Equatorial Guinea has the 31st highest GDP per capita in the world, as a result of the discovery of oil, yet this wealth is concentrated in the hands of the elite. As a result, health care in the country is extremely limited and there are significant barriers to access to medicine. The reality of the healthcare system is far away form the government's official rhetoric about universal health care for all. Sanitation is a major problem, with open sewers common, even in the capital city. The population of 600,000 is served by only 17 hospitals, all of which are located in the two big cities.
Equatorial Guinea has sought to create an open investment regime, under pledges of reform, and has lifted many nontariff measures since 1992, a move endorsed by the World Bank. However, customs bureaucracy is still cumbersome and costly. There is also a tariff on pharmaceuticals of 5%, including vaccinations, and an additional sales tax of 12%.