Healthcare system

Since 1992, the national health system has been divided into four types of services: (i) public; (ii) for profit; (iii) non-profit; and (iv) traditional. The public sector also covers the health services provided by the Angolan Armed Force and the Ministry of the Interior (MOI), and public-owned companies such as Endiama and Sonangol among others. Community Development and Health Agents or ADECOs depend on the Ministry of Territorial Administration and not the MoH. The private sector, under the supervision of the General Health Inspection Department, is concentrated in urban and peri-urban areas where the public health service network is limited or non-existent. The traditional sector is unregulated. However, the MOH plays a prominent role in the definition and implementation of health sector policy and in the promotion and execution of the Government health programmes, which aim to achieve universal health coverage (UHC) by 2025. [3] 

The healthcare system in Angola consists of three levels: [3] 

  • Level 1: 1,650 Health Posts; 331 Health Centres; 43 Maternal and Child Health Centres; 165 Municipal Hospitals; 83 general healthcare facilities 
  • Level 2: 25 General Provincial Hospitals 
  • Level 3: 20 Central and Speciality Hospitals  

According to the MOH 2016 diagnostics for health sector improvement, the main challenges are: [3] 

  • Insufficient health service coverage and quality of care; 
  • Weak referral and counter-referral systems between the three levels of the national health service; 
  • Insufficient human resources for health (HRH) in terms of quantity, quality and distribution; 
  • Weaknesses in health management systems, including the health management and logistics management information systems (HMIS and LMIS); and in communication systems; 
  • Insufficient financing and inadequacy of financing models; and 

Weak collaboration within the public health sector and with the other sectors providing health services. For example, with regard to the private sector, Angola does not have reliable information on the use of private healthcare facilities. Since 99.9% of private healthcare facilities are located in Luanda, it is likely that the majority of the population in Benguela or Cuanza Sul would use public healthcare facilities. Although Benguela has more private healthcare facilities than Cuanza Sul, these are mainly located in urban settings; and the majority of the population in these provinces live in rural settings. 

Human Resources for Health 

With 4,165 physicians and 33,043 nurses for a population of over 30 million in 2019, Angola has 1.38 medical doctors and 10.95 nurses per 10,000 inhabitants.[3] In addition to the insufficient number of health professionals at all levels, the national health system is characterised by an unequal distribution of available human resources for health (HRH) across all services and levels. The imbalance between HRH requirements and HRH available at each tier of the health system remains a huge challenge. There is a dearth of health professionals trained in health sciences such as public health, epidemiology, statistics, disease programme management, pharmacy, logistics and health information technology (IT). 

In public sector healthcare facilities, morale is generally poor due to the low remuneration and limited career development prospects. Poor training and lack of motivation also affect the quality of patient care in the public sector. These factors also affect staff compliance with MOH regulations, guidelines, protocols and data reporting requirements; and performance management systems are not enforced in a systematic manner. Angola does not have data on informal payments into the national health system. 

Malaria supply chain in Angola 

 Angola’s National Plan for Health 2012–2025 (Plano Nacional de Desenvolvimento Sanitário – PNDS 2012–2025) highlighted the lack of a comprehensive and strategic supply chain plan as a key challenge to access pharmaceuticals in Angola.  

The Angolan Ministry of Health (MOH) drafted a National Supply Chain Strategy in 2016 that is meant to serve as the principal guiding document for better planning and the effective alignment of financial, technological, and human resources to improve the overall performance of health commodity supply chains, including that of malaria, in Angola. 

The National Malaria Control Programme (NMCP) has aligned its interventions with the current existing draft of National Supply Chain Strategy, and is leading and participating in activities such as: 

  • Elaborating the national commodity procurement and distribution plans. 
  • Strengthening the joint planning and coordination of all actors throughout the supply chain. 
  • Improving the use of antimalarial consumption data to accurately determine future commodity needs for each service delivery point, municipality, province and the central level. 
  • Generating timely and accurate data to be used for supply chain decision-making. 
  • Improving storage conditions for pharmaceutical products. 

In conjunction with the Direcção Nacional de Medicamentos e Equipamentos (DNME), developing a drug registration, approval, rational use, and quality control system, as well as a surveillance drug network to monitor adverse effects. 

The President’s Malaria Initiative (PMI) has highlighted challenges in its focus provinces that have slowed implementation of effective malaria supply chain management: 

  • Delays and non-initiation of antimalarial commodity procurements made by the Government of Angola, portions of which were intended to be used in PMI-focus provinces, which affected the stock levels of some products. 
  • Delays in conducting real-time inventory at the end of each month at the National Warehouse and Procurement Agency (CECOMA) and delays in the submission of monthly provincial malaria reports constrained stakeholders in their respective planning due to the unavailability of timely logistics data. Additionally, even when logistics data are available, due to staffing constraints at the central level, there is generally more focus on completeness and accuracy than on deeper analysis of this data for use in decision-making. 
  • Delays in information sharing and inadequate coordination of antimalarial commodity procurements between MOH and partners. 
  • Regular changes of technicians from municipal warehouses trained in the management of pharmaceutical product tools in most municipalities in the six PMI-focus provinces were observed during the supervisions. 
  • COVID-19 had an impact on international commodity delivery timeliness and in-country logistics. 
  • Inadequate use of quantification exercise outputs to inform supply planning requirements by MOH and partners. 
  • Lack of follow through with action points from analyzed stock data from the monthly stock status report at central level to accelerate decision-making. 
  • Limited involvement of GEPE (MOH Procurement Department) with the malaria quantification increases the effort needed to advocate at other levels of government for the GRA-funded procurement needs of antimalarial products.