Deep-seated health challenges

The ministry of health's goal to provide quality healthcare to all has been an uphill battle since independence, with notable achievements along the way - in addition to frequent challenges.

Over the past two years, the public health sector has been dealt one of its most significant setbacks, with sweeping measures imposed across government to cut spending in line with the country's economic crisis.

The ministry, headed by Dr Bernard Haufiku, emphasised that cost-cutting will not compromise patient care where possible, but compromises have been inevitable.

Manga Libita, spokesperson for the ministry, told Namibian Sun that the challenges haunting the public health sector are multiple.

Inadequate human resources top the list of problems.

“These range from medical specialists, medical officers, pharmacists, nurses, and all allied health professionals such as social workers, radiographers and environmental health practitioners,” she said.

Libita said the ratio of health professionals to the population remains far lower than that recommended by the World Health Organisation (WHO).

While WHO recommends that the ideal ratio of health professionals to population be 1:435, the current ratio of medical officers to the population is 1 to 4 234.

Registered nurses in the public sector stand at 1 to 761.

Huge gaps are visible in the ratios of pharmacists, who number 1 to 20 881 to the population.

A dire lack of social workers is also identified, with a ratio of 1 social worker for 12 586 people.

Inadequate quantity of high technology medical equipment is another problem.

“The challenges are further compounded by dwindling financial resources … This means that, although there may be health professionals who are ready to join the job market, inadequate financing would not allow the ministry to recruit.”

In February Haufiku commended international aid partners and other stakeholders for their continued and critical support to public health in Namibia, which has helped the ministry in numerous ways.

Libita said the priorities for the upcoming financial year include increasing the ratio of health professionals, and reducing patient waiting times at health facilities.

The ministry further intends to implement electronic health systems and aim to equip all levels of health facilities with essential medical equipment.

Infrastructure development will be accelerated, she said.



A good run so far

Libita said despite challenges, the public health sector has notched a number of successes on their goalpost since 1990.

“The state of public healthcare improved tremendously after independence,” she said.

Shortly after independence, an emphasis on primary healthcare, which focuses on disease prevention and health promotion, was implemented.

“As a result, more health facilities, especially clinics, were constructed to increase access to healthcare services.”

In February, Namibian Sun reported the inauguration of a new maternity waiting home constructed through funding from the European Union (EU) in the Omaheke Region.

Another maternal waiting home was also opened at Opuwo.

Libita further pointed out that there have been significant improvements in the field of HIV/Aids.

Last year, Haufiku noted that about 10% of Namibians or 247 126 live with HIV according to 2016 statistics.

HIV remains the leading cause of death in Namibia since 1996, but its prevalence dropped by over 60% between 2006 and 2015.

Another achievement an overall reduction in maternal deaths, although Namibia still falls short of global targets.

According to recent statistics, Namibia's infant mortality rate currently stands at 39 deaths per 1 000 births.

The country's maternal mortality ratio is currently estimated at 130 deaths per 100 000 live births, while 18% of pregnant women attending the country's antenatal clinics are living with HIV.



Serious concerns

Nevertheless, problems remain.

The Legal Assistance Centre's Sharen Zenda and Corinna van Wyk of the social justice department emphasised that many challenges faced by the state healthcare system “stems from poor management of hospitals and lack of innovative thinking in terms of improving the whole system.”

A further challenge is that specialised medical care is centralised.

“Hence people from the different regions can only access specialist care if they come to Windhoek.”

They noted that it frequently happens that serious conditions of state patients are not diagnosed and “patients often are sent home with Panado prescriptions”.

Zenda and Van Wyk concluded that “at the moment the state of our healthcare system is of serious concern.”

Their offices are inundated with medical negligence matters on a daily basis and litigating does not seem to reduce the numbers.

She said reports of negligence appear frequently, such as pregnant women camping in the open to access healthcare, state clinics restricting how many pre-natal patients are attended to and turning the rest away.

The pair added, however, that “needless to say that the system includes competent medical staff with a passion for human life, as well as state facilities and available medicines in the rural areas and villages,” which are some of the positive aspects in the sector.



The brunt of it

Reports from 2017 found that the ministry's attempts to keep patients out of the cost-cutting fray, could not be allayed completely.

State patients who needed hip or knee replacements were forced to buy their own, costly, prostheses, as reportedly payments to suppliers were significantly in arrears.

Towards the end of the year, doctors in Windhoek submitted a hand-written letter to the Haufiku, exposing a critical shortage of medical supplies at state hospitals.

A long-standing feud moreover was revealed between Haufiku and former health permanent secretary Andreas Mwoombola.

Mwoombola was eventually transferred to the Office of the Prime Minister in December.

The ministry later blamed the shortages of medical supplies on a new central procurement system.



JANA-MARI SMITH