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Country analysis > Angola Last update: 2020-11-27  
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Review of health service delivery in Angola

Suzanne Fustukian

DFID, Health Systems Resource Centre

SARPN acknowledges the following website as the source of this report:
http://www.dfidhealthrc.org/shared/publications/SDDE/Angola.pdf
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Country context

Angola, with a population of 13.6 million1, has faced almost forty years of war from 1961, when a war for independence was fought against the colonial Portuguese state, to 2002, when a peace settlement was signed between the two opposing parties; the government (led by the MPLA) and UNITA. Despite two prior attempts at negotiated peace settlements between the government and UNITA, first in 1991 (Bicesse Accord) and then in 1994 (Lusaka Protocol), it was not until the outright victory of the government forces in April 2002, upon the death of the UNITA leader, Jonas Savimbi, that a sustained peace settlement was possible. This has left the ruling government, the MPLA, in uncontested control since 2002.2

Classifying Angola as a difficult environment

‘Difficult environments’ is a relational concept based on operational and outcome oriented issues, focusing on whether ‘normal lending instruments can be used successfully’ by donors3, particularly where ‘partner governments do not have credible commitments to effective policies and their implementation’4. Furthermore, ‘difficult environments’ are characterised by high levels of insecurity, significant human rights infringements, weak state institutions, and low levels of transparency and accountability to its own citizens5. Angola manifests all of these characteristics and has been a ‘difficult environment’ since its independence from Portugal in 1975. Following independence from Portugal, with the subsequent migration of most of the skilled Portuguese professionals6, the country became a proxy Cold War struggle between the Soviet Union and Cuba and the USA and Africa through their support for the MPLA and UNITA, respectively. Both of these events severely curtailed its capability to implement its radical social programme. Since then, defence spending by the MPLA government had been sustained at very high levels throughout much of this period, with limited support for the social sectors.7 This, linked with low managerial capacity, limited territorial control (particularly of areas under UNITA control) and high levels of insecurity, has led to the virtual collapse of the state social sector throughout the country.8

Up to the signing of the Bicesse Accord in 1991, external involvement by western development agencies (donors and NGOs) in Angola’s social sectors was extremely limited.9 Reasons suggested for this lack of engagement include the lack of commitment by the government to these sectors, given the rich mineral resources available, a perception that continues to hinder donor engagement in 2004. Donors were also reluctant to provide aid that would, inadvertently, allow the government to re-allocate funds from the social sectors to the war.10 Despite significant revenues from highly lucrative extractive industries – oil (coast/offshore) and diamonds (northeast), neither the Government nor UNITA invested significantly in state administration or development in the areas under their control, using the revenues instead to pay for their war machines, for personal gain and to secure a network based on patronage.11 12 External assistance has been slowed by donors’ concerns over the lack of commitment and responsiveness of the Government to the country’s recovery needs. The Norwegian Refugee Council highlights that the lack of transparency and accountability over its oil revenues has clouded the Government’s record and inhibits the donors from committing resources:
    “Angola has one of the biggest oil reserves in the world and the foreign owned offshore oil industry accounts for over 90 per cent of state revenue. The country is also the world’s fourth largest diamond producer. Allegations of corruption and embezzlement are rife, in spite of the government’s clear and unambiguous public commitment to account for all its oil revenues (Global Witness, 20 June 2003). According to an IMF report, about US$1 billion could not be accounted for in 2002 – approximately one third of the entire state revenue (Angola Peace Monitor 14 Jan 2004)”.13
At the British Angola Forum in November 2003, the donor consensus was that “shortterm emergency aid to Angola will continue”.14 Three government bilateral programmes, the UK, Netherlands and Norway, indicated that they would only give limited help outside the scope of humanitarian aid. Finally, the 2002 UN Common Country Assessment15, also underlines that “the absence of a basic policy framework for good governance, sound economic management and poverty reduction measures has led most donors to classify Angola in the ‘fragile partnership’ category”.16


Footnotes:
  1. UN 2003 estimate in UNDP, 2004
  2. ICG, 2003b
  3. World Bank, 2002
  4. OECD, 2001
  5. OECD, 2001
  6. Brittain, 1998
  7. Tvedten, 1997
  8. Pavignani and Colombo, 2001
  9. Cain et.al.2002
  10. Pavignani and Colombo, 2001
  11. ICG, 2003a
  12. Jenkins et.al., 2002
  13. Norwegian Refugee Council reliefweb March 2004
  14. Angola Peace Monitor, December 2003
  15. UN 2002
  16. UN 2002: 87


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