NAMIBIA Reaching the WHOUNAIDS 3X5 initiative target

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NAMIBIA - Reaching the WHO/UNAIDS 3X5 initiative
target

• WHAT WILL IT TAKE.
• Albertina Thomas
• R/N Midw. BNsc.
• Humphrey Fellow
• Tulane University

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REPUBLIC OF NAMIBIA

• GEOGRAPHY
• HISTORY
• POPULATION
• NATURAL ENVIRONMENT
• GOVERNMENT
• ECONOMY
• HEALTH INDICATORS
• OVERVIEW OF HEALTH PROBLEM
• CHALLENGES
• WAY FORWARD
• HEALTH PROVISION

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NAMIBIA - GEOGRAPHY

• SITUATED IN SOUTHWESTERN AFRICA
• SOUTH AFRICA - SOUTH
• BOTSWANA EAST
• ATLANTIC OCEAN WEST
• ANGOLA AND ZAMBIA NORTH

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HISTORY

• Long inhabited by indigenous people
• European Missionaries 1805-1883
• Von Bismarck proclaimed German Protectorate
  1884 -1889
• Genocide 1904-1906
• German rule 1907 -1914
• South African Invasion 1915

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HISTORY

• South African rule 1915 1989
• Liberation struggle begins 1957 -1989
• Independence - 1990

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Population

• Population 2 million
• Population growth rate 2.6
• Approximately 315 580 sq mi. (825 118 sq km) size
  of Alaska
• Population density two people per square
  kilometers

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Population

• Ethnically diverse population
• First inhabitants were the San people, Namas

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NATURAL ENVIRONMENT

• Typical semi-desert dry climate
• Flora Over 120 species of trees
• Fauna Abundant wildlife
• Avifauna Majority of bird species of Southern
  Africa is found in Namibia

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Namibian Women
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GOVERNMENT

• Multiparty Parliament
• 72 seat National Assembly
• Democratic Constitution
• Division of Power Executive, Legislative and
  Judiciary Branch
• Divided 13 Political Regions Governed by
  Governors

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ECONOMY

• GDP 6,6 billion US
• GDP/capita US2700
• Inflation rate 7
• Currency US1 N6.5
• Pillars of the economy mining, fishing,
  agriculture and tourism
• Major Trading Partners UK, S.A, U.S.A, Spain,
  Japan and Germany
• Major producer of gem-quality diamonds
• Uramiun, copper, lead, gold, tin, silver

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Health Indicators

• Annual population growth rate 2.7
• Fertility rate 4.9
• Infant Mortality 60/1000 livebirths
• Maternal Mortality ratio 270/100 000 livebirths
• HIV prevalence rate 19.7
• Life expectancy at birth 46 years

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REGIONAL HIV PREVALENCE
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TIME TO DELIVER

• Reduced prices of drugs
• Greater political will
• Proven models Uganda
• Improve Technology

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Timeline of ARV Introduction in Namibia

• Feb 02 PMTCT pilot in 2 large public hospitals
• Nov 02 Approval of Namibias Global Fund Rd 2
  Prop.
• Dec 02 ART Technical Advisory Committee est.
• Feb 03 Ministerial decision on ART taken
• Apr 03 Guidelines launched and sites mobilized

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WHO/UNAIDS 3X5 INITIATIVE

• LAUNCHED IN 2003 AS A WHO/UNAIDS STRATEGY
• PILLARS Global Leadership, strong partnership,
  strong advocacy

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Timeline for ART introduction

• May 03 First ART training (joint publ. priv.
  sector)
• June Oct 03 First seven ART sites launched
• June Dec 03 Compilation of Third Medium Term
  Plan
• Jan 04 PEPFAR support to Namibia begins
• Apr 04 May 05 - Total of 24 ART sites launched
• Dec 05 32 public hospitals offer ART services
• Apr 06 All public hospitals covered

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Model of ART Service Delivery in Namibia

• Communicable Disease Clinic
• All HIV-positive patients receive comprehensive
  care
• Multi-disciplinary team approach (MDs, nurses,
  counselors, etc.)
• Linkages with TB clinic, PMTCT services/ANC and
  close collaboration with pharmacy and laboratory
  services links to community-/home based care
• Care package Counseling and testing Clinical
  and social criteria assessment OI prophylaxis
  and treatment ART (1st line NVP or EFV
  d4T/3TC or AZT/3TC or AZT/ddI) Adherence
  counseling Referral.
• Patient record keeping and health information
  system.

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CUMULATIVE NUMBER OF PATIENTS ON ARV SEPT.
2003-MARCH 2006
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Support from Developmental Partners

• 2004-2006 US30.1 mil.
• ARV treatment
• Strengthening of Faith-based initiatives,
  Training Community counsellors

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Support from Developmental Partners

• 2005 - 2006 Global Fund US 7.4 Mill.
• 2003 - 2006 BMS US 5.3 Mill.
  (Mapilelo/Caprivi Project)

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Socio-economic upliftment

• Namibia Politicians split on basic income grant
  issueWindhoek - Political parties hold opposing
  views over suggestions that Namibia gives its
  citizens a Basic Income Grant (BIG) as a first
  step towards addressing destitution. By Wezi
  Tjaronda, New Era (Namibia) 11.11.2004
• While some feel a BIG would help the poorest of
  the poor, others feel it would promote laziness.
  The need for the country to have a BIG was
  proposed two years ago by the Nami-bian Tax
  Consortium (Nam-tax). It was then tasked with
  reviewing the current tax system and as a
  redistributive measure, it suggested a BIG.

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CHALLENGES

• SUSTAINABILITY
• SOCIAL UPLIFTMENT

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WAY FORWARD

• Working towards Sustainability
• Decentralization and task transfer
• Quality improvement
• Strategic human resource development
• Strategic management and institutional capacity
  building
• Financing

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Organogram Ministry of Health
Minister
Multisector response
Health Sect. response