Ministry of health & social services

Mr Speaker

Honourable Members

In introducing my Ministry’s budget for 1999/2000, I wish to indicate that the mission of this Ministry is to eliminate the main causes of physical ill–health, mental and social ailments in order to give the Namibian people the opportunity to lead a normal fulfilling life in accordance with the government Vision 2030. In order to achieve this we have adopted the strategy of primary health care approach, which include among others, reproductive health, immunisation, prevention of epidemics, support to PHC services by improving secondary and tertiary health care, as well as social relief to vulnerable persons.

The underlying principles are equity, accessibility and affordability of services and community involvement and participation. Before I deal with the main divisions I would like to give you a brief performance indicators for the immediate past years.

1. Health Sector Reform.

• The restructuring of the Ministry has been completed and will be implemented once the official approval is obtained. The aim of the exercise was to make the structure more responsive to the demands placed on the Ministry.
• The new National AIDS Co-ordination Programme (NACOP) and the Second Medium Term Plan (MTP II) were launched by the H. E. The President on the 24^th March, 1999. The new approach aims at making the control of HIV/AIDS everybody’s business.
• Preparations for the commercialisation of the Medical Laboratory Services are underway. The enabling legislation is currently before this august body for consideration.
• The preparations for the establishment of the first Medicines Quality Surveillance Laboratory in Namibia are 90% completed. The Laboratory is expected to be operational by July this year. This will enable the Ministry to establish and monitor the quality and potency of drugs in Namibia.
• The Orthopaedic Technical Services Mobile Unit was completed and commissioned last month. This important service will be brought closer to the majority of our population who did not have access to this service before.
• The construction of the National Health Training Centre has been completed and the Centre will be officially commissioned by H.E. The President on the 6^th May, 1999 at ten o’clock in the morning. I extend an invitation to you Hon. Members to witness the commissioning. This Centre is prelude to the envisaged Namibia School of Public Health.
• The Mental Health Care Centre, with its Medium Security Forensic Psychiatry Unit was commissioned last year. Previously, the forensic psychiatric service was only available in South Africa where we used to send our patients at a high cost.
• A state of the art computerised tomography (CT) Scanner was established at Windhoek Central Hospital. Similar facility will be established at Oshakati Hospital during the course of this year.

2. Primary Health Care Services

• Successful National Immunisation Days were conducted. The response of the community, especially in Oshikoto, Oshana, Omusati and Ohangwena regions, was overwhelming. The coverage for polio during the two rounds was more than 90%. The coverage for measles and Vit. A was 98% and 87% respectively.
• Highly successful eye camps were carried out in the northern regions. A total of 1386 patients had their vision restored. The next eye camp will take place at Grootfontein hospital for the population of Tsumkwe next month.

3. Human Resource Development

4. Capital development projects

• The Ministry was able to manage 45 projects, both physically and financially, which include government as well as donor-funded projects to the amount of N$74 million.
• The following projects have been completed: Forensic Psychiatric and Mental Health Care Centre, Luderitz hospital upgrading, Grootfontein hospital upgrading, National Health Training Centre Mpungu Vlei clinic construction, Rupara clinic construction and Yinzu clinic construction.
• The following new projects were commenced: Upgrading of Walvish Bay hospital, upgrading of Bunya, Tondoro and Sambu Health Centres in collaboration with the Roman Catholic Church, upgrading of seven clinics in Kavango with co-funding from Lux Development and upgrading of six clinics in Omusati region.

5. Social Welfare Services

Mr Speaker

Allow me to motivate for my Ministry’s budget for 1999/2000 which is one thousand and ninety six million nine hundred and seventy eight thousand Namibia dollars (N$ 1 096 978 000). This budget consist of two parts: The operational budget, which is one thousand and seventeen million and thirty eight thousand dollars (N$1 017 038) (92.71%) and the development budget, which is seventy nine million and nine hundred and forty thousand Namibia dollars (N$79 940 000) (7.29%). I will indicate how this budget was consolidated, by explaining individual main divisions. This budget amount exceeds last financial year’s appropriation of nine hundred and forty one million, six hundred and seventy two thousand Namibian dollars (N$ 941 672 000) by one hundred and fifty five million, three hundred and six thousand dollars (N$ 155 306 000). The reasons for this apparent increase will become clear when I will be explaining individual main votes. It suffice to mention here that this apparent increase is partly attributed to the provision we made in the budget for payment for work done on Sundays and Public Holidays, (second phase) to medical, paramedical and nursing personnel retrospective to 1995. We also made provision for payments for Wascom re-grading due to medical, paramedical and nursing personnel since November 1997. The two projects mentioned above require an amounts of one hundred and eight million Namibian dollars (N$108 000 000). We made provision for 800 Ex-combatants who were absorbed in my Ministry. We also made provision for the starting capital for the commercialisation of the Namibia Institute of Pathology, (NIP) which amounts to four millions dollars (N$4000 000).

Mr Speaker

Allow me briefly to explain by way of the table below, the salary structure of nurses, as this has been a subject of discussions even in this House.

Post Pre-WASCOM WASCOM Re-grading % Increase

Nursing Assistant 11118-16449 16125-19923 16125-19923 45

Enrolled Nurse 16449-21141 23487-28257 35229-50151 114

Registered Nurse 25302-31998 35229-44841 57567-127050 127

Fifty eight percent (58%) of the operational budget goes to personnel expenditure. This does not compare favourably to fifty one percent (51%) of the previous financial year. Reasons for this are as stated earlier, the unliquidated obligations with regard to payments for work done on Sundays and Public Holidays for 1995 and 1996 and the re-grading.

This main division deals with the administration of my office and the Special Advisers. The objective of this division is to oversee all Government policies and operations in regard to health and social services to ensure that the goals set are achieved and policies properly implemented.

I propose that a total amount of one million six hundred and eleven thousand dollars which constitute 0.16% of the operational budget (N$1 611 000), be allocated to this division, which is four hundred and eighteen thousand dollars (N$418 000) less than previous allocation. This is mainly as a result of the reduction in the number of Special Advisers in my Ministry. The breakdown of this division is shown on page 195 of the Estimates of Revenue and Expenditure for the 1999/2000 Financial Year.

This main division is designated to advise and assist the Ministry of Health and Social Services in the development of relevant policies in accordance with legislative requirements and national objectives and to facilitate the implementation of the operations of the Ministry. An amount of thirty four million and three hundred and eight thousand dollars (N$34 308 000) (3.37%) is required, which is two million one hundred and ninety three thousand dollars (N$2 193 000) less than previous allocation. This is mainly as a result of the decentralisation of the payment for water and electricity bills to the regional offices. The breakdown is indicated on pages 196-197.

This main division deals with the provision of specialised clinical and diagnostic services for patients referred from regional and district hospitals and to develop and strengthen the skills and knowledge of health practitioners through clinical training. A total amount of two hundred and sixty five million eight hundred and ninety one thousand dollars (N$265 891 000) (26.14%) is requested which is twenty two million five hundred and twenty two thousand N$22 522 000) more than the previous appropriation. This vote is dedicated to hospitals, which provide specialist services, namely Windhoek Central, Katutura and Oshakati hospitals. The Oshakati State Hospital serves as a referral hospital for fifty percent (50%) of the population. The Windhoek Hospital Complex serves as Namibia’s tertiary specialist referral centre, and is linked to the UNAM Faculty of Health Sciences for teaching purposes.

The increase in the budget amount from the previous fiscal year is partly necessitated by the increase in specialist diagnostic and clinical services cost, which has further been compounded by the high inflation rate and the falling exchange rate.

New specialist services, namely, radiotherapy for cancer treatment, forensic psychiatry and a high technology computerised tomography (C.T.) scanner for diagnostic and planning purposes were added. Maintenance of ageing equipment and vehicles especially ambulances has become more expensive. It is imperative on us, to maintain the present standards of health care and improve on them. For this, dedicated trained staff and adequate funding for supplies and services, is necessary. The breakdown is indicated on pages 198-199.

In line with the government’s policy of decentralisation, and within the restructuring process of the Ministry of Health and Social Services, Katutura State Hospital will be de-linked from the Windhoek Central Hospital and will have its own separate budget allocations.

Eighty eight percent (88%) of this vote is allocated to personnel expenditure, thus reflecting the demand to employ a wide range of professional and administrative personnel and to provide an all year round twenty four-hour service. The implementation of new salary structure for certain job categories and the Labour Act bore a significant influence on personnel costs in terms of overtime payments for work done after hours, as well as payments for work done on Sundays and Public Holidays. The proportion of personnel expenditure is alarming and actually is a reflection of inadequate funding.

This main division deals with the maintenance and improvement of community and environmental health services, improvement of awareness of individuals and communities concerning health practices and behaviours and to encourage them to accept greater responsibility for their own health, and reduction of health risks through the provision of appropriate Primary Health Care Services and supportive secondary health care.

In order to realise these objectives, a total amount of four hundred and twenty six million one hundred and ninety one thousand dollars (N$426 191 000) (41.91%) is requested. This is eighty million eight hundred and seventy nine thousand dollars (N$80 879 000) more than last year.

Likewise, this is due to the implementation of the new salary structures and the effect of the Labour Act, price increases on materials and supplies, catering services maintenance of vehicles and equipment, and a modest allocation of funds to mission hospitals, which we subsidies 100 %. The breakdown of this division is shown on page 200-201.

This main division deals with the provision of diagnostic medical laboratory support services throughout the country. This service is considered to be essential but non-core. As I have mentioned earlier, this entity will be commercialised only during the 1999/2000 financial year, due to the various stages involved in law making.

An amount of twenty eight million and thirty seven thousand dollars (N$28 037 000) (2.76%) is requested for this main division. This represent an increase of two million one hundred and thirty three thousand dollars (N$2 133 000) from the allocation of last year. Four million (N$4 000 000) from the allocation represents the start up capital for the commercialised entity which will be known as the Namibia Institute of Pathology. The other reasons for the increase is leave gratuity pay out that has to be made to staff leaving the Government Services to join the Namibia institute of Pathology as well as additional staff that need to be appointed in vacant posts. The breakdown of this division is shown on pages 202-203.

This main division is responsible for the provision of social welfare and relief services to families and individuals with special needs. Its main area of operation is the provision of social assistance to the aged, disabled and other vulnerable groups. It also provides for general professional social welfare services, support to welfare organisations, old aged homes, places of safety for children, and the administration and management of social pensions benefits, children allowances and foster care grants. An amount of two hundred and fifty three million one hundred and two thousand dollars (N$253,102 000-00) (24,89 %) is requested for this main division. Two hundred and eighteen million dollars (N$218 000 000) (21,44 %) is requested for the payment of social pensions and disability grants. In addition to the amount requested for the actual pension payments, the Ministry of Health and Social Services requests nineteen million, four hundred and seventy six thousand dollars (N$19 476 000 000) to meet the corresponding cost associated with the cash payment of social pensions. Five million three hundred and eight thousand and eight hundred dollars (N$5 308 800 00) is requested to provide for maintenance grants, foster parent grants and places of safety allowances. Forty nine million four hundreds and thirteen thousands dollars (N$49 413 000) is requested to cater for the shortfall from previous allocation and for new applicants.

The Ministry of Health and Social Services also provides for general social support to Welfare Organisations. For this purpose an amount of one million dollars N$1 000 000 is requested for subsidies to bona fide welfare organisations and institutions. Currently, there are twenty-one (21) organisations on the subsidy scheme. In addition, a further one million dollars (N$1 000 000) is requested to defray areas in respect of remission of rent and services fees used to assist needy people with rent and service fees levied by local authorities. The breakdown of this division is indicated on pages 204-205

This main division deals with providing pharmaceutical supplies to hospitals, health centres and clinics. The medicines supplied to hospitals, health centres and clinics are procured through the Central Medical Stores, which is required to keep a certain level of stock at all times.

This main division also co-ordinates the activities of the Medicines Control Council to ensure safety, efficiency and good quality of medicines through a system of registration or certification. An amount of four million, one hundred and fifty nine thousand dollars (N$4 159 000) is requested, which is eight million, and seventy four thousand dollars (N$8 074 000) less than last year. The decrease is mainly due to the fact that seven million dollars (N$ 7 000 000) were provided for last year to increase the stock level in the Central Medical Stores. The breakdown of this main division is shown on pages 206.

This main division provides for management support, through the development and maintenance of comprehensive systems for strategic planning, policy formulation, health management information, research co-ordination, donor co-ordination and the development of human resources. An amount of three million three hundred thirty four thousand dollars (N$3 334 000) (0.33%) is requested which is four hundred and fifty six thousand dollars (N$456 000) more than the previous allocation. The breakdown of this division is shown on pages 207-208.

This main division serves as the co-ordinating body for the health service professions under which professional boards have been established, to regulate the practice of the professions, set professional standard and control education and training of prospective professionals. Provision for secretarial service is also made under this main division. An amount of four hundred and five thousand dollars (N$405 000) (0.04%) is requested for this main division, which is two hundred and twenty six thousand dollars less than previous allocation. The breakdown of this main division is shown on page 209.

Mr Speaker,

I have concluded the explanation of my operational budget. Before I proceed with the development budget, I wish to inform the House that, in support of the above expenditure, the Ministry of Health and Social Services estimates to collect revenue to the value of eighteen million four hundred and thirty five thousand dollars (N$18,435 000). This Ministry is currently reviewing all user charges with a view to adjust them to appropriate levels.