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Commonwealth Health Partnerships 2015

The most recent act relating to mental health in Namibia is the Mental Health Act 1973. Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. For Namibia to achieve its targets for the reduction of child mortality, which form MDG 4, it should have reduced under-five deaths per 1,000 live births to 25 and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2013 under-five mortality was approximately 50 deaths per 1,000 live births – double the target figure – and measles immunisation was 82 per cent, which suggests that it is unlikely that Namibia will have met this goal when the 2015 data is analysed. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. For Namibia, maternal mortality should fall to 50 cases per 100,000 live births. In 2013 Namibia had an adjusted maternal mortality ratio of 130 deaths per 100,000 live births (this figure was estimated at 200 deaths per 100,000 live births by UN agencies/World Bank in 2010), so Namibia is very unlikely to meet this target. MDG 5 also stipulates that 100 per cent of births must be attended by a skilled health professional. In the most recent year for which data was available in the period 2007–12, this figure stood at 81 per cent, so achievement of this target also looks unrealistic. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other diseases. Namibia has demonstrated a decline in the percentage of the population with HIV, although the figure remains very high. Deaths from malaria have declined since the beginning of the MDG period, while the estimated rate of mortality from TB (when mortality data excludes cases comorbid with HIV) is now approximately double that of 1990. The country may achieve some of the targets set by MDG 6 by 2015, but it unlikely to achieve them all. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Almost two-fifths of health care in Namibia (38 per cent) was paid for by patients or funded by other non-governmental entities – such as private insurers, charities or employers – in 2012. Total health expenditure constituted 8.3 per cent of GDP in 2012, of which 62 per cent (US$292 per capita) was covered by the government. The sheer size of the country versus the sparseness of the population causes geographical accessibility barriers to health care. A 2010 WHO exit survey from a range of health facilities found that 13 per cent of patients had travelled more than 21 km to receive treatment. Another major barrier is cost, with fees chargeable for most health services. Some social groups are exempt from payment, including those receiving certain preventive services, and for vulnerable groups, such as children under five and pregnant women. However, government policy is not to turn away patients who cannot afford to pay, with a waiver mechanism in place for this purpose. The San face particular problems accessing health care as they live in remote areas and frequently go into the bush on long hunting expeditions. In addition, few health staff speak their language. Nami b i a There is an insurance scheme providing health insurance for public sector employees, while private insurance companies provide health insurance policies for private sector employees. The Ministry of Health and Social Services, with support from development and implementing partners, has initiated Namibia’s National Strategy and Action Plan for the Elimination of New Paediatric HIV Infections and Keeping Their Mothers Alive 2012/13–2015/16. The plan, developed through a series of consultations with internal and external stakeholders, aspires to eliminate mother-to-child transmission of HIV in Namibia. The WHO’s strategic agenda for Namibia’s second Country Cooperation Strategy cites strengthening the health system as one of its priorities, with a focus on financing, human resource development, vaccines and service delivery. Health is a priority area of support from donors, accounting for 79 per cent of all donor payments to Namibia. A large proportion of this goes towards treatment and prevention of AIDS. Namibia was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 1994 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination. Care of the elderly: There are 81,717 people in Namibia over the age of 65 – four per cent of the total population (2013). At the age of 60 a person living in Namibia can be expected to live for an additional 17 years, on average (2013). Namibia’s Old Age Pension dates back to 1949 and has been universal since 1992. Today, monthly pension credits are paid by the state at a rate of US$60 per person (2007–12) on a universal basis. Overall, public pension spending is equivalent to 1.3 per cent of the country’s total economic output (2004). Population over 65 Thanks to the universal pension, elderly people in Namibia at the lower end of the socio-economic scale are not as impoverished as in other African nations. However, unemployment and AIDS has seen some elderly people supporting children and grandchildren on their modest pension payments. There are also a number of old people’s homes in urban areas – a mixture of government, private and charity run institutions. Further information Ministry of Health and Social Services: www.mhss.gov.na Commonwealth Health Online: www.commonwealthhealth.org/health/africa/namibia Commonwealth Health Partnerships 2015 221 4%


Commonwealth Health Partnerships 2015
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