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Analytical summary

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The health status of Namibia has been heavily impacted by the HIV/AIDS epidemic and negatively affected by the country’s unequal socioeconomic development. The top 10 causes of death are currently AIDS, diarrhoea, pneumonia, pulmonary tuberculosis, health failure, other respiratory system ailments, anaemia, malnutrition, stroke and malaria.

The Ministry of Health and Social Services has prioritized the implementation of three health Millennium Development Goals, namely goals 4, 5, and 6: to reduce child mortality, improve maternal health, and combat HIV/AIDS, malaria and other diseases, respectively.[1]

The 2001 Population and Housing Census showed a dramatic drop in life expectancy in Namibia since the previous census in 1991 – from 59 to 48 for men, and 63 to 50 for women. The main reason for this drop, as was the case in many countries in the WHO African Region, was the HIV epidemic.[2] Thanks to the concerted HIV response, as well as other health initiatives, Namibia has already exceeded its 2012 target as set by NDP 3 (ensure that life expectancy is 51 years); according to latest figures, life expectancy in Namibia is currently estimated at 62 years.[3]

Maternal, newborn, child and adolescent health have recently emerged as priorities for Namibia due to a range of concurrent factors. The maternal mortality ratio is on the increase (almost doubling between 1992 and 2007) and the under‐five mortality rate is not decreasing fast enough.

Namibia is ranked 59th in the world for under-five mortality, which has decreased between 1990 and 2009 from 73 to 48 deaths per 1000 population.[4] Despite this decrease, the average annual rate of reduction is only 2.2, and Namibia is unlikely to meet either the under-five or infant mortality targets for the Millennium Development Goals.[5]

Newborn mortality accounts for 50% of child mortality. Infant and child mortality varies considerably between urban and rural areas, as well as across regions, with Ohangwena and Caprivi having the highest rates.

These trends occur in a context of increased delivery at health facilities, indicating weaknesses in the quality of services. At the same time, spending on maternal, child and adolescent health is declining and emergency obstetric care coverage is very low and inequitable. A 2005/06 survey of all hospitals found that only four out of 34 hospitals provided comprehensive EmOC.[2]

Efforts are being made to build capacity and skills of health workers to provide quality essential services to mothers during pregnancy and after delivery. The 2011-2015 Strategic Plan for Nutrition includes strategic priorities to improve maternal nutrition and contribute to improved maternal health.

The National Strategic Framework on HIV/AIDS delineates additional relevant strategies to address issues related to HIV infection and unwanted pregnancies, abortion, etc. A Road Map for Accelerating the Reduction of Maternal and Neonatal Morbidity and Mortality (2010) was developed to guide Government and partners in achieving universal access to comprehensive quality maternal and neonatal health care, and accelerate progress towards achieving the Millennium Development Goals.

The primary direct causes of maternal mortality in Namibia are severe eclampsia (33%), haemorrhage (25%) and obstructed or prolonged labour (25%). The most common direct obstetric complications treated in Namibia in 2006 was obstructed or prolonged labour (38%). According to the MoHSS, HIV/AIDS is the leading indirect cause of maternal mortality in health facilities, accounting for 37% of total mortality. Other causes include malaria, tuberculosis, meningitis and pneumonia (MoHSS, 2010).

Child health is mainly based on immunization, micronutrient supplements, diagnosis and management of common diseases among infants and children such as diarrhoea, malaria and pneumonia (HIS 2006).

Immunization coverage varies between regions with recent measles outbreaks as an indication of low immunization coverage. Adequate immunization coverage remains a challenge in Namibia. The national immunization coverage for the reporting period stood at 67 percent, which is below the 80 percent target. (MoHSS, 2010)

Such a low coverage has a negative impact on the sustained elimination of neonatal tetanus, poliomyelitis, and measles. (MoHSS, December 2010) Growth monitoring is also an important part of child health and child malnutrition is found to be very high.

Infant and child care is organized and delivered through the package of Integrated Management of Newborn and Childhood Illness (IMNCI), which has achieved a high coverage. (MoHSS, July 2010) Mechanisms in place to coordinate sector-wide approaches to reducing mortality among mothers and children include: the UN Maternal, Child Health and Nutrition (UN-MNCH & Nutrition) coordination committee, the MNCH Management Committee and the National Alliance For Improved Nutrition (NAFIN). (WHO Namibia, 2011)

For a number of reasons, little is known about adult mortality in Namibia compared with infant and child mortality. First, while early childhood mortality can be estimated through the birth history approach, there is no equivalent for measuring adult mortality. Second, death rates are much lower among adults than young children, and hence estimates for particular adult age groups are associated with large sampling errors. Third, there is usually limited information available about the characteristics of adults who have died. While much the same can be said about data on childhood mortality, it is reasonable to expect that the characteristics of the parents will directly influence their children’s chances of survival.

Adult mortality rates derived from the 2006-07 NDHS data are higher for males than females (10.4 and 8.3 deaths per 1,000 population, respectively). A comparison of the 2006-07 NDHS and the 2000 NDHS rates indicates that there was a substantial increase in adult mortality in Namibia during that period.

The rate for females almost doubled between the two surveys and the rate for males is 65% higher than it was in 2000.[2] The MoHSS Strategic Plan 2009‐2013 places priority on the top three communicable diseases: HIV/AIDS, tuberculosis and malaria.

Successful control of these major diseases requires cross‐border cooperation with neighbouring countries in the context of the SADC Health Protocol, implementation of WHO resolutions and recommendations, and other relevant instruments. Despite the challenges, in recent years the country has made some progress in curbing the impact of major communicable diseases. Most updated estimates have highlighted the fact that the global health sector response to HIV/AIDS represents 55% of the overall response. (WHO, 2010)

The HIV prevalence dropped from 22% in 2002 to 18.8 in 2010 (MoHSS, November 2010). Data show that the HIV prevalence is decreasing in younger age groups (15–19 and 20–24), while prevalence in the older age groups appears to be increasing . Significant progress has been made in HIV/AIDS with regard to voluntary counselling and testing, the number of eligible patients on antiretroviral therapy (ART), and the number of facilities providing ART services.

At the end of March 2009, 64,637 patients were enrolled in ART programmes, representing 84% coverage of people eligible for treatment. This high coverage is one of the highest in the African region and does not include patients being treated in the private sector. In terms of prevention, there is a significant increase in reported condom use; however, much still needs to be done to reduce the number of new infections.

TB remains a serious concern in Namibia, which has one of the highest case notification rates in the world. Key approaches for tuberculosis prevention and control remain effective implementation of the directly‐observed treatment short‐course (DOTS) and expansion of community‐ and clinic‐based DOTS.

The emergence of multidrug‐resistant TB and the growing problem of extensively drug‐resistant TB pose new challenges to improve the capacity for the management of identified cases, infection control in health facilities (including the provision of isolation wards), and strengthened surveillance and reporting. (WHO, 2010)

HIV infection is the major driver of the current TB epidemic. Of those TB patients tested, 59 percent were HIV positive. (MoHSS, December 2010) However, the number of TB cases notified has dropped from 16,156 in 2004 to 13,332 cases in 2009 (WHO Namibia, 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) Namibia practices indoor residual spraying and promotes the use of insecticide‐treated nets for malaria control. The annual incidence of malaria has dropped since 2000. Although malaria is virtually confined to the northern part of the country, malaria is still one of the leading causes of death among under‐five children and adults in Namibia, with approximately 67% of the population living in malaria‐endemic areas.

Namibia has a relatively efficient Surveillance and Emergency Preparedness and Response system in place. Despite this, the country experienced a number of epidemics such as cholera, crimean congo haemorrhagic fever, influenza H1N1 (2009), measles, meningococcal meningitis, polio and rift valley fever, just to mention a few.

In order to strengthen disease surveillance and response in the country, the Ministry of Health and Social Services has adopted the Integrated Disease Surveillance and Response strategy. The first IDSR guidelines were launched in 2003 and have recently been updated to further improve district-level capacity. (MoHSS, 2011)

There is growing concern about noncommunicable diseases (cancer, diabetes, cardiovascular diseases, hypertension, etc.) as a cause of morbidity and mortality, although there is lack of population‐based data in this area. Between 2004 and 2008, institutional mortality due to cancer rose from 3.2% to 54.7%, while cardiovascular diseases (all types) rose from 5.3% to 21.2%, and diabetes mellitus rose from 1.0% to 14.6%. (WHO, 2010)

Diabetes alone is emerging as one of the greatest threats to health. Between July 2010 and July 2011, 3,650 new cases of the disease were recorded in the country’s public health facilities. (WHO Namibia, 2011)

Poor diet and nutrition, tobacco use, physical inactivity and alcohol use (all of which are associated with increased risk of cancer, cardiovascular disease, diabetes and other chronic diseases) are the risk factors. NDHS figures since 1992 show an increasing trend in overweight and obesity. Strengthening health promotion and health extension is seen as a key intervention for improved health outcomes in this area.

Namibia has put in place a number of programmes to reduce the underlying causes of non-communicable diseases (NCDs). Most importantly, the restructuring of the health system is serving as an important opportunity to build synergies among programmes such as the NCDs, Tobacco Control Programme, IEC, health promotion, school health and community based-programmes.

In addition, planned activities such as the development of the NCD strategy and training in management and control of major NCDs, in particular diabetes, are expected to facilitate the implementation of community-based interventions addressing the modifiable risk factors for NCDs. (WHO Namibia, 2011)

References

  1. Windhoek, Government of Namibia, Ministry of Health and Social Services, 2010
  2. 2.0 2.1 2.2 Namibia Demographic and Health Survey 2006-07 (pdf 2.6Mb). Windhoek, Ministry of Health and Social Services; and Calverton, Maryland, Macro International, 2008
  3. United Nations Children's Fund
  4. Levels & trends in child mortality. Report 2010. Estimates developed by the UN Inter-agency Group for Child Mortality (pdf). United Nations Children's Fund, 2010
  5. The state of the world’s children 2011. Adolescence: an age of opportunity. New York, United Nations Children's Fund, 2011