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Is there a Brazilian solution for every African problem? Brazilian Health Cooperation in Angola (2006-2015)

Is there a brazilian solution for every african

problem? Brazilian Health Cooperation in Angola

(2006-2015)

Existe uma solução brasileira para cada problema

africano? A cooperação brasileira em saúde em

Angola (2006-2015)

DOI: 10.21530/ci.v11n2.2016.561

Paulo Esteves

João Moura Fonseca

Geovana Zoccal Gomes



Abstract

The international system in general, and the international cooperation for development

specifically, have been through important changes in the last decades. The emergence of

South-South Cooperation (SSC) has become a trending topic among academics, practitioners

and policy-makers. The assumption that the common problems and shared experiences of

countries in the global South would make SSC more legitimate and perhaps more effective

is frequently mentioned, as a former Brazilian minister of foreign affairs once said, “for

every African problem there is a Brazilian solution”. This paper challenges this assertion

synthesizing key findings, contextual information and analysis required for understanding

Brazil’s engagement in Angola, within the sector of public health, from 2006 to 2015.

Keywords: South-South Cooperation; Brazil; Angola; Public Health.

Resumo

O sistema internacional em geral, e especificamente o sistema da cooperação internacional

para o desenvolvimento, passaram por importantes mudanças nas últimas décadas.

A emergência da Cooperação Sul-Sul (CSS) tem tido atenção crescente entre acadêmicos,

1 Professor do Departamento de Relações Internacionais da Pontifícia Universidade Católica do Rio de Janeiro.

2 Banco Mundial – Moçambique.

3 Doutoranda em Relações Internacionais pela Pontifícia Universidade Católica do Rio de Janeiro.

Artigo recebido em 05/10/2016 e aprovado em 15/11/2016.

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Paulo Esteves, João Moura Fonseca, Geovana Zoccal Gomes

profissionais e policy-makers. Frequentemente o pressuposto de que problemas comuns

e experiências compartilhadas entre países do sul global define a CSS como mais legítima e

possivelmente mais efetiva, como disse um ex-Ministro de Relações Exteriores do Brasil,

“para cada problema africano existe uma solução brasileira”. Esse artigo desafia essa

afirmativa sintetizando conclusões importantes, informação e análise contextual necessárias

para compreender o engajamento brasileiro em Angola, no setor da saúde, entre os anos

de 2006 e 2015.

Palavras-chave: Cooperação Sul-Sul; Brasil; Angola; Saúde Pública.

Introduction

South-South Cooperation (SSC) has become a trending topic among academics,

practitioners and policy-makers (BESHARATI; ESTEVES, 2015). Three sets of

assumptions underpin the analysis of South-South Cooperation in general, and

of Brazilian cooperation in particular, namely that: (i) the shared experiences of

countries in the global South reveal important differences in regards to practices

of South-South providers vis-à-vis Northern donors; (ii) the uniqueness of SSC

rests on the principles it stands for, which are allegedly sharply different from the

ones shared by traditional donors; and (iii) the volume of resources channelled

through South-South cooperation, although currently modest, is about to see

significant increase.

This paper discusses the first assumption, which relates to the frequently

purported maxim that the common problems and shared experiences of countries

in the global South would make SSC more legitimate and perhaps more effective

As a former Brazilian minister of foreign affairs once said, “for every African

problem there is a Brazilian solution” (AMORIM, 2016). This paper challenges

this assertion through the presentation of findings from the Brazil SSC project

4 For a comprehensive discussion on this assumption, see Cesarino (2013)

5 The project, conducted by the BRICS Policy Center from September 2013 to February 2015, aimed to analyse

Brazilian development cooperation practices in Africa within the broader context of the BRICS’ growing presence

on the continent. The project investigated the impacts of Brazil’s role in the fields of agriculture and public

health, on both Brazilian cooperation agents and on a variety of local stakeholders. Geographically, the project

focuses on two countries where Brazil has been rapidly expanding its engagement and cooperation programmes:

Angola and Mozambique. The framework approach was used as the methodological strategy. A field research

and the organization of a validation workshop conducted in Angola allowed the team to interview more than

20 people in Luanda, including representatives from multilateral and bilateral donor agencies, academia, civil

society, and the national government, in addition to representatives of the Brazilian government. Due to the

sensitive content of the interviews, it was agreed that no interviewee or institution would be directly identified.

Also, the team had many opportunities to conduct additional interviews in Brazil.

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The objective of this article is to synthesize key findings, contextual information

and analysis required for understanding Brazil’s engagement in Angola, as well

as basic information on Brazilian projects under execution during the time the

fieldwork was carried within the sector of public health. Very little on Brazilian

development cooperation in Angola seems to have been produced by other

research projects, which highlights the importance of this article. Information

gathered, including additional interviews with implementing and coordinating

institutions in Brazil, will also feed into deeper analysis in future publications.

The article sets out by presenting a contextual analysis, going briefly through

Angola’s recent historical trajectory, and state-society relations in the country in

light of traditional development cooperation. Brazilian relations with Angola are

subsequently discussed, which provides a background for subsections on health

cooperation and a case study on the PROFORSA project. Based on the analysis

of health cooperation between Brazil and Angola, this article tries to show that

the supposed similarities among developing countries were rarely found in the

field. The South-South Cooperation characteristics are largely dependent on the

beneficiary country’s context, as the Angolan case has shown. Indeed, in Angola,

where the political elite holds control of the country’s development agenda, the

fieldwork indicated important resistances against some of the Brazilian technical

cooperation projects.

Context

Independence and Civil War

As soon as the Portuguese left Angola in November 1975, disagreements

between different national liberation movements who had been fighting for

independence led to a protracted civil war. MPLA (Popular Movement for the

Liberation of Angola) managed to become the dominant political faction, promoting

economic reforms based on its Marxist-Leninist ideals. José Eduardo dos Santos

was appointed President in 1979, after the death of Agostinho Neto. Subsequent

attempts to achieve lasting peace between MPLA and UNITA (National Union for

the Total Independence of Angola) were unsuccessful.

6 Main sources used to develop the historical segments include Durost Fish (2002) and UNESCO et al. (2010).

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Vast volumes of development cooperation resources provided by United

Nations agencies, bilateral donors, international NGOs and religious organisations

were directed towards Angola during the civil war. Those were primarily aimed

at emergency and humanitarian objectives, often reaching beyond government-

controlled areas. The availability of funds gave rise to the establishment of a

number of international and national civil society organisations in the country.

In addition to providing funding, international agencies played a significant role

in facilitating the safe mobility of development workers through war zones

Angola’s civil war ended with the killing of Jonas Savimbi, UNITA’s leader,

by government troops in 2002. The war resulted in at least 500 thousand Angolan

deaths. More than one third of the country’s population were forcibly displaced

(POLGREEN, 2003). While the death of its leader left UNITA in disarray (CAUVIN,

2002), opposition would frequently arise from inside the government, and the

threat of a new civil war was always a concern for the Santos regime. Such political

considerations played an important role in guiding the government’s domestic

and international engagement. According to the World Bank (2005), the post-

war budget “reflect[ed] political choices still concerned with the prevalence of a

wartime budget”.

Mistrust and plotting

were deeply rooted features in Angola’s political system,

and the Santos government attempted to stifle internal disputes and secure its

position by expanding the role of the state rather than reducing it (POWER,

2012). When Angola turned to traditional donors for reconstruction funds after

the civil war, it faced various conditionalities. These included, for example, the

establishment of a monitoring mechanism to assess government performance

for a period of three semesters before the country became eligible for renewed

financial support. The government was not willing to relinquish its autonomy on

policy formulation and implementation in exchange for assistance. As a result,

International Financial Institutions (IFI) did not provide the large quantities of

funds required for reconstruction and development. The reluctance of donors to

participate in Angola’s donor conference, a priority initiative for the government

after the end of the civil war, continues to be a source of resentment for the

government of Angola (GoA). Its is relevant to notice that the oil production

was a key factor increasing GoA’s bargaining power toward traditional donors,

7 Anonymous interview carried out in Luanda in September 2014.

8 As exemplified by the wide restructuring of the security apparatus after Miala, Santos’s head of foreign intelligence,

was sacked in 2006 for engaging in “activities against the president” (JORNAL DE ANGOLA 2007 apud 2008).

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enabling the government to refuse conditionalities traditional donors tried to

impose (FERREIRA, 2005).

Despite impressive economic growth during the last decade, 30.6% of Angolans

live below the national poverty line

. Wealth is unequally distributed among its

20.8 million citizens (2012), with economic growth benefits are mostly restricted

to the top 5% of the population and 0.18% of the country’s territory (CENTRO

DE ESTUDOS DE INVESTIGAÇÃO CIENTÍFICA, 2011). Angola’s gini coefficient

is 0.586, one of the highest in Sub-Saharan Africa (WORLD BANK, 2016a).

Notwithstanding the harsh circumstances inextricably linked to more than 25 years

of civil war, Angola is today a functioning state that is not dependent on foreign

aid. Paradoxically, the same war that destroyed the region’s infrastructure, killed

at least half a million people, and displaced another four million, also enabled the

development of a sense of national identity and allegiance to the state, facilitating

large-scale indigenous capital accumulation (MALAQUIAS, 2007).

Dependence on Aid and Oil

As previously discussed, after the end of the war the convening of a

donors’ conference, aimed at raising funds and establishing commitments for

the reconstruction of Angola’s infrastructure and economy, stood as one of the

government’s priority initiatives. The failure of the IMF and the GoA to reach

an agreement, prompted by different views on governance and transparency,

as well as donor concerns over incompatible sets of statistics, were significant

obstacles to the conference

. With no substantial concessions from either side,

the conference was repeatedly delayed over the years, never actually taking place.

Additionally, the GoA never got the “seal of approval that could then make them

eligible for debt rescheduling through the Paris Club” (BRAUTIGAM, 2009, 274).

According to more than one informant, many of the GoA’s senior officials exhibit

to this day great resentment against Northern donors for “not helping Angola in

times of need”

Some regard this dispute as triggering closer China-Angola relations, since it

was at that time that Southern countries, particularly China, began to consolidate

9 National estimates are based on population-weighted subgroup estimates from household surveys. Source:

World Bank, 2016b.

10 See Misanet, Angola Peace Monitor, Afrol News (2003).

11 Anonymous interview carried out in Luanda in September 2014.

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their foothold in Angola. One informant reported that, when discussing China-

Angola relations, more than once he had heard from senior officials at the GoA that

“when you are drowning, it doesn’t matter who is throwing you the life jacket”.

Angola’s increased oil production and the discovery of new oil fields, the then

rising oil prices in the international market, and China’s “go out” policy lined up

to boost bilateral relations.

Endeavouring to rebuild the country’s war-torn infrastructure, Angola has

since invested heavily in its partnership with China

. In exchange for guaranteed

oil supplies, Angola has gained access to multi-billion dollar Chinese credit lines.

Meanwhile, Angola surpassed Saudi Arabia as the largest supplier of oil to China

both in 2006 and 2010, and has become China’s main trade partner in Africa, with

bilateral trade reaching US$ 24.6 billion in 2010 (POWER, 2012). The deepening of

these relations between credit-hungry Angola and oil-starved China has enabled

Angola’s government to carry out its development policies without promoting the

broad institutional reforms imposed by donors and IFIs in other African countries,

such as Mozambique and Uganda (GIROD, 2008).

State-society relations and traditional development cooperation in Angola

Vast fluxes of development cooperation provided by United Nations agencies,

bilateral donors, international NGOs and religious organizations shifted towards

Angola during the civil war. Those were primarily geared towards emergency

and humanitarian objectives, and often got to places virtually unreachable by

government actors. The availability of funds enabled a mix of international

and national civil society organizations to emerge and grow in Angola. Besides

providing funding, international agencies played a significant role in facilitating

safe mobility of development workers within war zones

12 The oil-backed loan that China provided to Angola in 2004 is often depicted as an alternative that enabled the

African country to dismiss reforms supported by the IMF, which, allegedly, would have led to greater governance

in Angola, if implemented. With some nuances, this also represented the view of most interviewees. Brautigam

convincingly argues, however, that the Chinese government did not do anything that Western banks such as

BNP Paribas, Commerzbank, Societé Générale, Barclays or Standard Chartered were not doing before or after

the Chinese deal. The difference was that Chinese conditions were significantly more favorable to Angola,

including smaller interest rates and larger grace and repayment periods. Moreover, Angolans later managed

to pay their debts with revenue from the booming oil industry, increasing their transparency in the meantime

(BRAUTIGAM, 2009, 273-277).

13 Anonymous interview carried out in Luanda in September 2014.

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After the end of the war, many civil society organizations disappeared with

the retraction of traditional development cooperation in Angola following the end

of the civil war. Not only were they fund-starved, but they also had to cope with

rising costs and more strict government regulations. This trend was particularly

evident in Luanda, where significant numbers of people had moved in search of

security during the conflict years

. Due to especially high costs in Luanda, some

NGOs also relocated their headquarters to Benguela. More manageable direct

expenses came at significant operational costs and difficulties, since Luanda

remained the country’s administrative centre.

Additionally, Angolan interviewees often pointed out the regulatory framework

pertaining to associations, including the law of associations – “Law n. 14/91 of

May 11

” (GOVERNMENT OF ANGOLA, 1991) – as another driver of the reduction

in the number of civil society organizations during the post-War years. Related

obstacles mentioned by some informants included the difficulties in receiving

foreign funds, as well as the substantial limitations to institutional autonomy

imposed on organizations registered as “associations of general interest”. As a

result, most interviewees characterized Angolan civil society as small, with capacity

concentrated in a handful of organizations, and non-independent, with many of

the more vocal organizations being linked to MPLA, the ruling party. However,

the same interviewees pointed out significant progress in the past 3-5 years, due

to parallel positive developments in democratic governance and transparency.

The GoA is increasingly active within the region, and plays important roles in

regional bodies such as the African Union (AU), the New Partnership for Africa’s

Development (NEPAD), and the Southern African Development Community

(SADC). The document Angola 2025 establishes the country’s long-term vision,

being carried out in the medium-term through the National Development Plan

2013-2017, the first national development plan elaborated under the new Angolan

Constitution, in 2010 (MPDT, 2012). The Plan defines the following six broad

national objectives: 1) preserving national unity and cohesion; 2) securing

the basic principles necessary for development

; 3) improving quality of life;

4) engaging youth in active life; 5) strengthening private sector development; and

6) promoting the competitive insertion of Angola in the international context.

14 Anonymous interview carried out in Luanda in September 2014.

15 Defined as the preservation of macroeconomic stability, promotion of national population policy, promotion of an

active employment and national human resource valorization policy, increasing productivity and transforming,

diversifying and modernizing the country’s economic structure.

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Box 1 – Angola’s National Development Plan 2013-2017:

objectives and priorities for the health sector

Objective Priorities

To sustainably promote

Angolan population’s sanitary

state, guarantee the population’s

longevity, supporting less

favoured social groups and

contributing to the ﬁght against

poverty

1. To increase life expectancy at birth

2. To improve the Human Development Index and the Millennium

Development Goals

3. To reduce maternal, child and youth mortality, as well as

morbidity and mortality under the national nosology framework

4. To improve the organization, management and functioning of

the National Health System, through directing necessary funds

and adopting norms and procedures aimed at improving the

efﬁciency and quality of NHS’ response

5. To improve health care services in the areas of promotion,

prevention, treatment and rehabilitation, reinforcing the

articulation between primary care and hospital care.

6. To participate in the transformation of social determinants of

health and promote national and international partnerships

aimed at reducing maternal and child mortality and

strengthening the programmes of ﬁght against major endemics

7. To improve health care services in the areas of promotion,

prevention, treatment and rehabilitation, reinforcing the

articulation between primary care and hospital care

8. To adequate human resources to objectives and goals, and adopt

new health technologies

9. To develop the capacity of individuals, families and communities

for the promotion and protection of health

10. To monitor and assess the performance of the sector through

SIS and special studies

Source: Angola’s National Development Plan 2013-2017 (MPDT, 2012).

The National Development Plan 2013-2017 reveals a robust, modernizing

conception of development, with significant emphasis placed on economic growth.

However, despite the substantial growth rates of Angola in the last few years, social

indicators remain generally low. Life expectancy at birth in Angola (51 years) is

below the average for sub-Saharan Africa, and 36.6% of the population still lives

below the national poverty line

This context points to both the potential and challenges for development

cooperation. While it is safe to assume that development cooperation funds will

continue to play a marginal role in the country’s Gross National Income – the

16 Source: World Bank Data (2016c).

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current total of US$ 200 million of net ODA (2011) encompasses less than 0.3%

of the country’s GNI – it could also play an important role in improving social

indicators as well as reducing poverty and inequality.

Among OECD’s Development Assistance Committee donors, the United States

is by far the largest in terms of gross Official Development Assistance (ODA)

– totalling approximately US$ 63 million between 2010-2011. European Union

institutions (US$ 26 million), Japan (US$ 25 million), South Korea

(US$ 18

million) and Portugal (US$ 18 million) are also significant donors. Donor’s ODA

is primarily directed to Angola’s social sectors, particularly education, health and

population

As with civil society organizations and donors, budgets of United Nations

agencies in Angola were significantly reduced over the past decade, which

contributed to a redefinition of scope of action in light of the GoA’s demands and

needs. As shown in Table 2, UN agencies’ efforts are concentrated in the GoA’s

institutional and human capital development, particularly through the provision

of targeted technical assistance.

Initiatives of UN agencies are based on the UN Development Assistance

Framework in Angola (UNDAF-Angola). UNDAF-Angola aims to harmonize and

integrate the UN system at a country level. The new UNDAF has not yet come to

fruition. UNDAF 2009-2013 prioritizes 4 support areas, highlighted by outcome

in Table 2. The World Bank Group (WBG) has similarly redefined its strategic

engagement in Angola. Following a decade of ill-established relations with the GoA,

the International Bank for Reconstruction and Development (IBRD), International

Development Association (IDA), International Finance Corporation (IFC) and the

Multilateral Investment Guarantee Agency (MIGA) have released in August 2013

a joint country partnership strategy for 2014-1016

17 It is noteworthy that, although a DAC member, South Korea considers itself a South-South provider.

18 According to the OECD, population sector activities typically include population/development policies, census

work, vital registration, migration data, demographic research/analysis, reproductive health research, as well

as other unspecified population activities (OECD, 2015)

19 The World Bank’s institutional engagement in Angola was renewed with an Interim Strategy Note that accounted

for the period of 2003-2005, focused on macroeconomic stability programmes and disarmament, demobilization

and reintegration efforts. Many interviewees mentioned that the GoA nurtured some frustration with the Word

Bank during the first half of the 2000s, mainly due to the perception that the international institution had

not pushed strongly enough for the organization of a donor’s conference, as it was expected by the national

government. Subsequent attempts, supported by the World Bank, to constitute a formal development partners’

coordination structure in Angola were allegedly watered down by the Ministry of Planning. Two other Interim

Strategy Notes were developed for 2005-2007 and 2007-2009. With significant socioeconomic improvements

enabled by the development of the extractive industries in Angola, the World Bank decided to formalize a

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Box 2 – UNDAF 2009-2013: Support areas and outcomes

Support area 1:

Governance, Justice and Data

for Development

UNDAF outcome 1:

National Institutions responded to the needs of the whole population,

including the poor and most vulnerable and at the same time national

and local public institutions were strengthened, as well as community

engagement, civic participation towards social cohesion, national

reconciliation and the empowerment of women

Support area 2:

Social Sectors

UNDAF outcome 2:

Increased and more equitable access to integrated social services at

national and sub-national levels with emphasis on MDGs

Support area 3:

HIV & AIDS

UNDAF outcome 3:

Strengthened national institutional and technical response to HIV and

AIDS to accelerate progress towards universal access to prevention,

treatment, care and support as a step on the road to the achievement to

the MDGs by 2015, and to eradicate stigma and discrimination, and to

meet the epidemic’s multigenerational challenge

Support are 4:

Sustainable Economic

Development

UNDAF outcome 4:

National and decentralized institutions strengthened integrated rural

development guaranteeing food security based on environmental

protection of natural resources and the management and adaptation to

climate change

Source: UNDAF Angola 2009-2013 (UNDAF, 2009)

As it has appeared in the World Bank’s Country Partnership Strategy

2014-2016, the general perception among interviewees was that the GoA has been

maintaining a “strong record of own-management of its development agenda”

(WORLD BANK, 2005, p.18). As such, both bilateral and multilateral development

partners, with few niche-related exceptions, have to play by the GoA’s rules if

they wish to participate in development policy formulation and implementation.

This is in many ways a result of GoA’s not so “new-found sense of political and

economic leverage” (CORKIN, 2008), which has been intrinsically linked with

the development of the oil and extractive industries in the country. Moreover, the

oil and extractive industries have attracted both traditional and emerging powers

willing to take part in the expansion of these economic sectors. Even though the

GoA is still highly dependent on natural resources and international commodities

prices, when compared to other settings, such as Mozambique, oil and natural

clearer country strategy for the following years. An informant pointed out that the World Bank, after conducting

an assessment of the credit situation in Angola, also ended up agreeing with the idea of having one country

partnership strategy for the World Bank Group, which came into effect in August 2013, accounting for the

period 2014-2016.

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resources dependency has distinctive effects on how the actors posit themselves

within the development field. Hence, while aid dependency in Mozambique

has been contributing to limiting national ownership, oil dependency in Angola

has enabled the Government to take over its development agenda, despite the

negative short and medium-term effects on wealth concentration and democratic

consolidation. Furthermore, as discussed below, the growing emerging powers’

foothold in Angola has enhanced the GoA’s capacity to carry out development

policies and programs.

Brazil-Angola development relations

Relations between the regions that would, eventually, become Brazil and Angola

date back to the XVII century. Brazil was the first Western nation to recognize

Angola as a sovereign country, in 1975, a fact that is regularly remembered by

Angolan senior officials in mid and high-level meetings. The Brazilian embassy

to Angola was formally created in the same year.

Brazil’s national development bank (BNDES) funds several projects carried out

by Brazilian companies in Angola, particularly in the infrastructure sector. Banks

such as Caixa Econômica Federal, Banco do Brasil and Bradesco are also present

in the country. Like China, the Brazilian government also uses commodities and

raw material as credit guarantees (GARCIA; KATO; FONTES, 2013).

Angola is the main target of Brazilian investments in Africa. Currently,

Brazil ranks 4

in Angola’s top import countries and 19

as Angola’s top export

destinations (WALDERSEE, 2015). For Brazil, trade with Angola represents 0.4% of

its total foreign trade. According to APEX, Brazil has been benefiting significantly

from Angola’s growth. Bilateral trade between Brazil and Angola grew significantly

between 2000 and 2010, reaching an all-time high in 2008 of US$ 4.21 billion.

Brazil’s leading export sectors to Angola in 2010 were production and packing

of meat and fish (23.7%) and the manufacturing and refining of sugar (13.0%).

Main Brazilian imports from Angola in the same year were oil and natural gas

20 This contextual analysis does not imply, however, that Angola is achieving better development outcomes than

aid dependent countries like Mozambique. Rather, the oil and natural resources dependency very often stresses

the negative impacts of focusing on static comparative advantages and the consequent economic concentration

around specific sectors.

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(73.7%) and oil-derived products (25.9%)

. From 2009-2013, Brazilian exports to

Angola were reduced by 4.6% and imports increased by 427.6%, which indicates

a transformation of the trade balance in favour of Angola.

Angola is also a relevant destination for Brazilian private companies’

investment. In fact, Angola concentrates the highest number of Brazilian small

and medium enterprises in Africa. Furthermore, BNDES has disbursed US$ 2.8

billion for private investments in Africa since 2007, of which Angola has received

96% (WALDERSEE, 2015). Table 3 presents some of the main projects carried out

by Brazilian transnational companies in Angola and figure 1 locates the projects

in Angola’s map.

Figure 1: Brazilian infrastructure projects in Angola

Source: Waldersee, 2015

21 Apex Brasil Website, 2014

22 MDIC, 2014

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Box 3: Brazilian transnational companies in Angola

Company

Present

since

Sector Activities

Petrobras 1980

Energy /

Oil&Gas

Exploration of oi and biofuels. Partner in 6 oi blocks and operator

in 4. Since June 2013, Petrobras acts in a joint venture with BTG

Pactual Bank (50% each) worth US$1.5 million for oil and gas

exploration in several African countries, including Angola.

Vale 2005 Mining

Joint venture with Genius for mineral excavation (primarily

nickel and copper) and research.

Andrade

Guiterrez

2005

Construction /

Infrastructure

Works in partnership with Zagope Construções e Engenharia,

a Portuguese subsidiary, to gain access to EU ﬁnances. It has

constructed various roads and the express highway between

Luanda and Viana to the International Airport of Luanda.

Renovation of the International Airport of Lubango. Extended

contracts for rehabilitation of Container Terminal in Luanda Port

in 2011.

Camargo

Corrêa

2005

Construction /

Infrastructure

Construction of Uige-Maquela road. Partners with Escom, a

Portuguese ﬁrm, and Gema, an Angolan ﬁrm, in constructing

a cement factory in Benguela.

Odebrecht 1984

Construction /

Infrastructure /

Agriculture /

Energy / Retail/

Real State

Holds 25 contracts in the country in real estate, biofuels, minerals,

agribusiness, and energy. Highlighted examples: Construction of

Capanda Hydroelectric Dam in Malange. Hydroelectric project

in Cambambe. Owns 40% of Biocom, Angolan bioenergy ﬁrm

(ethanol), and 20% of Sonangol. SENAI does training programs

for Biocom, for example. Runs Nosso Super supermarket chain

in joint venture with Angolan government, with 37 shops in

the country. An agribusiness project that may be highlighted is

the Farm Pungo a Ndongo (or Pungo Andongo). Odebrecht is

responsible for the management of agroindustrial production,

construction of factories and capacity building. Embrapa-Africa

participated in experiments with varieties of corn, black beans,

rice and soy.

Engevix 2005 Energy

Works in partnership with Angolan group Genius. Environmental

engineering, electricity generation and distribution, involved in

Cambambe hydroelectric project in Cuanza Norte.

Fidens 2009

Construction /

Infrastructure

Construction of runways at Catoca airport, Luanda Sul.

Asperbras 2007

Real State /

Infrastructure

Involved in Special Economic Zones in Viana, Catete, Huambo,

Negage, M'Banza Congo. Construction of real estate and

residential condominiums, irrigation systems, and commercial

vehicles.

Queiroz

Galvão

2005

Real State /

Infrastructure

Real estate, roadwork construction and renovation.

Stefanini 2004 ICTs Technology and information industries.

Source: Vieitas and Aboim (2012); Institutional websites

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165

Paulo Esteves, João Moura Fonseca, Geovana Zoccal Gomes

Brazil’s development cooperation with Angola dates back to the civil war

period, focused then on professional development and vocational training.

Inaugurated in 1998 with support from Brazil’s SENAI (Serviço Nacional de

Aprendizagem Industrial- National Service for Industrial Training), the CFPC

(Centro de Formação Profissional do Cazenga – Cazenga Center for Professional

Training), located on the outskirts of Luanda, trains around 2,500 professionals

yearly. Today cooperation sectors range from sports to fire fighting

. Embrapa

and Fiocruz also respectively implement agricultural and health projects in

the country.

In 2012, Angola occupied the 10

position in terms of volume of technical

cooperation received from Brazil, and it received the second least when compared

to other developing countries in the Community of Portuguese Language Countries

(CPLP) (ABC; IPEA 2016). According to Brazilian informants, Brazil’s bilateral

cooperation with Angola would be characterized by low performance, allegedly

related with factors such as difficulties in dialogue with Angolan counterparts,

low decision-making power of executing agencies, and high rates of turnover

among local coordinators.

Brazilian development cooperation in the health sector

Brazilian-Angolan development cooperation in the health sector begun in

1996 when the Brazilian Cooperation Agency (ABC) organized a mission with

health experts to discuss prospective projects in strategic areas already defined

within the CPLP. Since then, governments from Portuguese speaking countries in

Africa, Angola included, have demanded support for their own national health

systems. Table 4 presents the projects listed at ABC website.

23 Information available at Brazilian Embassy in Luanda (MRE, 2016).

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Is there a Brazilian solution for every African problem? Brazilian Health Cooperation in Angola (2006-2015)

Box 4: Brazilian-Angolan cooperation projects in the health sector (2006-2014)

Project Partners Period

Brazilian

Institutions

Assessment of Angola’s need in the areas of malaria, family

health, nutrition, health surveillance and milk bank.

Brazil and

Angola

10/05/2006 –

20/06/2006

Ministry of

Health (MH)

Support in structuring the network of health sector

libraries in Angola and Mozambique.

Brazil,

Angola and

Mozambique

16/02/2007 –

16/04/2007

Fiocruz/MH

Support to Angola’s health system. Brazil and

Angola

10/09/2007 –

11/09/2008

Fiocruz/MH

Nursing course – human resources training program for the

Josina Machel Hospital – Luanda.

Brazil and

Angola

4/10/2007 –

02/12/2007

University of São

Paulo (USP)

Hospital administration course – human resources training

program for the Josina Machel Hospital – Luanda.

Brazil and

Angola

20/11/2007 –

20/01/2008

Hospital Santa

Cruz – HSC/SP

Mission of the Pastoral Care of Children for development

and detailing of technical cooperation projects.

Brazil and

Angola

3/1/2008 –

26/02/2008

Farmanguinhos/

Fiocruz

Laboratorial analysis course – human resources training

program for the Josina Machel Hospital – Luanda.

Brazil and

Angola

1/2/2008 –

15/05/2008

Brazil – BRA

Radiology technical course – human resources training

program for the Josina Machel Hospital – Luanda.

Brazil and

Angola

11/2/2008 –

11/05/2008

State University

of Campinas

(UNICAMP)

II Hospital administration course – human resources

training program for the Josina Machel Hospital – Luanda.

Brazil and

Angola

23/07/2008 –

23/12/2008

XIII International course on tropical diseases – (JFY2008) Brazil and

Angola

1/10/2008 –

20/12/2008

Pernambuco

Federal University

(UFPE)

Study mission on tbe Uniﬁed Health System for Portuguese

speaking countries.

Brazil and

Angola

4/11/2008 –

30/12/2008

Mission for Project detailing for follow-up and extension of

support to Angola’s health system.

Brazil and

Angola

24/01/2009 –

24/03/2009

Fiocruz/MH

Mission to Angola to ﬁnalize and sign cooperation projects. Brazil and

Angola

8/2/2010 –

01/04/2010

Joint mission to elaborate and discuss the project for

Development of Human Resources in Angola’s Health Services.

Brazil, Japan

and Angola

1/6/2010 –

01/07/2011

Pilot project in sickle cell disease. Brazil and

Angola

23/06/2010 –

30/08/2015

Support to Angola’s Health System – Phase II. Brazil and

Angola

23/06/2010 –

30/08/2016

Fiocruz/MH

II International Training Course for health promotion, local

development and healthy cities.

Brazil,

Angola

(scholarship

holder

countries)

19/08/2010 –

19/10/2010

Prospection mission for Human Milk Bank project in

Angola.

Brazil and

Angola

17/01/2011 –

17/12/2011

Aisa – MH

PROFORSA – Project for strengthening health systems

through Human Resource Development in Josina Machel

Hospital and other health services and revitalization of

primary health care in Angola.

Brazil, Japan

and Angola

1/7/2011 –

01/08/2014

Fiocruz/MS/

UNICAMP

Source: ABC website, access on Aug./2015.

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167

Paulo Esteves, João Moura Fonseca, Geovana Zoccal Gomes

During the 1990’s the emphasis was on training and capacity building. After

ten years, CPLP health ministries were able to set up a strategic plan (2009-2012)

for the health sector. The strategic plan had as its main objective strengthening

national health systems in order to assure universal access to quality health

services

. The plan encompassed seven strategic axes and four structuring

networks. Besides the structuring networks established within CPLP’s health plan,

Brazilian Health Ministry and FIOCRUZ expanded to African countries the Human

Milk Bank Network. When compared with Mozambique, the Angolan case shows

its problematic engagement in CPLP’s strategic axis and structuring networks.

Table 5 presents CPLP’s strategic axes, and a comparison between Angola and

Mozambique, both in terms of projects developed with Brazilian agencies in these

two countries, and their participation within the structuring networks.

Box 5: CPLP’s Strategic Axes and structuring networks and Brazilian SSC

projects in Angola and Mozambique

CPLP's strategic axes (SA) and structuring

networks (SN)

Brazilian SSC projects

within CPLP’s Strategic

Axes

Engagement in

Structuring Networks

Angola Mozambique Angola Mozambique

SA1 – Training and development of health

workforce

X X

SA2 – information and communication in health X

SA3 – research in health X

SA4 – development of the health-industrial

complex

SA5 – epidemiological surveillance and

monitoring of health situation

SA6 – emergences and natural disasters

SA7 – promotion and protection of health X X

SN1 – national health institutes X

SN2 – national schools of public health X X

SN3 – health technical schools X X

SN4 – technical centres of installation and

maintenance of equipment

Source: The authors, based on Buss, Ferreira and Hoirisch (2011)

24 For more information, see: CPLP’s Strategic Plan for Health Cooperation (CPLP, 2009).

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Is there a Brazilian solution for every African problem? Brazilian Health Cooperation in Angola (2006-2015)

According to a document provided by the Embassy of Brazil in Luanda

during one of the interviews, referring to July 2013, there were only two bilateral

cooperation projects being executed in Angola in the area of health – Pilot Project

in Sickle Cell Disease and the Phase 2 of Capacity Development for Angola’s

Health System Project. These projects were also the only ones listed as being

under execution on the ABC website.

Despite the “under execution” status attributed to the projects, correspondence

exchanged with Brazil’s Ministry of Health in September 2014 on the sickle cell

disease project noted that there was several inconsistencies in project execution,

insinuating that the project had been finalized without partners having completed

previously agreed activities. The second mentioned project also seems to have

been finalized, though no involved Angolan party in Luanda was available for

comment.

Additionally, it is not unlikely that, as in many other countries, technical

cooperation projects under negotiation in Angola were stopped due to the severe

budget cuts in both Brazil’s Ministry of Foreign Affairs and ABC. The following

subsection discusses specifically PROFORSA, Brazil’s most well-known health

project in Angola, highlighting some of its successes and challenges.

PROFORSA

PROFORSA was a 3-year triangular cooperation initiative involving Brazil,

Japan and Angola aimed at strengthening individual, institutional and systemic

capacity in the Angolan health sector. It was found to be the most well known

among Brazil’s health cooperation projects in Angola, although specific knowledge

about the project varied significantly across health sector stakeholders.

The origins of PROFORSA are related to the intersection between UNICAMP’s

cooperation – ongoing since 2004 in the area of capacity development for Angolan

tertiary health workers – and JICA’s efforts to develop capacity at Josina Machel

Hospital in Luanda. JICA’s project involved both the infrastructural rehabilitation

of the Hospital, and targeted health trainings activities for employees. Japan’s

bilateral agency engaged Brazilian teams to carry out trainings, including through

its Third Country Training Program (JICA-TCTP), due to the large benefits related to

improved communication in the Portuguese language. Additionally, the coordinator

of UNICAMP’s referred cooperation programme was a Brazilian infectious disease

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Paulo Esteves, João Moura Fonseca, Geovana Zoccal Gomes

specialist of Japanese descent, a factor that appeared in interviews as an enabler

of further approximation between JICA and Brazilian counterparts.

Both formal and informal assessments of such initiatives highlighted access

to and quality of primary health care as key issues to be addressed in improving

Angola’s health system and indicators. These issues manifested themselves in

the vast number of unnecessary referrals of patients to central hospitals, which,

consequently, overloaded central parts of Angola’s health system. This overarching

diagnosis served as basis for the design of PROFORSA.

Table 1: PROFORSA’s initial budget

Country Share (US$ / %)

Brazil 970,415 24%

Japan 2,500,000 61%

Angola 630,000 15%

Total 4,100,415 100%

With the formulation of PROFORSA as a triangular cooperation project in

2011, Fiocruz, through Joaquim Venâncio Polytechnic School of Health (EPSJV/

Fiocruz) and Sergio Arouca National School of Public Health (ENSP/Fiocruz),

became the lead institution in the project’s primary health component. The project

targeted capacity development at four health reference centres

in Luanda, chosen

due to their strategic location and high number of referrals to central hospitals.

The tertiary component, led by UNICAMP, particularly through Hospital Sumaré

in Brazil, and JICA, focused on improving the organization of hospital services

and nursing care, in areas such as neonatal and women’s health, at both Josina

Machel Hospital and Lucrécia Paim Maternity.

Given that PROFORSA identified primary care and health management as the

main issues to be addressed, a capacity development programme divided in 10

modules, as well as a course for specialization in management of primary health

units, was developed and implemented during the 3 years of the project. During

the SSC project team’s visit to Luanda, PROFORSA’s Angolan counterparts were

implementing recommendations that responded to participatory assessments

conducted during PROFORSA’s execution. Interviews pointed out that these

25 The health centers in Samba, Ingobota, Rangel and Ilha. According to anonymous interviews, JICA had also

previously donated equipment to those same health centers.

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Is there a Brazilian solution for every African problem? Brazilian Health Cooperation in Angola (2006-2015)

recommendations have been generally well accepted, pertaining to basic structural

issues such as the integration of registry and record systems of clinical processes.

In fact, the need for integration was reemphasized by a decree issued by Angola’s

Ministry of Health in 2010. However, informants pointed out that the decree hadn’t

been implemented systematically, due in part to lack of capacity and understanding

by health workers who were supposed to implement those changes about the

fundamental issues at hand.

In that sense, PROFORSA was a jointly developed structuring project. The

project strived to provide capacity and knowledge needed for the implementation

of basic public policies across the entire health sector, including through trainings

on management and organization of health and clinical process records. Its design

was guided by a consensual diagnosis of systemic yet context-specific issues

within Angola’s health system, which had already been identified and, sometimes,

targeted by public policies shown to be largely ineffective.

According to interviewees, the models of management and processes

implemented were guided by decrees issued by Angola’s Ministry of Health,

which were regularly discussed with regulatory authorities such as the National

Directorate of Public Health and the Provincial Directorate of Health of Luanda.

“On the job” training with key managers was also conducted in Brazil. The

informants frequently stressed that all information used as evidence for diagnosis

and implementation of solutions was locally collected. Altogether, such practices

would guarantee the project’s national ownership and context sensitivity.

One of the informants emphasized how Fiocruz had been very apt in promoting

understanding of basic issues related to Angola’s health system among sectorial

stakeholders. The same informant criticized other top-down initiatives, including

the ones implemented through private health consultancy firms, some of which also

from Brazil, which would impose new management rules, directives and practices

without discussion with local health workers. The same was said to be true in

relation to PROFORSA’s tertiary health component. While a management system

had recently been implanted in Josina Machel Hospital by a health consultancy,

UNICAMP and JICA found it necessary to develop a simpler management system,

discussing it with health workers at the Hospital. During project execution, some

emerging demands were met with specific activities proposed and led by JICA,

one of which included the “Maternal-Infant Health Notebook”. This might have

led to significant divergences between the Brazilian and Angolan counterparts,

as highlighted below in the discussion of the project’s challenges.

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Paulo Esteves, João Moura Fonseca, Geovana Zoccal Gomes

Besides issues related to management, participatory recommendations

also highlighted poor signage at health care facilities. A task force of Angolan

participants in the PROFORSA project was set up to propose changes to external

and internal signage, which were brought to the Provincial Directorate of Health

of Luanda for approval. During the visit of the SSC researcher to Luanda, signage

changes had already been approved and were being implemented in the city.

While interviews pointed to the potentially significant and sustainable impact

of gains from PROFORSA, many of the respondents also had a sizable stake in its

success. Nonetheless, interviews exposed substantial challenges in the execution

of PROFORSA. While interconnected, for analytical purposes, challenges may be

understood in terms of three categories, related to: 1) implementation, 2) financing,

and 3) political/cultural context.

Implementation challenges highlighted in interviews were mainly related

to delays in the institutionalization of recommendations, attributed both to

infrastructural issues that had to be overcome (e.g. creating an area for the storage

and management of records in primary health units) and the lack of human

resources required to carry out the transformations envisaged. There were reports

of complaints, which where allegedly solved over the course of the project, related

to inadequacies of the course venues at the beginning of the project, such as lack

of ventilation and electricity, which hindered learning. Finally, there appeared to

be significant inconsistencies in activities that should have been implemented by

Brazil’s Ministry of Health, including the monitoring and evaluation of PROFORSA.

Further research would be required to understand the specific causes of such

inconsistencies.

Financial problems were related to the Brazilian counterparts, more specifically

the Brazilian Cooperation Agency. With budget cuts in Brazil’s Ministry of Foreign

Affairs, which significantly affected ABC’s work and projects, there had to be a

restructuring of responsibility for PROFORSA’s third year project expenses. Most cuts

were absorbed by JICA, while a smaller yet significant amount was allegedly absorbed

by Angola’s Ministry of Health. Interviewees reported significant discontent from

JICA in regards to this financial rearrangement. While it did not affect the project

in the end, one can extrapolate that many similar projects may not have succeeded

without a triangular, developed country partner to absorb such budget cuts.

The political/cultural challenges highlighted by interviewees were related to

the striking differences in professional practices among the Brazilian, Japanese

and Angolan counterparts. While JICA seemed to emphasize thorough planning

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of activities, with a somewhat rigid schedule, Fiocruz stressed the importance

of getting a common diagnosis of the situations with partners. Naturally, the

challenges that arise in the alignment of expectations and practices may also

been seen as an opportunity for mutual institutional learning. As expected, such

related problems were reportedly less obstructive towards the end of project

implementation.

Finally, there were significant divergences around the “Maternal-Infant Health

Notebook”, which was designed based on Japan’s experience. Despite contrary

recommendations from the World Health Organization, Angola recommends that

every baby be breast fed, including those with HIV-positive mothers. According

to the GoA, this was required to mitigate the poor nutritional situation and high

rates of under-five mortality in Angola. Both Brazil and Japan recommend artificial

feeding when mothers are known to be HIV-positive. According to one interviewee,

Brazil’s Ministry of Health and ABC decided not to participate after knowing that

the “Maternal-Infant Health Notebook” would include Angola’s breastfeeding

recommendation. According to another interviewee, the Brazilian government did

not participate in the development of the tracking tool due to the perception that

it would not meet Angola’s current needs, particularly in light of mother literacy

issues in the country. Additionally, while a similar tool is implemented in parts

of Brazil, the instrument has yet to consolidate itself as a successful national

experience. The government of Brazil typically only provides technical cooperation

in areas where a particular experience is shown to be successful domestically

over a considerate period of time. Paradoxically, the “Maternal-Infant Health

Notebook” was pointed out by many health stakeholders not directly involved

in the triangular cooperation project as PROFORSA’s main result, which may be

explained by the many consultations that occurred during its formulation.

Final remarks

Economic and political dependence tend to be associated with higher

vulnerability and lower resiliency. While tapping on their respective comparative

advantages, as well as the country’s natural and developed resource endowments,

governments frequently strive to improve the sustainability of their socioeconomic

systems by mitigating dependency-related risks. Yet, dependency on different

resources, institutions or foreign aid, also has diverse implications to formulation,

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Paulo Esteves, João Moura Fonseca, Geovana Zoccal Gomes

ownership and implementation of national development policies. In that sense,

managing dependencies is an important aspect of the management of development,

particularly for governments of developing countries.

Angola’s socioeconomic trajectory since the late 1990s shows GoA’s prioritization

of the extractive and oil industries over the attraction of foreign aid. Strict political

conditionalities attached to North-South cooperation, as well the knowledge of

extensive natural resources in Angola, contributed to GoA’s decision. Besides that,

extractive and oil industries have attracted traditional and emerging powers willing

to be part of these economic sectors expansion. Even though the GoA is still very

much dependent on natural resources and commodities’ international price, oil

revenues allowed the Angolan government to take on its development agenda, in

spite of negative effects in short and medium terms related to concentration of

wealth and democratic consolidation. Furthermore, recent presence of emerging

powers in Angola has increased GoA’s capacity to conduct development policies

and programmes.

Using the five fundamental principles defined in the Paris Declaration (2005)

for making aid more effective within this context

, it is possible to notice that

Angola has high ownership of the international cooperation projects, nevertheless,

low alignment and mutual accountability, as indicated in the table that follows:

Box 6: GoA and the four principles of Paris Declaration

Paris principles GoA

Ownership High

Alignment Low

Harmonisation N/A

Managing for Results N/A

Mutual Accountability Low

Source: Elaborated by the authors

The GoA clearly “owned”, for better or worse, its development agenda, even

though ownership in Angola could be described as top-down rather than bottom-

up. This is related to the absolute and relative size of development cooperation

in relation to the Angola’s budget and GDP, both of which cannot be dissociated

26 It is important to notice that this can be a controversial approach, as those principles were defined under OECD’s

umbrella and South-South Cooperation principles do not follow this effectiveness perspective. Even so, this

approach is useful to understand how the partner’s domestic dynamic impact upon development cooperation.

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Is there a Brazilian solution for every African problem? Brazilian Health Cooperation in Angola (2006-2015)

from the GoA’s choice to pursue economic development centred on the extractive

sector since the beginning of the 2000s. This assessment shows how context and

particular historical paths matter when SSC projects are designed and executed.

The increasing engagement of the BRICS countries in Angola has been certainly

impacting oil dependency in complex ways. When attention is devoted to Brazilian

health cooperation in Angola, similarities and differences between Brazil’s South-

South and North-South cooperation seem to be largely maintained, in spite of the

different country settings. As is the case of North-South cooperation, Brazilian

development cooperation is much smaller in volume and number of projects in

Angola in comparison with other CPLP countries. However, Brazil’s most recent

and important projects are either based on Brazilian domestic experiences, or

emphasize a “structuring” dimension. The project’s research shows that institutions

such as Embrapa and Fiocruz also seem to be projecting their particular settings,

sectorial systems and policy choices through their development projects in Angola.

This move must be seen not only in light of Brazil’s government more general

foreign policy in that period, but also as a way to strengthen their particular

institutional positions and principles that underlie their work within international

and domestic fields.

The fieldwork has shown that Brazilian partners in Angola resisted against

certain Angolan practices already under implementation for several years. This

was clear in particularly regarding Angola’s policy of mandatory breastfeeding.

In this sense, Brazilian resistance would defy the SSC principle of autonomy and

ownership of the GoA to decide its own path. Finally, PROFORSA does not seem to

have enough recognition, contrary to the broadly known and debated Prosavana

in Mozambique, to raise resistance or support from civil society, which makes it

more difficult to deepen the analysis.

Even though Angola shares much of its development problems with other CPLP

countries, Angola’s historical trajectory and the country’s political configuration

this trajectory generated make the Brazilian cooperation processes to vary widely,

challenging the proposition commonly defended when discussing SSC that the

shared colonial past and common development problems among emerging

countries distinguish SSC providers from traditional donors. At the end of the day,

contrary to assumptions always taken for granted, the Angolan case is perhaps

demonstrating that African problems must find African solutions.

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