Light at the end of many a tunnel

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…. Kamwi reflects on challenges and successes

Two days ago, New Era had an exlusive interview with the Minister of Health and Social Services, Dr Richard Kamwi, on a wide range of issues concerning the health sector and this is what the minister had to say.

 

NE:  Share with us some of the most significant highlights of the ministry this year. What have you achieved as a ministry in terms of provision of medical services particularly to people in rural areas? 

RK: “We have decided to establish three training centres to train registered nurses but it will be a diploma course in Keetmanshoop, Windhoek and Rundu. We do hope that if these young men and women work hard we will certainly see a revolution, (laughs) in a way. We have been attending world health assembly meetings and conferences and we have been meeting at AU level as ministers of health. We came to learn from Ethiopia how they are coping with their vast rural areas. We came to find out how they are managing with maternal and child health,  how they have moved and they are meeting their Millennium Development Goals, what helped them. They came up with what is called task fitting that was previously done by nurses. They trained a cadre known as health extension workers. Last year for the first time we introduced health extension workers in Kunene Region. A total of 40 health extension workers were trained and as a result we this year decided to roll out in six regions – Zambezi, Kavango East and West, Ohangwena, Omusati and Kunene. We are training 565 health extension workers. This is a real achievement because these cadres will be working at village level and they will be connecting – it will be a bridge between the primary health care clinics and the villages. They will be in a position to monitor at rural level, the expecting mothers, as soon as a mother is two months pregnant they will be followed to see to it that they access clinics and where you need an ambulance they will be there. This year we entered into a Memorandum of Understanding with Zambian authorities. We have a scholarship programme to pursue training in that great country. They will pursue courses in pharmacy, physiotherapy, diagnostic radiography, environmental health, clinical science and bio medical sciences. All these cadres, once they have qualified we will be sending them to district hospitals where they will be serving the rural sector.”

 

NE:  Namibia is one of the African success stories in the fight against HIV/AIDS, malaria and TB.  How have you been able to achieve this despite the numerous challenges facing your ministry such as staffing?

RK: “You are right we have made headlines, President Hifikepunye Pohamba as a result received an African Leaders Malaria Alliance (ALMA) Award. This year for the first time this ministry received an international award. For HIV/AIDS, right at independence the ministry came up with a programme to address HIV/AIDS, in 2003 to be specific when we realised that Namibians were dying like flies as a result of AIDS. I recall then minister (of Health and Social Services) Dr Libertine Amathila called me to launch the Prevention of Mother to Child Transmission of HIV (PMTCT). Supported fully by government we introduced it. The following year we introduced ARVs and that is when we came to receive support from the Global Fund and PEPFAR. At the time it was an issue of 50/50, they came in handy and the World Health Organisation gave us technical support. We decided to come up with the National Strategic Frameworks.

“The ministry came up with a multi-sectoral approach where we brought in the private sector. We realised that for the private sector to realise their maximum production the health of their workforce must be in place so when we approached them they agreed. We asked them to take care of their workforce. They put in place PMTCT and antiretroviral therapy programmes and those who qualified were put on treatment. And then we spoke to the churches and civil society. Mine was to give the leadership and to work on the policies that work and to listen to what WHO was guiding us on, to listen to what UNAIDS was saying.

“And then we brought in the traditional authorities. The next move was to bring in the first lady of the republic, Madam Penehupifo Pohamba. I am proud of her, as a minister I look at her as the ambassador in State House standing there for the health sector. She has done so much to educate the President on matters related to the health sector so much so that today His Excellency the President speaks with authority on matters related to HIV/AIDS, malaria and TB. When I brief his Excellency the President and when I am presenting something in Cabinet the President will always come in handy. We are now the leader on the African continent in terms of response, meeting the targets set by the heads of state and government in New York in 2001 to respond to the crisis (HIV/AIDS). We are far ahead of all the targets that were set for HIV/AIDS for malaria and TB, we are way ahead. On treatment we have put 85 percent of those who qualify for ARVs, for malaria, for PMTCT 95 percent and as a result I am pleased to say that 97 percent of babies born by HIV positive mothers are born HIV negative.”

 

NE: And what are the main challenges?

RK: “The main challenge now is resources. One of the areas where the international community is talking big about Namibia is the quality of resources, putting in resources and investing in key challenge areas. I am proud to say that as a result of that in July when the American government was commemorating PEPFAR’s tenth anniversary it was Namibia who was invited to go and speak at that occasion. Again this month, His Excellency the President was invited to Washington during the Fourth Global Fund replenishment conference. He was invited by the American government to go and share how he managed to turn the tide in terms of shared responsibility, in terms of resources. In the end the president sent me there.”

 

NE:  What is the general situation in the fight against malaria because we rarely hear people speaking about malaria? And how does Namibia fair compared to other African countries in its fight against malaria?

RK: “It is true, we have managed it from where at independence we reported 700 000 clinical cases. There were 521 000 in 2001 but by 2012 clinically we managed to bring that down to 3 163 but reported real cases which came through the microscope in 2001 were 41 636.  By 2012 only 50 were registered. Last year in terms of death only four deaths were recorded. As a result of that you no longer hear people talk of malaria. Namibia is leading in its fight against malaria on the African continent.”

 

NE:  What are the major projects that your ministry has implemented, such as the construction of clinincs, health centres and hospitals across the country? And what were the main setbacks faced?

RK: “If there is an area where I’m pleasing our president it’s on infrastructure. We have built more clinics than at any other time during President Hifikepunye Pohamba’s term.”

 

NE:  Your ministry remains one of the most criticised ministry in terms of service delivery especially from the public. How do you cope with such a flood of criticism from the public on a daily basis?

RK: “The Ministry of Health and Social Services is one of the most complex in Cabinet and it is not only here in Namibia. I owe it to His Excellency the President. Experience is simply the best teacher. I am happy to state that as I speak here I do know that I am the longest serving Minister of Health and Social Services on the African continent. As a result of this experience I have come to learn that whilst you are making significant achievements people out there say one death is just too many deaths. So, I understand them and as I attend international meetings I have come to learn that Namibia is only a developing country but even in countries such as the USA they too are experiencing challenges such as maternal deaths, infant mortality. I am not saying this has made me to rest on my laurels, not at all. I have come to accept genuine criticism but at the same time I keep on talking – addressing my staff and the nation when I have the opportunity to say ten years ago Namibians were dying of AIDS. But it is not the same today and I am saying surely this did not just come on its own. It did not fall from heaven like manna. I tell my staff to accept genuine criticism because out of this we will learn to deliver.”

 

NE: In your view do you think all this criticism is valid considering the fact you are in charge of one of the largest and most complex government ministries?

RK: “I don’t think they are all correct but none of us would love to see their loved ones die. I do know that there are some deaths that were beyond our means because we could not handle it – it was meant to. But at the same time I will be the first to acknowledge that negligence does occur. When negligence occurs we immediately attend to it. It is Namibians’ constitutional mandate to complain.”

 

NE:  What are you doing to improve service delivery for the nation and to limit complaints by the public?

RK: “We have just finished a new organisational structure for the Ministry of Health and Social Services. I will table it in Cabinet when it resumes. This new organisational structure will assist us in creating more posts for professional medical and midwife care-givers. There is need for us to invest more in health in order for us to meet with the Abuja Declaration. When Namibians call Kamwi to go here and there it’s about resources. With resources in place I do think we may improve.”

 

NE: We have not seen much surprise visits on your part this year compared to previous years considering that is a way you got first hand information on the situation on the ground. Do you plan on doing that next year?

RK: “I was the first minister to introduce surprise visits and I can tell you it helped us immensely. This year was one of the most challenging years and exciting at the same time. It was the time I experienced a report of the presidential commission of inquiry on the activities of this ministry. I was following it whilst at the same time delivering and delivering both inside the country, regionall and internationally. I felt let me not interfere with this in order to attend to the recommendations of the commission of inquiry. But, I want to warn them if ever they think Kamwi has taken a break I am coming. In the new year, mind you we will be concluding the term of office and I want to conclude it in style by giving a real Pohamba legacy and I am going to leave it in this ministry – one that is never to be forgotten.“

 

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