Health & Education
Training Healthcare Personnel in Angola
Image credit: Unsplash / Francisco Venancio
Angola has had a national health service since the late 1970s, which provides primary healthcare to the citizens free of charge, though its operations are not free of problems.
The Angolan healthcare system has been struggling to catch up with the population’s growing needs since the return of peace in 2002. While the COVID-19 pandemic exhausted the sector considerably, it was also a wake-up call, raising awareness about the health service’s critical importance.
In addition to the limited clinical infrastructure and para-clinical technology, lack of healthcare professionals is a major bottleneck. Healthcare differs from most other sectors in that its human resources cannot be trained overnight or even in a couple of years. Training nurses, clinical technicians, and especially doctors is famously lengthy and requires long-term planning.
Public hospitals, which are the access point of the majority of Angolans to healthcare services, are notably understaffed. “Public hospitals cater to almost 60% 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,” commented a 2021 report on the state of the sector by the US International Trade Administration.
Much of the problem arises from the absence of enough specialists in state hospitals. While Angola’s population is approaching 35 million, there are under 6,000 registered physicians and 50,000 nurses in the country, mainly concentrated in the capital city, Luanda.
It is not uncommon for internists and infectiologists to visit over 100 patients in a single ward round, which reduces the quality of care provided to each patient. Specialists dealing with more acute conditions such as neurosurgeons, cardiovascular surgeons, and oncologists are even fewer, forcing some patients to seek treatment abroad.
The Ministry of Health has tried to address the shortage of practitioners. The National Plan for Health Development (2012-2025) cites the expansion of medical training as one of its top three priorities. In the first step, 2,000-3,000 practitioners will be added to the workforce. At the same time, many current personnel must be re-educated, as WHO as well as local institutions has cast doubt on the sufficient training of some professionals working in healthcare.
The shortage of medical personnel in Angola is not due to lack of interest in medical education. Quite on the contrary, the nation’s younger generation is very eager to pursue a medical career, partly as it guarantees a stable income. The problem arises from the fact that not many doctors were trained in Angola until the end of the civil war in 2002. Completing medical school, a mandatory internship, and a residency to qualify as a specialist takes up to 12 years in some cases, while more years are needed to gather experience.
Seeing that medical education is not an early-yield enterprise, the Ministry of Health is determined to ramp up enrollment of the country’s medical schools and nursing programs. “In the past decade, the Angolan government has invested in the expansion of faculties of medicine in the country,” according to a 2021 scholarly article by Fronteira and Freitas published in the journal BMC Medical Education.
Angola currently has 19 faculties of medicine spread across seven provinces, the oldest famous of which is Faculdade de Medicina da Universidade Agostinho Neto. Most of the newer medical schools have been launched after the turn of the century, including five faculties in 2008-2009 and another two in 2016.
This expansion will hopefully bear fruit circa 2023, giving a new generation of doctors to the health service, as obtaining a medical degree takes six to seven years in Angola.
Another notable trend is observed in medical faculties, which can have a significant impact on the sector. While in the past medical students were predominantly from upper social classes, recent statistics are indicative of the democratization of medical education, partly thanks to competitive admission.
Over 70% of all medical students and 60% of those enrolled in Luanda-based medical schools come from provincial and rural backgrounds. These future doctors are more likely to work outside Luanda, where the shortage of physicians is most pressing.
A well-planed healthcare system needs more than doctors. The country’s medical schools are also offering two- and four-year courses to train hygienists, epidemiologists, and community health counselors. Adding such programs to faculties will surely prove effective, as health and hygiene counselors can contribute to the prevention of diseases across the country, thus reducing the workload of the clinical staff in the coming years.
There are also short-term on-the-job training programs that impart specialized skills to nurses in a particular area, such as midwifery. Carolina Manuel Sousa, a midwifery nurse in Namibe Province, told the UN’s Relief Web program that “training was beneficial because there are things I didn’t do before, such as calculating the gestational age and tracking sexually transmitted diseases. I’m implementing what I learned. With the knowledge I acquired, I have trained my colleagues and today, there is more demand for our services.”
Investing in medical education has of course been a necessary measure. However, there are more options that the Ministry of Health can focus on: expanding private healthcare, preventing the immigration of the existing personnel, and sending Angolan practitioners abroad for complementary training, especially in other Portuguese-speaking nations.