CHAPTER 1 INTRODUCTION 1.1 Geography, History, and Economy Geography Namibia has a surface area of 824,295 km2 and ranks as Africa's fifteenth largest country. It is located in the southwestem part of the continent and shares borders with Angola and Zambia on the north, Zimbabwe at the eastem end of the Caprivi Strip, Botswana to the east, and South Africa in the south and southeast. Geographically, Namibia is divided into three major regions, the Namib Desert, the Central Plateau and the Kalahari Desert. The Namib Desert is in the westem part of the country, stretching approximately 1,400 km along the Atlantic coast. Its width varies between 97 and 160 kin. Despite the barrenness of the Namib, it is endowed with rich mineral deposits. The Central Plateau, which forms part of the Central African Plateau, lies between the two deserts. The plateau, comprising over 50 percent of the total land area of Namibia, stretches from the northern to the southern border. It is the most fertile area in the country and most suitable for human settlement. To some extent this area is suitable for cattle-raising and crop cultivation. The mountain ranges of the plateau are endowed with rich mineral deposits. The Kalahari is a semi-desert covering the southeastern part of the country; it consists mainly of terrestrial sands and limestones. Unlike the Namib Desert, vegetation grows in the Kalahari. The northern parts of the Kalahari are most suited to cultivation, while the southem part is suitable for sheep-raising and the eastern part is suitable for cattle, goats and to lesser extent, sheep. Rainfall is the main factor influencing the climate of Namibia. The average annual rainfall for the country is only 270 mm and 92 percent of the land is categorised as extremely arid (22 percent), arid (33 percent) or semi-arid (37 percent), while the remainder is sub-humid. History On 21 March 1990, following the successful implementation of United Nations General Assembly Resolution 435, Namibia became the 1ast colony in Africa to attain its independence after more than 100 years of colonialism. Designated South West Africa, it was a German colony from 1884 until World War I. The territory was invaded and occupied by the Union of South Africa during the war, and then became the responsibility of the League of Nations. In 1920, the mandate of Namibia was handed over to South Africa under category "C" status, in which South Africa was expected to promote to the utmost the material and moral well-being and social progress of the inhabitants of the territory. To the contrary, the government of South Africa pursued a policy of exploitation and armexation of the territory. Following the refusal by the United Nations Assembly in 1946 to allow South Africa to incorporate the territory into its union, the South African government declared it would administer the territory without United Nations jurisdiction and shortly afterwards began to introduce its apartheid system. In 1971 the lntemational Court of Justice declared South Africa's occupation of Namibia illegal. Following the recommendations of the apartheid-oriented Odendaal Commission in 1964, Namibia was divided into a number of ethnic "homelands," which made up forty percent of the land in Namibia. Forty-four percent was reserved for whites, and the remaining 16 percent consisted of game reserves, diamond mining areas, etc. In the early 20th century, Namibians fought bloody wars against the German occupation (e.g., Nama and Herero wars). In 1960, the South West Africa People's Organisation (SWAPO), under the leadership of Sam Nujoma, was established and led the liberation struggle against the South African oppressors. Guerilla warfare took place from 1966 until independence, principally in northern Namibia. Thousands of Namibians fled to camps in Angola, Botswana, and Zambia. In tile seventies and eighties, the warfare increased, resulting in an estimated 10,000 civilian deaths. After independence in March 1990, Namibia set about redesigning the national infrastructure, administrative bodies, and basic services. The Government of the Republic of Namibia operates under a multi-party system. There is an executive branch comprised of the President and Cabinet, and a legislalive branch made up of the National Assembly. The country is divided into 13 regions and the election of Regional Councils took place in 1992. The Ministry of Health and Social Services administers four health regions, which were used in the Namibia Demographic and Health Survey. The Northwest health region includes Oshana, Omusati, Ohanguena, and Oshikoto regions; the Northeast health region includes Okavango and Caprivi; the Central health region comprises Kunene, Otjozondjupa, Erongo and Omaheke; and the South region includes Khomas, Hardap and Karas regions. Economy Namibia is one of the wealthier, more resource-rich countries on the continent. It is the fifth largest mineral producer in Africa and its fishing grounds are among the richest in the world. However, the national economy inherited by the Namibian government is fragile, dependent, and has an over-extended public sector. In its own interest, Namibia has decided to stay in the South African Customs Union and it still operates in the Rand Monetary Area and Bank of Namibia System. Namibia's economy is heavily dependent on a few prim ary commodity exports--diamonds, uranium, copper, other base metals, lead and mercury and livestock, followed by the Karakul (Persian lamb) pelt industry. The balance is made up by fish, manufactured products, and the tourist industry. Mining accounts for about two-thirds of all export earnings. Namibia depends on South Africa for about 75 percent of all imports. The majority of the population are dependent for their livelihood on livestock, i.e. cattle, sheep, goats and pigs. Per capita income varies greatly. The gross domestic product (GDP) was estimated at US$100 per year in mral areas, US$305 in the semi-urban areas, and US$580 in Katutura (a former black residential area in Windhoek, the capital city), while the annual GDP for whites was estimated at US$14,650 (UNICEF, 1990). 1.2 Population The last comprehensive population census, which was conducted in October 1991, reported a total population of 1,401,711 with an annual growth rate of 3 percent (Central Statistical Office, 1992). Despite the small size of its population, Namibia has a rich diversity of ethnic groups including Ovambo, Herero, Nama, Damara, Kavango, Caprivians, San, Twana, and Whites, Coloureds and Basters. 2 The population of Namibia is concentrated in the northern part of the country (60 percent); the south is least populated (7 percent); and the remainder are in the central part of the country. As a consequence of the apartheid policy, which reserved nearly 60 percent of the land for whites (who constituted less than 10 percent of the total population), ethnic distinctions were reinforced and different subgroups were encouraged to live in separate regions and, in urban areas, in separate localities. The majority of the black population is now concentrated in restricted rural areas, previously called "homelands." Overall, about one-third of the population lives in urban areas (in 57 "towns"), while 67 percent live in rural areas, including communal areas and commercial farms. At less than two persons per square kilometre, population density for the country as a whole is low. However, there are substantial regional differences in population density. For instance, Oshakati and Ondangwa districts in Northwest region exceed 11 persons per square kilometre. 1.3 Population and Family Planning Policies and Programmes Although population growth has been considerable during the last decade, the Government of the Republic of Namibia has yet to formulate an explicit population policy. However, population issues have received some attention, and different sectors of the govemment have come to realise the intersectoral impact of population issues, and of the importance of integrating population issues into a holistic planning perspective. Several surveys and needs assessment missions have indicated the need for information and understanding on the relationship between population and development, and a need for organised and coordinated population/health information, education and communication activities. Although family planning services in Namibia are underdeveloped and far from meeting the needs of the population, 191 (79 percent) of the 242 health facilities are providing family planning services. However, there are substantial differences in the availability and accessibility of family planning services. In the Northwest region, where nearly 50 percent of the population resides, only 43 percent of the health facilities are providing such services. One of the major components of primary health care (PHC) in the Ministry's Development Programme is the Maternal and Child Health/Family Planning (MCH/FP) programme. Its tasks, as stipulated in the draft policy, include: The promotion and improvement of MCH/FP services at all levels where such services are provided; To increase knowledge and access to family planning services, especially for distant communities; Identification of high-risk groups among pregnant women, mothers, and children, and to provide appropriate intervention; and To decrease morbidity and mortality associated with pregnancy. 1.4 Health Priorities and Programmes Namibia inherited a health structure that was segregated along racial lines and based entirely on curative health services. The administrative structure for delivery of health services was based on the Representative Authorities proclamation of 1980 (Proclamation AG8 of 1980), which created a two-tier system, resulting in an unequal allocation of resources and services. The ethnic-based second-tier was poody funded and administrators could not raise the necessary income to provide basic health care services. As a result, there were large inequalities in the delivery of health care services in the country. 3 Shortly after independence, major changes occurred in all sectors, many of which have been restructured to meet the challenges facing the new nation in the post-apartheid era.