Health in Guinea-Bissau

The Serviço Nacional de Saúde is Guinea-Bissau's formal public health system. MINSAP sets health policy, regulates services and leads national programmes. The system also includes private, religious, NGO and traditional medicine providers, but their formal integration with public care remains limited. INASA supports research, quality control and the National Public Health Laboratory. CECOME manages the import, procurement, production and marketing of medicines and health products, while ARFAME regulates pharmacy, laboratory, medicines and other health products. Guinea-Bissau has 11 health regions, including the autonomous sector of Bissau, and about 114 health areas. A health area generally serves approximately 5,000 to 12,000 people. Health Centres of types A, B and C provide local primary health care, including preventive and curative services. Regional Hospitals provide the first referral level. Hospital Nacional Simão Mendes, commonly called HNSM, is the main national reference hospital in Bissau and provides specialist and tertiary care together with other specialized hospitals. Limited capacity can require transfer from a Health Centre to a Regional Hospital, then to HNSM, or evacuation outside Guinea-Bissau when the needed service is unavailable. The nearest facility is not always the most suitable facility. Health services are concentrated in Bissau and regional capitals. Distance, transport, staff availability, equipment, diagnostic capacity and maintenance differ between regions. About 66% of people live more than 5 km from the nearest health structure, and access is especially difficult in rural areas, on islands and in other hard-to-reach locations. A mobile clinic, mobile laboratory or telemedicine consultation can extend access, but these services do not provide the same coverage as permanent local care. A telemedicine pilot connects HNSM with Bubaque for specialist advice, referrals and training. In 2026, two mobile clinics, one mobile laboratory and biomedical equipment were supplied, although their coverage and continuity should not be treated as nationwide regular care. Community Health Workers, called Agentes de Saúde Comunitária, support care close to households. More than 2,200 were active across all 11 health regions in 2025. They provide integrated community case management for pneumonia, diarrhoea and malaria, visit households, give health information, register pregnancies, screen children with a mid-upper-arm measurement and refer people to health facilities. In 2025, community workers reached about 123,320 children each month with essential services and supported regular antenatal care for about 45,203 pregnant women. Preventive care includes vaccination, malaria prevention, nutrition and breastfeeding counselling, hand hygiene, mosquito nets, screening and family planning. Guinea-Bissau introduced a malaria vaccine on 28 January 2026, initially for about 58,000 children aged 5 to 59 months in 19 health areas and 24 Health Centres. Routine vaccination and catch-up campaigns remain necessary. A 2024 measles-rubella campaign also included vitamin A and albendazole. In 2025, yellow fever vaccination reached 229,944 children, or 61% of those eligible. Seasonal malaria chemoprevention reached 98% of its target children. Malaria remains one of the largest health burdens. It accounts for more than one third of consultations and hospitalizations. Guinea-Bissau reported about 114,000 cases in 2025 and more than 220 deaths, including 45 children under five. In 2026, a campaign distributed more than 1.2 million insecticide-treated nets to over 400,000 households. Reported net use was about 84%, below the regional target of 95%. Early testing and treatment, consistent net use, seasonal prevention and vaccination work together; no single measure replaces the others. Pregnancy care requires early contact with a Health Centre and continued follow-up. First antenatal contact is common, but later appointments are less regular, and contraceptive use remains low. National guidelines for antenatal care and normal childbirth were updated in 2024, with the World Health Organization target of eight antenatal contacts. Casa das Mães provides temporary accommodation for pregnant women who need to stay near obstetric care, but only five such facilities exist nationally and rural access is limited. A pregnancy with elevated risk may require an early move closer to an obstetric facility, although transport, cost and distance can make this difficult. Skilled attendance at birth remains limited, and home or birth-house deliveries can carry additional risks. UNICEF estimated maternal mortality at 725 deaths per 100,000 live births in 2024 and neonatal mortality at 35 deaths per 1,000 live births. Community Health Worker visits during the first week of a newborn's life support early detection and referral. Child health services address malnutrition, malaria, pneumonia, diarrhoea and vaccination. UNICEF estimated under-five mortality at 74 deaths per 1,000 live births in 2025, while stunting affected about 30% of children. Community screening reached 115,972 children in 2025. The integrated management of acute malnutrition programme reported a 78% recovery rate, severe acute malnutrition treatment was available in 52 facilities, and vitamin A supplementation reached 344,529 children. Multiple micronutrients were provided to 5,703 pregnant or breastfeeding women. Food quality, breastfeeding, clean water, sanitation and hygiene all affect child health alongside clinical treatment. HIV, tuberculosis, hepatitis B and C, diarrhoea, pneumonia, malaria and non-communicable diseases are priority concerns. Paediatric HIV services are integrated into primary care. In 2025, 211 health workers supported prevention of mother-to-child transmission and paediatric antiretroviral treatment in all 11 regions. National programmes include PNLS/HV for HIV, PNLT for tuberculosis and PNLP for malaria. Treatment interruption is a documented problem for tuberculosis, antiretroviral treatment and chronic diseases, so a prescription alone does not replace reliable follow-up. Guinea-Bissau has also recorded an active mpox outbreak since 26 June 2026. By 23 August 2026, there were 58 suspected cases, 10 confirmed cases and no deaths; about 90% of confirmed cases were in Bissau and one was in Biombo. The response includes surveillance, contact monitoring, PCR testing, isolation, supportive treatment, infection prevention and control, and community engagement. About 98% of suspected cases were investigated within 48 hours and 87% of laboratory results were available within 72 hours. For acute illness, a Health Centre is usually the first formal point of contact when it can safely provide the required service. A Regional Hospital receives referrals, while HNSM and specialist facilities handle more complex care. National assessments identify gaps in non-communicable disease care, mental health, surgery and blood transfusion. The 2022 MINSAP staffing figures included 235 generalist doctors, 822 general nurses, 161 midwives, 144 laboratory technicians and 63 pharmacy technicians, but distribution, skills and motivation are uneven. The Rede Integrada de Ambulâncias provides emergency ambulance transfers. Its emergency number 112 is free and available around the clock. The service averages about 15 inter-hospital and 5 pre-hospital transfers per month, but vehicle maintenance, travel distance and access from islands or rural areas remain risks. An emergency may therefore require regional transfer, central treatment or evacuation outside Guinea-Bissau. The 2024 fifth edition of the Lista Nacional de Medicamentos Essenciais lists medicines and health products selected for the country's epidemiological situation, national development plan and validated treatment protocols. It includes vaccines, rehydration products, neonatal and obstetric medicines, malaria, HIV, tuberculosis, non-communicable disease and palliative-care products, as well as assistive products. Inclusion on the list does not prove that a product is stocked at a particular facility. People should verify the product, strength, expiry date, packaging and source because local stock-outs, quality problems and falsified medicines remain possible. Mental health services are weakly documented and have substantial gaps. Psychosocial support is mainly delivered through Health Social Workers for women and children affected by violence or gender-based violence. There were 52 Social Work Assistants, including 16 in Bissau, providing counselling, referrals and home visits after discharge. General access to psychiatry and psychotherapy is not reliably documented nationwide. Rehabilitation, assistive technology and palliative care appear in the national medicines and health-product framework, but local service density is unclear. After treatment, follow-up may include newborn home visits, social-work visits for protection cases, continued HIV or tuberculosis treatment, monitoring of chronic disease and rehabilitation. Therapy interruption can lead to avoidable deterioration, especially when medicines or transport are difficult to obtain. Patients can ask the facility for the responsible follow-up contact, the date of the next appointment and the action to take if symptoms return. Direct household payments remain high. National health-account data for 2018 to 2021 indicate that families financed more than 66% of current health spending on average. No current nationwide tariff list was established in the reviewed sources, so charges can vary by facility and service. Vaccination campaigns, seasonal malaria prevention and selected programmes may be free or partner-financed. The 112 emergency call is free, while travel, medicines, tests and referral costs can still create financial barriers. Guinea-Bissau has a Health Area Management Committee structure for community participation, but the reviewed sources do not establish a clearly published nationwide patient-rights and complaints procedure. Local facilities should therefore be asked how complaints, consent, records and referrals are handled.