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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
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
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.
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.
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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Is there a Brazilian solution for every African problem? Brazilian Health Cooperation in Angola (2006-2015)
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.
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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Paulo Esteves, João Moura Fonseca, Geovana Zoccal Gomes
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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Is there a Brazilian solution for every African problem? Brazilian Health Cooperation in Angola (2006-2015)
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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Paulo Esteves, João Moura Fonseca, Geovana Zoccal Gomes
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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Is there a Brazilian solution for every African problem? Brazilian Health Cooperation in Angola (2006-2015)
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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Paulo Esteves, João Moura Fonseca, Geovana Zoccal Gomes
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
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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Is there a Brazilian solution for every African problem? Brazilian Health Cooperation in Angola (2006-2015)
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
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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Paulo Esteves, João Moura Fonseca, Geovana Zoccal Gomes
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:
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
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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Is there a Brazilian solution for every African problem? Brazilian Health Cooperation in Angola (2006-2015)
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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Paulo Esteves, João Moura Fonseca, Geovana Zoccal Gomes
(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