NAMIBIA Health Facility Census 2009

NAMIBIA Health Facility Census 2009 Key Findings on Family Planning, Maternal and Child Health, and Malaria This report summarises the reproductive and maternal and child health findings of the 2009 Namibia Health Facility Census (HFC) which was carried out by the Directorate of Special Programmes (HIV/ AIDS/TB/MALARIA) in the Ministry of Health and Social Services (MoHSS). ICF Macro provided tech- nical assistance. The 2009 Namibia HFC is part of the worldwide MEASURE DHS project which assists countries in the collection of data to monitor and evaluate population, health, and nutrition programmes. Financial support for the census was received from the United States Agency for International Develop- ment, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Government of the Republic of Namibia, and the World Health Organisation. Additional information about the 2009 Namibia HFC may be obtained from the Ministry of Health and Social Services (MoHSS), Private Bag 13198, Windhoek, Namibia; Telephone: (264-61) 203-2826; Fax: (264-61) 224-155; E-mail: [email protected]; Internet: www.healthnet.org.na Additional information about the DHS project may be obtained from ICF Macro, 11785 Beltsville Drive, Calverton, MD 20705 USA; Telephone: 301-572-0200, Fax: 301-572-0999, E-mail: reports@measuredhs. com; Internet: http://www.measuredhs.com. Recommended citation: Ministry of Health and Social Services (MoHSS) [Namibia] and ICF Macro 2010. Namibia Health Facil- ity Census 2009: Key Findings on Family Planning, Maternal and Child Health, and Malaria. Wind- hoek, Namibia. MoHSS and ICF Macro. Cover photographs, courtesy of Photoshare, left to right: ©2003 Harvey Nelson; ©2003 Harvey Nelson; ©2004 HCP Namibia; ©2005 Alfredo L. Fort. Investing in our future The Global Fund To Fight AIDS, Tuberculosis and Malaria Contents Introduction . 1 Family Planning (FP) Services. 2 Method Availability . 3 Components Supporting Quality FP Services . 5 Infection Control . 5 Equipment and Supplies for Specific Methods . 6 Sexually Transmitted Infection (STI) Services . 6 Observation of Client Visits. 7 Management Practices and Training. 8 Maternal Health Services. 9 Antenatal Care (ANC) Services. 10 Items to Support Quality ANC Services. 10 Availability of Medicines . 11 Management and Training . 11 Adherence to Standards in ANC. 12 Delivery Services . 13 Domiciliary Care Practices . 13 Elements and Practices to Support Normal Deliveries. 14 Supplies for Normal and Complicated Deliveries . 14 Management and Training . 15 Infection Control . 16 Newborn Care . 16 Child Health Services. 17 Immunisations . 18 Growth Monitoring . 19 Care for the Sick Child . 19 Essential Medicines for Treating Sick Children. 19 Observation of Sick Child Consultations . 20 Treatment by Diagnosis . 21 Management Practices Supporting Sick Child Care . 22 Caretaker’s Opinions . 22 Malaria.. 23 Treatment of Children. 24 Training . 24 Antenatal Care and Malaria . 24 Conclusions . 25 Key Indicators . 26 Ohangwena Namibia map Omusati Caprivi Kavango Kunene Oshikoto Otjozondjupa Omaheke Erongo Oshana Khomas Hardap Karas Throughout the report, indicators are presented by type of facility, managing authority, and region. The regions, and the districts they comprise, are as follows: Caprivi Katima Mulilo Erongo Swakopmund, Walvis Bay, Omaruru, Usakos Hardap Mariental, Rehoboth, Aranos Karas Luderitz, Karasburg, Keetmaanshoop Kavango Rundu, Andara, Nyangana, Nankudu Khomas Windhoek district Kunene Opuwo, Outjo, Khorixas Ohangwena Engela, Eenhana, Okongo Omaheke Gobabis Omusati Tsandi, Outapi, Okahao, Oshikuku Oshana Oshakati Oshikoto Onandjokwe, Tsumeb Otjozondjupa Otjiwarongo, Grootfontein, Okahandja, Okakarara Page 1 Introduction The 2009 Namibia Health Facility Census (NHFC) describes how the formal health sector in Namibia provides services for family planning, maternal health, child health, malaria, HIV/AIDS, and other com- municable diseases. The NHFC was carried out by the Directorate of Special Programmes (HIV/AIDS/ TB/MALARIA) in the Ministry of Health and Social Services (MoHSS). The major objectives of the 2009 Namibia HFC are to: •Describe how well prepared facilities are to provide quality reproductive and child health services as well as services for some infectious diseases (HIV/AIDS, STIs, malaria, and TB); •Provide a comprehensive body of information on the performance of the full range of public and private health care facilities that provide reproductive health, child health, tuberculosis (TB), malaria, and HIV/AIDS services; •Help identify strengths and weaknesses in the delivery of reproductive health, child health, TB, malaria, and HIV/AIDS services at health care facilities, producing information that can be used to better target service delivery improvement interventions and to improve ongoing supervisory systems; •Describe the processes used in providing child, maternal, and reproductive health services and the extent to which accepted standards for quality service provision are followed; •Provide information for periodically monitoring progress in improving the delivery of reproductive, child health, and HIV/AIDS services at Namibian health facilities; •Provide baseline information on the capacity of health facilities to provide basic and advanced HIV/AIDS care and support services, and on the record-keeping systems in place for monitoring HIV/AIDS preventive, diagnostic, care, and support services. The 2009 NHFC provides national- and regional-level representative information for hospitals, health centres, clinics, stand-alone voluntary counselling and testing (VCT) facilities and sick bays offering maternal and child health (MCH) and HIV/AIDS-related services. Data were collected from all functioning health facilities in Namibia. These facilities were under various management authorities, including government, private-for-profit, mission, NGOs, ministry of defence (MoD), and the Namibia police. In each facility, data were collected from all or a sample of health service providers available on the day of the visit, as well as from a sample of sick children, family planning clients, and antenatal care (ANC) clients. Trained interviewers collected the data between July and October 2009. This report summarises the major findings on family planning, maternal health, child health, and malaria based on interviews and observations at 411 health care facilities. Graphs and figures presented in this report include table numbers in parentheses. These table numbers refer to the tables in the 2009 Namibia Health Facility Census Final Report. Table numbers that include an A in the title, e.g. Table A-5.5, refer to tables found in the appendix of the final report, rather than the chapters. To put the results of the 2009 NHFC into context, this report also includes data from the 2006 Namibia Demographic and Health Survey (NDHS) based on data from almost 14,000 (13,719) Namibians. DHS information is provided in red boxes. Page 2 2009 Namibia HFC Results: Family Planning (FP) Services Availability of Modern Family Planning Methods Overall, 90% of all health care facilities in (Table 5.1) Namibia offer modern methods of family Percent of facilities offering any modern method* of family planning planning. Almost all health centres and (N=396) clinics offer modern methods, compared to only half (49%) of hospitals. Facilities Omusati Ohangwena 91% managed by the Ministry of Health and 94% Caprivi 93% Kunene Social Services (MoHSS) and Mission/ 96% Oshikoto Kavango NGO are most likely to offer modern 91% 96% methods (96% each) while only 69% of private facilities and 31% of Ministry Otjozondjupa Namibia of Defense (MoD)/Police facilities offer 86% average: modern methods. In most facilities that Omaheke Erongo offer modern methods (81%), services are 94% 90% Oshana 86% available five or more days per week. 85% Khomas Availability of family planning services 76% varies by region. Only three-quarters of Hardap facilities in Khomas offer any modern 90% methods compared to more that 95% on facilities in Kavango and Kunene. *contraceptiveKhomas pills, injectables, Karas implants, IUCD, male condoms, Long-term methods are less widely avail- 92% spermicidal,76% or diaphragm able. Only 33% of facilities offer male or female sterilisation. Sterilisation is most available at hospitals (44%). Putting the NHFC into Context: Family Planning in Namibia According to the 2006-07 NDHS, Namibian women have an average of 3.6 children. Fertility has decreased from 5.4 in 1992 and 4.2 in 2000. Almost all men and women know of at least one modern method of family planning, and 46% of all women are currently using a modern method. This is an increase from 37% in 2000, due primarily to the increasing use of male condoms. Injectables and male condoms are the most commonly used modern methods (17% each) followed by female Current Use of Family Planning, NDHS 2006-07 sterilisation and the pill (5% each). The NDHS reported Any method 47 that 75% of modern method users obtained their methods from a public source, such as a government hospi- Any modern method 46 tal or health centre, while 10% of users obtained their methods from a private medical source, and another Injectables 17 13% of users from another private sector source, such Male condom 17 as a shop or church. 5 Only 3% of women have an unmet need for family plan- Female sterilization ning—that is, they do not want any more children or Pill 5 want to wait at least two years before having their next child but are not using any family

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