Funding questions for Namibia’s health reforms

Namibia’s ambitious drive towards Universal Health Coverage (UHC) is gaining policy momentum, but fresh analysis warns that major questions remain over affordability, structure and implementation.

This is according to the Institute for Public Policy Research (IPPR) in its latest quarterly economic review, which examines the country’s health financing system and the proposed transition to a universal model.

At the heart of the reform agenda is a plan to overhaul Namibia’s fragmented health system – currently split between state services, the Public Service Medical Aid Scheme (PSEMAS), and private medical aid funds – into a more equitable, unified framework.

The report highlights stark disparities in health spending across the population. While the general public relies on state-funded services costing about N$3 971 per person annually, public servants benefit from subsidies of around N$26 800 through PSEMAS. Meanwhile, privately insured individuals spend an average of N$56 094 per year on medical cover.

“These mechanisms give rise to highly unequal levels of resources available for health services,” the report notes, pointing to persistent inequality in access and quality of care.

Namibia’s public health system remains extensive, with over 400 clinics, 60 health centres and nearly 50 hospitals nationwide. However, challenges such as resource constraints, staffing shortages and uneven access continue to hamper service delivery.

Reforms gather pace

Government has committed to introducing UHC through legislation, including the establishment of an Essential Health Services Package (EHSP) and a National Health Equity Fund (NHEF). These reforms aim to ensure all Namibians can access healthcare without financial hardship.

The ruling party has also pledged to spend N$15 billion over five years on health system upgrades and UHC implementation, alongside job creation in the sector.

In a significant policy shift, senior government officials were expected to start using public healthcare facilities from April – a directive widely interpreted as a step towards phasing out PSEMAS and integrating funding into a broader national system.

PSEMAS under scrutiny

PSEMAS, which covers nearly 119 000 civil servants, has long faced criticism over inefficiencies, fraud and high costs. The scheme is currently allocated N$3.2 billion in the national budget, with additional contributions expected to push total funding beyond N$4 billion.

Past estimates suggested losses of up to N$900 million annually due to fraud, prompting ongoing reform efforts, including the establishment of a new governance committee to improve oversight.

Despite the policy direction, the IPPR cautions that the financial sustainability of UHC remains unclear.

Key uncertainties include how the benefits package will be defined, whether private medical aid members will be required to contribute to the new system, and how additional resources will be mobilised.

“If the aim is to oblige current members of medical aid funds to pay for some or all of the additional resources required, this needs to be clearly stated,” the report argues.

The analysis concludes that while the goal of universal health coverage is “laudable”, current funding mechanisms may be insufficient to deliver a comprehensive package to the entire population.

The health reform push comes amid modest economic growth, with Namibia’s GDP expanding by just 1.7% in 2025 – below earlier projections. Growth is expected to recover slightly to around 3% in the medium term.