Namibia's Health Sector Reform: A Path to Universal Health Coverage
Recognizing health as a fundamental right, Namibia's government is embarking on significant reforms to enhance the functioning and performance of its health systems. With a focus on achieving universal health coverage, the country aims to provide quality health services to all its citizens regardless of their ability to pay, ensuring the welfare and well-being of the population. The reform process includes changes in policies, financing, care provision, resource generation, and governance to address the population's healthcare needs effectively.
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HEALTH SYSTEMS (SECTOR) REFORMS HEALTH SYSTEMS (SECTOR) REFORMS Economic Association of Namibia Economic Association of Namibia Dr Dr Davi Davi / /Uirab Uirab MBChB MBChB( (MEDUNSA MEDUNSA) ) MBA (Edinburg Business School, Heriot MBA (Edinburg Business School, Heriot- -Watt University Watt University) )
INTRODUCTION INTRODUCTION HEALTH: A state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. Article 95 of our Constitution provides the mandate of ensuring the welfare of the people of Namibia.
REFORM REFORM HSR HSR Usually refers to fundamental changes in policies and institutional arrangements of a country s health sector. The process is normally guided by government. Such reforms usually cover: Health care financing-how do we fund health care provision. Provision of health care health care packages and programmes. Resource generation-HRH and community /individual involvement. Governance-planning, decentralization.
WHY REFORM? WHY REFORM? Usually to improve the functioning and performance of the health sector and ultimately the HEALTH STATUS OF THE POPULATION! HEALTH STATUS OF THE POPULATION!
WHY REFORM? CONT... WHY REFORM? CONT... In the case of Namibia, Government takes a human rights- based approach to health care: People must receive health care according to need and NOT the ability to pay hence a virtually free public health sector. GRN spends about 13% of the budget on the MoHSS. But what makes reforms imperative in our case: Is the human rights-based approach the only reason? Is health care ok in Namibia? Is Government trying to fix something that isn't broke?
+80% of population N$ N$ N$ PCHE: N$16,887 N$ 12% of populatio n N$ 8% of populati on N$ PCHE: N$7,489 N$ N$ N$ N$ N$ N$ N$ N$ PCHE: N$3,545 N$ N$ N$ N$ N$ N$ N$ N$ N$ N$ N$ N$ N$
WHAT SHOULD WE DO THEN? WHAT SHOULD WE DO THEN? WHO= UNIVERSAL HEALTH COVERAGE! UHC Defined All People Receiving the Quality Health Services they Need Without Suffering Financial Hardship in so Doing.
HOW HAVE WE RESPONDED TO THE CALL FOR UNIVERSAL HOW HAVE WE RESPONDED TO THE CALL FOR UNIVERSAL HEALTH COVERAGE HEALTH COVERAGE Universal Health Coverage Advisory Committee of Namibia ( UHCAN ) Social Commission Security Ministry of Health and Social Services Various Background and Supporting Studies and Reports Health Financing Review Health Financing Review Burden of Disease Study Burden of Disease Study Performance of the Health System Review Performance of the Health System Review Unit Cost Of Health Services Study Unit Cost Of Health Services Study Public Expenditure Review Public Expenditure Review National Health Accounts National Health Accounts O/M/As; DBA; USAID/HFG; World Bank; etc
HOW HAVE WE RESPONDED TO THE CALL FOR UNIVERSAL HOW HAVE WE RESPONDED TO THE CALL FOR UNIVERSAL HEALTH COVERAGE HEALTH COVERAGE Key Points from Background and Supporting Studies and Reports Reveals inefficiencies in the utilization of resources. High inequalities in resources allocation and utilization (funding; HRH; infrastructure). Continued burden, but good response to Communicable Diseases; Increasing Burden of Non-communicable Diseases. Disproportionate allocation of resources between THC vs PHC; Secondary Care vs Primary Care. RECOMMENDS POOLING OF RESOURCES AND EQUITABLE DISTRIBUTION RECOMMENDS POOLING OF RESOURCES AND EQUITABLE DISTRIBUTION
UHC is measured in terms of Health Coverage and Financial Protection against the Health Service Service Coverage Cost Of Health Services. Health Health Service Service Coverage Coverage Namibia UHC Service Index = 59 Ranking 120th in a list of 183 Countries. Financial Financial Protection household out-of-pocket expenditures at 11% Protection: : of THE - below the WHO threshold of 20% of THE.
HOW DO WE WANT TO DO IT? HOW DO WE WANT TO DO IT? One National Health Insurance Fund (Super Medical Aid): Current MoHSS Budget; PSEMAS Fund; compulsory contributions from each employed person and employer. To cover the essential health service package for every Namibian Resident Service Provision through contracting public and private health care service providers Fund management through an independent institution-? Social Security Commission Private medical aid funds to continue to exist as voluntary funds: For top up services over and above the essential health service package and for those who wish to still have full cover through a private medical aid fund.
Inter-Ministerial Committee (OPM, MHSS, MoF, MIREC, MPESW) Multi-stakeholder & Multisectoral Consultative Forum (UHCAN / NHA) NCD Service Package RMNCH UHC Technical Advisory Committee CD Service Package UHC Unit Essential Health Service Package TWG Medicines, Products & Clinical Supplies TWG Human Resources for Health TWG Health Information TWG Health Infrastructure TWG Leadership & Governance TWG Health Financing TWG
CONCLUSION CONCLUSION NEED FOR CONSENSUS BUILDING AROUND THE PRINCIPLE. NEED FOR IN-DEPTH RESEARCH AND BENCHMARKING. NEED FOR A PHASED IMPLEMENTATION APPROACH. ONE THING IS CLEAR THOUGH: AS THINGS STAND, THE TRAIN IS GOING TO SMASH!! IT CANT BE BUSINESS AS USUAL FOREVER,
Thank you!! Thank you!!
