Windhoek-Namibia is most likely one of the few African countries whose spending on access to health per person is way above the N$494 threshold recommended by the World Health Organisation (WHO) more than ten years ago. Yet, the health minister Dr Bernard Haufiku is displeased by the fact that such high public investment has not managed to eliminate queues at hospitals across the country. Haufiku, in an exclusive interview with New Era, had a mortified expression on his face as he told of patients having to travel long distances to camp overnight at hospitals just to have a refill of their prescriptions for high blood pressure, ARVs or TB.
“Do we get the [best] outcome with these investments? I do not think we get much impact out of the dollar invested,” said Haufiku, before he fired off a number of hindrances he vows to address during his term as health minister.
“We need to have innovations [to public health care], such as taking services to the community where people live,” he said, referring to a pilot case where the ministry uses 4×4 vehicles to dispense prescription refills to people in a remote village called Onghalulu, Ohangwena Region. He foresees that approach as the means to reduce queues from hospitals, based on his observations that many people in hospital queues countrywide are there to collect prescription refills.
The WHO’s Commission for Macroeconomics and Health recommended that spending should rise to US$34 per person by 2007 and to US$38 by 2015 in sub-Saharan Africa. This stems from the background that many African states spend on average between US$13 (N$169) and US$21 (N$273) per person.
Although Haufiku could not give exact figures of the current spending per person, statistics from the WHO indicate that public patients only spend an equivalent of 6 percent of the total health bill whenever they visit a state hospital, which “is comparable to more developed economies”.
Yet Haufiku points out that the infrastructure through which the ministry dispenses public health care is antiquated, that they now care for people triple their original design capacity. “Engela was not planned to have a pharmacist, it was considered to be a small health centre. And there are many such hospitals,” he says.
And there is more: “The management of our public hospitals has not been up to scratch, [including] electrical, plumbing. I accept as current minister that we have not done well in that respect,” he said.
The planning of the new structure to make public health delivery smoother took five years to operationalise. Even the planning of new hospitals after independence was poorly done “because there was no supervision by medical experts of what is needed,” Haufiku said, referring to Omuthiya hospital that was donated to the government.
“It was left to the people. But we have to spend extra money we don’t have at Omuthiya,” he said.
As of today the entire country’s 14 regions refer patients to Windhoek’s only hospital that is designed and equipped to attend to serious medical care.
“The reason we want to build a referral hospital is to lessen the burden, so that we do not have buses every day bringing in people for referrals,” said Haufiku.
A referral hospital takes care of complicated cases, surgery, high care, specialised surgery, all complicated medical care that could not be attended to by physicians at other hospitals, including district hospitals in the regions.
Health caregivers – especially doctors – were never enough for the population of the country, despite the fact that the country has expatriate doctors from other countries in both the public and private sectors.
“For the first time in the history of this country we have more than 200 doctors graduating from various institutions. One hundred already came, and we are expecting another 100 in September. They would start next year,” said Haufiku.
But not all is doom and gloom. Haufiku singles out clinics and health centres, saying: “On that score I would say the government has done well in bringing service to the people.”
“Also, health workers have made a difference. We have now more than 1,649 health workers deployed in each region, except Erongo. They have done very well with [combating of] malaria and Congo Fever. On this score I would say we have done well in the matter of dollars spent,” he says.
“On the issue of HIV, especially the prevention of mother to child, we have done very well. We have also stabilised the HIV epidemic among adults. Unlike many countries in Africa we buy our own medicine. We spent about 65 percent of our money to buy ARVs, malaria [medicines], and 100 percent [of our money] to buy TB and other medicines. [And] we can almost say we on the verge of eliminating polio,” he says proudly.
What is now needed, he says, is leadership not only at executive level, but as a community. “We need a multi-sectoral approach with other ministries to ensure that health education and prevention education happen. So, that is the overarching approach to public health care,” he says.