18 January 2013

Namibia: Where Is the Health Probe Report?


FIVE months have passed since President Pohamba ordered the commission of inquiry into the state of Namibia's public health sector. The president wanted the commission to report back with their findings within four months. But where is the report?

Chaired by retired Judge Simpson Mtambanengwe, the mostly male commission, with only one woman, consists of an impressive panel of individuals: A retired judge, a former health permanent secretary, a gynaecologist, and a human resources director. However, no policy or technical expert is included. No ordinary citizen or community representative either.

The commission was instituted in the wake of a barrage of negative media reports about the sorry state of Namibia's public healthcare system. With this commission, the first presidential commission for him, not only did President Pohamba appear to demonstrate his political will to tackle Namibia's healthcare crisis, but he also showed there was sudden urgency about this matter.

However, did we really need a commission to investigate what we already know about the nation's public health system? Did we need a commission when we already know that the Katutura State Hospital is going down the drain; when we already know that our public healthcare system largely depends on foreign doctors; and when we already know that there is a skewed health resources distribution between urban and rural areas? It is not that the Ministry of Health lacks policies/programmes, but it is the implementation of these policies/programmes that is found wanting?

I believe, however, that the president's heart is in the right place, and that he is going after a clearly identified problem; a crisis that has astronomical consequences for the country's governance and democracy.

Obviously, it is the president's prerogative to appoint a commission, and the Namibian Constitution gives him that power to do so. And it should be abundantly clear that the very existence of this commission is testimony that the president disagrees with me on this one.

My beef is that the scope of the probe seems too broad for a commission of this type. I am even starting to wonder if what we need in this case is not a different approach, a more technical-oriented approach, than a commission? Does the president want a rigorous and technical report to help him overhaul the whole healthcare system? Or merely a report with some recommendations about what needs to be done, that would tell him what is actually being done and not being done?

So what do you do if you are the health minister? Probably also agree with the president, and welcome the inquiry as the health minister, Dr Richard Kamwi, reportedly has done. So dysfunctional is the public health system that people seemed surprised that his ministry was not affected by the presidential cabinet reshuffle of last year. Political commentators believe the pending outcome of the commission spared him to stay longer in his current ministerial position. This is simply because the president did not want to pre-empt his own commission's finding. So Kamwi's worries, so to speak, are not yet over.

Let's be fair that Namibia's ailing public health is not entirely of Kamwi's making. Previous health ministers, starting with medical doctors Nicky Iyambo and Libertina Amathila, equally share the blame. But his term at the helm of the health ministry has been marked by worsening conditions in most (if not all) of the country's state hospitals, that include a high maternal mortality rate that has been estimated between 60 to 80 deaths per year, with some of these having occurred under dubious circumstances. Disgracefully, the Katutura hospital (the biggest hospital in the country) has now become a microcosm of the appalling conditions in public medical facilities throughout the country.

Please note that I am not saying here that Minister Kamwi is incompetent (the opposite is quite true), but being the person in charge of the health ministry, the buck stops in his office. Therefore, he should own all the failures, including those of his predecessors. Word is that strides have been made since, but why wait for a presidential inquiry to alert you to a crisis that is everywhere - warning signs Dr Kamwi shouldn't have ignored - in the media, doctors' operating rooms, in the patient waiting rooms, and in parliament discussions?

Therefore at the risk of overshadowing the commission's findings, I am curious and keen to see what new information this commission will bring out. But more importantly, I am eager to see their methodology, especially with regard to broader public views, and how their report will predict the political and technical feasibilities, and alternative course for addressing Namibia's health care crisis.

*Ndumba J Kamwanyah is a public policy consultant and an Africa blogger for the Foreign Policy Association.

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