HIV/AIDS
cases further increased. By the end of September 2001 there were 90,000
HIV/AIDS cases (positive tests) in Namibia (cumulative since the beginning of
the epidemic in the country). Also, the number of hospitalisations has
increased compared to the previous year (in some hospitals up to 50 % of beds
were occupied with HIV/AIDS related cases). Furthermore, the number of maternal
deaths compounded by HIV/AIDS has continued to increase.
A
very severe malaria epidemic occurred from April to July in the North-West
regions, with focus on Oshikoto.
A
potentially devastating meningitis outbreak took place in Khomas and Ohangwena
during July and August.
Fight
against AIDS:
The National AIDS Committee was established and met for the first time during
the year. It endorsed three policies, namely: National Policy on HIV/AIDS in
Namibia; HIV/AIDS Counseling Policy, and Home and Community-based Care Policy.
Co-ordination of the response was further strengthened through regular meetings
of NAMACOC, the multi-sectoral AIDS Committee, which met three times during the
year. Regional AIDS Coordinating Committees were further strengthened and
regional AIDS coordinators were appointed. In addition, HIV counselors
training, and house-to-house community counselors training took place in three
regions. The ministry has further progressed in its preparations for the launch
of a Comprehensive Prevention of Mother-to-Child-Transmission programme.
Outside of the ministry, but strongly supported by it, the first Voluntary
Counseling and Testing Center has been opened by the Council of Churches, and
the community-based organisation Lironga Eparu, which supports people living
with AIDS, has been launched in various centers of the country.
The
Malaria epidemic in the North was successfully brought under control,
which required the relocation of staff and many other resources on an emergency
basis.
Very
successful meningitis vaccination campaigns were held in Khomas and
Ohangwena, which brought the outbreak of meningitis under control within a very
short time.
National
Immunisation Days (NID’s) were once again successfully completed with
coverage ranging between 70 and over 90 percent in some regions.
Vitamin
A
supplementation coverage during NID’s reached 86.3%.
The
World Health Organisation declared Namibia Neonatal Tetanus – free;
Also,
the leprosy prevalence in Namibia has been reduced to WHO certified
level of elimination (less than 0.1/1,000).
Tuberculosis: The treatment success rate
has reached 70% and the incidence of multi-drug resistance was below 5%.
Outreach
and community-based health care (CBHC): Existing mobile outreach services were
strengthened through the allocation of new vehicles to certain districts, e.g.
Engela, Katima Mulilo, Opuwo, Mariental, Omaruru, Windhoek;
Community based health care was strengthened, particularly in Omaheke region, where training of Community Based Resource Persons was done very successfully. Also, the development of a training manual for Traditional Birth Attendants was completed.
Water
and sanitation:
construction of more than 100 VIP latrines in Otjozondjupa and Kunene regions
took place.
Integrated
Management of Childhood Illnesses was introduced in six pilot districts;
Health
Promoting Schools Initiative: a Memorandum of Understanding was signed with
MoBE; the Initiative was launched in various regions, e.g. Khomas had 53
schools certified as health-promoting schools;
Community
Eye Care Programme: Surgical camps were held in Kunene, Omusati/Oshana, and
Caprivi/Kavango; a total of 494 patients were operated on (cataracts removed)
and had their vision restored;
Patient
Care:
Improvements, particularly in medical care, through the introduction of weekly
joint “academic” ward rounds by doctors in all hospitals, were achieved.
Nursing
care was strengthened through the establishment of
infection control committees in various hospitals. Also, the Patient Charter
has been translated into all local languages.
Pharmaceutical
Services: A
very successful Pharmacy Week was held during March to promote the public’s
awareness of the appropriate use of drugs. The notification for retention of
registration of medicines registered before Independence was published. Based
on this, the medicines register is currently being compiled. The National Drug Control Commission has been
established. Extensive renovations of the Central Medical Store have commenced.
Quality
Improvement:
The Committee on Patient Care and Infrastructure Management was put in place
under the leadership of the Honourable Deputy Minister. It visited all regions
and districts during the year and brought many challenges and problems to the
attention of the relevant managers.
2.2. Developmental Social Welfare Services:
The
First National Orphans and Vulnerable Children Conference was held in
May. A steering committee to coordinate further development of this programme
was put in place at that occasion.
A
national workshop on the Protection of Women and Children was
successfully held.
A
country-wide poster competition on Drug Abuse took place and calendars
containing Substance Abuse Prevention messages were distributed.
A new Funeral Death Benefit Scheme was introduced for all registered pensioners and received wide acclaim from the public.
2.3. General Management Services:
Policy
development:
Policies for various programmes, including Orthopaedic Technical Services,
Reproductive Health, Mental Health, and Guidelines on Infant and Young Child
Feeding were finalised.
Construction
or renovation of facilities: A large number of clinics were renovated or constructed, including
Ruacana and Olukonda in the North, Noordoewer in the South, Eiseb and Omitara
in the East, and Henties Bay and Hakhaseb in the West. District hospital
upgrading continued in places like Oshikuku, Kongo, Tsumeb, Okakarara,
Khorixas, and Karasburg. Construction and renovation at all four referral
hospitals continued. The Rundu hospital renovations, and the new OPD and
Casualty Departments at Oshakati were completed. Social Welfare facilities were
constructed in form of a new National Rehabilitation and Treatment Centre
(Etegameno) in Brakwater and a Multi-purpose Youth Centre in Walvis Bay.
Strategic
Planning:
The ministry’s contribution to NDP2 (HIV/AIDS chapter, Health chapter and
Social Welfare chapter) was finalised during the year. Strategic plans were
compiled by various regions based on NDP2. A Modeling exercise on the future
impact of AIDS was completed and the first report of the working group was
released. The ministry actively participated in the GRN initiative to compile
Vision 2030.
Research:
The Namibia Demographic and Health Survey 2000 data-entry and analysis
was completed and the preliminary report was finalised.
HIS:
the revised Health Information System was introduced in all facilities
and launched in January 2001.
Intersectoral
Collaboration:
participation of regional MoHSS staff in Regional Development Committees was
strengthened. There was also increasing co-operation of the various sectors at
regional level through the Regional AIDS Coordinating Committees (RACOCs).
Decentralisation: besides further
deconcentration of authority within the ministry, agreement was reached on the
specific subfunctions, which will be the first to be decentralised (eventually
devolved) to the Regional Councils (community-based health care, sanitation,
social allowance administration).
Regulation: Licensing of private
hospitals and health facilities continued routinely during the year. Two
authorisations for the establishment of new private hospitals were issued as
follows: for a new private thoracic surgery hospital in Windhoek, and for a new
private general hospital in the Oshakati/Ongwediva area. Under the existing
statute, the Registrar of the Council of Health and Social Service Professions
successfully coordinated the election and establishment of the new Optometric
Board. Furthermore, a Joint Complementary Health Professions Board and a Joint
Allied Health Professions Board were established.
Legislation: various Bills were taken
forward: the Medicines Control Bill and Atomic Energy Bill were approved by
Cabinet for submission by the Hon. Minister to Parliament during 2002; the
draft of the Medical, Dental and Pharmacy Professions Council Bill was
finalised; the following drafts were further refined: Nursing Council Bill,
Social Workers Council Bill, Allied Health Professions Council Bill,
Traditional Healers Council Bill, as well as the draft Public Health and Mental
Health Bills, and the Older Persons Bill, National Welfare Bill, and Child Care
and Protection Bill.
2.4. Functional and Technical Support Services:
Human
Resource/Personnel Management: the review of the staff establishment and
restructuring exercise was completed and the finalised establishment submitted
to the PSC; new personnel manuals for managers and for staff members were
launched; the personnel function was further decentralised and a number of new
personnel offices were established in the regions;
Human
Resource Development: A feasibility study for the commencement of a Pre-medical/pharmacy
training programme at the University of Namibia was completed. Based on the
study it was decided that as from 2002 UNAM will accept 35 students into this
two-year course. Those, who complete this course successfully, will then be in
a position to obtain acceptance to medical training programmes at universities
in South Africa. In addition, during 2001 a total number of 20 Namibian medical
students commenced their training at universities abroad. Furthermore, 187
students graduated from the ministry’s National Health Training Centre and
Regional Training Centres as enrolled nurses, environmental health assistants,
orthopaedic technicians, radiographic assistants, and pharmacist’s assistants.
Financial
management:
the ministry received a budget of over N$ 1,3 Billion for the fiscal year
2001/2002 budget. Indications are good that the ministry will be able to stay
within the operational budget amount for the fiscal year. However,
disbursements on the development budget have been slow. With regard to
financial management, there were clear improvements after earlier difficulties
related to the processing of payments; also, the various finance subfunctions
were further streamlined, including budgeting and budget control, revenue
collection and the processing of S&T claims.
Facility
maintenance:
an extensive situation analysis was executed and a workshop on policy
development for improved facility management was successfully completed.
Equipment
management:
various initiatives during the year included an increase in the recruitment of
technical staff, the upgrading of the Windhoek workshop and the establishment
of a clinical workshop in Keetmanshoop, the launching of two mobile workshops,
and the compilation of an equipment user guideline.
Information
Technology:
further progress was achieved in making more districts and regions accessible
by email; the procurement of a new telephone exchange for the ministry head
office and the Windhoek hospitals was also finalised.
Transport: around 40 vehicles,
including heavy duty ambulances, were procured and distributed to the various
operational units. The vehicle accident rate decreased markedly during the
year.
3.
Main Setbacks and
Challenges:
HIV/AIDS remains the largest
challenge both to the ministry and to the nation as a whole.
There
is great need to further improve patient care, both in terms of medical
services, nursing care and the ready availability of appropriate drugs, medical
supplies and health care technology.
Medical equipment: the ministry continued to experience difficulties in adequately replacing obsolete health care equipment. According to the latest equipment inventary, it is estimated that health care technology to the total value of around N$ 150 Million requires immediate replacement. To arrange funding for this initiative remains a challenge for 2002.
The
improvement of the management of information technology and the
extension of the IT system to cover all districts and regions requires
increased attention.
Constraints
were continued to be experienced with regard to the relatively slow process of
reviewing, drafting and clearing of relevant new legislation before
final submission to Parliament.
4.
Outlook:
The
national response to the HIV/AIDS epidemic will require further
streamlining and strengthening of the multisectoral approach as part of a
larger smart partnership between all the sectors in the Namibian
economy. The launching of the prevention of mother to child transmission
programme (PMTCT) early in the new year will introduce a new public health
intervention that will reduce the HIV infection rate amongst infants and
introduce the treatment of HIV positive mothers.
Medical
services
will be further extended in the new year. A number of clinics will be upgraded
to health centers. With the arrival of a large contingent of medical and other
personnel from Cuba early in the new year, the ministry will be in a position
to place medical doctors in all health centers. This will make medical services
more accessible to the general population.
The
new staff establishment will be introduced during the fiscal year 2002/2003.
This will entail the introduction of a more rational organisational structure
at the ministry’s head office. It will also include the phasing-out of the
current four regional directorates, and will strengthen the health and social
welfare offices in each of the 13 political regions.
Given
the 3 year rolling budget as contained in the Medium Term Expenditure
Framework, which was approved by Parliament during April 2001, and taking into
account the fiscal framework for 2002/2003 as elaborated by the Ministry
of Finance during November, it may be expected that the next financial year
will not be an easy one for the ministry. It may particularly be anticipated
that the national inflation rate and the drastic devaluation of the South
African Rand (and with it the N$) will exert considerable pressure on the
relatively small proportion of finance available for important goods and other
services, including drugs, medical supplies and new health care
technology.
==++==++==
Compiled
from Directorate’s submissions by:
Dr.
Norbert Forster
Under
Secretary: Policy Development and Resource Management
2001/12/20