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

1. Algeria Health Sector overview
Seminar in Helsinki
Heli Pasanen-Zentz, Finpro Life Sciences
October 27, 2011

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. People's 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 Prospects
2010. Worrldbank 2011 3 © Finpro

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-
venture
Sources: ONS; IMF 2.2010; Ministére de la PME et de l‟Artisanat; ANDI
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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.
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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. 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.
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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.
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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.
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10. Public Sector healthcare infrastructure
• Algerian healthcare structure is based
Creation of 3
on the public service provision within
strategic
centers in the U the 48 districts ‘wilayas’ and with a
pipeline : 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 health
2/Oran, hospitals policies and acts as
ongology ( 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
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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
Health
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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.
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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 sports
Sources: ONS; ANDI
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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 )
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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.
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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 medical
Sources: BMI Algeria, and surgical devices : 40 – 60 % of the euipment are of French origin
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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 and
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patients 17

18. Health ICT infrastructure organization
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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.
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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, radiotherapy
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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.
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22. Opportunities - public/private hospitals
PRIVATE SECTOR
PUBLIC 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 planned
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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 health
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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 tendering
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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. market
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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 Med
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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.fi
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