Introduction
Namibia’s health system comprises the facilities for the provision of health services, social welfare and social security. The Ministry of Health and Social Services plays a pivotal role to help citizens lead a healthy life.
At independence on March 21 1990, Namibia had inherited a racially segregated health care system based on the apartheid doctrine of South Africa. The main features of the health care delivery system at independence were:
1. Racial segregation of healthcare resulting in separate and unequal services for blacks and whites.
2. Fragmentation of health services delivery through the establishment of numerous health services administrations based on ethnicity.
3. Curative orientation and an extensive hospital-centred health care infrastructure with little or no organisational linkage between curative and preventive health care.
4. Marked urban bias resulting in the neglect of rural majority in the provision of health infrastructure and targeting of health interventions. This bias emphasised meeting the needs of urban minority at the cost of the disadvantaged rural majority suffering from infectious diseases, malnutrition, and inadequate maternal and child care services.
5. Domination by whites of health services management.
Development of a National Health Policy
In order to address these inequities, the Minister of Health and Social Services issued a policy statement in March 1990, entitled Towards Achieving Health for All Namibians: A Policy Statement. Subsequently the government committed itself to providing access to health services for all Namibians by the year 2000. The fact that approximately 15% of total government expenditure is devoted to the public health sector is a testimony to the government’s commitment to investing in the citizens’ health.
National health policy was reviewed in 1997 and the reviewed policy yet again emphasised that primary health care approach was the best strategy to address the citizens’ health care needs. The purpose of the new health policy was to ensure that citizens’ health care needs were given their rightful place in planning the course ahead for socio-economic development. Therefore, Namibia’s health care policy is being driven by the following principles:
1. ensuring equity of access to health care services to all with special provision for those most vulnerable and most affected by inequalities, such as, the rural poor, women and children;
2. promoting community involvement and greater citizen participation and say in decisions about priorities for access to and provision of health services;
3. providing affordable health services by strengthening health care systems which are sustainable, cost-effective, efficient and culturally relevant and acceptable;
4. facilitating co-operation and inter-sectoral action with all major players in the provision of health care;
5. instituting measures to counter major health risks including the prevailing communicable diseases, such as, malaria, tuberculosis and HIV/AIDS, and the deadly children diseases, such as, measles and polio;
6. ensuring the development of human resources in sufficient numbers for manning various health delivery systems;
7. ensuring the development of a national health care system that is capable of providing a fully comprehensive range of preventive, curative and rehabilitative health care that is cost-effective, sustainable and acceptable to the most disadvantaged communities, and promotes equity and facilitates the effective implementation of defined strategies and interventions; and
8. providing quality health care services.
The first major step towards the realisation of the goals and objectives defined in the National Health Policy was the unification and rationalisation of the fragmented second tier structures under the central control of the Ministry of Health and Social Services. This process was completed during the first few months after the country became independent.
The ministry furthermore incorporated all existing health and social services in a rationalised organisational structure designed to ensure the provision of health and social services at the local, district, regional and national levels.
National Primary Healthcare Guidelines
Impetus for change in guiding the principles of the new policy was spearheaded by the President of the country and was supported by leading politicians, community leaders, international organisations, non-governmental organisations, senior officials in the ministry, and the community. Through a national workshop held in Oshakati in 1991, followed by a series of other workshops held at national, regional and district levels, a broad consensus on the approach to be followed in the implementation of primary health care/community-based healthcare (PHC/CBHC) was reached. The outcome of this consensus was the development and adoption of the PHC/CBHC guidelines which were launched by the President in 1992. Achievement of this consensus and the strong political will in support of the new initiatives in health development have been important contributors to the success of the primary health care approach.
Strategic Planning
Since 1991, development of annual plans has become an annual event in the ministry and a planning culture has now been institutionalised in the ministry.
The World Summit for Children in 1990 and its recommendation that countries develop strategic plans to guide the implementation of programmes in order to meet the mid-decade goals (1995) and end-decade goals (2000) added further impetus to the strategic planning process. This was followed by the compilation of an implementation framework that emphasised the organisational set up of healthcare services in the country. This guide, better known as the Otjiwarongo Document, set the pace for strategic reform during the mid-1990s. It also formed the basis for the compilation of the health chapter in the government’s First National Development Plan (NDP1). Furthermore, all thirteen regional management teams went through a strategic planning processes that formed the basis of five year strategic plans.
While the basic thrust of the new healthcare system has been towards community-based healthcare activities, significant success has been recorded in a number of nationwide public health programmes and initiatives with special reference to the following:
At the time of Namibia’s independence in 1990, no national programme, policy or guidelines on immunisation were in place, nor did health facilities have any cold chain equipment. Health personnel were uninformed about new approaches to immunisation and information on the immunisation status of children in the country was non-existent. The government therefore identified the immunisation of children as a priority area and proceeded to reduce morbidity and mortality due to immunisable diseases among children under the age of five years. In June 1990, the ministry adopted the national immunisation policy and guidelines, procured all the necessary equipment and supplies and initiated a national Expanded Programme on Immunisation (EPI). This effort was accomplished with assistance from Unicef, World Health Organisation, and other development partners.
A national immunisation coverage survey carried out in December 1990 recorded 42% immunisation coverage of children under the age of one year. By 1992, 58% of all children under the age of one year were fully immunised, while 71% were protected against measles.
During the National Immunisation Days carried out in May 1997, 80% of children under the age of five were immunised, and by July 1997, 100% coverage of children under the age of five was achieved. As a result, there was dramatic decrease in the incidence of measles from 12 471 reported cases in 1992 to 4556 in 1997.
In its effort to eliminate tetanus the ministry included the immunisation of women of childbearing age with tetanus toxoid as part of the immunisation programme. To date 74% of women of childbearing age have had two or more tetanus toxoid vaccinations. Intensity of this effort is being sustained, and Namibia can hope eliminate tetanus in the near future.
Table 1: Programme on immunisation |
|||||||||
Immunization < 1 |
1991
(Survey) |
1992 |
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
| BCG |
85% |
68% |
92% |
127% |
92% |
79% |
66% |
82% |
78% |
| OPV3
|
53% |
87% |
71% |
80% |
73% |
71% |
66% |
72% |
71% |
| DPT3
|
53% |
82% |
73% |
79% |
74% |
70% |
66% |
71% |
71% |
| Measles |
41% |
71% |
71% |
70% |
68% |
61% |
59% |
61% |
86% |
| Schedule
completed |
42% |
71% |
71% |
68% |
65% |
57% |
53% |
58% |
61% |
| Morbidity
< 5 |
|
|
|
|
|
|
|
|
|
Selected
diseases/conditions
|
|
|
|
|
|
|
|
|
|
| ARI
|
|
35% |
33% |
30% |
20% |
23% |
20% |
23% |
25% |
| Malaria
|
|
20% |
23% |
20% |
18% |
19% |
22% |
20% |
21% |
| Diarrhoea
without blood |
|
25% |
19% |
16% |
19% |
17% |
13% |
14% |
13% |
| Mortality>
5 |
|
|
|
|
|
|
|
|
|
Selected
diseases
|
|
|
|
|
|
|
|
|
|
| ARI |
|
25% |
20% |
17% |
9% |
10% |
9% |
11% |
11% |
| Malaria
|
|
20% |
23% |
18% |
16% |
18% |
19% |
16% |
19% |
| Diarrhoea
without blood |
|
11% |
9% |
5% |
5% |
0% |
0% |
3% |
3% |
| ENTM |
|
|
|
|
14% |
11% |
10% |
13% |
11% |
| Women
delivery at the medical facility |
|
|
48% |
49% |
51% |
51% |
51% |
52% |
54% |
|
|
|
|
|
|
|
|
|
|
| ANC |
|
|
62% |
67% |
85% |
73% |
73% |
62% |
75% |
|
|
|
|
|
|
|
|
|
|
| PNC |
|
|
|
|
|
30% |
42% |
40% |
54% |
|
|
|
|
|
|
|
|
|
|
| Incidence
HIV/AIDS |
543 |
734 |
|
2517 |
4126 |
7757 |
10576 |
11608 |
|
|
|
|
|
|
|
|
|
|
|
| Eradication
of diseases |
|
|
|
|
|
|
|
|
|
| Measles
|
|
|
12471 |
1328(7%) |
1535(2%) |
2043(3%) |
4881(4%) |
4556(35%) |
|
| Neonatal
Tetanus |
|
|
44 |
12(0%) |
17(16%) |
26(13%) |
20(3%) |
30(5%) |
|
| Poliomyelitis/AFP |
|
|
40 |
53(0%) |
4(2%) |
28(3%) |
8(1%) |
2(0%) |
|
|
|
|
|
|
|
|
|
|
|
| Nutritional
status |
|
|
|
|
|
|
|
|
|
| Severe
Malnutrition (IP) |
|
|
|
|
1786(8%) |
1786 |
1700(8%) |
1600(11%) |
1560(8%) |
|
|
|
|
|
|
|
|
|
|
| Social
benefits |
|
|
|
|
|
|
|
|
|
Control of
Diarrhoeal Diseases and Acute Respiratory Infections
Diarrhoeal
diseases and acute respiratory infections (ARI) are major killers
of children under the age of five and therefore the ministry made
this programme a national priority. Policy documents and
protocols for both diarrhoea and acute respiratory infections
(ARI), as well as guidelines for cholera preparedness have been
developed and are guiding the implementation of these programmes
at all levels of healthcare delivery.
To date
approximately 8000 health workers have been trained in correct
case management and prevention of acute respiratory infections
and some 1000 health workers have been trained in correct case
management and prevention of diarrhoeal diseases. In addition,
community sensitisation was initiated on as an ongoing activity.
Because of these
efforts, a decrease of 47% in the incidence of ARI was recorded
from 1992 to 1995, while a marked decrease of 58% in the
incidence of diarrhoeal diseases was reported between 1992 and
1996. In addition, awareness among communities about the dangers
of diarrhoeal diseases, and the use of oral rehydration therapy
increased to 68%.
Reproductive
health or maternal and family planning programme was introduced
with the overall objective of promoting, protecting and improving
the health of family members, especially women and children.
Objective of this programme is to reduce maternal and infant
deaths, increase contraceptive use among women of reproductive
age, and promote and improve access to reproductive health
services at all levels of health care delivery.
Introduction of
this programme has resulted in increased use of antenatal,
postnatal and family planning services in all parts of the
country. Currently antenatal care services are available in 63%
of government health facilities, family planning services are
available in 93% of government health facilities, and delivery
services are available in 55% of government health facilities.
Antenatal care and family planning services are also provided at
more than 800 outreach points distributed across the country. A
family planning policy has also been developed and is being
implemented.
Approximately 400
health workers have been trained in reproductive health programme
management, service provision, information, education,
communication, and research.
In 1992, maternal
mortality rate was reported to be 225 per 100 000. Heath
facility- based maternal mortality estimates showed a marked
decline to an estimated level of 77 per 100 000 in 1996. This
figure is, however, not based on national statistics and covers
mortality rates of women delivering in government health
facilities. Some 49% of women are not delivering in government
health facilities.
National
Malaria Control Programme
Malaria is one of
the major contributors to illness and death, especially in the
northern parts of the country where it is endemic. Soon after
Namibia gained independence, a national malaria control programme
was established. To re-emphasise the gravity of the problem in
the northern part of the country, the national office of the
programme was established in Oshakati and not in Windhoek.
Programme focus has been on vector control campaigns,
strengthening of epidemiological surveillance, applied research,
development of human resources, and the provision of physical
infrastructure including equipment and vehicles.
The programme got
additional impetus when four Namibians joined the effort after
acquiring graduate degrees in entomology and parasitology. One
more Namibian is undergoing training in vector control.
Community bed
nets projects have been put up at Ongandjera and Rundu. These
projects will gradually be expanded to other parts of the
country. Studies on chloroquin resistance were carried out but
chloroquin still remains the ideal drug in Namibia. Careful
monitoring of development of chloroquin resistance is, however,
ongoing.
In general, there
has been a decrease in the number of reported cases of malaria,
especially between 1992 and 1995. The highest drop in cases was
noted between 1994 and 1995 with a decrease of 28%. This decline
might be attributed to improved vector control measures, improved
diagnostic skills of health workers, and probably the use of
other protective measures by the citizens. In 1996, however,
there was a marked increase in malaria cases due to an outbreak
in Caprivi, and increased number of malaria cases in the Omaheke
Region.
Malaria remains a
very serious disease and is rated number two cause of illness
among children under the age of five years and number one cause
of illness among adults. The disease is busy showing its ugly
face in areas where traditionally it was not a problem,
especially in the Omaheke Region. Efforts are being made to
intensify control mechanisms in new areas where malaria has
recently been reported.
Pulmonary
tuberculosis is among the top ten killer diseases in the country.
Policy guidelines for the control and management of tuberculosis
were developed. These guidelines put emphasis on improving case
management, reducing defaulter rate, strengthening the case
detection and surveillance system, and improving reporting.
Namibia also participates in the Southern African Tuberculosis
Control Initiative (SATCI) launched in 1995.
A new health
information system specifically for tuberculosis was developed
and introduced in selected districts in 1995. To date 100% of
districts are using the new system and reporting has improved
significantly. Defaulter rate has decreased from 50% in previous
years to 7% in 1996 and tuberculosis incidence rate had dropped
from more than 400 per 100 000 population to 344 per 100 000 by
1996.
Plague Control
Plague had been a
public health problem in Namibia for quite sometime with annual
reported cases averaging 100 per year. In 1991, Namibia
experienced a major plague outbreak, with more than 1000 cases
reported in that year. Strategies employed to control the disease
included: extensive community information and education
campaigns, dusting of vectors, identification and follow up of
suspected cases, provision of the necessary drugs in affected
areas, and the setting up of a surveillance system. A plague
laboratory was also set up in Oshakati, the first of its kind in
Namibia. Prior to the setting up of this laboratory blood samples
had to be sent to South Africa. No plague cases were reported
between 1994 and 1998.
AIDS is the
leading cause of death amongst the young population in Namibia.
On average, HIV prevalence rate in sub-Saharan Africa is 7.4%,
while five southern African countries show a prevalence rate of
more than 18%.
The National AIDS
Control Programme was established in 1990 to ensure effective
control and prevention of the spread of the virus causing AIDS.
First HIV cases were reported in Namibia in 1986. Since then, the
situation has become increasingly worse. The disease has spread
fast and by 1998 more than 53 000 HIV cases have been reported.
Because most persons with HIV do not have symptoms, the majority
of persons with HIV have not been tested. The total number of HIV
infected Namibians is probably two to three times higher.
Incidence of HIV in children under five is also very high. In
1998, about 1400 of the reported new HIV cases were children
under five years. The total number of paediatric HIV/AIDS is
probably higher because it is often difficult to make the
clinical diagnosis of AIDS in children.
Table 1 : HIV/AIDS in Namibia – Infections, hospitalisations, and deaths, 1986-1999 |
|||||||||
|
'86-'92 |
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
Total |
| Positive
HIV Tests by Health Directorate |
|||||||||
|
|
|
|
|
|
|
|
|
|
| Northwest |
|
|
|
2243 |
3322 |
4045 |
4779 |
5918 |
|
| Northeast |
|
|
|
872 |
985 |
997 |
958 |
785 |
|
| Central |
|
|
|
985 |
1567 |
1651 |
1939 |
2024 |
|
| South |
|
|
|
416 |
907 |
1076 |
1309 |
1739 |
|
| Windhoek |
|
|
|
3241 |
3795 |
3839 |
3716 |
4400 |
|
| Total |
4045 |
2517 |
4126 |
7757 |
10576 |
11608 |
12701 |
14866 |
68196 |
| Hospitalisations
by Health Directorate |
|||||||||
| Northwest |
156 |
140 |
215 |
782 |
1402 |
1842 |
2725 |
|
7262 |
| Northeast |
157 |
153 |
108 |
545 |
423 |
634 |
724 |
|
2744 |
| Central |
28 |
31 |
46 |
101 |
155 |
340 |
459 |
|
1160 |
| South* |
72 |
31 |
83 |
56 |
135 |
212 |
333 |
|
922 |
| Windhoek
(hospitals) |
|
|
|
342 |
505 |
880 |
914 |
|
2641 |
| Total |
413 |
355 |
452 |
1826 |
2620 |
3908 |
5155 |
|
14729 |
| Deaths
by Health Directorate |
|||||||||
| Northwest |
52 |
43 |
108 |
258 |
563 |
828 |
1175 |
|
3027 |
| Northeast |
17 |
25 |
76 |
200 |
251 |
243 |
365 |
|
1177 |
| Central |
8 |
12 |
12 |
41 |
51 |
110 |
198 |
|
432 |
| South* |
9 |
12 |
11 |
31 |
95 |
106 |
152 |
|
416 |
| Windhoek
(hospitals) |
|
|
|
98 |
165 |
252 |
289 |
|
804 |
| Total |
86 |
92 |
207 |
628 |
1125 |
1539 |
2179 |
|
5856 |
| Infection
in Blood Donors |
|||||||||
| HIV
positive donors |
0.6% |
0.9% |
0.9% |
1.3% |
1.6% |
1.7% |
1.6% |
|
|
| Infection
in Pregnant Women |
|||||||||
| Oshakati |
4% |
|
14% |
|
22% |
|
34% |
|
|
| Walvisbay |
|
|
|
|
|
|
29% |
|
|
| Katima
Mulilo |
14% |
|
25% |
|
24% |
26% |
29% |
|
|
| Windhoek |
4% |
|
7% |
|
16% |
|
23% |
|
|
| Onandjokwe |
|
|
8% |
|
17% |
|
21% |
|
|
| Engela |
|
|
7% |
|
18% |
|
17% |
|
|
| Otjiwarongo |
2% |
|
9% |
|
|
|
16% |
|
|
| Andara |
|
|
2% |
|
11% |
17% |
16% |
|
|
| Swakopmund |
3% |
|
7% |
|
17% |
|
15% |
|
|
| Rundu |
|
|
8% |
|
8% |
18% |
14% |
|
|
| Nankudu |
|
|
|
|
|
|
13% |
|
|
| Nyangana |
|
|
6% |
|
5% |
7% |
10% |
|
|
| Gobabis |
1% |
|
|
|
|
|
9% |
|
|
| Keetmanshoop |
3% |
|
8% |
|
|
|
7% |
|
|
| Opuwo |
3% |
|
1% |
|
4% |
|
6% |
|
|
| Namibia |
4.2% |
|
8.4% |
|
15.4% |
|
17.4% |
|
|
| *
Windhoek Specialised Services included in South Health
Directorate up to 1994. |
|||||||||
The First Medium
Term Plan was launched in 1992 and came to an end in 1998. This
Plan was reviewed in 1993 and 1996. The Medium Term Plan’s
focus was mainly on:
1.
programme management,
2.
information, education and communication,
3.
epidemiology and surveillance,
4.
sexually transmitted infections management,
5.
laboratory support and blood safety, and
6.
HIV/AIDS management and counselling.
The National Aids
Control Programme, too, was reviewed and evaluated in 1996 and
its status and placing in the Ministry of Health and Social
Services was seriously considered. Importance of inter-sectoral
collaboration was re-emphasised. Consequently, composition of the
National AIDS Committee is scheduled to be reviewed with a view
to broadening its membership to include all the relevant sectors.
Under this
programme, a number of policies and guidelines initiatives were
taken as follows:
1.
A National Code on HIV/AIDS and Employment has been developed.
2.
Sexually Transmitted Diseases Management Guidelines have been
upgraded.
3.
National Policy and Guidelines on HIV/AIDS has been developed and
are currently being revised.
4.
National Guidelines on HIV/AIDS Home Based Care have been drafted
and will be finalised in the near future.
5.
National Policy on Counselling and Social Support have been
drafted and will soon be finalised.
6.
Guidelines for Breast-feeding of Infants of Mothers infected with
HIV virus will be revised.
Although the
situation seems hopelessly discouraging, the National Aids
Control Programme has relentlessly continued in its efforts to
make the nation aware of the dangers of this deadly disease.
Numerous information campaigns, rallies, meetings and workshops
to raise public awareness have been conducted. Today more than
90% of the Namibian population is aware of HIV/AIDS and sexually
transmitted infections. What is now required is for the people to
change their sexual behaviour. Prevention and control of the
virus remain the only effective strategies, and therefore efforts
to try and convince communities to change their sexual behaviour
will continue.
Fight against
this disease needs to be multifaceted and requires a concerted
effort from all sections of society. Efforts have been made to
involve other partners. Non-governmental organisations and
volunteers have been trained in counselling and home-based care
and some communities, such as, the Katonyala Group in the
Oshikoto Region, are taking care of AIDS sufferers in that
region.
In Namibia, malnutrition is a major cause of illness among children under the age of five years. The 1992 Demographic Health Survey reported that nearly three out of ten or 29% of children under the age of five years were chronically undernourished or stunted; over one in four or 27% of children under five years of age were underweight; and one in ten or 9% of children under the age of five years suffered from acute undernutrition, that is, wasted or too thin for their age.
A National
Nutrition Programme was set up to promote and monitor the growth
of and nutritional status of children under the age of five
years. The major objective of the programme is to contribute to
the overall reduction of maternal malnutrition, and malnutrition
in children under the age of five years as well as reduction in
the incidence of micro-nutrients deficiencies.
Though the health
information system is showing an improvement in the nutritional
status of children under the age of five years, the information
might not reflect the extent of the problem as community-based
growth monitoring information is not captured within the formal
reporting system.
In the context of
the National Nutrition Programme, the following highlights have
been major achievements during the last decade:
1. Legislation passed on iodised salt. All salt in Namibia for both human and animal consumption must be iodised.
2. Establishment of a National Food Security and Nutrition Council. This multi-sectoral organ plays a significant role in the reduction of malnutrition in the country through concerted, collaborative and co-ordinated efforts.
3. Development of a National Food and Nutrition Policy in 1995.
4.
National Declaration on Food and Nutrition compiled by the
National Food Security and Nutrition Council.
5.
Vitamin A and iron supplements administered at antenatal clinics
and other health centres in the country.
6.
Introduction of baby-mother-friendly health facilities, leading
to extensive promotion of breast-feeding countrywide.
7.
Administering of iodine oil to school children in the Caprivi
Region who had goitre. This measure has been a tremendous success
in reducing the incidence of goitre.
Human
Resources Development
One of the tragic
legacies of apartheid has been the shortage of skilled human
resources in the health sector. Although an acceptable number of
nurses have now been trained, considerable shortage of Namibian
doctors, dentists, pharmacists, paramedical staff, health
inspectors and medical laboratory technologists in the public
sector continues. On the other hand, the private sector, due to
its competitive salaries, is relatively well supplied.
To meet this
shortfall, new curricula were developed and two-year training
programmes for environmental health assistants, medical
laboratory technicians, rehabilitation assistants, pharmacist
assistants, and enrolled nurses were started. To date 105
enrolled nurses, 28 pharmacist assistants, 12 medical laboratory
technicians, 18 medical rehabilitation assistants, and 32
environmental health assistants have been trained.
Training schools
for sub-professionals have been established at Keetmanshoop,
Otjiwarongo, Rundu, Katima Mulilo, and Oshakati. In addition, a
National Health Training Centre has been established in Windhoek,
and an in-service training centre has been put up in Engela.
Construction work is now underway to replace the National Health
Training Centre facilities in Windhoek with new facilities.
Problems have,
however, been encountered in the training of medical doctors and
pharmacists because of lack of availability of candidates with
appropriate science background. As shortage of the said health
professionals is mainly in rural areas, the ministry’s
strategy has been to recruit students from those areas. The
unfortunate reality, however, is that most students in rural
areas have weak science background. The ministry therefore
adopted a strategy of recommending students to the University of
Namibia to study science before they are considered for studies
in medical schools in the neighbouring countries.
The justification
for establishing a medical school in Namibia has been a subject
of some discussion. In fact, a task force investigated the
possibility of establishing a medical school in Namibia and
recommended as such. However, given the high cost of running a
medical school, the ministry will evaluate this option by
carrying out an economic analysis of the proposal.
In-service
training programmes are also offered to health personnel with the
aim of reorienting them towards the primary health care approach,
as well as the development of programme-specific skills required
to ensure speedy and proper implementation of national
programmes. The ministry, however, realises that short courses
that are programme-specific are expensive, difficult to
co-ordinate and counterproductive in a health system aimed at
integrated comprehensive health service provision and should
therefore be the exception than the rule. Longer integrated
courses addressing a variety of programmes targeted to specific
needs in the different regions are becoming the basis for future
in-service training strategies.
Social services
like health services have been facility and client-based. The
ministry has been re-addressing this approach and has refocused
social services to have a developmental and community-oriented
approach.
In the past, the
amounts paid out as pensions and social grants depended on the
colour of the person, with coloureds getting more than the blacks
and the whites getting more than anybody else. This situation was
rectified with the equalisation of social grants. The ministry
experienced a lot of problems with pension pay-outs. This
prompted the ministry to privatise pension payments to eliminate
theft and improve efficiency. Approximately 116 000 pensioners
are receiving state old age grants.
Another significant
achievement of the ministry has been the establishment of centres
for abused women and children. These centres have been set up in
collaboration with the Ministry of Home Affairs and the donor
community. Centres have been established at Windhoek,
Keetmanshoop, Walvis Bay and Oshakati. Similar centres would also
be established in Gobabis and Rehoboth.
The ministry is
also playing a major role in combating substance abuse.
Programmes aimed at early detection and awareness raising have
been started in collaboration with the private sector.
One of the major
shortcomings inherited from the apartheid regime has been the
total lack of information on health. The ministry therefore had
to develop a health information system (HIS) from scratch. This
system is generating information from the lowest health centre
and clinic to the highest level in the healthcare system and
allows the ministry to follow disease trends in the country and
to act swiftly when outbreaks occur. Computerisation of the
system will be further extended to the district level.
The ministry committed itself to the improvement of the health conditions of especially the disadvantaged communities, the rural poor. Concerted efforts have therefore been made to develop health infrastructure supportive of the primary health care model adopted by the government.
Namibia is a vast
country with small population sparsely scattered all over the
country. Low population density that is very pronounced in some
areas, makes it very difficult for the ministry to establish
health facilities that are cost-effective and cost-efficient to
run. Nevertheless, approximately 119 facilities have been
constructed, renovated and upgraded. In addition, outreach points
(Mobile Teams) have been established to service areas where no
facilities can be put up.
Table
3: Growth in medical facilities, 1990 – 1999
|
||||||||||
|
1990 |
1991 |
1992 |
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
| Number
of hospitals |
65 |
37 |
37 |
42 |
42 |
43 |
44 |
44 |
44 |
44 |
| Number
of health centres |
none |
25 |
25 |
35 |
35 |
35 |
36 |
36 |
36 |
38 |
| Number
of clinics |
181 |
198 |
198 |
218 |
221 |
228 |
254 |
269 |
273 |
280 |
| Number
of beds |
7102 |
6842 |
6842 |
6450 |
6445 |
6432 |
6406 |
6249 |
6249 |
6738 |
| Number
of doctors |
324 |
325 |
324 |
324 |
325 |
325 |
375 |
403 |
441 |
476 |
| Number
of nurses |
4471 |
4471 |
4471 |
4480 |
4480 |
4480 |
4480 |
4495 |
4495 |
4495 |
With the dawn of the year 2030, the Namibian people would have attained a level of health and social welfare status which allows them to enjoy full physical, social and mental potential.
We shall work in
a focussed and co-ordinated way with our partners to achieve the
common goal of eliminating preventable physical illnesses, social
risk factors and mental aberrations.
1.
To attain the highest possible immunisation coverage in order to
eliminate vaccine-preventable diseases (TB, measles, diphtheria,
pertussis, polio and tetanus).
2.
To attain the highest level of environmental sanitation,
community and personal hygiene in order to eliminate air, water
and vector-borne diseases.
3.
To attain the highest level of good behavioural practices which
promote, enhance and protect community and individual health and
social wellbeing in order to eliminate sexually transmitted
diseases, HIV infection, and alcohol and substance abuse.
4.
To avail necessary facilities and resources for prevention, and
early recognition and correct management of physical and mental
illnesses.
5.
To promote and protect physical, mental and emotional wellbeing
of mother and child.
1.
Efficiency
2.
Professionalism
3.
Quality
4.
Equity
5.
Accessibility
6.
Ethics
7.
Compassion
8.
Friendliness
9.
Promptness
10.
Partnership
Vision 2030
involves government, non-governmental and international
organisations, community and individuals working together in
national and global partnership to accomplish this goal by the
year 2030.
The biggest task
facing the Ministry of Health and Social Services is to reassess
health sector priorities and attempt to establish technical and
analytical capabilities required to meet the new challenges. The
following areas are the major challenges for policy
consideration:
Improvement of
Equity and Access to Health Services: Reviewing and comparing
outcomes of current policies and strategies with regard to
different regions in the country, and developing equity
indicators in order to monitor equity in health between the
regions.
HIV/AIDS: HIV/AIDS is a serious socio-economic problem currently having devastating effect on the social fabric of the country. Rate at which the disease is spreading is alarming, and the care of an increasing numbers of people affected by the HIV virus will put a heavy burden on the country’s health resources. Concerted efforts by all sectors is required, and the ministry therefore needs to steer these efforts and ensure that appropriate strategies are put in place to avert a national disaster.
Sustaining the
Current Level of Health Care Financing: The health sector
must guard jealously its current share of the budget which
constitutes approximately 15% of total government expenditure.
Efficiency improvements, priority setting, improved financial
management and cost containment measures need to be addressed and
operationalised. Alternative strategies in financing health care
therefore need to be further explored.
Human Resource Development: There is an acute shortage of trained human resources, especially in the areas of medicine, pharmacy, managerial and technical areas, such as, epidemiology, biostatistics, health policy and planning, and health economics. Challenges facing policy makers with regard to the development of human resources include:
1.
Development of support mechanisms necessary for the development
of human resources.
2.
Development of a comprehensive plan for human resources
development.
3.
Addressing the maldistribution of health personnel.
4.
Ensuring optimal utilisation of available personnel.
5.
Introduction of measures to ensure that those trained remain in
service.
Decentralisation of Services: The process of decentralisation needs further strengthening, and decentralisation of authority to regional managers will enjoy new momentum in the next five years. There is, however, a pressing need to improve management capacity of regional managers before authority can been decentralised. This will be fully addressed in the next five years.
Prevention and Control of Communicable Diseases: This objective will remain a major challenge for years to come as diseases like malaria and tuberculosis remain major public health problems. There is, however, the emergence of non-communicable diseases in the form of hypertension, diabetic mellitus, and cancers. Co-existence of communicable and non-communicable diseases will therefore require a right mix of strategies and interventions to ensure that today’s killers are effectively contained and at the same time a proper foundation is put in place to overcome tomorrow’s emerging problem.
Improvement of Quality Services: Continuous quality improvement measures will need to be introduced at district and regional hospitals, health centres, clinics and outreach services.