Algeria Health Sector overview. Heli Pasanen-Zentz, Finpro.

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Algeria Health Sector overview. Heli Pasanen-Zentz, Finpro.

  1. 1. Algeria Health Sector overviewSeminar in HelsinkiHeli Pasanen-Zentz, Finpro Life SciencesOctober 27, 2011
  2. 2. Contents• Algeria in brief• Economic indicators and doing business in Algeria• Algeria – WTO, EU, IMF, World Bank• Public Healthcare infrastructure• Healthcare Development Policy and modernization plans• Governmental reforms & FDI• Pharmaceutical and Medical device Market• Piloting e-health and ICT solutions• Hospital cases• Conclusions: Business Opportunities public/private• Algeria LS SWOT 2 © Finpro
  3. 3. Peoples Democratic Republic of Algeria in brief Population 34,9 million (47 % under 25 years) Area 2 381 741 km2 (2nd largest in Africa) Capital Algiers (3 M inhabitants) (largest city in Maghreb) Languages Arabic (French, Berber) Currency Algerian dinar (DZD) (1€ = 100 DZD approx.) GDP USD 140,6 billions GNI USD 4 420 per capita Minim. wage 15 000 DZD / month Government Presidential Republic Main cities: Algiers (3,5 m inhabitants), Oran (0,77), Constantine (0,5), Annaba (0,38), Batna (0,31)Sources: ANDI Investir en Algérie 2010;ONS; UN World Population Prospects2010. Worrldbank 2011 3 © Finpro
  4. 4. Economic indicators 2009 2008 Share of Oil & Gas sector in GDP Unemployment 10,2% 11,3% 50.00 % 45.00 % GDP growth 2,1% 2,4% 40.00 % 35.00 % Growth Oil & Gas 30.00 % sector -6,6% -2,3% 25.00 % 20.00 % Real nonhydro- 15.00 % carbon GDP growth 9,2% 6,1% 10.00 % 5.00 % Gross investment as 0.00 % a % of GDP 49% 37,7% 2001 2002 2003 2004 2005 2006 2007 Investment projects in 2008 Sectoral distribution of active (in M€) population 16,000.00 14,000.00 12,000.00 10,000.00 13% Agriculture 8,000.00 6,000.00 Industry 13% 4,000.00 Construction 2,000.00 56% 0.00 18% Tertiary Domestic FDI Foreign and domestic joint- ventureSources: ONS; IMF 2.2010; Ministére de la PME et de l‟Artisanat; ANDI 4 © Finpro
  5. 5. Trading partners • EU countries absorbed 53,4% of Algerian exports, and supplied 52,8% of its imports in 2009. Other OECD countries represent 31,5% of Algerian exports and 16,3% if imports • Finnish exports to Algeria reached 108 M€ in 2009 – Represents 0,2% of total Finnish exports and 0,003% of Algerian imports • 60% of Finnish exports were wood, pulp and paper; boilers and generators 23%; Electric machines and devices 14% – Imports were 139 000 € Algeria Main Clients Algeria Main Suppliers France USA 16% 21% Others 36% China Others 12% Italy 48% 14% Italy 9% NL Spain Spain 6% France Germany8% 12% 11% 7%Sources: CNIS, Statistiques du Commerce Exterieur de l‟Algérie, 2009. Tulli. 5 © Finpro
  6. 6. Doing business in Algeria• Exporting to Algeria – Tariffs and quotas for most of the products – Since 2009 documentary credit is the only method of payment possible – Algeria is disadvantaged by cumbersome bureaucracy, but enjoys a solid score for its continuity of policy.• Investing in Algeria – Foreign Direct Investment (FDI) projects must be presented to the „Agence National pour le Développement de l‟Investissement‟ (ANDI) • In addition to promote investments in Algeria, ANDI has the mission to inform and assist local and foreign investors • Since 2009, only joint ventures with at least 51% of the capital owned by Algerian partners are allowed. In 2009 only 4 FDI projects were presented to ANDI (102 in 2008)• Corruption – High level of corruption among officials and civil servants. – In 2009 Algeria ranked 111th out of 180 in the Corruption Perception Index – The problem is well-known but no official plan to tackle it has been set.• Travel & safety issues – A visa is required to enter the country – The security situation in Algeria has improved markedly since a couple of years, nevertheless recent uncertainties in the whole region since Tunisia‟s Jasmin revolution of Jan 2011. Recommended to check official information sources before travelling. Sources: ANDI; Transparency International; www.diplomatie.gouv.fr *The country ranking 1st is the least corrupt., New Zealand in 2009, scoring 9,4. 6 © Finpro
  7. 7. Algeria – WTO, EU, IMF, World Bank.. • One of the main reasons deterring foreign investment is the fact that Algeria is not yet a member of the WTO - World Trade Organization and as such has not implemented Trade-Related Aspects of Intellectual Property Rights (TRIPS) protection. Algeria is a signatory of the Paris Convention regarding the protection of industrial property. • Algeria will continue negotiations to join the WTO (excluding strategic sectors, however) and is considering a free trade agreement with the United States. • As in the past, Algeria will cooperate with the IMF and the World Bank, • Algeria has also accepted the European Commission’s proposal of an action plan under the European Neighborhood Policy. Algeria, in short, is quite prepared to engage with other states in terms of economic and social change but will not tolerate political initiatives that it believes threaten its sovereignty. • From the perspective of economic actors, the conditions for project implementation are wanting – as domestic entrepreneurs have limited access to financing, – and external actors have to pay additional taxes or reinvest parts of their budget in Algeria.Date 7 © Finpro
  8. 8. Algeria – administrative regions/districts • Algeria is the second- largest African country, although most of its territory is actually inhospitable Sahara desert. • The country is divided into 5 regions > 48 districts (wilayas) > 185 administrative health districts • The northern coast is the most densely populated area of the country – The biggest cities are Algiers, Constantine and Oran.08/11/2011 © Finpro 8
  9. 9. Public Sector healthcare infrastructure • Health infrastructure comprises 13 university hospitals, 34 specialized hospitals, 460 polyclinics, 1110 medical centers, 3600 basic health units. • Most health services are yet provided by the public sector, although a small private sector comprising some 20 percent of Algerian physicians also exists. • As for the private sector, its institutional and regulatory framework leaves much to be desired, and it has been unable to offset the shortcomings of the public sector in the areas of quality and access to care. Resources per 10 000 people 2009 • A network of hospitals and ambulatory Physicians 11.9 facilities are organized into health districts. The districts consist of a Dentists 3.0 - general hospital / polyclinic Pharmacists 2.0 - one or more urban&rural maternity centres, - medical centres, Nursing and midwifery 32.8 - and small, basic health units / dispensaries. Hospital beds 20.9 • These facilities are complemented Infrastructure - primary health 2.0 by specialized hospitals and Sources: WHO and centres care units , teaching university hospitals.Date 9 © Finpro
  10. 10. Public Sector healthcare infrastructure • Algerian healthcare structure is basedCreation of 3 on the public service provision withinstrategiccenters in the U the 48 districts ‘wilayas’ and with apipeline : hospitals minimum of one hospital serving each one of the 185 administrative health ( 13 CHU)1/Algiers, hea districts.rt diseases • The wilaya level is responsible for Specialized implementation of the national health2/Oran, hospitals policies and acts asongology ( 34 EHS) coordinator/organizer in each district . • University hospitals (CHU and EHU)3/Blida,kidney provide all medical services and act as Regional -48 wílayas general centres for surgery composed of 185 administrative health districts • Specialized hospitals (EHS) offer ( 460 polyclinics) treatment in a narrow medical speciality: Basic local structures Maternity, Oncology, Rehabilitation, Ne 1 110 medical centers urology etc. Almost half of the 3 600 basic health units specialized hospitals are Psychiatric 120 blood transfusion units centres Date © Finpro 10
  11. 11. Algeria – total 61 800 hospital beds (2007) TOTAL General hospitals Maternity clinics Specialized hospitals CHU- University hospitals Private Clinics (approx. 6 % of the total ) Source : Ubifrance, Ministry of Health08/11/2011 © Finpro 11
  12. 12. Algerian healthcare system 2011 • The Algerian healthcare system enjoys a considerable level of development, The GDP share of health expenditure is increasing (4.1 % in 2003, 5.6 % in 2009), but remains low in relation to huge modernization needs of the health care infrastructure. • Algeria‟s progress towards the 2015 Millennium Development Goals (MDGs) have recently been assessed by the WHO : The country has been judged as not likely to achieve the targets in eight key areas, much like the rest of the African nations covered by the review. • Quantitatively the numbers related to infrastructure and professionals look fine but the Algerian health care system suffers from significant qualitative failings Primary healthcare establishments are often underutilised, and the various levels of healthcare are used in much less than optimally => The government plans to reorganize the care provision with a large modernization programme – Facilities and equipment are afflicted by lack of maintenance and upkeep, and still show high levels of nosocomial infections and breakdowns. • The country‟s epidemiological profile is changing rapidly and such diseases as cardiovascular diseases, diabetes (est. 8 % incidence), obesity, cancer are on the rise • Nevertheless, the resurgence of “poor country” diseases, such as cholera and tuberculosis, remains health system is largely still that of a developing country.Date 12 © Finpro
  13. 13. National Development Policy • The president and the government strive to diversify the economy and develop the local industry in order to: – Reduce the dependence of the economy on hydrocarbon exports – Create jobs for the young Algerians • Although the official unemployment figure is around 10 %. It‟s a fact that some 21 % of Algerians between 16 and 24 are unemployed, representing over 40 % of the jobless • Governmental Launch of the Five-Year Plan of Public Investments – 206 000 M€ to be invested between 2010 and 2014 • 94 000 M€ to complete projects initiated during the previous five-year plan • 112 000 M€ for new projects – Housing and medicine continue to be important problems in Algeria. Failing infrastructure and the continued influx of people from rural to urban areas have overtaxed both systems : Largest share is reserved to modernize and develop infrastructures : • For transportations (26% of investments), • Education, healthcare, utilities, housing and sportsSources: ONS; ANDI 13 © Finpro
  14. 14. Major Healthcare Modernization Plans In 2010 the government has PAST healthcare modernization projects included 2005-2009 the USD 2 billion plan, which envisaged outlined a NEW medical the building of 65 general and specialized hospitals, orientation plan to 2025, which will 76 polyclinics, 168 health centres, 40 treatment be funded to the tune of USD 28.5 rooms, and six sanitary control centres billion in order to improve sanitation and overall hygiene level that have been strongly criticized in the country : 1/ To double the number of hospitals beds focusing on maternity and cancer wards ( to construct 57 cancer treatment From 1960s to 2007 the number of hospital beds centres and 200 hospitals in order to had been reduced dramatically. Today the major increase healthcare access across challenges are related to : the country  optimization of professional resources and structures nationwide 2/ To renovate 12,181 existing  healthcare funding for even the poorest hospital beds in 320 public  better prioritization of the public investment targets hospitals (investing 1 % of the Algerian budget )08/11/2011 © Finpro 14
  15. 15. Governmental Reforms and FDI  The government has launched various initiatives to encourage FDI, including privatisation, However, a July 2009 meeting of experts highlighted Algeria‟s need to diversify its bid for FDI to health, information and communication technologies (ICT and tourism. Authorities are committed to economic liberalisation, as Algeria Pharmaceuticals & Healthcare Report illustrated by the sale of various enterprises over the past years, including part of the Saidal pharmaceutical group.  The government is committed to encouraging foreign investment particularly in the pharmaceutical sector, with reforms such as the lowering of corporate profit tax from 30 to 25%, and the cutting of reinvestment profit tax from 15 to 12.5%, but the IP and the regulatory environment remain major obstacles.  As part of these efforts, the Algerian government signed a letter of intent with a number of US firms in October 2010 . Objectives :  Investments in the Algerian pharmaceutical and healthcare industry  Increasing technology transfer, R&D and direct investments.  Investments also expected in specialized healthcare services such as oncology centres.08/11/2011 © Finpro 15
  16. 16. Pharmaceutical & medical device market Algeria imports the major part of medical devices and pharmaceuticals : Pharmaceutical market : over 1 billion USD in 2007 (up from 700 MUSD in 2004) (Imports representing over 80 %.)  The import sector of pharmaceuticals is dominated by three firms, Biopharm, LPA and Prodiphal, which together control almost 50% of the market.  Leading foreign companies operating in Algeria are French Sanofi-Aventis, US major Pfizer, UK‟s GSK, and Spanish Asac Pharma, all of which partner with local investors.  The Central Pharmacy Purchasing body (PCH) is the main tendering authority for the hospital market representing 30-40% of the total market. Medical devices and equipment market : Approx. 396 MUSD in 2009 (BMI) (Imports over 95 %)  Medical device Importers have to be registered as « Importateurs d‟équipements médicaux ». Their number has increased over tenfold from 1996 to 2007 : over 400 companies as medical equipment and product importers are currently active in Algeria.  France is Algeria‟s most important commercial partner for importation of medicalSources: BMI Algeria, and surgical devices : 40 – 60 % of the euipment are of French origin Date 16 © Finpro
  17. 17. Piloting E-health and ICT solutions Since 1999 : Development of Portal Santé-Algerie http://www.sante-algerie.com/ to interconnect all Algerian health organisations and structures managed by ANDS and piloting Chifa – Electronic social security card telemedicine and physician training Following a successful pilot programme that tested 700,000 solutions –eg radiology in cards in five regions, a national roll-out of the country’s CHU Bab-el-Oued first electronic social security smart card (Chifa) was launched in 2008 by Gemalto (European company). National plan for the The cards are supposed to improve administration of development of ICT use reimbursement claims and recording of patient data. in the sector exists since In January 2011 Minister of Labour, Employment and Social 2002 to build Security Tayeb Louh announced that "the year 2012 was connectivity and better chosen as deadline for Chifa card generalization" information for the nationwide and for "all social insured persons." professionals and08/11/2011 © Finpro patients 17
  18. 18. Health ICT infrastructure organization08/11/2011 © Finpro 18
  19. 19. Public hospital EHU Bir el Djir in Oran  The most recent university hospital  established in 2003 and ordered  by the Wilaya of Oran  NB : Already a CHU university hospital  In Oran´( 1 700 beds, 6 000 medical staff)  Triple Mission : 1. High level medical  practice, 2. Education center  3. Research activities  Huge 17 acres area : 740 beds in the beginning- objective: 1 200 beds  10 operating theatres, 59 lifts  Construction cost : > 12 billion DZD (120 Million €uros) –by a Chinese company.  Equipped mainly by Oran Santé – responsible of 3 separate contracts to cover all the equipment needed in 40 separate departments of the EHU. Total budget has been estimated around 3 billion DZD ( 30 Million €) . Two European imaging equipment providers were selected : ICUATRO (Spain) and SIEMENS.  Official opening took place in July 2007 : 3 years after the buildings were ready ! , but yet it has taken several years to recruit the staff and open services little-by-little.08/11/2011 © Finpro 19
  20. 20. Private Clinic Al Azhar  One of the best and most recent private clinics  Established in 2005 in Algiers  Approved by the Ministry of Health of Algeria  ISO 9001-2000 accredited  Medico-Surgical  Multidisciplinary except maternity Clinique Al Azhar Djenane Achabou No.  6 500 m2 4  Physician in charge present Dely-Ibrahim 16020 24/24 h Algeria  X-Ray center Tel: + 213 21 91 73 96  5 operating theaters Fax: + 213 21 91 74 29  102 beds  Development plans include - Gynecology - Neonatal care - Oncology, radiotherapy08/11/2011 © Finpro 20
  21. 21. Opportunities / HOSPITAL construction Important hospital construction is budgeted in Algeria over the next years in the major cities of Algiers, Oran and Constantine but also in remote areas, as the Algerian Government intends to also focus significant construction in the country‟s rural health improvement. There are needs for a wide scale of medical equipment, appliances, devices, and disposals. Opportunities are also increasing for radiology: echography and mammography equipment, dental radiology, IMR, scanners, and other imaging consumables And also : Emergency care / Hospital hygiene and waste management Over the next five years, medical and pharmaceutical values and volumes are estimated to be boosted by various health care modernization programmes. Algerian healthcare market is growing and main products and devices are almost all imported : These will provide substantial opportunities to foreign players – most of which operate in Algeria through imports or local partnerships.08/11/2011 © Finpro 21
  22. 22. Opportunities - public/private hospitals PRIVATE SECTORPUBLIC SECTOR There are also number of Private Sector 48 University hospitals; hospital projects – especially by a number of 3 serious burn hospitals of 120-140 beds – Jordanian and Gulf Arab investors. One of one in Algiers, one in Oran, and one in the main projects in discussion is an Emirati Skikda; hospital complex project in Algiers focusing on radiotherapy, cardiology and to a lesser extent 2 Geriatric centers with 120 beds treatment of renal diseases. 5 Cancer centers with 150 beds each; Loiola Al-Djazair, a modern ophthalmology 4 Maternal/Pediatric Health centers with hospital, a JV between Spain and 150 beds each; Algeria, has been operational since the 3 Assisted Reproduction centers – one in beginning of 2008 and will also require medical Algiers, one in Oran and one in supplies. Constantine; Algerians and Cubans have recently 14 Psychiatric hospitals; discussed the creation of 7 opthamological hospitals in Algeria‟s remote areas. 53 Toxicology centers Another 12 private sector cancer diagnosis and treatment centers are also planned08/11/2011 © Finpro 22
  23. 23. Other LS Opportunities in Algeria Algeria is expected not to meet A changing demographic profile and population The MDGs 2015 Millennium Development ageing will provide new opportunities Goals of reducing child mortality, improving Neonatal and newborn diagnostics kits maternal health and expanding the reach of - Preventive care concepts - Hygiene monitoring solutions medical professionals  This will foster the Development speed Mother & Child Young adults Construction of new and the modernization of existing cancer treatment centres , as well as building a National Cancer Care Institute in Oran Radiology, ONCOLOGY E-health and software solutions Consumables Hospital waste management Market needs according to All supplies related to Imaging and radiology ! Importers Diagnostics –kits, instrumentation, automates, consumables. Equipment for blood transfusion centres Ophthalmology – public and private sectors Dentistry and dental surgery : Training for professionals ! Laboratory instrumentation and consumables. HOSPITAL engineering Occupational health08/11/2011 © Finpro 23
  24. 24. Information on Public tender Opportunities 3 levels of public tenders www.algeriatenders.com 1) Market below 1 M DZD (10 000 €) => Free choice 2) Market < 6 M DZD (60 000 €) => consultation minimum at least 3 providers 3) Market over 6 M DZD (60 000 €) => International tendering08/11/2011 © Finpro 24
  25. 25. Algeria LS Sector SWOT Strengths Weaknesses • Market opacity – reform implementation • Algeria has fincancial resources : lacking behind schedules and missing Funding from Oil and Gas revenues competent organization to prioritize and • Governmental healthcare modernization focus the multiple objectives programme until 2025 • Patchy healthcare provision due to • A strong, potential market for imported geographical distances medicines and medical devices • Intellectual property environment • A relatively large and young population Opportunities Threats • Small local industry leaving plenty of • A failure to revise pricing regulations room for foreign players. and import restrictions damaging • Important and increasing needs in all chances of WTO accession and deterring hospital and laboratory equipment and multinational investment. medicines • Government drive to increase and • E-health – launch of Chifa smart improve local production (especially healthcare cards medicines) to further discourage imports. • Government encouraging foreign direct • Growing international competition in the investments - FDI. market08/11/2011 © Finpro 25
  26. 26. Main Information sources • Agence Nationale de Développement Algérien – www.andi.dz • Ministère de la Santé Algérien - www.ands.dz • OECD – Algeria 2008 • OMS – Country Health Profile / Algeria • BMI – Algeria Pharmaceuticals and healthcare Q4 2010 • WHO/OMS - Stratégie OMS de coopération avec les pays ‟République Algérienne Démocratique et Populaire • www.imf.org • Ubifrance – Algérie le marché des équipements et matériels médicaux, perspectives et opportunités • Anima – Invest in Med08/11/2011 © Finpro 26
  27. 27. Thank you . Contact information in France : Heli Pasanen-Zentz Finpro France Finlande Trade Centre 23, rue Vernet 75008 Paris, France +33 1 58 56 53 05 +33 6 03 81 44 50 mobile heli.pasanen-zentz@finpro.fi08/11/2011 © Finpro 27

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