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 cater to almost 60percent of the Angolan population, and access is free-of-charge but the quality of care is not perceived by the general public to be particularly good. Private clinics are overpriced, and for those who can afford private clinics, they still experience the need for improved infrastructure and services. Consequently, the best healthcare service is found abroad, and middle– to upper-income families choose to travel abroad, especially for complex medical interventions. Regardless of affordability, treatment at public institutions is generally perceived to be highly discouraging, with a reputation for inconsistent quality of care and poor customer service.
Practically speaking, for acute diseases, with travel abroad usually necessary, coverage of expenses associated with consultations, examinations, procedures, surgeries, hospital/clinic admission, and lodging and meals for accompanying family members is challenging. 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 challengess 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 and 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 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. Closer inter-ministerial collaboration in the healthcare process is needed to ensure effective governance. All programs and funding within the umbrella of the Ministry of Health should be aligned to facilitate dialogue between procuring agencies, and to guarantee good performance in the implementation of programs. Furthermore, Angola’s healthcare system requires policy reforms and ideally, restructuring leading to harmonized standards for cross-border and regional cooperation.
National Healthcare Plan
Despite the government;s initiatives, Angola’s welfare system is far from being on par with the standards of western 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 major limits in the budget allocated.
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 32,097,671 in 2021 has approximately 5,610 physicians, or 0.17 physicians per 1,000 inhabitants, and 1.3 nurses per 1,000 inhabitants. There are a total of 3,163 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 current 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. Careful planning utilizing data detailing workforce needs, including mapping, and sourcing of contractors and service providers would all be useful. Well-conceived strategic and operational plans will be critical to achieve improvements in Angola’s healthcare system.
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 healthcare providers in the workforce with improved knowledge 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.
A national plan with incentives for scholarships, to train additional doctors, surgeons, technical staff, assistants, nurses, and midwives,could guarantee the quantity, quality and specializations of the workforce, and would be very impactful. The new university hospital being built in Angola is an opportunity to improve knowledge, train trainers to disseminate skills, and reduce the learning curve of healthcare providers.
Some health practitioners leave Angola because the skills they have acquired are not utilized. The knowledge and experience acquired abroad are not entirely exploited. Hence, some pursue other careers, and the highly trained, especially physicians and surgeons with specializations, decide to depart the country to practice. 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 adequate 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 provide the basis mitigate at least a portion of their dissatisfaction and inefficiencies.