Angola: Health Care in a War-Torn Country

BY VINCENT TRAN

Along the Atlantic coast of Sub-Saharan Africa lies Angola, a country attempting to recover from decades of war and turmoil. Widespread tropical diseases, poor health care, and inadequate education all contribute to a startling life expectancy of fifty-two years, one of the lowest in the world.1 Compared to the US life expectancy of seventy-nine, the difference in quality of life is apparent. Angola’s struggle to rebuild its health care system is due in part to its deeply impoverished population, but largely is a result of its turbulent history.

From 1961 to 1974, Angolan nationalist parties fought against Portugal’s centuries-long colonial rule in a war for independence. After the war, these same parties struggled for power. This Guerilla warfare conflict was exacerbated by ethnic fissions, and was largely funded by illegal “blood diamonds.” Various factions also received support from foreign powers. The main conflict occurred between the Soviet Union-supported “Popular Movement for the Liberation of Angola” (MPLA) government and the United States-supported “National Union for the Total Independence of Angola” (UNITA) opposition. This long conflict, which was fueled by Cold War hostilities, lasted for 27 more years and finally ended in 2002 when both nationalist parties signed a peace agreement. However, decades of war had left Angola in ruin; over 500,000 people were killed and a third of its population was displaced.2

Like much of Sub-Saharan Africa, Angola was home to numerous tropical diseases, and the country’s war-torn infrastructure was poorly equipped to provide quality health care to its constituents. Approximately 65 percent of medical facilities were destroyed; considering that a higher concentration of damage occurred in rural areas, this damage resulted in drastically limited access to healthcare.3 The uneven distribution of healthcare coverage has resulted in a severe inequities in quality of life, especially among children. Children in rural areas are much more affected by malnutrition and lack of immunization than those living in urban areas. This disparity is even more apparent in children who live in areas that were seriously affected by conflict.4 For example, Luanda, the capital city, is a rapidly developing urban center and port at the forefront of Angola’s oil and mineral industries. On the other hand, cities such as Lubango have much higher incidences of tropical diseases and infant mortality. Now, cities like Lubango are beginning to receive more attention from international organizations to address these challenges. Despite this aid, however, regional inequities persist and there is a great demand for hospitals and clinics in rural areas.

Another key issue in Angola’s health care system is the lack of trained healthcare professionals. During the Angolan Civil War, many child soldiers were used for guerilla warfare. Forcefully recruited at an early age, these children did not receive any education during the war. Many of the soldiers who were lucky to survive did return home after years of fighting, but they lacked the skills and education needed to pursue careers. Nearly an entire generation’s capacity to contribute positively to society was lost, a loss that disproportionately damaged the healthcare system. This “Lost Generation” found itself relying heavily on international organizations for medical care immediately following the war; the strikingly low supply of trained professionals meant few healthcare facilities were well equipped to handle the need.

Despite its weak infrastructure, Angola is one of the countries with the most natural resources in Sub-Saharan Africa. Capitalizing on these resources, which include enormous reserves of oil, natural gas, and minerals, has been a high priority for the Angolan government over the past several years. While this goal is laudable, it means that only a small proportion of the national budget is dedicated to the provision of public health services. However, Angola’s economic growth has actually been a key factor in the improvement of healthcare. Because many foreign oil and natural gas companies build facilities inside the country, they often provide health services and facilities for their employees. Many Angolans benefit from these private company provisions. This is one example of how foreign influence may benefit more than just Angola’s economy in the long-term. Yet, because Angola is able to depend on these companies and international organizations for healthcare provision, the government has not emphasized rebuilding its national health care system – this is unsustainable. Federal total health expenditure in 2012 was only 3.5 percent of gross domestic product (GDP), compared to the United States’ expenditure of 17.9 percent of GDP.5 Further, corruption and the capture of federal funds for private gain are prevalent in Angola – this hinders the efficacy of the already small budgetary allocation for healthcare.

Today, the state of Angola’s health care is noticeably improved. In the past several years, the government has opened five universities, forty-five health worker training schools, and several clinics. For now, foreign intervention aids the country with service packages that include mosquito nets, vaccinations, and other necessities.6 In Angolan national clinics where UNICEF staff distribute service packages, significant health improvements have been observed. Specifically, Cuba has emerged as an especially effective partner in healthcare improvements. A strong partner of Angola since the Angolan Civil War, Cuba recently sent 800 doctors to the Sub-Saharan African nation. Also, a significant number of Angolan doctors receive medical training in Cuba. Thanks to more widely available education and training opportunities, the number of doctors in Angola is now approximately 3,000; triple 2005 levels.7

Yet, despite these advancements, Angola still struggles to rebuild its health care system. The end of the civil war was relatively recent, and its effects are still very visible in society. Even in comparison to wars in other Sub-Saharan African countries, the Angolan Civil War was devastating. The road to recovery has been understandably slow, and unfortunately a large portion of the country has not observed improvements in its healthcare in over a decade. However, despite the enduring effects of civil war, Angola has substantial resources and a rapidly developing economic structure that is on the path toward a modern healthcare system and improved quality of life for all. The past few years of progress have shown that readily available access to quality health care in Angola is not too far in the future.

Vincent Tran is a sophomore at the University of Texas at Dallas majoring in Biochemistry. He can be contacted at triet.tran@utdallas.edu.

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References

1. Human Development Report: Angola. (n.d.). United Nations Development Program. Retrieved from http://hdr.undp.org/en/countries/profiles/AGO.
2. “The Angolan Civil War: The concept of “Blood Diamonds” explained.” (n.d.). UGS-Angola. Retrieved from http://www.ugs-angola.com/the-angolan-civil-war-the-concept-of-blood-diamonds-explained.php.
3. Angola: Health Action in Crisis. (2005, December). World Health Organization. Retrieved from http://www.who.int/hac/crises/ago/background/Angola_Dec05.pdf.
4. Agadjanian, V., & Prata, N. (2003). Civil war and child health: Regional and ethnic dimensions of child immunization and malnutrition in Angola. Social Science & Medicine, 56(12), 2515-2527.
5. Health expenditure, total (% of GDP). (n.d.). The World Bank. Retrieved from http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS.
6. Bloemen, S. (2010, June 22). Brick by brick and doctor by doctor, Angola rebuilds its health care system. UNICEF. Retrieved from http://www.unicef.org/infobycountry/angola_54038.html.
7. Health. (n.d.). Angola Today. Retrieved from http://www.angola-today.com/society/health/.