Namibia The work of WHO in Namibia 2008-2013 Namibia A WHO Cover page.indd 1 05/02/2014 19:36 B Namibia The work of WHO in Namibia 2008-2013 C We can change the world and make it a better place. It is in your hands to make a difference. Nelson Mandela © World Health Organization, 2014 All rights reserved. Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. Copies of this publication may be obtained fromo the WHO Country Office in Namibia: UN House, 2nd floor 38 Stein Street, Klein Windhoek P. O. Box 3444, Windhoek Namibia Tel.: +264 61 255121; Fax: +264 612046202 Email: [email protected] Requests for permission to reproduce or translate this publication – whether for sale or for non-commercial distribution-should be sent to the same address. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’s products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed of implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed in Namibia: John Meinert, 2014 Design and Layout: Imagine Design, 2014 D TABLE OF CONTENTS Page Acronyms and Abbreviations iii List of Tables and Figures vi Acknowledgements vii Foreword ix Executive Summary xi Introduction 1 1. THE CONTEXT 2 Geography and Climate 3 The People 4 The Economy 4 The Politics 5 2. HEALTH TRENDS 6 Mothers, Babies, Children and Adolescents 8 Major Communicable Diseases 10 Health Emergencies 11 Lifestyle and Health 12 The System and its Challenges 13 Working together for Better Health Outcomes 13 Partnerships 14 3. PROMOTING DEVELOPMENT 15 Achievements in Combatting Communicable Diseases 16 Progress in Reducing Lifestyle Diseases 20 Putting the Health of Mothers and Children First 22 Immunizing Every Child 24 Nutrition 25 4. FOSTERING HEALTH SECURITY 26 Are We Ready For Emergencies? 27 Preventing Disease Outbreaks 28 Water and Sanitation 29 Getting the Message Across 30 i Page 5. STRENGTHENING HEALTH SYSTEMS 31 Governance 32 Human Resources – Developing the Health Workforce 34 Health Financing – Ensuring Sufficient Resources 36 Health Information – Taking Stock of Health Trends 37 Service Delivery – Getting Health Care to the People 37 Medical Products, Vaccines and Technologies – The Tools of the Trade 38 6. HARNESSING RESEARCH, INFORMATION AND EVIDENCE 39 Generating Evidence 40 Using Evidence for Policy Decision 40 Launch of the World Health Report 2008 41 Library Services 41 Country Health Portals 41 7. ENHANCING PARTNERSHIPS 42 Key Partners 43 Keeping Everyone on the Same Page 44 Resource Mobilization 45 Cross Border Collaboration 45 WHO Official Visits 46 8. IMPROVING PERFORMANCE 47 Human Resources 48 Office Location and Conditions 49 Finances 50 Steering the Agenda 50 9. THE WAY AHEAD 51 10. REFERENCES 53 ii ACRONYMS AND ABBREVIATIONS ACs Assessed Contributions AFP Acute Flaccid Paralysis AFRO WHO Regional Office for Africa AIDS Acquired Immunodeficiency Syndrome ANC Antenatal Care ART Antiretroviral Therapy ARV Antiretroviral AU African Union CCN Council of Churches in Namibia CCS Country Cooperation Strategy CDC Centers for Disease Control and Prevention CERF Central Emergency Response Fund CHS Catholic Health Services DAPP Society for Family Health, Development Aid People to People (DAPP) DG Director General DOTS Directly-Observed TB Treatment – Short Course Strategy e-MTCT Elimination of Mother-To-Child Transmission of HIV EDT Electronic Dispensing Tool EmOC Emergency Obstetric Care EmONC Emergency Obstetric and Newborn Care EPI Expanded Programme on Immunization EPR Emergency Preparedness and Response EU European Union EWI Early Warning Indicators FBO Faith-Based Organization GDP Gross Domestic Product GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria GIVS Global Immunization Vision and Strategy GIZ Deutsche Gesellschaft für Internationale Zusammenarbeit (German Society for International Cooperation) GLP Global Learning Programme HIS Health Information System HIV Human Immunodeficiency Virus HIVDR HIV drug resistance HRH Human Resources for Health HSSR Health and Social Services Systems Review HTC Hospital Transfusion Committee IAEA International Atomic Energy Agency iii IBBSS Integrated Biological and Behavioural Surveillance Survey IDSR Integrated Disease Surveillance and Response IMNCI Integrated Management of Newborn and Childhood Illness IMPAC Integrated Management of Pregnancy and Childbirth IST/ESA WHO Intercountry Team for East and Southern Africa JANS Joint Assessment of National Strategies KAP Knowledge, Attitudes and Practices MAMPA Monitoring Alcohol Marketing Practices in Africa MC Male Circumcision MDG Millennium Development Goal MDR-TB Multi Drug-Resistant Tuberculosis MMR Maternal Mortality Ratio MNCAH Maternal, Child and Adolescent Health MOHSS Ministry of Health and Social Services MSH Management Sciences for Health MTCT Mother-To-Child Transmission of HIV MTEF Mid Term Expenditure Framework MVA Motor Vehicle Accident Fund NABCOA Namibia Business Coalition on AIDS NaCCATuM Namibia Coordinating Committee for AIDS, Tuberculosis and Malaria NAEC National AIDS Executive Committee NAFIN Namibia Alliance for Improved Nutrition NAMAF Namibian Association of Medical Aid Funds NAMBTS Blood Transfusion Service of Namibia NANASO Namibia Network of AIDS Service Organizations NAPPA Namibia Planned Parenthood Association NBPr National Blood Programme NCD Non-Communicable Disease NDHS National Demographic and Health Survey NDHS+ National Demographic Health Survey Plus NDP National Development Plan NFP National Focal Point NGO Non-Governmental Organization NHA National Health Accounts NHFC Namibia Health Facility Census NID National Immunization Day NIP Namibia Institute of Pathology NLSA Nutrition Landscape Analysis iv NPCS National Planning Commission Secretariat NRCS Namibia Red Cross Society NRSC National Road Safety Council NTLP National Tuberculosis and Leprosy Programme NVDCP National Vector-Borne Disease Control Programme OPV Oral Polio Vaccine PARMaCM Programme for Accelerating the Reduction of Maternal and Child Mortality PEP Post-Exposure Prophylaxis PEPFAR President’s Emergency Plan for AIDS Relief PHC Primary Health Care PITC Provider-Initiated Testing and Counselling PMDRC Policy and Management Development Review Committee PMTCT Prevention of Mother-To-Child Transmission of HIV RD Regional Director RED Reach Every District SACU Southern African Customs Union SADC Southern African Development Community SSC Social Security Commission STI Sexually-Transmitted Infection STOP Stop Transmission of Polio TB Tuberculosis TWG Technical Working Group UN United Nations UNAIDS Joint United Nations Programme on HIV/AIDS UNAM University of Namibia UNCT United Nations Country Team UNDAF United Nations Development Assistance Framework UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development VCs Voluntary Contributions VSO Voluntary Service Overseas WBW World Breastfeeding Week WCO WHO Country Office WFP World Food Program WHO World Health Organization WHS World Health Survey XDR-TB Extensively Drug Resistant TB v LIST OF TABLES AND FIGURES Page Figure 1: Under five world wide mortality rate 8 Figure 2: World wide maternal mortality ratio 9 Figure 3: Estimated HIV and AIDS Incidence, Prevalence and Mortality, 1990-2015 10 Figure 4: Trends in notified DR-TB cases, 2007 - 2011 11 Figure 5: Trends of WHO estimated TB prevalence and incidence in Namibia, 1990–2011 18 Figure 6: Malaria burden in Namibia, 2001–2012 19 Figure 7: Motor Vehicle Accidents in Namibia 21 Figure 8: WCO Core Values 49 Figure 9: WCO Strategic Priorities, 2010-2015 50 vi ACKNOWLEDGEMENTS Throughout the period 2008 to 2013, we have Honourable Minister of Health and Social Services consistently emphasized the importance of and his entire team at all levels. We are extremely partnerships. We have also translated our strong grateful for the conducive working environment, belief in the power of partnerships into concrete the excellent and productive collaboration, and the actions which led to significant improvement in our unwavering support to the work of WHO. collaboration with Government, Civil society, private sector, bilateral and multilateral partners in various We extend our deep gratitude to the teams at the fronts. WHO Country Office, Inter-Country, Regional Office and Headquarters. Without their collaboration, it Effective partnerships require constant dialogue and would have not been possible to provide