COMMISSION ON SOCIAL

DETERMINANTS OF HEALTH

REGIONAL CONSULTATION MEETING

BRAZZAVILLE; CONGO

27TH -29TH JULY 2005

COUNTRY: NAMIBIA

PRESENTERS: MRS. ERNA AWASEBMRS. PETRONELLA MASABANE

• 1. Cover page• 2. Map• 3. Introduction• 4. Key indicators• 5. Nat. & Millennium Dev. Goals• 6. Triple Threat• 7. Policy and Legal Framework• 8. Environmental Health Status• 9. Slides 1-17• 10. HIV/AIDS slides 1-9

Key Demographic Indicators

1991 2001

Population 1,409,920 1,830,330

Pop. Growth rate 3.1 2.6

Sex ratio (males per 100 females) 95 94

Urban population (%) 28 31

Avg. household size 5.2 5.1

Total fertility rate (avg. children/woman) 6.1 4.1

Life expectancy at birth (yrs.):

Females 63 50

Males 59 48

Age composition (%):

Under 5 years 16 13

5-14 years 26 26

15-59 years 51 52

60+ years 7 7

Key Economic Indicators (In % unless otherwise indicated)

1994 2002

GNP per capita (US$) 1,970 1,463

GDP growth 7.3 3.3

GDP growth, per capita 4.1 0.7

Exchange rate (N$ per US$) 3.6 10.5

Inflation 10.8 11.4

Unemployment 19 20.2*

(As a share of GDP:)

Agriculture sector 7.6 5

Mining sector 10.8 13.1

Manufacturing sector 11.8 9.8

Government services 20.6 19

Central Government Debt** 17.4 25.4

Budget deficit** 1.6 2.7

Foreign Direct Investment 3 6.4

Exports 48.5 44.4

I 51 3 46 8

GOAL 1992 2003 2006 target

Progress towards target

1. Eradicate extreme poverty and hunger

Proportion of households living in relative poverty 38% - 28% Lack of data*

Proportion of households living in extreme poverty 9% - 4% Lack of data*

2. Achieve universal primary education

Net primary school enrolment 89% 92% 95% Good

Survival rate for Grade 5 75% 94% 95% Good

Literacy rate, 15-24 years 89% 89% 94% Slow

3. Promote gender equality and empower women

Primary education (girls per 100 boys) 102 100 100 Good

Secondary education (girls per 100 boys) 124 113 100 Good

Tertiary education (girls per 100 boys) 162 111 100 Good

Proportion of seats held by women in National Assembly 9% 19% 30% Slow

4. Reduce child mortality

Infant mortality (per 1000 live births) 67 52 36 Slow

Under-five mortality rate (per 1000 live births) 87 71 54 Slow

Proportion of 1-year-old children immunised against measles 63% 72% 80% Good

Underweight among children under five 26% 24% 17% Slow

5. Improve maternal health

Conventional impact of crisis

Sustained progress in human development1a

2a

4a

External shock: drought, flood

Recovery3a

Time

State of human development

Sustained progress in human development

Most critical development challenges

• High prevalence of HIV• Income Poverty• Environmental Degradation• Heavy burden of preventable diseases

and conditions• Access to senior secondary education• Impact of AIDS on education sector

The Triple Threat

• HIV/ADIS epidemic• Deepening food insecurity and income

poverty and disparities• Weakening capacities for governance and

delivery of social services

Cross-cutting issues and root causes

• Gender inequality • Social cultural issues• Alcohol abuse• Historical legacy

5. Environmental Health Status (Based on the 2001 Population and Housing Census)

• Population – 1 830,330 (inter census growth rate• 40% aged below 15 years• 54% aged above 15 years• 31% Unemployment rate within the labour force.• Slight variation in household dwelling which has a average of 4 and 6

member house hold respectively.• The country has about 143,810 traditional dwellings, housing about

878,059 people and 31,930 households live in improved (shacks) houses.

• 79% of households have access to safe drinking water compared to68% in 1992.

• 45% of households have sanitary means of excreta disposal compared to 40% in 1992 however further analysis showed that 85%of households in urban areas have sanitary toilets compared to 19% of rural households.

Life expectancy 1991-2005

35

40

45

50

55

60

65

1991 2005

With AIDS

Without AIDS

2001 census: 49 years

Source: MOHSS 2001A; CBS 2003

Expenditures as share of total budget 1990-2004

0%

10%

20%

30%

Education Debt servicing Health Defense

1990/911997/982004/05

• The right to a decent standard of living remains unfulfilled for many Namibians. In 2003, one-third of the population was identified as in need of humanitarian food assistance and the most recent figures show that 40% of Namibians are living below the income poverty line. Among rural households, 80% have access to safe drinking water and 21% have access to basic sanitation; 58% live in houses with thatch or grass roofs, one-third have mud or clay floors, 12% have access to electricity, 77% have access to a radio, 22% have access to a telephone and 2% have access to a computer. Just 25% of all households and below 5% of rural ones are using electricity as their main source of energy for cooking.]

• A total of 38% of households in Namibia live in relative poverty and 9% in extreme poverty. Relative and extreme poverty are defined as households spending 60% and 80%, respectively, of their total incomes on food. The national medium-term targets for 2006, which are linked to the first MDG to eradicate extreme poverty and hunger, are to reduce relative poverty to 28% and extreme poverty to 4%.

•

Unemployment by age and sex, 2000

0%

20%

40%

60%

80%

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Allages

Both sexesMaleFemale

Source: MOL 2002

HIV prevalence among pregnant women 1994-2009

TARGETS

0

5

10

15

20

25

30

1994 1996 1998 2000 2002 2007 2009

13-19 years20-24 years25-29 years

Source: MOHSS 2003b

Projected deaths with and without AIDS 2005-2010

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

0-4 5-14 15-34 35-49 50-64 65+

Without AIDSWith AIDS

Source: UN Population Division 2001

Top 10 causes of death in hospital - 2003

173

300

326

370

555

966

1412

1675

2004

2237

0 500 1000 1500 2000 2500

Slow fetal growth

M alnutrit ion

Anaemias

Heart failure, CCF

Other respiratory

M alaria

Pneumonia

Pulmonary TB

Diarrhoea,GE

HIV disease

Source: MOHSS unpublished-c

Infant and child mortality, per 1000 live births

TARGETS

0

25

50

75

100

1991 2001 2006

Under-five mortality

Infant mortality

Source: NPC 2003, NPC Undated-a

Malaria mortality rate

1624 25

20

30

46

3035

56

96

54 50

0

20

40

60

80

100

1992 1994 1996 1998 2000 2002

deat

hs p

er 1

00,0

00

Source: MOHSS unpublished-c

Regional variation in TB prevalence 2002

306

371

435

540

545

595

678

707

800

866

869

940

1168

1177

0 500 1000 1500

Kunene

Oshana

Otjozondjupa

Kavango

Omusat i

Ohangwena

NAM IBIA

Omaheke

Khomas

Caprivi

Hardap

Oshikoto

Karas

Erongo

cases per 10 0 ,0 0 0

Source: MOHSS unpublished-c

Child malnutrition

24

27

16

9 10

7

24 2422

0

5

10

15

20

25

30

Namibia Rural Urban

% c

hild

ren

unde

r 5

Underw eight Wasted Stunted

Source: MOHSS 2003a

Access to safe water

0 25 50 75 100

Namibia

Urban

Rural

Khomas

Erongo

Hardap

Otjozondjupa

Karas

Oshana

Omaheke

Oshikoto

Caprivi

Omusati

Ohangwena

Kunene

Kavango

% of households with accessSource: CBS 2003

Diarrhoea prevalence children under 5 - 2000

12

13

12

6

8

10

11

11

11

11

12

12

13

17

17

21

0 5 10 15 20 25

Namibia

Urban

Rural

Oshana

Erongo

Omusati

Otjozondjupa

Omaheke

Ohangwena

Karas

Oshikoto

Khomas

Caprivi

Kunene

Hardap

Kavango

% having diarrhoea within two weeks prior to survey

Source: MOHSS 2003a

Fertility rates 1991-2001

5

3

5

6

5

7

0 2 4 6 8

Namibia

Urban

Rural

Average births per woman

2001 1991

Source: CBS 2003

Net primary school enrolment 1992-2001

80

85

90

95

100

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001

Total Girls Boys

Source: EMIS various years

Source: World Bank 2004Government Expenditure per Pupil - 2001

0 5 10 15 20 25 30 35 40

Primary

Secondary

Polytechnic

Vocational

UNAM

Colleges of Education

N$ '000

Estimated number of orphans under 18 years 1990-2010

74,00074,00090,000

120,000

180,000

0

40,000

80,000

120,000

160,000

200,000

1990 1995 2001 2003 2010

Source: UNAIDS, UNICEF and USAID 2004

HIV/AIDS in NamibiaPrevalence

• HIV/AIDS prevalence trend (pregnant women):1992 : 4.2%1996 : 15.4%2002: 22.0%

• Higher prevalence in:– Northern regions– Urban areas

• Stabilisation in:– Some regions, e.g. Erongo, Khomas– Certain age groups, e.g. 13-19 year olds

HIV/AIDS in NamibiaImpact

• 50% of hospital beds (public sector) occupied by patients with AIDS or AIDS related disease.

• Deaths: around 3,000 per year over past 5 years.• Orphans: 13.5% of children under 15 years (2001).• Attrition and absenteeism amongst workforce increasing.• Households: Mounting poverty in terms of: a) increasing demand for limited resources (foster children,

caring for the ill; funeral attendance and costs; etc.) and b) decreasing income (loss of work by family members;

decreasing productivity in the subsistence farming sector; etc.)

HIV/AIDS in NamibiaThe Response

• The Minister for Health & Social Services, Dr. LibertinaAmathila, MP, has been tasked by Cabinet to coordinate the national response to HIV/AIDS.

• The Minister chairs the National AIDS Committee, which reports to Cabinet.

• NAMACOC, committee of Permanent Secretaries and CEOs/MDs of umbrella organizations, responsible for coordination of implementation of the response.

• All 13 regions have RACOCs chaired by Reg. Governor.• Lironga Eparu (people living with HIV/AIDS); NABCOA

(business coalition); NANASO (NGOs)

HIV/AIDS in NamibiaThe Response

• Second Medium Term Plan (MTP2) review findings (2003)Positive Developments:– Political commitment is increasing.– Awareness levels are high.– Communities are increasingly active.– National and regional structures to coordinate the

response are developing.– Some model workplace programmes in the private sector.– PLWHAs are getting organised.– Health sector response w.r.t. PMTCT and HAART piloting

has commenced; VCT is becoming more available

HIV/AIDS in NamibiaThe Response

MTP 2 Review findings: The Challenges:– Weak structures for inclusive policy development.– Appreciation of broader issues that drive the epidemic, e.g.

general poverty, gender inequality, violence, etc.– Relatively under developed multi-sectoral response.– Inadequate resources, esp. finance and human resources– Weak mechanisms for monitoring and evaluation.– Inadequate community-based behaviour change, response

to stigma, leadership

HIV/AIDS in NamibiaThe Third Medium Term Plan (MTP3)

• Launched by His Excellency, President Nujoma, April 2004.

Goal: Reduce the incidence of HIV infectionsStrategic results:• Enabling environment for the response (strong

leadership) and equal rights for PLWHAs• Prevention• Access to treatment, care and support• Impact mitigation (OVC, workplace, poverty reduction)• Integrated and coordinated programme management

HIV/AIDS in NamibiaMTP3 Guiding Principles

HIV/AIDS is a development issueMulti-sectoral engagementBroad political commitmentCivil society involvementHuman rights based approachesReduction of stigma and discriminationContinuum of prevention to careAccess to care (equity)Confidentiality and privacyGood governance, transparency and accountabilityPrioritizationResponsiveness and flexibility

HIV/AIDS in NamibiaMTP 3 Implementation Progress

Some milestones (as per September 2004) :

• ART in 17 of 35 public hospitals• No. of patients on treatment (public

sector): 3,000• PMTCT in 25 of 35 public hospitals

Responses to national development challenges

• Addressing the multiple impacts of HIV and AIDS through prevention, treatment and care with special attention on the most vulnerable households and communities; especially those caring for orphans;

• Ensuring household food security through economic growth and job promotion while ensuring environmental sustainability and addressing deep income poverty and disparities;

• Strengthening the capacities for governance, at the national, regional and local levels, encouraging the deepening of democracy and ensuring effective delivery of critical social services, especially to the most vulnerable groups.