The Minister of Health, Dr. Bernard Haufiku, had a frank discussion with us about what it’s like to run Namibia’s healthcare system.
But before I write about our meeting, I have a background story.
What I did in January
The past few weeks I’ve been writing essays for medical school, while simultaneously finishing a literature review for grad school. Free to choose any topic, I researched the connections between the obesity and HIV epidemics in Namibia. I found that the prevention of obesity through promotion of a healthy lifestyle would have lasting benefits on the HIV epidemic as well. For example, regular exercise mitigates the serious metabolic and morphological side effects of HIV medication. If the side effects are less severe, a person is more likely to take their medication. This reduces their viral load, and thus reduces their chances of spreading the disease.
These connections were interesting, but the most telling information was the comparison between Namibia’s mortality data and foreign aid money. 25% of Namibians died from HIV in 2012, but another 25% died from the non-communicable diseases (cancer, diabetes, heart disease) associated with an unhealthy lifestyle. Despite this equal mortality burden, in 2012, Namibia received 4.5 million USD for HIV/AIDS spending. This accounts for 86% of the total foreign aid the country received for healthcare in that fiscal year. In the same year, foreign aid agencies gave a mere $104,000 USD for non-disease specific health care funding, (2% of the amount allocated for HIV), and gave $0 to non-communicable diseases.
I concluded that the two epidemics need to stop being addressed separately. Currently each clinic has a separate HIV wing with its own nurses, pharmacies and funding. Dissolving that boundary between the HIV wing and the rest of primary care would benefit the country in few ways. First, it reduce some of the stigma surrounding HIV. It would no longer be possible for people to be identified as HIV positive because of where they go for treatment. Second, those millions of dollars for HIV could be spent making improvements to the healthcare system. A stronger health system is good for everyone, people living with HIV included. Third, a separate HIV program funded by outside donors is not sustainable. If we dissolve it into the primary care system now, HIV prevention and treatment has a safety net if and when that funding dries up.
I finished this paper on Friday, and went to a friend’s house for the weekend.
Fun in Usakos
One of the volunteers there had met the Minister of Health, Dr. Bernard Haufiku, in the airport on their way back from vacation. He had invited her to bring other volunteers to get lunch with him on Sunday. So I cancelled my trip back to Outjo and went with her.
Namibia has a universal healthcare system, so the Minister of Health is in charge of all the public hospitals, clinics, and health programs in the country. He makes policy decisions and is the one working closest with foreign aid donors to decide the future of Namibian healthcare. Basically he’s a big deal. After spending weeks writing a paper to propose a change in policy, I couldn’t believe I would get to pitch it to the most influential healthcare policy maker in the country!
the Minister of Health himself
He chatted with us for two hours about his life, his goals for Namibia, what we do as volunteers, and the challenges we have with the Ministry of Health. Here are some of the things we talked about:
- His biggest goal as Minister is to eliminate mother to child transmission of HIV. Cuba did it earlier in 2016, so we know it is possible.
- His biggest frustration is his lack of ultimate power to control healthcare policies (he didn’t use the words ultimate power, I’m paraphrasing). When he tried to start a tax on sugary beverages, the ministry of finance stopped him. When he tried to fire an unqualified employee, the ministry of labour tied his hands with red tape.
- When I told him about my research, he agreed that HIV treatment should be delivered through primary care, as all other outpatient treatment is. He has already discussed it with PEPFAR, and said they are moving away from the current system. Win!
- He said it’s hard to go home now because people in his village accuse him of witchcraft. How else can a man from a small village become a national leader? It couldn’t have been his academic studies and 40+ years of medical experience, it must have been witchcraft.
- He liked my suggestion that we put a cap on the number of workshops a hospital employee attends each year. Currently, they go to an average of 10 per year, and each one is a week long. This seriously disrupts work flow and delays implementation of the exact public health programs they’re learning about in those workshops.
- He told us he’s heading to India to recruit doctors that have specialized in fields like anesthesiology, gastroenterology, and oncology to come work in Namibia.
Talking about policy to the Minister of Health was really exciting for me. In grad school we had a lot of project simulations that said ‘if you were the Minister of Health and had x amount of money how would you fix problems a b and c’. This time I got to meet the person who changes things with real money, effecting real people. Despite his position compared to ours, he was genuinely interested in answering our questions and hearing our experiences. Having the opportunity to translate my research into real world dialogue has given me some closure to my time in Namibia, and I feel ready to get back to the U.S.