UN Joint Assessment Mission to Namibia 2-16 December 2003 Health Sector Assessment

General Health indices improving – 1992/2000 High level government funding Infrastructure generally good but some gaps Management weak especially at periphery

Areas with Poorest Health Status Ranked on LE, IMR, <5 MR, % mortality increase, LBW, Wt/Ht, Wt/Age, Diarrhoea, Diarr/Blood, Low VitA, Low vaccination coverage, Orphans, Lack of safe water, HIV prevalence RegionVisitedPopulation KavangoY202,694 OhangwenaY228,384 CapriviY79,826 OmusatiY228,842 OshikotoN161,007 OmahekeN68,039 OshanaY161,916 Total Visited5901,662 (49.3%)

Areas discussed Malaria control programme EPI Nutrition Health Sector EPR HIV –VCT –ARV : PMTCT and HAART –HBC –Impact on Service OVCs

Malaria Control Programme Based on IEC, IRS, ITNs, Prompt diagnosis and treatment Performance of IRS varies between regions –Caprivi poor –Kavango good –Ohangwena mixed – areas prioritised –Omusati, Oshana, Oshikoto satisfactory Availability of insecticide for ITNs mixed Common problems –Late start –Lack of transport –Lack of insecticide –Inadequate supervision

EPI Reported coverage likely to be optimistic Vaccine availability Integrity of cold chain Transport for outreach Supervision

Nutrition Food availability Growth monitoring performance Cases not identified in clinics /OPD Nearly always associated with other condition, esp HIV Management of severe cases inappropriate and inadequate TB and HIV No policy, no written protocols, no programmes (with exception of Oshikati)

Health Sector EPR No formal structure –Managed within REMU –Managed on ad hoc basis No focal points No budget No vulnerability assessment No preparedness plans although response appears good

HIV and AIDS I General –Not prioritised –No urgency –Limited appreciation of full scale –Little community involvement VCT –Very patchy –Limited testing sites ARV – PMTCT and HAART –Patchy –Small scale –Poor uptake HBC –Patchy very small scale –Little government support –Volunteer (and mainly church) based

HIV and AIDS II Impact on Service –Increased demand at clinic and OPD –Increased TB case load –Increased hospital bed occupancy and LoS –Increased hospital mortality –Staff illness and compassionate leave increased –Staff mortality increased –Psychological implications - stigma –Quality of care –Budget implications

Over the three year period Jan 01 – Oct 03, staff mortality rate has increased 65%

HIV and AIDS II Impact on Service –Increased demand at clinic and OPD –Increased TB case load –Increased hospital bed occupancy and LoS –Increased hospital mortality –Staff illness and compassionate leave increased –Staff mortality increased –Psychological implications –Quality of care –Budget implications

OVCs A large and growing problem Recognised by everyone Most with extended families Increase in child headed HH Few school drop-outs Little formal response –Grant system not working Some local projects –Mutaro in Caprivi –Odipo in Ohangwena Many (most) individuals and HH food insecure

Conclusions No emergency just yet, but definitely a crisis Crisis is HIV Malaria and measles (or other) outbreaks likely Malnutrition will be a major issue if rains fail Response to HIV is inadequate No health sector emergency preparedness or planning Capacity of health sector to respond is limited –Management –Staff availablity

Suggestions Aim to reduce morbidity and mortality consequent on a future crisis by: –Conduct a survey to assess the impact of HIV on the health sector –Conduct staff attitudinal change workshops on HIV –Provide a boost to national HIV programme –Urgently strengthen EPR capacity in MoHSS and WCO –Give targeted increased support to MCP –Improve detection and management of malnutrition Strengthen growth monitoring Improve case management of malnutrition - especially severe cases by introducing WHO management protocols Conduct local community based nutritional surveys –Link food assistance to treatment programmes –Provide specialised transport (swamp boat) to Caprivi to improve access during flood season