Namibia: Corona Exposes Health Inequities and the Marginalisation of the Poor

23 March 2020

The government has gone into overdrive in an effort to contain the spread of the coronavirus since two Romanian tourists tested positive for the virus after landing in the country on Wednesday, the 11 March 2020. The worldwide outbreak of the coronavirus, which has since been declared a pandemic by the World

Health Organisation (WHO), is a cause for concern for all humanity.

However, it also raises issues of ethical concern regarding the Namibian government's commitment to

ensuring the health and wellbeing of all its citizens as envisaged in the country's constitution.

The government's commitment to realising the United Nations Sustainable Development Goals

also comes into question when one juxtaposes the governments seeming reluctance to deal with the

persistent Hepatitis E outbreak which has killed 63 people since it first broke out in 2017 with the hands

on emergency response/approach to the corona virus.

An article published in The Namibian newspaper of 11 March 2020, paints a glaring picture of a crises at

hand if the government does not directly confront and contain the spread of Hepatitis E with the same level of concern it is approaching coronavirus that has so far not claimed any casualties.

Arlana Shikongo, in an article titled "Hepatitis E continues to spread", provides alarming statistics of

"300 cases of Hepatitis E reported in the country since the beginning of the year". Shikongo further states that "in the two weeks preceding the 11 of March 2020, 99 cases of Hepatitis were reported countrywide".

"These cases emanate from the informal settlements of Havana, Goreangab and Hakahana where portable water, sanitation and hygiene is limited," she noted.

According to the WHO Commission on Social Determinants of Health (CSDH), the reduction of health inequities is an ethical imperative that 'requires ministers from all policy domains to consider the impact

of their decisions on the social well-being and health of all Namibians'.

It further advises, "these decisions require a longterm view and sustained political will." President Geingob on a recent visit to Katutura hospital downplayed the appalling conditions at the hospital and said he was satisfied with a condition that most citizens describe as filthy, unhygienic and below humane health standards. Backing up his appointing authority, Minister of Health and Social Services Kalumbi Shangula, attributed the deteriorating infrastructure at the hospital to 'normal wear and tear' given the age of the building. This is withstanding the fact that the ministry has a maintenance budget which could be utilized to keep the hospital in good shape.

Health inequities and the marginalisation of the poor within Namibian society are both avoidable and unfair.

Health inequities which are systemic differences in the health status of different population groups

are the reason why there is a difference in the quality of health care accessed by the poor in comparison to

that accessed by the rich; in other words public versus private healthcare.

The contrast is most apparent when one compares the government's response to corona to its laissez faire

approach to Hepatitis E. Because Hepatitis E is confined to the informal settlements made up of black inhabitants, the values of their lives do not seem to matter to the state and its leadership.

In contrast, the contagious coronavirus, which is less discriminate than Hepatitis E, receives top priority

because government leaders and their families are at risk of infection due to the relative ease with which it

can be contracted and it's non- confinement to areas based on socio-economic or class status.

This begs the question of whether the Namibian government truly considers access to healthcare as a

human right. According to the United Nations Declaration for Human Rights, "everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services."

Classism and economic discrimination in access to healthcare are a reflection of the broader issues that

occur in society. Whether it is access to quality education, access to a nutritious diet or access to land to build a home for oneself and one's own families, these factors all contribute to the health of a nation and have exacerbated the spread of Hepatitis E in the informal settlements of Havana, Goreangab and Hakahana. The outbreak of the corona virus worldwide and its arrival on Namibian soil offers us a chance to pursue social equality and a narrowing of the gap between rich and poor.

Otherwise these inequalities will be transmitted through to the next generation. There is no doubt in anyone's mind that if the coronavirus were to impact Namibia at the scale it did Europe and China our health care system would not be able to cope.

This is evidenced by the fact that the government does not have a contingency plan to deal with the virus but is rather engaged in a knee-jerk reaction hoping that it will not spread any further.

The Ministers of Health, Urban and Rural Development along with the municipalities need to create economic and social conditions that support all people to achieve their potential and this entails making sure all Namibian citizens a have access to housing and adequate healthcare in the event a virus like corona hits alarming proportions like it did in other countries Namibia as a nation state will be better prepared to deal with it.

Once the threat of the coronavirus has subsided, it is imperative that government address the outbreak of Hepatitis E with the same urgency and seriousness in did the coronavirus.

Anything less will be an indication to the population of where the governments' priorities lie.

* Vitalio Angula is a socio-political commentator and independent columnist

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