At Independence, the Namibian government inherited a fragmented healthcare and social welfare system, which was administered by second-tier authorities that created 11 different administrations and parallel programmes.
One of the first reforms introduced by the new government was to bring together these second-tier authorities, which led to the creation of the Ministry of Health and Social Services.
The new government adopted the primary healthcare (PHC) approach, which is based on principles of equity, affordability, community participation and involvement as well as inter-sectoral collaboration.
“Notable achievements are in the area of HIV/AIDS prevention, care and support. The Namibian Population-based HIV Impact Assessment (NAMPHIA) study reported that 86% of people living with HIV aged 15 to 64 years know their HIV status. In terms of treatment, 96.4% of people living with HIV aged 15 to 64 years who knew their status were on ART,” said health minister Dr Kalumbi Shangula.
From independence to date, the country has managed to have 35 hospitals, including intermediate and referrals, 46 healthcare centres, 274 clinics and 1 150 outreach points.
HIV
To date, it is estimated that about 202 000 Namibians are infected with HIV. The National AIDS Coordination Programme (NACOP) was established in 1990 with a focus on palliative care and prevention activities such as condom distribution and STI management. HIV counselling and testing was mostly provider-initiated and laboratory-based. There is now a rapid test, which can give an instant result.
The first case of HIV infection in Namibia was diagnosed in 1986. Since 1992, HIV sentinel surveillance surveys among pregnant women attending antenatal care (ANC) has been conducted every second year. Overall, HIV prevalence amongst pregnant women increased exponentially from 4.2% in 1992 to reach a peak of 22.0% in 2002, and dropped to 17.2% in 2016.
Shangula noted that “among people living with HIV aged 15 to 64 years who were using ART, 91.3% were virally-suppressed. The ministry implemented programmes to strengthen Antiretroviral Therapy (ART) coverage and increase TB Prevention Therapy (TPT) uptake and completion rates, striving to reach the newly-revised and adopted Fast Track targets 95/95/95.”
NAMPHIA began fieldwork in June 2017, and concluded it in November of the same year. Survey teams visited about 11 000 households, interviewed participants, and provided counselling and testing.
Faced with this heavy load, Shangula said, the ministry also faced a shortage of human resources for health, a limited number of high-tech medical equipment, and an increase in both communicable and non-communicable diseases.
The ministry states that before independence, the immunisation coverage (with the exception of BCG) was low, for DPT3 – 53%, Polio 53%, Measles 41% and children fully immunised at 26%, with an exception of BCG, which was at 85%. Bacillus Calmette–Guérin (BCG) is a vaccine primarily used against tuberculosis.
The Expanded Programme on Immunisation (EPI) was one of the first programmes established in June 1990, with five vaccines, namely Polio, BCG, Diphtheria-Pertussis and Tetanus (DPT) for children under one year, and Diphtheria for children aged five and 10 years given as a booster.
“The programme aims to ensure that all children under five years are protected against vaccine-preventable diseases by achieving immunisation coverage of 80% and above in all districts,” said Shangula.
Non-Communicable Diseases
The Non-Communicable Diseases Programme focuses on a reduction in morbidity and mortality due to Non-Communicable Diseases and Conditions (NCDCs) through improving the control and surveillance of NCDCs, its risk factors, and through effective health prevention, case management and promotion actions.
The National Multi-sectoral Strategic Plan for the prevention and control of Non-Communicable Diseases (NCDs) is the first national strategic plan (2017/18 – 2021/22) which addresses chronic diseases and injuries in the country through coordinated multi-sectoral action for the promotion of healthy lifestyles and the prevention of chronic diseases.
Tuberculosis
Shangula said since an interruption in taking anti-TB medicines can lead to drug-resistant TB, the ministry strengthened public education through community health workers and adopting Directly Observed Therapy (DOT), whereby a community health worker or family member observes the patients as they take their medicines.
“The country has also realised significant improvements in the TB treatment success rate for TB cases, from 66% in 1996 to 87% in 2020,” the minister said.
Tuberculosis (TB) is endemic in Namibia, and people with untreated, infectious TB are the source of transmission. Unless TB is considered when individuals attend healthcare services, the diagnosis will be delayed or missed altogether, and effective TB infection control (IC) measures (including effective treatment), might not be in place.
Cancer
Cervical cancer ranks as the second-most frequent type of cancer among women in Namibia, and the third-most frequent cancer among women between 15 and 44 years. Human Papilloma Virus (HPV) is the virus that causes cervical cancer, while other anogenital cancers and high-risk HPV types are detected in 99% of cervical cancers.
Data is not yet available on the HPV burden in the general population of Namibia. However, in southern Africa, about 21% of women in the general population are estimated to harbour cervical HPV infection at a given time. Cervical cancer can be prevented through prevention strategies such as HPV vaccination, screening and early detection for precancerous lesions.
HPV vaccinations are not available in government facilities, but the vaccines are available in the private sector.
The National Cervical Cancer Prevention Guideline was developed in 2018, and the recommended methods of cervical cancer screening and early detection is Pap smear and Visual Inspection with Acetic Acid (VIA).
Despite progress made in various programmes, the ministry also faced inadequate staffing to meet demand, and inadequate medical equipment and technologies to keep up with fast-changing technological advancements.
“Stock-outs of pharmaceuticals and clinical supplies; limited financial resources to meet demands for infrastructure development; increases in non-communicable diseases, which put a strain on the health system due to the chronic nature of these diseases; outbreaks of communicable diseases, which demand the mobilisation of additional resources for responses, are other challenges facing the ministry,” elaborated Shangula.
Although the ministry has made tremendous progress and strides over the past three decades, it is imperative that it sustains gains made in various health programmes and strives to improve in areas where it fell short. “We should explore alternative ways to make medical equipment and technologies available in public health facilities. Additionally, attention should be given to the preventative maintenance of medical equipment. We should also consider engaging other countries in the SADC Region to procure some pharmaceuticals on a pooled-procurement basis,” he proposed.
Outbreaks
Namibia has a good track record in eradicating or eliminating outbreaks. Among them are plague, Crimean-Congo Haemorrhagic fever, polio and now at the beginning of March 2022, Hepatitis E. A concerning outbreak that has been in existence for two years in the country is the novel coronavirus.
Shangula said: “This gives me confidence and optimism that the same fate will befall Covid-19, as long as we get vaccinated and observe public health measures as announced from time to time.”
“We have eradicated polio in Namibia a decade ago through mass vaccination. We can do the same with Covid-19. Have faith in your government. Let us get vaccinated in order to return Namibia to normal life,” he stated. - psiririka@nepc.com.na