdated and in need of replacement. The best hospitals and clinics are in Luanda, and most public and private healthcare assistance is delivered there. Other provinces and cities outside of Luanda lack modern facilities. In rural areas, citizens travel significant distances to receive basic healthcare.
Quality health infrastructure is needed. There is a need for expanded healthcare infrastructure to provide more specialized treatments and procedures, in the fields of cardiology, oncology, orthopedics, trauma, and burns.
Many healthcare facilities are decaying infrastructures and lack basic sanitary conditions, including water and electricity. They run using alternative power and water sources like generators and water tanks and lack proper treatment plants for wastewater. Angola’s rural network requires significant expansion. Remote geographical areas are not covered by roads and people are effectively excluded from basic public services.
Increased internet connectivity combined with cutting edge equipment and technology are essential for improved management of data of patients and healthcare services. Digital technology for improved information systems and data storage to upgrade service quality are critical to sustain the business of private companies and for the purpose of improved healthcare policies.
Healthcare Budget
In the 2023 budget, the social sector was allocated 23 percent of the government’s expenditure, with healthcare receiving 6.7 percent of the total government expenditures. This represents an increase of 48 percent compared to the 2022 national budget. While healthcare is supposed to be universal and free, healthcare in Angola is still underfunded.
The Ministry of State for Social Affairs (MSSA) is the authority overseeing the Ministry of Health and healthcare overall. MSSA provides input regarding budget allocation and diversification of financing sources for social projects, including healthcare and education. Apart from public financing, some funding comes from non-governmental organizations, charities, and private companies via corporate social responsibility efforts. Donations from diplomatic missions also contribute to assistance provided to local populations. Multilateral banks, primarily the World Bank and the African Development Bank (AfDB), have credit lines available to use on structural and other projects to assist local populations and relevant country initiatives.
Health Initiatives
Within the Ministry of Health, there are several major global health initiatives, including the GAVI Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) , the U.S. President’s Malaria Initiative (PMI), Polio Eradication, Stop TB, and PEPFAR. All these programs are partially (GFATM, Polio Eradication, GAVI, GFATM, Stop TB) or wholly (PMI, PEPFAR) funded by the U.S. Government to support the wellbeing of the Angolan population.
Public-Private Partnerships
More studies are needed on national health needs, including hospital planning and design, expansion plans to increase universal health coverage, workforce demands, reimbursement plans, equipment planning, operations and logistics, and clinical outcome improvements.
Support from U.S. companies could focus on programs and projects related to:
- research facilities and teaching to advance the quality of healthcare and services to the community.
- American university knowledge sharing through workshops or training.
- facilitating scholarships for healthcare professionals
- training on hospital management, and
- expertise in addressing supply chain and cold chain issues.
U.S. suppliers of healthcare products and services should also look at procurement opportunities funded by the United Nations, the African Development Bank, the World Bank, and other entities. Registering as an accredited vendor can result in tenders and leads being sent where there is a match to the vendor’s profile.
Market Entry and Registration Process for Pharmaceutical and Other Healthcare Products
The Government of Angola has replaced the National Directorate for Medicines and Equipment (DNME), formerly in charge of the healthcare supply chain system, with the Regulatory Agency for Medicines and Healthcare Technologies (ARMED), a more robust structure to respond to the challenging healthcare environment.
ARMED inherited more responsibilities, and will regulate and supervise the sector, license pharmaceuticals and health technologies for human use, ensure quality healthcare products and services are entering Angola, and guarantee healthcare safety, security, and wellbeing for all. ARMED’s main objectives are to elevate the standards, quality, and protection of public health for Angola. ARMED is responsible for monitoring the quality of imported pharmaceuticals and medical equipment, and ensures that medical devices imported into the country meet WHO norms and Angolan regulations. ARMED determines a list of essential pharmaceuticals and medicinal plants approved for human consumption.
At present, there are 13 private pharmaceutical laboratories certified to operate in the Angolan market namely: AstraZeneca, Bayer Health Care, Bial, BluePharma, Dafra Farma, Edol, GSK, Labesfal, Laboratórios Azevedos, Merck Serono, Sandoz, Sanofi, and Tecnifar. Novartis and Shalina are awaiting approval.
To import into Angola, pharmaceutical products must be registered with ARMED, submitted for laboratory tests to meet compliance to norms and standards, and be labelled in the Portuguese language. To import medical devices into Angola, the registered importer must present a Certificate of Origin, a Certificate of Free Sale, and a certificate proving compliance with ISO 9001 quality norms to ARMED.
Only resident companies can import, and they must be registered and licensed by ARMED. The licensing of distributors is governed by Presidential Decree No. 202/21 of 26 August 2021. ARMED has plans to liberalize the market to allow increased access for new entrants in the distribution, retailing, and manufacturing of medicines and equipment. The purpose is to reduce barriers to market entry and permit increased importation and local manufacturing.
Taxation and Regulations
Currently there is a VAT exemption for health care-related imports. Increased regulation of imports is expected to commence in 2023.
For information contact:
U.S. Commercial Service Angola