Angolan healthcare infrastructure is outdated and in a state of severe decay. 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 acceptable facilities. In rural areas, citizens travel significant distances to receive even basic healthcare.
Quality health infrastructure is highly needed. There is a need for expanded healthcare infrastructure to provide more specialized treatments and procedures, in the fields of Cardiology and Pulmonary, Mother and Childcare, Oncology, Orthopaedics, 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. The very few existing roads cannot support the intense traffic of people and goods.
Increased coverage of 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.
For the 2022 budget, the social sector was allocated 38.1 percent of the government’s expenditure, with health receiving 10 percent of the total government expenditures. This represents an increase of 28.2 percent compared to the 2021 national budget absorption rate. While healthcare is supposed to be universal and free, healthcare in Angola is severely underfunded.
For 2022, from the overall country budget,only 9.9 percent was allocated to public health spending, short of the 15 percent minimum public financing for health stipulated by the African Union’s 2001 Abuja Declaration on the percentage of national health budgets required to address pressing health challenges in Africa.
The Ministry of State for Social Affairs is the authority overseeing the Ministry of Health and healthcare overall and 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 (WB) 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.
Policy Reforms and Restructuring
Greater collaboration between ministries in support of healthcare needs would facilitate development of protocols which couldbetter integrate healthcare projects and programs: The Ministry of Finance (disbursement), Ministry of Public Works (building of hospitals and roads), Ministry of Energy and Water (addressing water and electricity supply), Ministry of Environment (wastewater and hospital waste), Ministry of Transportation (transportation services), Ministry of Economy and Planning (coordination of interagency plans), Ministry of Defense, Ministry of Interior (plans for new healthcare facilities), and theMinister of State for Social Affairs (budget allocation including any possibleincrease for health and education), as well as Parliament (legislation, policies, human resources) and to some extent the Presidency, as the main decision maker, are all involved in decision making.
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 of 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. There is a need to better align and integrate those programs, which aim to strengthen the health system, so as to facilitate navigation of the system for providers and users of healthcare products and services.
Given the aforementioned budgetary limitations and challenges in the healthcare system, there is a need for greater private sector involvement to increase supply and address demand for higher-quality services, with one option beingthrough public-private partnerships. Private sector stakeholders have noted the need for an official government procurement portal accessible in English, where U.S. companies can find information related to business opportunities.
Private companies are encouraged to support studies, planning, execution, and management of concrete programs. 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. companiescould 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 healthcare-related imports. Increased regulation of imports is expected to commence in 2022 and 2023.