“ Preventive & Integrative Social Protection Schemes in Namibia – A Case Study on Disability Management in Namibia” Presented by Phillip Nghifitikeko 07July 2015

Presentation Outline 1. Mandate of the MVA Fund 2. Benefits of the Fund 3. Value chain 3. Crash Statistics 4. Rehabilitation Programme 5. Spinal cord Injury rehabilitation unit 6. House Modifications 5. Challenges and Future outlook

Mandate of the MVA Fund “to design, promote, and implement crash and injury prevention measures; to provide assistance and benefits to persons injured in motor vehicle accidents /crashes and to dependents' of persons killed in such accidents/crashes”

Benefits of the Fund Injury Grant –Up to N$100,000 Funeral Grant –N$7000 Loss of Income –Up to N$100,000 per annum Loss of Support –Up to N$100,000 per annum Medical treatment and rehabilitation –Up to N$1,500,000

Value Chain Injury Prevention Service awareness Emergency care In hospital treatment Financial Support Rehabilitation

Crash Statistics Table 1: Crashes, injuries and fatalities per month MonthsCrashesInjuriesFatalities MonthsCrashesInjuriesFatalities Jan Jan Feb Feb Mar March Apr April May May June June July Aug Sep Oct Nov Dec Total Total

Rehabilitation Programme Rationale Motor Vehicle Accident Fund (MVAF) Strategy specifies ‘Rehabilitation goal attainment’ as one of its key institutional objectives. Deemed as worth investment as there are: –Benefits to employers –Benefits to employees and their families National benefits– NDP4, economy and health indices

Develop rehabilitatio n plan Act Implement rehabilitation plan Review rehabilitati on progress Take actions to improve rehabilitation success Implement the plan Establish the rehab goal and the interventions necessary to deliver the desired outcome Monitor and measure rehabilitation progress MVAF REHABILITATION CORE PROCESS

Rehabilitation: Before and After

Measuring Outcomes KPI = % customers achieving goal within 6 months of accident 30 April Oct Nov Dec May June 2014 Quarterly result = average 1 April 2014

Measuring outcomes (2014) MONTH RETURNED TO WORK RETURNED TO SCHOOL RETURNED TO COMMUNITY TOTAL % GOAL ATTAINMENT FOR THE MONTH April % May % June % July % August % September % October % % Average

Deciding eligibility for rehab programme Does Claimant require Rehabilitation post-discharge?  NO: –Condition does not have any impact on claimant’s functional performance –Claimant can return to work immediately post discharge or after a few days leave  YES: –Condition renders significant functional limitations even after discharge from health facility –Risk of prolonged absence from work due to ill health –Foreseeable challenge with returning to pre-injury duties –Needs assistive devices to improve functional performance

Spinal Cord Rehabilitation Unit Unit operational since 2013 Collaboration between the Ministry of Health, MVA Fund, Spinalis Foundation in Sweden Capacity of 8 Beds Patients are trained to be independent in: - Bowl and bladder management - Sexual Education - Daily Living (Washing/eating /dressing) - Wheelchair Skills training - Transfer from bed and wheelchairs Rehabilitated 85 patients successfully by the unit

House Modification Part of the Rehabilitation continuum is to ensure that injured persons are able to move freely in their homes. Rehabilitation plans cover house modification requirements such as: –Ramps/Landing –Widening of house entrance –Height adjustable shower –Handrails –Bathroom modification

House Modification cont. Seriously injured portfolio equals 158 Of the total 43 persons’ houses need to be modified. The MVA Fund managed to modify 18 houses since 2014 Plan for 2015 is to modify 25 homes

House Modification cont.

Challenges Lack of enabling legislation to fully support persons with disability e.g. public transport, access to buildings and sanctions for non- compliance Lack of Incentives to hire persons with disability Limited rehabilitation facilities in Namibia and centralized services e.g. rehab facilities Limited access to basic needs such as water. Land/home ownership Rehab professions are generally not well known in the Namibia, hence many learners opt to pursue the most common health professions

Challenges Limited awareness among community members on early identification of disabilities, and courses of action to take In low income earning families rehabilitation is often not prioritized as they focus on getting basic needs for survival (majority of people with disabilities are in poverty and are trapped in the Poverty-Disability Cycle Absence of functional/coordinated community based rehabilitation services (CBR) The Geographical vastness of Namibia makes it very difficult but not impossible for Rehab services to reach all PWDs.

Future outlook Legislation– ensuring responsive legislation that supports persons with disability with sanctions (e.g. access to building, access to public transport) Incentives for Employers to hire persons with disabilities e.g. Tax cuts Establishment of more rehab centres across the country Prioritise land and home ownership for persons with disability ( cheaper housing options such prefabricated houses) Capacity building for RTW e.g. Physiotherapist and Occupational therapist etc. Vocational training options Establish a Traumatic Brain Injury Rehabilitation unit Awarding bursaries for allied health professionals and creating awareness

Future outlook Closer collaborations between MVA Fund, SSC, Disability council

Thank you.