SECTION III: General Information about the Country Setting
18.1
HIV/AIDS
Disease burden: Globally, Namibia is ranked among the top 5 most AIDS-affected countries.
HIV/AIDS is the most important public health problem in Namibia, ranking as the first cause of
deaths and hospitalisations 1. The year 20002 Sentinel Sero Survey (SSS), carried out at urban
and rural sites in Namibia’s 13 regions, found that the HIV prevalence rate among pregnant
women varied from 7% to 33%, with a weighted national prevalence 3 of 22.3%. This is an
increase of 3% since the 1998 (SSS 4). At the end of 2001, UNAIDS5 estimated 230 000
adults and children to be living with HIV/AIDS. The greatest burden of the epidemic falls on
women, who become infected at a younger age and account for 56% of all reported new HIV
infections. Increased adult mortality has caused a dramatic rise in the number of orphans.
Currently estimated at 82,000, it is predicted that Namibia will have 118,000 orphans by 2006.
Please see chart overleaf.
Trends6: For the age groups 15-19, and 20-24, HIV prevalence has remained at the same
level since 1998. However it is still increasing in all other age groups. Geographically, where it
has been possible to compare longitudinal data, the SSS 2000 results indicate a trend of
increasing prevalence in every region but two. The four sites with the highest prevalence were
all in urban locations registering between 28 to 33% positivity. HIV prevalence is also high in
rural sites close to major movement corridors. These sites are also all in the seven most
populous regions of the country with over 66.7% of the population. Statistical modelling using
the national HIV prevalence figure of 22.3% suggests that Namibia is in the second phase
(HIV prevalence rises sharply) of the HIV epidemic. The model estimates that the national
prevalence rate will level off at 24% by the year 2005. 7 (Please see annexure L for figure 3
Age specific HIV prevalence in pregnant women Namibia 2000 and figure 5 HIV Prevalence
trends in pregnant women age 15 – 24 Namibia 1994 – 2000)
18.2
Tuberculosis
Disease burden8: Ten percent of all deaths in Namibia are due to TB, making it the second
cause of reported deaths after HIV/AIDS and the fourth cause of morbidity. TB was the
second most frequent cause of hospitalisation and a significant cause of outpatient
department attendance in Namibia9 between 1996 and 2000. Between 1991 and 2000, the
rate of notification has risen from 430/100 000 to 619/100 000 in the year 2000. This
escalation is attributed to the link between HIV and TB. The 1998 HIV SSS included
measuring co-infection amongst TB patients and found a co-infection rate of 45%. Multi-drug
resistance is also increasing. This places an additional strain on Namibia’s pharmaceutical
budget and causes an increase in the average length of stay in hospitals.
Trends: The age group 15-45 years remained the most heavily affected for new pulmonary
smear positive cases amongst both males and females during the past five years; this is
consistent with the most affected HIV/AIDS age group.10 Overall, the proportion of in-patients
diagnosed with TB rose from 10% to 27% between 1995 and 1999, while the number of
1
MOHSS, 2001a
The next Sero Sentinel Survey is due later this year
3 MOHSS, 2001b. UNAIDS (2002) estimates HIV prevalence among women in antenatal care clinics in urban areas as
29.6% in 2000
4 MoHSS, 2001b
5 UNAIDS, 2002
6 MOHSS, 2001b
7 MOHSS,2001b.
8 MOHSS, 2000
9
MOHSS, 2000
10 MoHSS, 2000
2
Section III – Page 1
deaths increased by 64% over the same period 11. Seven percent of in-patients aged 13 and
over, and 3% of those under 13 have tuberculosis. Regional differences in incidence during
the year 2000 ranged from 260/100,000 to 1,675/100,000 in Kunene and Erongo region
respectively12; five regions13 account for 50% of the overall burden of TB in Namibia 14, placing
a heavy load on health facilities in these regions. In cases registered during 1995-2000, the
increase was higher for females in the 14-24 year age group, whereas in males the increase
was higher in the 25-44 and older age group15. In all age groups, except among children, the
numbers of detected TB cases in males prevail over females 16. Given that the steady
escalation in the incidence and prevalence of TB is attributed to the HIV/TB link (45% 17 coinfection), statistical modelling predicts a similar rapid increase in HIV/TB co-infection before it
levels off in 200518. Increasing resistance to existing TB drugs is likely to play a contributory
role.
18.3
Malaria
Disease burden: Malaria is endemic in the northern regions of Namibia, with an average
incidence of 240,000 cases for the whole country, in the year 2000. Some 1,090,000 people
live in malarious areas. Malaria is the first cause 19 of outpatient consultations and hospital
admissions in Namibia. It is the leading cause of illness and death amongst Namibia’s underfive year olds, and the third important cause of death among adults. The mortality rate
increased from 30/100,000 in 1998 to 45/100,000 in 2000 respectively.
Trends: Seasonal20 climatic conditions generate high transmission risk, mainly between
January and May in the north-eastern and north-western regions of the country. In these
regions, malaria is an important cause of death. The effects of HIV/AIDS co-infection are
believed to play an important role in this regard, particularly related to maternal deaths.
Malaria also has a disproportionate effect on Namibia’s poorest rural households, particularly
in the disadvantaged regions in the North. The increasing poverty levels brought about in
these areas by the HIV/AIDS epidemic, and concomitant food insecurity, increase the potential
for a rapid increase in malaria incidence.
19
Current economic and poverty situation

With a total population of 1,8 million, Namibia’s GDP per capita was USD 1,173 in 2000 21.
This hides a significant disparity in income distribution, which is better represented in
Namibia’s Gini co-efficient of 0.70 in 200022. Half of Namibia’s population survives on
approximately 10% of the average income, while the ratio of per capita income between
the top 5% and the bottom 50% is approximately 50:1 23. These differences are
aggravated by a high national unemployment level of 35% (1998). In the age groups 1519, and 20-24, the unemployment rate was 62% and 55% respectively 24. In 2000,
Namibia’s HDI was 0.770 increasing from 0.683 in 1999 25. Namibia’s National Human
11
Health in Namibia pg. 49,TBHIS 2000
MoHSS, 2000
13 Karas, Erongo, Khomas, Okavango and Oshikoto
14 MoHSS, 2000
15 MoHSS, 2000
16 MOHSS/GTZ, 2000?
17 MoHSS, 2000
18 MOHSS, 2001b
19 There are about 400,000 outpatient cases; and over 30,000 in-patient cases per annum.
20 When environmental conditions (such as the high rainfall) are optimal, malaria epidemics can occur, as happened in 2001.
Such epidemics can cause high levels of morbidity and mortality among all age groups
21 Bank of Namibia, 2002a. Per capita GDP is N$ 8 096, divided by 6.9 (Namibia dollar per US dollar in 2000, according to
the Bank of Namibia’s quarterly bulletin for June 2002) = USD 1 173 (Exchange rate 2002 September 1:10)
22 A Gini co-efficient of zero means perfect equality, while a co-efficient of one means perfect inequality (UNDP, 2000/01)
Gini co-efficient for 2000 from Bank of Namibia quarterly bulletin June 2002.
23 UNDP, 2000/01
24
Ministry of Labour, 1998, quoted in UNDP 2000/01, and also in the Bank of Namibia annual report, 2001
25 UNDP 2000/01:
12
Section III – Page 2
Poverty Index score was 24.7 in 2000
considerably lower than the southern.

26.
The northern regions generally score
HIV/AIDS, and HIV/TB co-infection (45% in Namibia) are not only health problems, but
also socio-economic development problems. Poverty is both a cause and effect of
HIV/AIDS, and of HIV/TB co-infection. Those most capable of increasing Namibia’s GDP,
(i.e. those in the most productive and active age groups), are either those most affected
by unemployment, or most affected by HIV/AIDS, or both. HIV/AIDS (and by implication,
HIV/TB co-infection) affects Namibia’s economic growth, and increases poverty levels in
several ways:
(a) Decrease in GDP: According to the IMF, as quoted in NDPII, 2.5% of GDP per capita
will be lost per annum by 2010 if the HIV prevalence is not reduced.
(b) Declining health implies not only reduced productivity, but also increased care
expenditure. The Namibian Government (GRN) currently allocates between 10%12%27 of the national budget to the health sector. This is not sufficient to make an
impact on the burden of disease attributed to HIV/AIDS, TB and Malaria. The National
Planning Commission estimates that the indirect and direct cost of medical care of
HIV/AIDS to the Namibian economy will amount to N$8 billion by 2010, equivalent to
20% of the national GDP, or 6 times the expenditure on health in the public sector.
(c) Rising mortality: The ILO projects that Namibia is expected to lose a quarter to a third
(35.1%) of its workforce by 2020. Apart from the premature loss of well-trained and
experienced employees, many return to homes in the communal areas to die, adding
to poverty levels in already vulnerable regions.
(d) Increase in vulnerable children: Orphans are projected to increase by 2006 28. More
than 50% of these AIDS orphans are living in the northern regions. These are the
same regions, which already show both low development and high poverty indices 29.
Existing and anticipated poverty levels have implications for all 3 diseases, which are
complexly and systemically related to poverty. Some of these links30 are:

Poverty is associated with food insecurity. Parents of about 30% of all children are unable
to provide nutritious food of adequate quality and quantity and with the required
frequency31. Recent trends also indicate rising food inflation – the food basket has been
particularly influenced by the rising price of maize and grain products 32.

In traditional rural areas, there is a reduction in labour availability, as illness, death,
attendance at funerals, and time spent in care of the sick diverts labour. This labour
diversion is directly linked to food security, as acreages of staple crops planted decrease,
and less attention is given to crops at crucial times.

The extended family absorbs orphaned children at this stage of the epidemic. However as
numbers increase, so households are pushed further into poverty. Government orphan
assistance to families caring for orphans does exist through family grants and options to
waive school fees, but there is limited knowledge of this assistance and major obstacles
exist in the communication and implementation of assistance programmes.
26
The Human Poverty Index results from a formula including non-survival rate to age 40, adult illiteracy rate, people without
access to safe water, population without access to sanitation, under-weight children under age five, and population below
income poverty line (UNDP 2000/01).
27 UNAIDS, 2002
28 SIAPAC, 2002
29 UNDP 2000/01
30 Rural Poverty Strategic Framework report, 2002
31 GRN/UNICEF 2002; MoHSS, 2001a
32
The percentage change in food inflation has risen from just under 8% in 1999, to almost 16% in 2002 (Bank of Namibia,
2002b)
Section III – Page 3
20.
Current political commitment in responding to the diseases (indicators of political
commitment include the existence of inter-sectoral committees, recent public
pronouncements, appropriate legislations, etc.;
20.1
Existence of inter-sectoral committees
20.2

In 1999, the Government of Namibia instituted an Expanded National Response strategy
through the newly established National AIDS Coordination Program (NACOP), which
stipulated a multi-sectoral coordinating mechanism. Specifically, the 1999 National
Strategic Plan on HIV/AIDS (Medium Term Plan II) established two inter-sectoral
committees at central level to deal with the epidemic. These are the National Aids
Committee comprising Cabinet members and the National Multi-Sectoral Aids Coordination Committee (NAMACOC). NAMACOC comprises representation from 12
Government Ministries, the UN Theme Group, NGOs, Parastatals and the Private Sector.
Since 1999, 80% of the sectors have established HIV/AIDS focal points and developed
plans of action.

All 13 administrative regions have a Regional AIDS Co-ordinating Committee (RACOC)
chaired by the Regional Governor. (Please see organisational chart at Annexure A). The
expanded response was also institutionalised in HIV/AIDS-related national policy
documents. In 1999 the government also included TB in the Multi-sectoral National
Response to HIV/AIDS.

In each region, there are Constituency and Regional Development Councils (RDC),
chaired by the Regional Councillors and Regional Governor respectively. The composition
of both the RDCs and the CDCs is multi-sectoral. Duplication between these two regional
structures (i.e. the RACOC and RDC structures) is avoided in that the chairperson of each
is the Regional Governor.
Recent political pronouncements

The President of Namibia continues his decade-long support in the fight against
HIV/AIDS. Describing it in a recent address as a ‘war to be won’, he continued: “HIV/AIDS
infections and deaths have risen to an alarming proportion in recent years. Thus it can no
longer be considered as a health issue alone but a general development issue … We
should therefore all rise to the occasion to halt the further acceleration of this pandemic …
not only … by intensifying our educational campaigns, but also by changing our attitudes
as individuals and communities towards the disease and those infected with it … we
should stop sexual behaviours that put us at risk of infection like promiscuity, alcohol and
drug abuse, and adopt a more supportive attitude to those living with the disease…it is
also important that employers and insurance companies become part of this supportive
system.” As a practical measure, he proposed 33 that doctors trained through public funds
be contracted for long-term service in government hospitals because the “…issue of
quality health care to our people is of paramount importance given the high prevalence of
the HIV/AIDS pandemic which is killing thousands of our people who are in their
productive age.”

The President of Namibia took part in the African Heads of State Summit leading to the
Abuja Declaration of April 2001.

All 13 governors attended the XIII International AIDS Conference in Durban, in July 2000.
A multi-sectoral group led by one of the regional governors attended the ADF 2000 in
Addis Ababa and adopted the Africa consensus and plan of action: Leadership to
overcome HIV/AIDS. The report on this forum was presented and discussed in the
Namibian Parliament.
33
Statement by His Excellency Sam Nujoma President of the Republic of Namibia and President of SWAPO-Party on the
occasion of the official opening of the Central Committee meeting of SWAPO-Party, Windhoek, 9 August 2002
Section III – Page 4
20.3

More recently, the Minister of Health led the Namibian delegation to UNGASS in June
2001. Namibia has officially requested to be a part of the International Partnership against
AIDS in Africa (IPAA), and plans to launch the IPAA in 2002. MoHSS Deputy Minister
attended ICASA (2001) and the IPAA stakeholders meeting.

In February 2001, the UN Secretary General's Special Envoy on HIV/AIDS in Africa, Mr.
Stephen Lewis, visited Namibia on invitation of the government and had extensive
meetings with the President, Ministers from key sectors, senior government officials and
members of the regional authorities.

In the same year, government supported the establishment of an organization for People
Living with HIV/AIDS, called Lironga Eparu.

The National Development Plan II (NDP2), which guides resource allocation for the period
2003-2007, has set as priorities for the nation, the prevention and control of HIV/AIDS,
and disparity reduction in Namibia’s human development34. Also within this context, all
sectors e.g. ministries of defence, education, foreign affairs, and information and
broadcasting, are allocating funds to initiate HIV/AIDS activities.

As part of the resource mobilisation efforts supporting the AIDS medium term plan and
NDP2, a “Menu of Partnership Options” was compiled early in 2002 and launched at
international (African Economic Summit in Durban, South Africa) and national for a by the
Minister for Health. The menu enhances the partnership by private sector organizations in
the fight against HIV/AIDS.

The Government of Namibia is party to the Amsterdam Declaration to Stop TB (2000),
and Namibia is a member of the Southern African TB Control Initiative (SATCI). The
programme has recently undergone an extensive review and a strategic plan has been
drafted earlier during 2002 with assistance from WHO and relevant targets have been
included in NDP2.

In 2000 the President of Namibia participated in and signed the Abuja Declaration on the
Roll Back Malaria initiative. Subsequent to this, government has draft its RBM Strategy.
Targets related to RBM are also included in NDP2.
Appropriate legislation
Namibia’s Constitution is regarded as one of the most liberal on the African continent. It
includes an extensive Bill of Rights and explicitly promotes the welfare and public health of the
people of Namibia. Political commitment to responding to the three diseases is further
reflected in both Namibia’s ratification of several related international conventions and an
internal supportive legislative framework. A list of the relevant legislation is presented at
Annexure C.
Supportive national policies and multi-year strategic plans
34

In March 1999, the President of Namibia launched the second Medium Term Plan (MTPII)
on HIV/AIDS, covering the period 1999 to 2004, and emphasizing both broad multisectoral and sub-regional responses to the epidemic. A mid-term review of MTPII is due
later this year. (A more detailed list of policies and programmes is provided as Annexure
D).

The National Tuberculosis Control Programme was launched through a joint initiative of
WHO and GRN in 1991, using the policy package recommended by WHO and the Union
against TB and Lung Diseases as guidelines for implementation. National Policy and
Guidelines for TB were implemented in 1995; and in 1999 the government included TB in
the Multi-sectoral National Response to HIV/AIDS. An extensive review of the programme
GRN/UNICEF, 2002
Section III – Page 5
was conducted during 2001 and a strategy paper by the MoHSS and sponsored by WHO
has recently been completed35. It sets out a five-year strategic plan [2002-2007] for the
National Tuberculosis Control Programme, and focuses on priority work areas, including
the expansion of the DOTS strategy.

The National Vector-borne Disease Control Programme was established in 1991; and a
National Policy and Strategy for Malaria Control was implemented in 1995. The Roll Back
Malaria Programme was initiated in 2000, and a RBM Strategic Plan has been drafted.

Although not legislation, the Namibian HIV Charter of Rights published December 2000
represents the culmination of a widely consultative process on defining the legal and
human rights of People Living with HIV/AIDS.
21.
Financial context
21.1
Indicate the percentage of the total government budget allocated to health*:

21.2
In the 2000/2001 fiscal year, the MoHSS health budget (recurrent and capital
development) comprised about 12% of total government expenditure. The MoHSS fully
covers recurrent expenditure on health. Out of total development expenditure on health,
the ministry provides around 55%.
Indicate national health spending for 2001, or latest year available, in the Table III.21.2*:
Table III.21.2
Public
Private
Total
From total, how much is
from external donors?
Total national health spending
Specify year: 2001
(USD)
138,078,357.90
120,000,000.0036
258,073,357.90
Spending per capita
(USD)
8,000,000.00 (Approx. 5%)
4.37
75.00
75.00
Government health expenditure has remained static at around 3.7% of GDP for the past 3
years. Total expenditure on health as % of GDP in 1998 was 8.2. In the same year, public
expenditure on health as % of general government expenditure stood at 12%. Also during
1998, more than 90% of expenditure on health in the private sector was by private insurance
companies, which cover around 10% of Namibia’s population. However, more recently funding
trends in the public sector are subjected to considerable stringency. The Ministry of Finance
early in 2001 introduced 3-year rolling budgets as part of a medium term expenditure
framework (MTEF). This framework does not leave room for expenditure increases in the
health sector to the extent required for successfully fighting the HIV/AIDS epidemic. In terms
of the burden on curative health services, funding requirements are due to rise exponentially
over the next four to seven years. In fact, given the very limited funding increase within the
MTEF, as well as an annual inflation rate of around 10%, 37 real funding is declining. At the
same time, and affecting the affordability of imported drugs and other commodities very
negatively, the Namibian Dollar currency, which is pegged to the South African Rand, has
been under considerable pressure on international money markets during the past two years
and the USD/NAD exchange rate has declined from 1 to 6 in 2000 to 1 to 10 in 2002. While
the exchange rate has remained relatively stable at the latter value, there are strong
indications that the currency will further devalue over the medium term, thereby making even
generic ARV drugs unaffordable.
35
Strategic paper National Tuberculosis Control Programme. MoHSS. Sponsored by WHO, 2002
These are funds disbursed by approximately 10% of Namibia’s population and therefore are not relevant to per capita
spending for the majority of the population
37 Bank of Namibia, 2002b
36
Section III – Page 6
21.3.
Specify in Table III.21.3, if possible, earmarked expenditures for HIV/AIDS, TB and/or
Malaria (expenditures from the health, education, social services and other relevant
sectors)**:
Expenditure listed below is largely based on estimates. GRN expenditure estimates on
HIV/AIDS are based on costs of MoHSS HIV/AIDS and reproductive health programmes, on
expenditure related to treatment of opportunistic infections in MoHSS hospitals (assuming
around 40% of all hospital beds are occupied by AIDS related cases), on expenditure by the
Ministry of Women’s Affairs and Child Welfare on OVC (grants and psycho-social support) and
the Ministry of Basic Education, Sport and Culture on HIV/AIDS and life skills education in
schools. Expenditure by NGOs is based on extrapolations from a sample of organisations
based in the capital. Private Sector expenditure listed under HIV/AIDS includes prevention
programmes only. Expenditure figures on HIV/AIDS related curative services provided by
private health service providers are not available.
Table III.21.3
Total earmarked expenditures from government,
external donors, etc. Specify Year: 2001
HIV/AIDS – GRN
Donors
NGO’s
Pvt. Sector
Tuberculosis – GRN
Donors
NGO’s
Pvt. Sector
Malaria – GRN
Donors
NGO’s
Pvt. Sector
Total – GRN
Donors
NGO’s
Pvt. Sector
21.4
In US dollars:
35,000,000
3,700,000
1,500,000
2,000,000
10,000,000
600,000
40,000
50,000
12,000,000
400,000
60,000
100,000
57,000,000
4,700,000
1,600,000
2,150,000
Does the country benefit from external budget support, Highly Indebted Poor Countries
(HIPC) initiatives*, Sector-Wide Approaches? If yes, how are these processes
contributing to efforts against HIV/AIDS, TB and/or malaria? (1–2 paragraphs)**:
In 1999, Namibia was classified as a middle-income country (on the basis of per capita GDP)
and therefore does not qualify for external budget support. However, given the 40%
devaluation of the Namibian dollar on international markets, Namibia would likely be reclassified as a low income country. 90% of the population subsists on slightly more than 1USD
per day. Neither is the country part of the HIPC initiative. Sector-wide approaches are not
being implemented although the education sector is moving in the direction of a commonbasket approach for at least part of its development funding received from external partners.
*
HIPC is a debt-relief initiative for highly indebted poor countries through the World Bank
Optional for NGOs
**
Section III – Page 7
22.
National programmatic context
22.1
Describe the current national capacity (state of systems and services) that exist in
response to HIV/AIDS, TB and/or Malaria (e.g., level of human resources available,
health and other relevant infrastructure, types of interventions provided, mechanisms
to channel funds, existence of social funds, etc.),
GRN health delivery system philosophy and commitment
Since independence, GRN has concentrated on replacing the pre-Independence curative
approach to health service delivery with a comprehensive primary health care based
approach. Increased access to health services has remained a high priority in national
development plans. MoHSS has also re-aligned its organizational structure to accelerate
decentralized health delivery services. A decentralised MoHSS Regional Management Team
manages each of Namibia’s 13 regions. There are 34 public health districts in the country. All
health districts provide a package of essential services, including promotive, preventive,
curative and rehabilitative services for all three diseases. Since independence in 1990, the
MoHSS has considerably extended its physical health infrastructure. Currently, around 80% of
the population lives within 10 km radius of a public health facility.
Human resource and infrastructure capacity
Health services in Namibia are provided by Government working in both urban and rural areas
(70-75%), missions fully subsidized by the Government and working primarily in rural areas
(15-20%), and the private sector, working primarily in urban centres (5%). In total, Namibia
has 35 state hospitals, 12 private hospitals, 37 state health centres and 246 state clinics
providing together 7,653 beds. Despite this network of facilities, many communities,
particularly in sparsely populated rural areas, must depend on mobile outreach services for
health care. MoHSS has 9,000 professional and para-professional posts on its staff
establishment. In addition, it draws on the resources of many internationally recognized
NGOs, well-established local NGOs with extensive volunteer networks at community-based
level and various faith-based organisations (FBOs). At national level, the ministry has a wellestablished National AIDS Coordination Unit with 10 permanent staff. The National TB Control
Programme and the National Vector-borne Disease Control Programmes have 3 and 5
national level staff respectively. These units form part of the Primary Health Care Directorate,
which receives resource management support from the Planning and Finance and Logistics
Directorates. The vast majority of line ministries and private sector organizations have set up
HIV/AIDS focal points or small units. A small number of larger NGO’s, such as Catholic AIDS
Action, Namibia Red Cross Society, Women’s Action for Development, and NAMTA provide
services related to more than one of the respective diseases. There is a large number of small
NGOs, who require considerable capacity-building support in order to provide services beyond
a single location.
Mechanisms to channel funds
Transparency International ranks Namibia second best on the African continent with regard to
‘clean governance’ and corruption. Most donor funds in Namibia are channelled directly to
implementing agencies. Support to government is usually channelled outside the central state
revenue fund. Larger ministries, such as MOHSS and MBESC, have well established Planning
Directorates, which are involved in all aspects of the coordination and oversight of the project
cycle, while specific programme units are usually responsible for the day-to-day administration
of externally funded projects. Funds are usually deposited in a separate and independent
bank account with one of the internationally established banks in the capital city. Some
funding agents transfer funds as an advance into project/programme-specific bank accounts,
for example, the Aids Trust Fund of the MoHSS, and provide further advances after receiving
relevant progress and audit reports from independent external auditors. The latter are usually
auditing firms of good standing and international repute. There are various mechanisms for
project management, but one with proven effectiveness and efficiency and utilized by most
larger projects/programmes is the following: Projects are managed through a management
mechanism, which includes a project office, a project management team for day-to-day
operational decision making, a steering committee, which meets quarterly, includes the
operational level implementing units, and monitors progress of implementation, and a
Supervisory Board, which approves annual reports, work plans and budgets, and takes the
major policy decisions. The respective development partners are represented in all three
Section III – Page 8
bodies and provide financial support for the project management structures and the relevant
project staff.
22.2.
Name the main national and international agencies involved in national responses to
HIV/AIDS, TB and/or Malaria and their main programmes:
CONTRIBUTIONS to HIV/AIDS, Tuberculosis and Malaria
Name
Ministry of Health
and Social
Services
Ministry of
Women Affairs
and Child Welfare
Ministry of Basic
Education, Sport
and Culture
Ministry of
Information and
Broadcasting
Catholic AIDS
Action
Namibia Red
Cross Society
Council of
Churches in
Namibia
SMA (funded by
GTZ and DfID
respectively)
NaSoMa (funded
by KfW Germany)
Namibian
Chamber of
Commerce and
Industry (NCCI)
Type
Govt.
Govt.
Govt.
Govt.
NGO
Main programmes
- National AIDS Coordination
Programme Secretariat
- HIV/AIDS health sector
response, including IEC,
condom promotion and
distribution, PMTCT in two
pilot sites, treatment of OI’s
and HIV/TB co-infection,
provision of counselling
services
- National Tuberculosis
Control Programme, including
treatment
- National Vector-borne
Disease/Malaria Control
Programme, including
treatment
Services for Orphans and
Vulnerable Children and
provision of child and family
welfare grants and
allowances
Promotion of the use of the
female condom
My Future is My Choice
campaign in all schools
Co-ordination of Namibian
HIV/AIDS media (Take
Control) campaign
HIV/AIDS Home-based Care
and OVC
NGO
HIV/AIDS Home-based Care
NGO
HIV/AIDS VCT and social
mobilisation
NGO
Social Marketing of Condoms
and ITNs
NGO
Social Marketing of Condoms
Private
Promotion of HIV/AIDS in the
workplace interventions
Section III – Page 9
Budget (USD)
100,000 per year
28 Million per year
10 Million per year
12 Million per year
3,5 Million per year
10,000 per year
1,5 Million per year
20,000 per year
25,000 per year
800,000 per year
500,000 per year
20,000 per year
200,000 (2001)
700,000 (2001)
100,000 per year
Namdeb Mines
Private
UNICEF
Multi-lateral
UNESCO
UNFPA
UNAIDS
Multi-lateral
Multi-lateral
Multi-lateral
WHO
Multi-lateral
European Union
Multi-lateral
Germany (GTZ)
Netherlands
Finland
SIDA
Bi-lateral
Bi-lateral
Bi-lateral
Bi-lateral
HIV/AIDS in the workplace
(prevention and treatment for
employees)
GRN/UNICEF programme of
co-operation, 2002-2005
(children, adolescents and
maternal care);
500,000 per year
HIV/AIDS social mobilisation,
prevention, access to
services, policy development,
programme development
management, capacity
building
HIV/AIDS social mobilisation,
prevention, access to
services, policy development,
programme development
management
135,000 (2002)
500,000 (2002-05)
HIV/AIDS social mobilisation,
prevention, access to
services, reduction of impact
(discrimination), policy
development, programme
development management
HIV/AIDS capacity building,
policy development,
programme development
management, capacity
building
Technical support to MoHSS
on HIV/AIDS, IMCI, Vectorborne disease control
(Malaria) and TB
Support to MoHSS/NACP in
STI management and
capacity development
Support to public-, NGO- and
private sector on reproductive
health, safe obstetric care
and condom promotion
HIV/AIDS social mobilisation,
prevention, access to
services, programme
development management,
HIV/AIDS social mobilisation,
support to OVC, capacity
building through Health and
Social Sector Support
Programme Phase II
HIV/AIDS social mobilisation,
prevention, programme
development management,
capacity building
Section III – Page 10
130,000 (2001)
157,000 (2002)
103,000 (2002-03)
1, 400 000 (200205)
3,900 000 (2001-05)
690 000 (19972002)
725, 000 (2001)
90,000 (2002-03)
350,000 (2001)
500,000 (20022003)
1,350,000 (2001 –
2004)
2,500,000 (2001-05)
160,000 (2002)
100,000 (2002-05)
100,000 (2001)
700,000 (2000 to
2004)
409,000 (2002)
600,000 (19972002)
Oxfam Canada
French Cooperation
Spanish Cooperation
22.3.
International
NGO
Bi-lateral
Bi-lateral
HIV/AIDS social mobilisation,
prevention, access to
services, reduction of impact
(discrimination), TB DOTS in
one region
HIV/AIDS social mobilisation,
prevention, access to
services, reduction of impact
(discrimination), capacity
building
HIV/AIDS social mobilisation,
access to services,
programme development
management, capacity
building
HIV/AIDS prevention, access
to services, policy
development, programme
development
USAID
Bi-lateral
DFID UK
Bi-lateral
HIV/AIDS social mobilisation
CDC Atlanta
Bi-lateral
HIV/AIDS PMTCT, case
management, M & E
85,000 (2001-02)
200,000 (2001)
1,000,000 (2002 –
04)
25,000 (2001-02)
50,000 (2002-03)
2,250,000 (2001-02)
95,000 (2002)
52,000 (2001-05)
1,700,000 (2002)
300,000 (2003)
Describe the major programmatic intervention gaps and funding gaps that exist in the
country’s current response to HIV/AIDS, TB and/or Malaria (Guidelines para. III.41 – 42),
(2–3 paragraphs):
The total funding gap for the next five year funding period is presented next:
HIV/AIDS
IEC:
Despite relatively high awareness of HIV/AIDS, knowledge of more than one preventive
measure is low in many regions and significant change in behaviour is not taking place. This is
due to the relatively general nature of most awareness raising campaigns and the absence of
a community-based information environment, which amplifies consistent and mutually
reinforcing messages. The challenge is to establish community-based information and
behaviour change communication channels that will cover all 104 constituencies and 13
regions with culturally appropriate messages supported by an effective national information
structure. At a cost of USD 0.5 per capita for IEC related expenditure, particularly at
community-level, total funding requirements per annum are in the vicinity of USD 900,000.
Actual funding in 2001 was less than USD 300,000. Gap: USD 3,000,000.
Condoms:
The estimated demand for condoms in Namibia is around 23 million male condoms per year.
In 2001 around 15 million condoms were distributed. In 2007, it is estimated that 60 million
condoms per year will be required. In five years, 218 million condoms will be needed. Given
the relatively low population density and geographic vastness of the country, there is a
particular need for strengthened logistics and distribution mechanisms. A total funding of USD
17 million is required. MoHSS contributes 4,5 million, leaving a funding gap of of USD 12,5
million.
VCT:
Currently, Namibia has only one VCT centre in the capital city operating on a part time basis.
There is urgent need to expand the number of VCT centres to cover all 13 regions, to
implement a social mobilisation campaign for VCT, to ensure the availability of trained
counsellors, effective laboratory services and reliable referral systems both to health facilities
as well as to community-based support networks. At an average cost of USD 31,25 per VCT
visit (including all services listed listed above as well as pre- and post- test counselling and
Section III – Page 11
test) and an estimated demand of 413,000 VCT visits, the total funding needed is USD 13
million. Government, NGOs and donors contribute USD 2,1 million over the next five years.
The funding gap is therefore USD 11,9 million.
PMTCT PLUS:
Namibia has 35 public and/or mission/NGO hospitals serving around 90% of the population.
However, to date, only 2 of these hospitals (in 2 regions) provide PMTCT services on a pilotproject basis. High demand for the service has been expressed in all 13 regions. There is
need to ensure that all regions are covered with at least one site offering PMTCT in the
shortest possible time, with a further rollout of the programme to cover all 35 hospitals within
the next five years. The cost of the PMTCT PLUS programme f(including HAART) or five
years is USD 46 million. Government and partners contribute USD 4,6 million until the end of
2004. The funding gap is USD 41,4 million.
Case management
Comprehensive medical and palliative care for PLWHAs: To date care for PLWHA in public
hospitals consists of limited counselling services and treatment of certain opportunistic
infections. Capacity for early diagnosis, comprehensive counselling, more extensive treatment
of a larger variety of opportunistic infections, prophylactic treatment to prevent TB co-infection,
improved palliative care and provision of HAART needs to be established urgently in all 35
hospitals in the country. MoHSS and partners contribute USD 12,5 million. The gap is USD 28
million over the next five years.
OVC:
While programme mechanisms for OVC have been established in the past two years,
government relief and grant schemes are inadequately accessible to most OVC and
community and family-based psycho-social support networks are weak in all 13 regions,
particularly in more rural areas. There is need to ensure that all regions and constituencies
rapidly receive support to establish and strengthen community-based coping mechanisms for
OVC. Gap: USD 3,4 million.
Tuberculosis
In the wake of HIV/AIDS, Tuberculosis is an epidemic in Namibia. The need for improved cure
rates and reduced defaulter rates in Namibia is high. Regular follow-up of TB cases, given
Namibia’s vast distances, remains a huge challenge to the National TB Control Programme,
particularly in the high incidence regions. Strong local networks for community-based DOT are
only well established in 3 out of 35 health districts. There is need to rapidly rollout communitybased DOT to all affected regions. This campaign needs to be enhanced by strong social
mobilisation. At the same time the national programme capacity must be strengthened to
better monitor and control the epidemic. MoHSS contributes USD 10 million per year for TB.
The funding gap is USD 3,5 million.
Malaria
Malaria mortality is increasing in Namibia. Reasons for this are inadequate community
awareness, very low coverage with both ITNs (DHS) and residual house spraying, inadequate
coverage with prophylaxis and too late diagnosis and inadequate treatment of cases in health
facilities. In addition, monitoring, research, and programme management capacity is
insufficient to rapidly implement the relevant Roll Back Malaria strategies. MoHSS contributes
USD 12 million per year for malaria. The funding gap is USD 8 million.
Resources sought from the Global Fund complement and are consistent with all relevant
national policies, plans, strategies, and programmes (Annexure D), and also address the
programmatic gaps set out above. Existing infrastructure and human resource capacity in
main sectors is adequate to absorb the additional funds requested (see reply to question
22.1). Also, through its extensive review and proposal preparation process (Annexure F)
Namibia’s CCM has satisfied itself that all partners included in the proposal have an excellent
track record and have the capacity to absorb the additional funding requested.
Section III – Page 12