The government’s decision to redirect funds currently used for private medical care under the Public Service Employees Medical Aid Scheme (PSEMAS) to the public health system is a bold policy move. In principle, strengthening the public healthcare system so that it can adequately serve government employees is not a bad idea. In fact, it could be a progressive step towards building a stronger and more equitable national health system.

However, the lack of detailed communication about how the transition will work has created more questions than answers.

The uncertainty largely stems from the reality that many civil servants have become accustomed to the convenience and efficiency of private healthcare services. Private doctors, pharmacies and clinics offer shorter waiting times and predictable service. Naturally, when such a system is replaced or altered, anxiety kicks in to those affected if no clarity is provided.

Among the key questions is a practical one: who will be treated where?

Will civil servants now join the same queues as the general public at state hospitals and clinics, or will there be designated units within public facilities to handle them? This question is not unreasonable. Public health facilities across the country are already dealing with heavy patient loads. 

Adding over 170 000 civil servants and their dependents into the same system without a clearly communicated operational plan risks overwhelming facilities that are already stretched.

Take the example of Oshakati Intermediate Hospital, which has for years operated a private ward within the state hospital. The model – essentially a private service within a public facility – has functioned relatively well. It raises a legitimate question: will government expand such models to accommodate civil servants under the new arrangement? Or will an entirely different structure be implemented?

At present, the details remain unclear.

Health Minister Esperance Luvindao has indicated that more than 2 000 additional health personnel posts have been availed as part of efforts to strengthen the public health system. 

While this is certainly a positive development, it still raises further questions. Will these additional nurses and health workers be enough to absorb the expected influx of patients? Are there enough doctors? Are existing hospital facilities sufficient? And perhaps most importantly, are supply chains for medicines and equipment strong enough to support the expanded demand?

Public healthcare, when properly structured and adequately resourced, is one of the most powerful social equalisers in any society. Countries that have invested heavily in strong public health systems have demonstrated that quality healthcare does not need to be dependent on private insurance. But successful public health systems are not built overnight, nor are they implemented without careful planning and communication.

The transition also raises everyday practical concerns.

Consider the example of a teacher who needs to collect monthly medication for high blood pressure and goes back to work soon after collection. Under the current system, such a person can easily obtain medication from a private doctor or pharmacy through PSEMAS. 

If the shift to state facilities is not carefully managed, the same teacher may now have to spend several hours in queues at a public hospital simply to obtain a routine prescription refill. Imagine how many cases of the same nature will be experienced in one day. For many civil servants, this could mean losing an entire working day.

There is also the role of private pharmacies to consider. Over the years, private pharmacies have often filled gaps when public hospitals experienced shortages of medication. Under the current system, civil servants can obtain medicine from these pharmacies without difficulty. But if PSEMAS support to private healthcare is scaled back, what will happen when hospitals run out of certain medications? Will civil servants still be able to access private pharmacies under certain conditions, or will the system become entirely state-controlled?

The broader impact on the private healthcare sector should also not be ignored. Many private hospitals, clinics and pharmacies rely heavily on PSEMAS members as a key source of revenue. Any significant shift in policy could have financial implications for these institutions, which themselves employ thousands of Namibians. 

The question therefore becomes whether the private sector will be able to sustain itself if a large portion of its patient base moves to the public system.

Yet it would be unfair to dismiss the reform outright.

Namibia has successfully implemented ambitious public sector policies before. The country’s commitment to Universal Education Policy has ensured that basic education remains accessible to all citizens. 

That achievement required planning, resources and strong political will. If the same level of commitment is applied to healthcare reform, the outcome could ultimately benefit the entire population.

The key, however, lies in preparation and communication.

Civil servants, healthcare workers and the broader public need clear information about how the new system will function. Questions about access, facilities, staffing, pharmacies, medical equipments and the role of private healthcare providers must be addressed well before implementation.

With 1 April approaching, reassurance and clarity from the Ministry of Health will be essential. Reforming healthcare is a complex undertaking, but with proper planning, benchmarking and transparency, Namibia can build a public health system that works for everyone.

For now, however, many civil servants remain in the dark – and uncertainty is rarely a healthy prescription for reform.