Introduction
[Source: Namibia MoHSS Web Site – http:www.healthnet.org.na/mhssindex1.htm
For the convenience of MoHSS Web site visitors, on 3 June 2001 this document was translated to HTML from the Government of the Republic of Namibia Web Site page for the MoHSS. To visit the original page - which is entirely frames-based – go to http://www.grnnet.gov.na/Nav_frames/Gov_launch.htm, then click on Ministry Index, then on Ministry of Health and Social Services. Note that the Original document is undated and has no source attributed to it.]
Namibia’s health system comprises the facilities for the provision of health services, social welfare and social security. The Ministry of Health and Social Services plays a pivotal role to help citizens lead a healthy life.
At independence on March 21 1990, Namibia had inherited a racially segregated health care system based on the apartheid doctrine of South Africa. The main features of the health care delivery system at independence were:
1. Racial segregation of healthcare resulting in separate and unequal services for blacks and whites.
2. Fragmentation of health services delivery through the establishment of numerous health services administrations based on ethnicity.
3. Curative orientation and an extensive hospital-centred health care infrastructure with little or no organisational linkage between curative and preventive health care.
4. Marked urban bias resulting in the neglect of rural majority in the provision of health infrastructure and targeting of health interventions. This bias emphasised meeting the needs of urban minority at the cost of the disadvantaged rural majority suffering from infectious diseases, malnutrition, and inadequate maternal and child care services.
5. Domination by whites of health services management.
Development of a National Health Policy
In order to address these inequities, the Minister of Health and Social Services issued a policy statement in March 1990, entitled Towards Achieving Health for All Namibians: A Policy Statement. Subsequently the government committed itself to providing access to health services for all Namibians by the year 2000. The fact that approximately 15% of total government expenditure is devoted to the public health sector is a testimony to the government’s commitment to investing in the citizens’ health.
National health policy was reviewed in 1997 and the reviewed policy yet again emphasised that primary health care approach was the best strategy to address the citizens’ health care needs. The purpose of the new health policy was to ensure that citizens’ health care needs were given their rightful place in planning the course ahead for socio-economic development. Therefore, Namibia’s health care policy is being driven by the following principles:
1. ensuring equity of access to health care services to all with special provision for those most vulnerable and most affected by inequalities, such as, the rural poor, women and children;
2. promoting community involvement and greater citizen participation and say in decisions about priorities for access to and provision of health services;
3. providing affordable health services by strengthening health care systems which are sustainable, cost-effective, efficient and culturally relevant and acceptable;
4. facilitating co-operation and inter-sectoral action with all major players in the provision of health care;
5. instituting measures to counter major health risks including the prevailing communicable diseases, such as, malaria, tuberculosis and HIV/AIDS, and the deadly children diseases, such as, measles and polio;
6. ensuring the development of human resources in sufficient numbers for manning various health delivery systems;
7. ensuring the development of a national health care system that is capable of providing a fully comprehensive range of preventive, curative and rehabilitative health care that is cost-effective, sustainable and acceptable to the most disadvantaged communities, and promotes equity and facilitates the effective implementation of defined strategies and interventions; and
8. providing quality health care services.
The first major step towards the realisation of the goals and objectives defined in the National Health Policy was the unification and rationalisation of the fragmented second tier structures under the central control of the Ministry of Health and Social Services. This process was completed during the first few months after the country became independent.
The ministry furthermore incorporated all existing health and social services in a rationalised organisational structure designed to ensure the provision of health and social services at the local, district, regional and national levels.
National Primary Healthcare Guidelines
Impetus for change in guiding the principles of the new policy was spearheaded by the President of the country and was supported by leading politicians, community leaders, international organisations, non-governmental organisations, senior officials in the ministry, and the community. Through a national workshop held in Oshakati in 1991, followed by a series of other workshops held at national, regional and district levels, a broad consensus on the approach to be followed in the implementation of primary health care/community-based healthcare (PHC/CBHC) was reached. The outcome of this consensus was the development and adoption of the PHC/CBHC guidelines which were launched by the President in 1992. Achievement of this consensus and the strong political will in support of the new initiatives in health development have been important contributors to the success of the primary health care approach.
Strategic Planning
Since 1991, development of annual plans has become an annual event in the ministry and a planning culture has now been institutionalised in the ministry.
The World Summit for Children in 1990 and its recommendation that countries develop strategic plans to guide the implementation of programmes in order to meet the mid-decade goals (1995) and end-decade goals (2000) added further impetus to the strategic planning process. This was followed by the compilation of an implementation framework that emphasised the organisational set up of healthcare services in the country. This guide, better known as the Otjiwarongo Document, set the pace for strategic reform during the mid-1990s. It also formed the basis for the compilation of the health chapter in the government’s First National Development Plan (NDP1). Furthermore, all thirteen regional management teams went through a strategic planning processes that formed the basis of five year strategic plans.
While the basic thrust of the new healthcare system has been towards community-based healthcare activities, significant success has been recorded in a number of nationwide public health programmes and initiatives with special reference to the following:
At the time of Namibia’s independence in 1990, no national programme, policy or guidelines on immunisation were in place, nor did health facilities have any cold chain equipment. Health personnel were uninformed about new approaches to immunisation and information on the immunisation status of children in the country was non-existent. The government therefore identified the immunisation of children as a priority area and proceeded to reduce morbidity and mortality due to immunisable diseases among children under the age of five years. In June 1990, the ministry adopted the national immunisation policy and guidelines, procured all the necessary equipment and supplies and initiated a national Expanded Programme on Immunisation (EPI). This effort was accomplished with assistance from Unicef, World Health Organisation, and other development partners.
A national immunisation coverage survey carried out in December 1990 recorded 42% immunisation coverage of children under the age of one year. By 1992, 58% of all children under the age of one year were fully immunised, while 71% were protected against measles.
During the National Immunisation Days carried out in May 1997, 80% of children under the age of five were immunised, and by July 1997, 100% coverage of children under the age of five was achieved. As a result, there was dramatic decrease in the incidence of measles from 12 471 reported cases in 1992 to 4556 in 1997.
In its effort to eliminate tetanus the ministry included the immunisation of women of childbearing age with tetanus toxoid as part of the immunisation programme. To date 74% of women of childbearing age have had two or more tetanus toxoid vaccinations. Intensity of this effort is being sustained, and Namibia can hope eliminate tetanus in the near future.
|
Table 1: Programme on
immunisation |
|||||||||
Immunization < 1 |
1991
(Survey) |
1992 |
1993 |
1994 |
1995 |
1996 |
1997 |
1998 |
1999 |
|
BCG |
85% |
68% |
92% |
127% |
92% |
79% |
66% |
82% |
78% |
|
OPV3 |
53% |
87% |
71% |
80% |
73% |
71% |
66% |
72% |
71% |
|
DPT3 |
53% |
82% |
73% |
79% |
74% |
70% |
66% |
71% |
71% |
|
Measles |
41% |
71% |
71% |
70% |
68% |
61% |
59% |
61% |
86% |
|
Schedule
completed |
42% |
71% |
71% |
68% |
65% |
57% |
53% |
58% |
61% |
|
Morbidity
< 5 |
|
|
|
|
|
|
|
|
|
Selected diseases/conditions |
|
|
|
|
|
|
|
|
|
|
ARI |
|
35% |
33% |
30% |
20% |
23% |
20% |
23% |
25% |
|
Malaria |
|
20% |
23% |
20% |
18% |
19% |
22% |
20% |
21% |
|
Diarrhoea without
blood |
|
25% |
19% |
16% |
19% |
17% |
13% |
14% |
13% |
|
Mortality>
5 |
|
|
|
|
|
|
|
|
|
Selected diseases |
|
|
|
|
|
|
|
|
|
|
ARI |
|
25% |
20% |
17% |
9% |
10% |
9% |
11% |
11% |
|
Malaria |
|
20% |
23% |
18% |
16% |
18% |
19% |
16% |
19% |
|
Diarrhoea without
blood |
|
11% |
9% |
5% |
5% |
0% |
0% |
3% |
3% |
|
ENTM |
|
|
|
|
14% |
11% |
10% |
13% |
11% |
|
Women delivery at the medical
facility |
|
|
48% |
49% |
51% |
51% |
51% |
52% |
54% |
|
|
|
|
|
|
|
|
|
|
|
|
ANC |
|
|
62% |
67% |
85% |
73% |
73% |
62% |
75% |
|
|
|
|
|
|
|
|
|
|
|
|
PNC |
|
|
|
|
|
30% |
42% |
40% |
54% |
|
|
|
|
|
|
|
|
|
|
|
|
Incidence HIV/AIDS |
543 |
734 |
|
2517 |
4126 |
7757 |
10576 |
11608 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Eradication
of diseases |
|
|
|
|
|
|
|
|
|
|
Measles |
|
|
12471 |
1328(7%) |
1535(2%) |
2043(3%) |
4881(4%) |
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