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.