The Covid crisis and the need for health financing reform

CONS KARAMATAThe public health crisis caused by the Covid-19 pandemic has put the spotlight on the need for countries to have robust and well-functioning health systems. All over the world, health systems are experiencing tremendous pressure, with many countries having to make amends and invest billions to deal with the crisis.In Namibia, the alarming death rates in recent weeks caused by the third wave of Covid-19 in the country, has laid bare the weaknesses of the health system with both the public and private health sectors cracking under pressure. The current shortage of facilities, personnel, and medical supplies leading to rationing of hospital beds has exposed systemic weaknesses, both in terms of access and quality of health services.While efforts are underway to deal with the current crisis, it is important to take a step back, look at the overall health system and identify pre-Covid systemic inequities and inefficiencies that may have given rise to the current crisis, with the aim of planning for better health outcomes in the future.Several reports have in the past pointed out that there is a mismatch between Namibia's health care spending and health outcomes. According to WHO reports, while Namibia leads the pack amongst all the upper middle income in the WHO African Region in terms of average healthcare spending as a percentage of total government budget, the country is said to record the lowest health outcomes amongst the group. As an example, Namibia spent about 14,5% of its government budget in 2017 on healthcare, only 0.5% short of the Abuja declaration which set the target for healthcare spending by African Union member countries at 15% of total government budget. In the same year, the country had a Total Healthcare Expenditure (THE) in excess of USD 2.29 billion to cater for the 2.5 million population, translating into a per capita healthcare expenditure of USD 916.1. For comparison, Ghana had a per capita healthcare expenditure of USD 249 in the same year.Despite this disproportionately higher health spending, the country is reported to perform poorer than average for a number of critical health indicators. These include indicators such as life expectancy, health-adjusted life expectancy, HIV prevalence, etc. Moreover, a Presidential Commission of Inquiry into the country's health matters described the quality of patient care in public health facilities as below acceptable standards. Indications of poor quality of patient care cited in the report include overcrowding at outpatient departments, long waiting times, inadequate numbers of health professionals, inadequate equipment and supplies, and poor infrastructure.As indicated, this disparity between spending and health outcomes is indicative of inefficiencies in the allocation of resources and points to an urgent need for reform. The need for reform has been recognized by the current government. In his Mid-term budget review speech in October 2020, Finance Minister Iipumbu Shiimi highlighted the restructuring of the Public Service Medical Aid Scheme (PSEMAS) for alternative modes of benefits delivery as a needed step towards expenditure containment and as a way to introduce efficiencies in the allocation of health expenditure. Needless to say, from the above, it is evident that there is a need for a large-scale review of Namibia's health care financing system. The aim of such a review should be to conduct an audit of overall system efficiency (value for money), equity and quality of health services, revenue sources, and contribution mechanisms as well as investigate areas of synergistic partnerships between the public and private health sectors. The review must be candid, participatory, and inclusive to garner support from all stakeholders and produce evidence that can form the basis for policy reform and the introduction of innovative and efficient health care financing options. The aim should be to build a strong and robust health system, which will ensure equitable access to quality health services for the majority.It is only by building a strong and well-functioning health system, that Namibia will be able to respond to and withstand future public health challenges. Covid-19 should serve as a wake-up call and propel us into action. * Cons Karamata is the chief executive officer of the Economic Association of Namibia.

The Covid crisis and the need for health financing reform

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Namibian Sun 2025-11-17

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The Covid crisis and the need for health financing reform

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Namibian Sun 2025-11-17

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