WINDHOEK – Government hospitals consumed the single greatest portion of the total health expenditure with 29 percent in 2015/2016 financial year and 34 the following year, according to a report availed by the Ministry of Health and Social Services last week. 

Curative care dominates health spending at public hospitals, with 54 and 53 percent spent on inpatient care in 2015/16 and 2016/17, respectively. Further, 29 and 31 percent was spent on outpatient curative care in those years. Spending on prevention services represented 11 percent of spending at public hospitals in both 2015/16 and 2016/17, according to the report titled ‘Namibia’s health and HIV financing landscape: Evidence from the 2015/16 and 2016/17 resource tracking exercises’. 

“While this level of spending on prevention services seems quite low, one needs to bear in mind that these services are provided at public hospitals, which are secondary and tertiary health facilities, whereas prevention services should be provided at primary health care facilities, such as clinics and health centres, assuming an effective referral system is in place,” stated the report. 

Of the prevention services provided at public hospitals, health condition monitoring and early disease detection programmes consume the most spending, according to the report. 

“These types of prevention services would be expected at the hospital level as they include antenatal care, monitoring of chronic conditions, and screening services that are required for more complicated diagnoses. Smaller amounts are spent on immunisation programmes and epidemiological surveillance programmes.” 

The report also highlights that the total health expenditure in Namibia in 2015/16 was just over N$ 15 billion of which 96 percent was recurrent spending. Recurrent spending is the spending on goods and services consumed within the year of the analysis. 

The remaining four percent of spending was for capital investments, on goods and services whose benefits are consumed over a period longer than one year.

Further, health care related items such as social care for HIV positive people and orphans and vulnerable children which is not included in the total health expenditure totaled more than N$ 414 million.
Additionally, at public hospitals, employee compensation dominates the spending (at 53 and 58 percent of the total health expenditure in 2015/16 and 2016/17, respectively.

Pharmaceutical spending represents 11 and 9 percent of the total health expenditure in the respective years. Health care goods include items like diagnostic reagents and other supplies. Health care services include items like laboratory and imaging services. Non-health care goods include training, technical assistance, and operational research, according to the document.

In public health centres, the largest proportion of spending goes to outpatient curative care, which consumed 45 percent of this spending in 2015/16 and 52 percent in 2016/17. Prevention services consumed the second largest portion, 28 percent, in both years. Among the prevention services, healthy condition monitoring consumed the largest portion in both years, followed by immunisation programmes. Furthermore, at almost half of the expenditure at health centres and clinics, pharmaceuticals represent the largest portion (43 percent) of spending by inputs at public health centres and clinics, followed by health care services and employee wages and salaries. 

This prompted a recommendation that the balance of spending between primary health care facilities and secondary and tertiary facilities should be investigated. “The considerably higher level of expenditure at hospitals indicates that the referral system may not function effectively and that an unnecessary work burden is being placed on hospitals,” according to the report. 

The report also highlights that spending on prevention services in relation to overall public spending is quite low. “Here again, however, the balance of spending between primary health care facilities and secondary and tertiary facilities should be investigated. Spending on prevention services in health centres and clinics is at an acceptable level, and this is the health system level at which most such services should be provided. The high level of spending at hospitals level and the low level of spending on preventive care at this level significantly reduces the overall average spending on preventive care in public facilities,” reads the report.