New Era journalist Alvine Kapitako spoke to the World Health Organisation (WHO) new country representative to Namibia, Professor Dr Monir Islam, who took over from Dr Magda Robalo in March this year. Monir is originally from Bangladesh but visited Namibia in 1991 when working in Botswana, where he spent 10 years of his professional career.
New Era (NE): You have been here in the country since March, how do you find the country so far?
Professor Dr Monir Islam (MI): “Namibia is something I know and I am so happy to be back because my professional life started in Africa, in Botswana, and then I worked in Geneva [Switzerland], the Netherlands, India, in Thailand and coming back to Africa at the end of my career is wonderful.”
NE: What do you think are the current pressing issues in Namibia that you have to deal with as the WHO Country Representative?
MI: “Namibia has a double burden of diseases or health problems. Namibia still has communicable diseases like TB, malaria, HIV/AIDS and at the same time it also has the unfinished agenda of maternal and newborn and child health issues. But growingly in Namibia you see non-communicable diseases becoming an issue as well. These are diabetes, hypertension, cardiovascular diseases, cancer particularly breast cancer, cervical cancer, prostate cancer. Side by side as Namibia is growing and stress is growing mental health will also become a problem. The other issue is adolescent health and adolescent health problems. Another issue is road traffic accidents and premature deaths of people and how we can really combat that. Those are the pressing issues at this moment.”
NE: Namibia has many challenges in the health sector. How do you think the country can and should deal with these challenges?
MI: “I must say the Namibian achievement in the health sector is tremendous, it’s really significant. Namibia is one of those countries where the budget allocation in health most of the times is second. Of course, this year it’s third position because of the defence spending. There is a high level of government commitment for the health sector. Namibia is investing a lot in the health sector. What is really needed is not the quantity but the quality of services. It’s more an issue of quality of services. By this I mean when people come to health facilities they are attended to timeously, they are diagnosed properly and are treated properly, they get all the prevention information on time so that they can really look at it. We need to put more pressure on the issue of quality, it’s not much on the access side of it and that’s why you really need to further improve the skills and competencies of health care providers, the managers, the logistics and supply, infrastructure.”
NE: What is the area you believe Namibia is doing well in?
MI: “There are a lot of success stories. Malaria has really gone down and we are in the stage of eliminating malaria from Namibia. However, there are some cross-border issues where Zambia and Angola have malaria cases so we really need to work with them to make sure malaria doesn’t exist in Namibia. We need to be extra vigilant in malaria cases. There are also significant achievements with TB and HIV, and with TB cases we have made a significant gain because of antiretroviral therapy and so most people who are HIV positive and those with TB are getting treatment, so that’s really helping. Government is spending money on resistant TB too. Also, government has accepted the complexity and public health importance of cross-border issues. People who are in Angola are coming to Namibia for treatment and government is not saying ‘go back’. By treating them we are saving the lives of Namibians and they’ve accepted it and are using their own money for that. HIV incidence is going down, prevention of mother-to-child transmission has gone down because most of the pregnant women are tested and they are also getting treatment. HIV is no longer a life-threatening disease but a chronic disease because people are getting treatment, so that is a success story and the First Lady’s [Penehupifo Pohamba’s] contribution to that is significant. There are many success stories in Namibia but what we need to look at, as I said, is the quality issues. Not all the health facilities are doing badly but some areas are lagging behind. If we want to have accelerated action on gaining health we really need to see which are those areas, assess why they are lagging behind and we need to have concentrated and coordinated efforts in those areas.”
NE: What are your immediate plans – to consolidate the work done by your predecessor and what approach will you take?
MI: “You’re absolutely right. My predecessor Dr Magda Robalo did a wonderful job and her contribution is very significant. My priority is to consolidate those gains and successes and make sure those successes are sustained. But there are a few things I also want to look at and work on with the government for universal health coverage because the government has adopted the policy of implementing the constitutional rights of every citizen to have access to health care services and remain healthy. I want to work with the government to develop the policy, the strategy and its implementation. I want to look at non-communicable diseases, how I could reduce those by working with the government. I want to look at adolescent pregnancy and adolescent health. I want to concentrate on reducing road traffic accidents, its consequences and premature death. This is not the responsibility of the Ministry of Health and Social Services only, it needs other ministries and communities. I also want to look at mental health issues, how do we really provide community-based mental health services for the Namibian population.”
NE: You mentioned that Namibia has been hailed internationally for a number of achievements in health and the government has committed itself to the sector, judging from its involvement and investment. In your view, does that warrant for less international/donor support?
MI: “Namibia is now a middle-income country so many donor countries are trying to say ‘no this is a middle-income country so it should really take responsibility for its population and health’. And Namibia is doing so, as I said the country has the second or third highest budget allocation to the health sector. However, the donor community should not just leave because Namibia’ success story is going up but we need to look at how to consolidate the successes and how to sustain those successes. If they just pull back now everything might go, so I don’t see donor countries suddenly pulling back but they will gradually pull back so that when capacity is built the government is on its feet strongly. So I would say donor countries should not go, they should provide support in the building of capacity. It’s not the money that we are looking at in the case of Namibia, it’s the capacity – the managerial capacity, technical capacity, skill and competencies.”
NE: And how will WHO through your leadership ensure that capacity that you provide reaches the remotest areas in the country?
MI: “My priority is to build a strong technical team in WHO so that we can provide timely, quality technical support, policy support, strategic support. So I really need to have high standard, very good quality technical people in my office so that I can provide timely technical support so that’s what I’m going to be looking into and that’s why in the next budget I’m going to really see that I do have – either from here in Namibia – in my office highly qualified, good technical experts or I will bring technical experts from the world to provide support to Namibia. It’s not about the money in Namibia, the health sector doesn’t need money – it needs technical support.”
NE: Do you plan on going out often in the field to get first-hand information on the ground on what is happening in the country to help you with your work?
MI: “Definitely, because sitting in Windhoek and reading the assessments and things is one way to understand what’s going on but to really have the on-the-ground reality, I need also to go visit and I will be visiting. The Minister of Health and Social Services encouraged me to do so.”
NE: At the end of your tenure what is the one thing you would want to have achieved?
MI: “At the end of my tenure, I would be most happy if we can work with the government and the Ministry of Health and Social Services to have a policy, strategy and start implementing universal health coverage and when that happens I would say that at the end of my tenure Namibia is on its way to achieving universal health coverage.”