Namibia Stands Close to Adopting Universal Health Coverage Policy
Long-stalled effort gains traction through stakeholder collaboration
The Government of Namibia can point to many strengths in its health system. Tax-funded, public health services cover over 80 percent of the population, with most services available for free or minimal charge. A well-developed private health system funded through voluntary insurance covers about 20 percent of people. And there is a large network of primary health care facilities spread across the vast but thinly populated country, with links to district, regional, and referral hospitals.
Nevertheless, there are gaps — notably in the quality and availability of care, both of which can vary — and until recently, there was little energy behind efforts to develop a policy to guide improvements. A draft universal health coverage (UHC) policy crafted by a Ministry of Health and Social Services unit in 2019 received no external input and was never endorsed by ministry leadership.
A breakthrough came when the USAID Local Health System Sustainability Project (LHSS) began working with the Ministry of Health in 2022. Applying project approaches to collaboration and co-creation, LHSS assisted with a stakeholder mapping exercise to identify the broad set of players whose support would be critical to approving and implementing a UHC policy. Then LHSS helped the ministry bring these stakeholders together for a series of meetings where open and honest communication was encouraged and welcomed.
The diverse group, including some who were initially skeptical that consensus was possible, listened to the ministry’s vision for UHC, discussed their views, and offered feedback to the ministry. Participants that were initially focused on their own interests warmed to the process of working together. Side discussions occurred spontaneously as rapport grew between groups that rarely see eye to eye. By the end of one particularly productive weeklong workshop, the stakeholders were ready to divide into seven technical working groups to hammer out provisions for specific aspects of a UHC policy.
This stakeholder engagement approach to formulating the policy was a stark contrast to the well-meaning but isolated efforts of the ministry in the past.
“One of the remarkable aspects of the drafting process was its inclusivity,” said L’oreal Tjiueza, Manager of Insurance & Medical Aid Funds for the Namibia Financial Institutions Supervisory Authority. “Involving health care professionals, policymakers, regulators, medical aid funds, civil society organizations, and representatives from diverse organizations ensured a comprehensive understanding of the challenges and opportunities in health care.”
Priorities for action
The results of the collaborative effort are embodied in a new draft UHC Policy Framework that lays out the main challenges facing Namibia’s health system and how the country will go about addressing them. It prioritizes four areas for action:
- Remedying gaps in quality of care, such as extended waiting times for patients and lack of patient-centered care in the public health sector
- Addressing persistent health disparities associated with limited access to health care services for people in certain geographic areas and socioeconomic groups
- Ensuring widespread availability of preventive and promotive health services at the community level and specialized care at the national level
- Strengthening domestic public health sector financing to sustain and improve access to equitable, quality services for those who rely on public health services
Following a public comment period that recently concluded, the next steps are to finalize the policy and gain approval from Ministry of Health leadership and the Cabinet of the Government of Namibia, a process expected to be completed by early 2024.
Like his counterpart Ms. Tjiueza, Albert Tjaronda of the Ministry of Health’s Policy and Planning Directorate praised the broad stakeholder engagement that revitalized the UHC policymaking effort. “Collaborating with partners and stakeholders to develop our country’s universal health coverage policy offers the advantages of shared expertise, increased access to resources, and a more comprehensive and sustainable healthcare system that ensures better health outcomes for all citizens,” he said.
