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Analytical summary - Social determinants

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It is widely understood that the health is of a nation is heavily influenced by the social and economic conditions in which people are born, grow, live, work and age. In Namibia, gross inequalities in social and physical living conditions result in widely varying health indicators for different segments of the population. For the majority of the population, enjoying good health is inhibited by low income, lack of education, inadequate sanitation and water supply, and social problems such as gender-based violence.

Namibia is a vast country but is sparsely populated with 2.8 persons per square km. The majority of the population lives in rural areas, often beyond the reach of road infrastructure and basic social services including water, sanitation, food and health care. Almost two-thirds of the population reside in the four northern regions and less than one-tenth lives in the south. There are significant differences in average living standard indicators between urban and rural areas. For example, two thirds of the population have non-improved household sanitation facilities (mostly in rural or peri-urban areas) and nearly 27% of rural households require 30 minutes or longer to obtain drinking water. Inadequate sanitation and water provision is directly linked to increased health risks.

Namibia is ranked as an upper-middle income country. However, it has the greatest income inequality in the world (with a Gini coefficient of 0.63) and high unemployment rates (estimated at 52% in 2008). Furthermore, the Human Poverty Index (HPI-1) is about 25.9%, which implies that more than a quarter of the people suffer from human poverty.

Also, repeated drought and flood disasters have also reduced the resilience of an already vulnerable and poor population. The Government of Namibia is committed to stimulating and sustaining economic growth to reduce poverty and income inequality. The international donor community has been providing complementary funds to fill some of the investment gaps in development programmes. However, aid flows have declined steadily from US$110 per capita in the 1990s to US$60 per capita in 2005.

Additionally, the number of bilateral donors active in Namibia declined from 22 in the 1990s to 17 in 2006, with another three donors leaving the country in 2008. There has been no significant inflow of foreign direct investment (FDI) to compensate for the loss of ODA. Furthermore, donor assistance in the form of technical assistance (TA) and other areas is not as enthusiastic and effective as it should be.

Namibia’s population is relatively young, with a median age of 20.8 years old. This is due, among other facts, to the increase of mortality associated with the HIV/AIDS epidemic. Between 1991 and 2001, life expectancy experienced a sharp decrease for both male and female, largely attributed to HIV/AIDS. Male life expectancy decreased from 59 to 48 years while female life expectancy reduced from 63 to 50 years during the same period. Simultaneously, the percentage of households in rural areas with orphans and fostered children is 38%. Already sparse family resources are often stretched to the limit, with fewer productive adults able to provide for an increasing number of dependants.

Redressing current maternal and infant morbidity and mortality rates are high priorities for the Ministry of Health. However, the health of children is inextricably linked to the educational status of mothers. Children born to mothers with no education have a higher probability of dying before age five (78 deaths per 1,000 births) than those born to mothers who completed secondary school (27 deaths per 1,000 births). According to the NDHS 2006/07, the majority of Namibians have some formal schooling, with only 7% of women and 9% of men having never gone to school. However, only 47% of females and 43% of males are accessing secondary education.

Through the Millennium Declaration, Namibia is committed to promoting gender parity in primary and secondary school and women empowerment to combat poverty to stimulate development that is sustainable. Achievements in gender equality include impressive increases in women’s political representation since Independence in 1990. However, discrimination persists especially at the household level.

The WHO Multi-Country Study on Women’s Health and Domestic Violence shows that 1 out of 3 women in Namibia suffer domestic violence. Recent UN findings also confirm that women and girls appear particularly vulnerable to HIV due to deep-rooted cultural and social norms and widespread gender-based violence.

If the majority of Namibians are to attain a high standard of health, a broader view beyond the health sector is needed. Bold integrated strategies for improved education, water and sanitation (among others) must be pursued to address the underlying causes of health inequities.