Health Services in Namibia - MCA Namibia

Health Services in Namibia - MCA Namibia

Health and the Environment Health Services in Namibia Seen Environmental Learning Information Sheet no 6 Introduction The growth in health services ...

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Health and the Environment

Health Services in Namibia Seen Environmental Learning Information Sheet no 6 Introduction

The growth in health services

Namibia’s health system aims to improve and maintain the well-being of its citizens by providing services to : prevent and cure disease rehabilitate those who have suffered illness promote good health

Good health is important in order to live a comfortable and productive life. Poor health caused by debilitating diseases reduces productivity and increases dependence and the costs of a health service. So since independence Namibia has focused more on preventative care and on expanding the services provided to all people.

• • •

While the public health system is national, huge variations exist in The allocation of resources The performance of different facilities and health workers The needs of different communities The successes and challenges in different regions

• • • •

Early History The first health services in Namibia were established in the 1890’s in Windhoek and Swakopmund to serve German soldiers. Soon after, Finnish missionaries set up several clinics in the north. Since then the system has shown four clear trends: The increase in facilities, particularly after independence Greater support given by the SWA administration to mission facilities

• • • •

Huge differences between facilities for whites and blacks A focus on curative rather than preventative medicine

Before independence most Namibians did not have access to health services.

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Health services are managed at two levels: nationally through the Ministry of Health and Social Services (MOHSS) office in Windhoek and regionally through regional management teams in close collaboration with the regional council. Altogether 248 clinics, 37 health centres and 47 hospitals exist, most being in the north of Namibia and the larger towns where most of Namibia’s people live. Some clinics and health centres also have outreach points (such as a room built by a school) where health workers periodically visit to provide services. In a similar way to the provision of schools, two important aspects of any health service are that it should be accessible and efficient so that: people who need treatment have access to them

• •

health services are utilised to the extent that is expected of them

Since independence the area of coverage within10km of a health facility has more than tripled as a result of the number of health facilities rising from 98 in 1981 to 317 by 2001. As a result 80% of the population now lives within 10km of a clinic. This still leaves 20% or over 300 000 people in remote areas, particularly Omaheke and Kunene, without ready access to health services.

Information Sheet No 6


Theme: Health and the Environment Topic No 6: Health Services in Namibia As well as the variation in access to facilities, there are differences in access to staff and hospital beds. Khomas and Oshana fare the best while Omaheke and Ohangwena have the least access to a doctor or nurse. Overall there are about 7500 people per public service doctor and 250 people per hospital bed. Facilities in the private sector are more generous, with over 370 doctors and specialists ,250 of them living in Windhoek. While many clinics have been provided, many of them are in remote areas and not well utilised. Overall nearly half of the clinics treated less than 15 people every day, while a sixth attended to more than 50 people. In some areas such as Oshana, Kavango and Oshikoto where people visit most frequently, more clinics are probably needed.

Health, water and sanitation Having access to enough clean water and good sanitation is a major factor in enjoying good health (see Information Sheet on Water and Sanitation).Providing access to everyone is complicated by the size of the country, the arid climate and the dispersion of the population. While most people in urban areas have access to safe water (drawn through a pipeline or underground source) the figure drops to 67% for rural areas. In the north, particularly Kunene, Omusati, Oshana, Oshikoto, Ohangwena, Kavango and Caprivi, most water is sourced from open oshanas or rivers, making it unsafe. Differences in the provision of sanitation are similar to those for water supply with adequate facilities being available in towns but less than 25% of rural households having access to pit latrines, particularly in the North where most people are forced to use the bush. While the provision of safe water and sanitation to households has improved since independence, much remains to be done. Schools could play a key role in making future citizens aware of their right to water and sanitation as well as helping to give them the understanding and skills to improve local facilities.

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Source: Health in Namibia

Information Sheet No 6


Theme: Health and the Environment Topic No 6: Health Services in Namibia Staffing the health system Health services are provided by about 10 000 employees. About 3000 are trained medical doctors or nurses while the rest are employed to give administrative and other support. Nurses are trained in Namibia at UNAM with about 40 students enrolled every year. Training for other health staff is also at UNAM or national and regional training centres run by the MOHSS. All Namibia’s doctors have been trained outside; roughly two-thirds in South Africa and a further fifth in Europe. Over half of all the doctors employed are expatriates (about 125) highlighting the shortage of skilled personnel in the public health system.

Paying for the health service Government pays the bulk of health service costs. Since 1990 around 14-16% or toady around N$1.5 billion of every budget has gone to the MOHSS. Current allocations of expenditure reflect the change in emphasis from curative services focused on hospitals to providing primary health care involving education, immunisation and treatment.

patients ability to pay. Medicines are centrally procured through a tender system by the MOHSS according to a list of 400 essential drugs, with cheaper generics being bought wherever possible. They are then distributed regionally according to need.

Namibia’s health system: achievements and challenges Since independence access to health services in Namibia has greatly increased and the health of children has improved, not least because of expanded immunisation programmes. Some diseases such as measles, neonatal tetanus and polio have virtually been eradicated. Instances of malnutrition and diarrhoea have declined reflecting better education, nutrition and water supply. But there are also challenges. On an international WHO ranking, the efficiency of Namibia’s health service (the level of health of people compared to what ‘should’ be achieved for the money) came in 189 out of 191 countries. Since Namibia ranked 66th in terms of per capita expenditure, obviously the level of health should be much higher for the money spent. While the health system is now more equitable and accessible, it is still lagging in its quality and efficiency. People are the most important resource within the health system and Namibia’s progress continues to be hampered by a shortage of skilled health workers, managers and other technical professionals. Providing appropriate training is therefore a big priority.

MOHSS Expenditure breakdown 2000/1 Source: MOHSS

More than half of all the money goes to pay people working in the above areas meaning that less is available for capital projects, equipment or medicines. As a result international donors often provide ‘extra’ money to the government to support specific programmes. These include, immunisation, reproductive health, and HIV/AIDS. Further monies are received as fees from patients. These vary according to the type of service received, the type of facility and the

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The biggest challenge however is the HIV/AIDS pandemic. Because the prevalence of HIV/AIDS is expected to increase further, its impact will continue to be felt on the health service for much longer, (see SEEN Action Magazines and Teachers Pages on HIV/AIDS) placing a severe strain on existing financial and human resources.

Information Sheet No 6


Theme: Health and the Environment Topic No 6: Health Services in Namibia Ideas to stress in your teaching and learning

• • • • • • • •

Only since independence have health services been available to most people in Namibia. The health system is managed by the MOHSS through national and regional offices. Because of the colonial legacy, there are still big differences between regions and people in access and use of health services. Access to health services, together with the provision of clean water and sanitation, tend to be poorer in the northern areas of Namibia. Namibia has a severe shortage of well-trained medical personnel, particularly doctors. The MOHSS is largely paid for by the government out of tax revenue. While a lot of money is spent, the quality and efficiency of provision is low by international standards. Since independence, immunisation and primary health care services have resulted in less diarrhoea and malnutrition and a lower incidence of many diseases. The biggest challenge to the health service is the impact of HIV/AIDS. Increasingly both funds and human resources are being ‘swallowed’ to provide medical care for PLWA.

Glossary Arid climate Equitable Expatriate Immunisation Malnutrition Pandemic Rehabilitate Sanitation

Used to describe a dry region in which rainfall is less than 25cm per annum. Characterised by justice or fairness, and impartiality toward those involved. Somebody who has left his or her homeland to live or work in another country, usually for a long period of time. The process of making somebody resistant to a particular disease. A lack of healthy foods in the diet leading to physical harm. A disease or condition that is found in a large proportion of a population. To return something to health or its former good form. Relating to the maintenance of public health and hygiene, especially the water supply and waste disposal system.

Sources/Further Reading Health in Namibia: el Obeid et al, Raison 2001 Atlas of Namibia: Mendelsohn et al, MET/David Philip 2002

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Information Sheet No 6