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Nam Health System Below Par In Comparison To Peers

Nghiinomenwa-vali Erastus
The healthcare system in Namibia has been found not to be performing well in
comparison to other upper-middle income countries (UMIC).
This is according to a study by the Economic Association of Namibia and Hanns Seidel
Foundation titled, ‘Towards Universal Health Coverage in Namibia: Using PPP
Synergies for Equitable Health Outcomes’.
Despite a well-organised structured system, the sparse population does not make it easy
to deliver healthcare in Namibia.
The study was carried out by Steven Koch and Moipi Ngaujake.
As a result of these findings, the researchers are recommending health public-private
According to the study, the country has an under-5 mortality rate of 45.2 per 1,000 live
births which is higher than the world target of 25 under-5 deaths by 2030 and is 3.1
times higher than the UMIC average of 14.4.
In addition, life expectancy at birth for both males and females is considerably lower in
Namibia compared to other UMICs.
This is despite total government health expenditure increasing above N$8 billion since
2015 and currently accounting for about 15-16% of the government's overall
The study has also found that around 1.5 million uninsured Namibians, who account for
85% of the total population, rely on primary health care in the public sector.
The country's public primary health care includes cheap and easy medical treatment due
to government subsidies.
Public health services usually charge flat user fees depending on the level of the facility.
Due to highly subsidised user fees, medicine is generally affordable, which matches the
stance of the Ministry of Health and Social Services.
Everyone in the country can have access to public healthcare, even if they are not able to
pay, but those who can pay should pay for the health services.
The country's public health service delivery is founded upon the fundamental principle
of primary health care (PHC).
The PHC approach to service delivery entails a health system that is people-centred,
equitable and socially inclusive.

PHC is delivered through community outreach sites, clinics and health centres whilst
district hospitals and referral hospitals handle more complex medical procedures.
At the community level, health extension workers identify health needs in the
community and refer them to clinics.
Cases that cannot be handled at the clinic level are referred to the health centres, whilst
these facilities refer complex cases to district hospitals.
In turn, district hospitals refer complicated procedures to referral hospitals.
According to the researchers, there are, however, equity issues (inequity) associated
with service delivery in the country.
In Namibia, evidence suggests 62.4% and 66% of individuals in the poorest and second
poorest wealth quintiles access health services, while 70.6% and 72.5% of individuals in
the second richest and richest wealth quintiles use healthcare services.
Furthermore, poor women use public health facilities 30% less than their rich
counterparts for child delivery services.
Women covered by health insurance with secondary and higher education, who are
likely to be wealthier, are more likely to be screened for breast cancer than their
counterparts, who are not covered by health insurance and are less educated.
This outlines different forms of inequity in healthcare access.
The Namibian government spends nearly 15% of its total expenditure on the health
The study has, however, indicated that despite high levels of expenditure – and being a
signatory to most international healthcare declarations, "there is a need to improve
performance in the health sector".

Nghiinomenwa-vali Erastus

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