The public health sector is under distress, confronted by a myriad of issues that range from dilapidated facilities and a shortage of medication and personnel, which all compromise quality service delivery.

These findings are captured in a National Council report from its standing committee on health, social welfare and labour affairs, following oversight visits between March 2022 and February this year.

The parliamentarians toured the //Kharas, Hardap, Omaheke, Kunene, Omusati, Ohangwena, Oshana, Oshikoto, Otjozondjupa and Erongo regions during that period.

The results in all regions were almost similar as far as the dire state of most facilities is concerned.

The committee visited hospitals, health centres, clinics and maternal homes in those regions. “The committee observed that most public health infrastructure in all regions visited were in poor physical conditions, as evidenced by the cracking walls, peeling paint, damaged and falling ceilings and such other issues of dilapidation,” reads a section of the damning report.

The perilous physical conditions of the public health facilities were attributed to inadequate funding for major renovations and maintenance.

“Some hospital buildings such as the Outapi district hospital, Gobabis district hospital, Oshakati intermediate hospital, Otjiwarongo district hospital, Walvis Bay district hospital as well as the Maltahohe clinic are old and without renovations,” the committee found.

That is not all. “The Onandjokwe Intermediate Hospital, being one of the oldest hospitals in the country, is very old and falling apart, hence the need for urgent intervention. The Maltahohe clinic was destroyed by a storm in 2020, while the Mariental district hospital was destroyed by fire. Both facilities are due for renovation and upgrade.

Additionally, at the time of the visit, most renovation works at the Aranos hospital were completed, with only minor items outstanding”. “It was further reported that the snail’s pace and delay [at Aranos] was attributed to the constant change of contractors for the past seven years,” the committee stated.

Moreover, there are calls for a health centre in Swakopmund’s DRC settlement due to its growing population. The residents are currently catered for by the Mondesa clinic, which is overwhelmed. In Outapi and Okalongo, the health facilities are also unable to accommodate patients due to the fast-growing population and influx of patients from neighbouring Angola. “Maternity wards at some hospitals such as the Outapi district hospital admitted more patients than the bed capacity. At times, patients were thus accommodated on the floors and corridors,” the MPs found.

The situation gets worse in Otjiwarongo, where serviced and fenced-off land earmarked for the construction of a new district hospital has been vandalised. The site has been idling for the past seven years, without any development.

“On a positive note, it was indicated that the feasibility study to upgrade the Opuwo district hospital has been finalised. Plans were approved, and awaiting the allocation of funds in order to resume phase one of the hospital construction,” the report continued.

Unfit

The old structures also hampered the proper provision of basic hygiene for patients and health workers as most hospitals were unclean and infested with pests.

Some health centres and clinics, however, were found to be clean and well-maintained.

“The Epukiro Post 3 clinic relies on a borehole with saline water [which is] unfit for human consumption, whereas the Omuthiya district hospital reported that they had no water reservoir to cater for emergencies. Water supply at the Okalongo health centre has been reported as inadequate due to poor water pressure,” it was established.

What is more, most regions have inadequate and dilapidated staff accommodation.

“At times, nurses share accommodation which deprives them of their privacy. At most hospitals, some vacant positions have not been filled due to a lack of accommodation. In some cases, positions are filled, but staff operate from the head office due to inadequate or dilapidated staff accommodation,” the committee found.

No transport

Another major challenge confronting the visited regions is the shortage of transportation for patients and health personnel, particularly in cases of emergency.

In Hardap, for instance, the Mariental district hospital only had eight out of 17 ambulances operational during the visit.

“Most of the clinics in the region do not have ambulances, despite the vast distances between them and the Mariental district hospital. Health workers further indicated to the committee that the minibuses which have been modified or converted into ambulances always give problems as they are mostly used on gravel roads and wear off easily,” reads another section. Due to the unavailability of ambulances at the Aranos hospital, relatives “are being advised to bring the patients to the hospital themselves”.

“Some hospitals indicated that they were given normal double-cabs as ambulances. Unfortunately, these cars are not fitted with any medical equipment or life support equipment that will help the patients during transportation. A classic example was given in the Omaheke region, where the health workers had to transport a patient with a broken leg to the Gobabis District Hospital, but the patient could not fit into the car without causing further damage to his already broken leg,” reads another shocking revelation.

During the site visits, the committee also noticed many broken ambulances and other vehicles parked around most health facilities.

Adequate

While most health facilities face a plethora of challenges, the shortage of medicine is generally not one of their major headaches.

“During discussions with health workers, it was indicated that medicine and vaccines are generally adequate at public health facilities,” the oversight visitors say. “Some stock-outs were, however, reported at all the facilities visited, particularly the essential medicine for high blood pressure (BP). Patients were requested to buy their own medicines from private pharmacies.” It was also established that there is a shortage of pharmacists at State health facilities. The Opuwo district hospital has only one pharmacist, and at times it is challenging to dispense medication to all patients on a particular day.

Remedy

The committee then gave the government a dose of prescriptions to address the health mess. On the renovation front, the committee suggested outsourcing it to vocational training centres, correctional services or the National Youth Service to save costs, while also creating employment opportunities for the youth.

“Technical expertise can be sourced from engineers at the ministry of works,” they said.

The health ministry was likewise directed to roll out garden project initiatives to all waiting shelters to produce nutritious food for expectant mothers, as seen at Opuwo and Gobabis.

“Intensify campaigns and media coverage on mental health, cervical cancer, prostate cancer, diabetes and high blood pressure as cases, particularly of suicide, are increasing. Media coverage must be improved by using various outlets such as television, social media platforms and radio,” they added.

The ministry must urgently construct “suitable rooms at all hospitals, and capacitate and encourage more health workers to specialise in mental healthcare to deal with the escalating mental health issues.”

Priority must also be given to all dysfunctional mortuaries, and consider upgrading the holding capacity at existing mortuaries for the dignity of departed persons.