By Wezi Tjaronda SWAKOPMUND The health sector will need to address problems relating to infrastructure, transport and qualified personnel to be able to create an enabling environment for the provision of affordable and quality services to the people. At the moment, the Ministry of Health and Social Services’ administrative offices at national, district and local levels are accommodated in old buildings, which pose health hazards to the occupants, while office space, IT technology and furniture have also been singled out as problems. Among units that have insufficient capacity are the referral eye unit at the Windhoek Central Hospital, the rehabilitation unit, office accommodation facilities at hospital level, mental health units in certain districts and offices at some regional health directorates. Additionally, the ministry has a shortage of technicians and engineers working in the public health facilities, posing a threat to the provision of health care services. The health care professionals working for public health services are mostly foreigners with no continuity of services when they leave. These observations are contained in the Health Sub-sector presentation to the Thematic Working Group (TWG), which held its meeting in Swakopmund on Monday and yesterday. The key result area is quality of life with its goals being to reduce the spread of HIV/AIDS and its effects, promoting affordable and quality health and social care, and eradicating extreme poverty and hunger. The TWG meeting brought together contributions from the various sub-sectors that will form part of NDP 3, which is expected to be launched in August this year. Issues contributing to quality of life include proper health services and access to and the affordability of health services that would enable the population to live healthy lives. The three goals encompass various aspects of health, education, water and housing. Bertha Kavitjene, Deputy Director of Policy and Planning in the Ministry of Health and Social Services, told New Era yesterday the determining factors of quality of life include not only the number of health facilities but the availability of qualified personnel and infrastructure. The ministry’s Chief Medical Prosthetist-Orthotist, Hongo Amola, said in a presentation there are no appropriate infrastructure and furniture at public eye care units at all secondary hospitals throughout the country. There are no child and adolescent mental health units at Oshakati, no orthopaedic laboratory at Oshakati, no mental unit at Rundu and limited capacity at the National Forensic Psychiatric unit at the Windhoek Central Hospital. The ministry, the presentation adds, has a fleet of 1 000 vehicles, which includes tractors, buses, trucks, ambulances, 4×4 double cabs and trailers and quad bikes. But due to the depreciation of the vehicles, some vehicles require frequent maintenance with high costs. “This negatively affects the delivery of critical services as ambulances and outreach vehicles are found to be mostly aged and not adequate in number,” Amola said, adding that due to the shortage of funds allocated for purchasing vehicles, the replacement plan for vehicles cannot be implemented. In general, the presentation said most equipment, including laboratory and therapeutics, cannot efficiently deliver at the expected rate due to aging and changes in technology. Among other diseases, malaria is singled out as the first cause of morbidity among outpatients of all age groups although under fives are affected twice as much. Although it remains the major public health problem in the country and is the third leading cause of death among adults, the incidence rate among under fives is around 500 per 1 000 unlike 205 and 230 per every 1 000 for the age group 5-17 and 18 years and above. The top ten diseases affecting under fives include malaria, respiratory diseases, diarrhoea, common cold, nose and throat diseases, skin diseases, pneumonia, conjunctivitis, ear disease and trauma/injury. In 2004/2005, 131 237 cases were recorded representing an incidence rate of 511 per 1000. It is estimated that over 1 million live in malaria-endemic areas with nine of 13 regions and 22 out of 34 health districts forming part of the endemic areas. Annually, 400 000 outpatients and 30 000 inpatients and 1 000 deaths are reported country wide due to malaria. Tuberculosis also continues to be the major health problem and the country is the second in the world with the highest notification rate of 735 per every 100 000. In 2006, 15 771 cases were recorded. The four regions reporting case notification rates of over 1 000 per 100 000 are Erongo, Hardap, Karas and Oshikoto.