Analytical summary - Epidemic and pandemic-prone diseases
The diseases that are targeted for elimination and eradication include polio, measles, neonatal tetanus and malaria. Namibia has already achieved the elimination of neonatal tetanus and is recognized by the African Regional Certification Commission (ARCC) as a polio‐free country. (WHO, 2010) The malaria mortality rate declined drastically from 96.5 per 100,000 population in 2000 to 8.4 per 100,000 population in 2008 (WHO Namibia, 2010).
Although malaria is virtually confined to the northern part of the country, with approximately 67% of the population living in malaria‐endemic areas it is still one of the leading causes of death among under‐five children and adults in Namibia. (WHO, 2010)
However, the annual incidence and mortality rate due to malaria has dropped since 2000. A total of 199 deaths were reported in 2008, compared to 679 in 2000 (HMIS data as of August 2010 (MoHSS, December 2010)).
Namibia has recently experienced a number of emergencies related to climate change and environmental safety. These include droughts, floods and outbreaks of diseases such as cholera. Such events have underlined the need for better planning and coordination across a range of sectors, and the importance of attending to environmental health as a preventative measure. In addition, a number of gaps in the capacity for emergency response have become apparent at regional and local levels. (WHO, 2010)
Emergency response is currently coordinated by the Directorate of Disaster Risk Management (DDRM) within the Office of the Prime Minister, with responsibilities shared between various line ministries, such as MoHSS; Ministry of Regional and Local Government and Housing and Regional Councils; Ministry of Environment and Tourism; and Ministry of Agriculture, Water and Forestry. Issues such as climate change and necessary cross‐sector collaboration need to be taken into consideration. (WHO, 2010) There is a National Health Emergency Preparedness and Response Plan (NHEPRP), which was developed in 2003.
This plan defines responsibilities for preparedness and response and provides guidelines for the surveillance and management of specific epidemic-prone diseases. Health Emergency Management Committees are responsible for alerting and verifying outbreaks of disease at district, regional and national level. (MoHSS, April 2003) Capacity needs to be strengthened at all levels in order to make this plan fully operational.
During crises, humanitarian health partners, led by the Inter‐Agency Standing Committee Health Cluster under the leadership of WHO will empower humanitarian country teams to better address health and other aspects of humanitarian crises.
The WHO network for Health Action in Crises serves as a convener, provides information and services, and mobilizes partners to agree on standards and courses of action for the health response. The WCO is able to leverage timely and adequate support through this network and play a similar role at country level. (WHO, 2010)
The private sector and parastatals are keen to provide support in this priority area through sharing of information from private health libraries, and also through involvement in strategic planning and response. (WHO, 2010)
In Namibia, private and parastatal health institutions have an important role to play in harmonizing prevention and control efforts, as well as addressing drug resistance. The Namibia Institute of Pathology (NIP) plays a significant role in addressing the current and emerging public health concerns as the national medical laboratory for testing both epidemic‐ and non‐epidemic‐prone diseases and medical conditions in the public sector. (WHO, 2010)
Namibia needs to have a recognised National Public Health Laboratory (NPHL) although some relevant analyses can be performed at the NIP. UN agencies play a pivotal role (under UNDAF Outcome 2: “Livelihoods and food security are improved”) and organizations such as the Namibian Red Cross Society have been instrumental in initiating emergency appeals and responses. (WHO, 2010)
Capacity must be built in the area of surveillance at the ports of entry to detect and contain the spread of any public health emergency of international concern. In Namibia, IHR (2005) will be implemented in the context of Integrated Disease Surveillance and Response (IDSR). The IDSR guidelines and tools are currently under review, and will be updated and harmonized in line with the IHR. The MOHSS needs to devise optimal strategies for the integration of immunization with other interventions such as administration of vitamin A, distribution of insecticide‐treated mosquito nets, growth monitoring and administration of anti‐helminthics. (WHO, 2010)
Unlike the 1969 IHR, which initially covered six quarantinable diseases, the IHR (2005) that came into force in June 2007 address all events that may constitute public health emergencies of international concern and are binding to all WHO Member States. Namibia has assessed its core capacities and is about to develop a plan to address the identified gaps in order to comply with IHR (2005). A focus on environmental health will address issues related to water quality, food safety, sanitation standards and health‐related climate change impact. (WHO, 2010)
The MoHSS and WHO have identified the following priorities for improving Namibia’s capacity for readiness and response:
- Development of the Social Welfare Information System to improve emergency preparedness planning and to facilitate mitigation of needs
- Strengthening of the outbreak and emergency response capacity of the MoHSS and other relevant sectors with a protocol for preparedness and response
- Intensifying the cross-border collaboration for identification of shared problems and action
- Establishment of a National Public Health Laboratory in the NIP
- Strengthening the management of emerging diseases such as H1N1 influenza
- Adequate incorporation of the obligation of the IHR in relevant legal instruments
- Development of strategies for vulnerability, risk and capacity assessment
- Development of coordinating mechanisms within the health sector
- Contingency planning
- Training of personnel in emergency preparedness and response
- Development of specific capacities such as mass casualty management systems
- Coordination with other ministries and sectors within the country, such as the Directorate of Disaster Risk Management, emergency services, and Department of Meteorology
- Coordination with the international humanitarian community
- Assessment of safety of health infrastructure to hazards and hospital emergency preparedness
- Development of community‐based approaches to risk reduction and disaster management which integrate emergency preparedness with PHC
- Evaluation of response to floods and other emergencies, and identification of strengths and gaps.
(WHO, 2010; MoHSS, July 2010) STRATEGIES FOR FOCUS AREA 4.2: INTERNATIONAL HEALTH)
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