Govt turns to expatriates as nurses shun rural posts

The Ministry of Health and Social Services says Namibia’s rural health facilities are becoming increasingly dependent on foreign healthcare workers because many local health professionals are unwilling to work in remote areas.

Speaking during a stakeholder engagement in Otjiwarongo with members of the Parliamentary Standing Committee on Education, Youth, Civic Relations and Community Development on Monday, ministry official Dr Joyce Shatilwe said the country continues to face critical shortages of specialised and allied health professionals.

"We have approximately 340 expatriates, but our statistics indicate 322, of whom 66 are nurses,” she said.

Shatilwe explained that expatriates are primarily recruited to fill specialised positions and critical shortages that cannot currently be addressed locally.

“We are facing a situation in the country where we do not have enough allied health professionals. We are experiencing a shortage of skills when it comes to allied health professionals, as well as certain specialist skills that are not available in the country. Most of the expatriates we recruit are in these categories,” she said.

‘Our own children do not want to go there’

According to Shatilwe, remote health facilities are especially struggling to retain Namibian nurses and doctors, forcing government to rely heavily on foreign healthcare workers.

“As for nurses, most of the expatriate nurses we have are working in remote areas. Our own children do not want to go there. What happens is that they apply, and then after a week they resign and come back,” she said.

She added that feedback from regional health officials and hospital managers highlighted severe staff retention problems in rural regions.

“If you hear from them, you would be shocked. Nobody wants to go there,” Shatilwe said.

She cited a visit to Simbinda Health Centre in the Zambezi Region, where officials encountered a Kenyan nurse who had worked in the remote area for years.

“We found a very committed nurse there who had worked there for many years and she was from Kenya, deep in the rural areas of Zambezi,” she said.

Home Affairs scrutiny complicates recruitment

Shatilwe further revealed that the ministry recently halted applications to recruit 14 expatriate nurses due to increasing scrutiny from the Ministry of Home Affairs over foreign recruitment.

“I told them we would not pass scrutiny at the ministry of home affairs, because they are also monitoring us closely when we recruit,” she said.

Despite this, she stressed that Namibia still urgently requires expatriates in specialised medical fields because many local specialists are unwilling to relocate to rural areas.

“If you go to Rundu hospital, we recruited close to 19 expatriates, all specialists. Even our own specialists do not want to go to remote areas,” she said.

Shatilwe added that while the ministry still requires more nurses overall, recruitment must be carefully managed as the government expands healthcare infrastructure across the country.

“Yes, we still need nurses, but recruitment needs to be controlled properly. We should also remember that we are building hospitals in the country, and we will need personnel for them,” she said.

Young professionals reluctant to relocate

Two nurses who spoke anonymously said poor accessibility, isolation and limited opportunities continue to discourage young healthcare workers from accepting placements in remote areas.

One nurse said the environment is difficult for young professionals unfamiliar with rural living conditions and lacking access to services and support systems.

“For a young person, that just doesn’t work. Most of the infrastructure and services are far from town,” the nurse said.

Another nurse said many healthcare workers fear becoming permanently trapped in remote postings because transfers are difficult to secure once appointed.

“The problem is that if you want to transfer, you need someone to replace you before you can move. People are already hesitant to go there, so it becomes very difficult,” the nurse explained.

Ministry operating at half capacity

Last year, health minister Esperance Luvindao revealed that the ministry is operating at only 50% staffing capacity, a situation she described as “very dangerous” because of the pressure placed on exhausted healthcare workers.

“We need more staff; we need more nurses; we need more doctors, we agree on that 150%. But at the same time, what we now need to do is sit back, go back to the table, my team and I, who are here as well with me, to sit back and say, how can we find a way to accommodate these people,” she said during a parliamentary session last year.

During her budget motivation speech, Luvindao disclosed that the ministry requires more than N$4.6 billion to fill over 11 700 approved positions. However, only N$150 million had been allocated — enough to fund just 434 posts.

A Namibian Sun investigation last year further revealed that one doctor at Rundu Intermediate Hospital attends to more than 100 patients per day because of chronic staff shortages.

The hospital, which serves patients from Kavango East, Kavango West, the Zambezi Region and even southern Angola, has not undergone major modernisation since 2008 despite its reclassification to an intermediate referral hospital.

[email protected]