Analytical summary - Universal coverage
The public and private not‐for‐profit health‐care system serves 85% of the Namibian population and is accessed by the lower income population. The private for‐profit health‐care system serves the remaining 15% of the population, consisting of the middle and high income groups.
Organizational framework of universal coverage
Overview of main actors and arrangements related to universal coverage
The 2008 HSSR recommended a feasibility study for universal coverage (free health services through universal insurance scheme), which is one of the principles of the government’s Primary Health Care approach to public health.
Universal access to HIV prevention, treatment, care and support services has been a development priority for the Namibian government for the last 10 years, and is still a goal.
Specific regulatory framework
- Health mapping and geographical coverage
- Health financing strategy towards universal coverage
- Breadth – extending the target population
- Depth – expanding the package of services
- Height – reinforcing protection against financial risk
- Transversal challenges of universal health financing
- Other initiatives towards universal coverage
Barriers on access to health services
The vastness of country causes geographical accessibility challenges, high opportunity cost and lack of transport. Out of the 295 clients interviewed upon exit from the 76 health facilities, 41.5% had travelled for less than 5 kilometres, 27% travelled for 5-10 kilometres, 8% 11-20 kilometres and 13% travelled for greater than 21 kilometres.
Although Namibia is an upper middle‐income country, the socioeconomic inequalities are significant. Policies that remove financial barriers to access to health care exist but need to be strengthened.
Fees vary between different health facilities and range from N$ 4 (clinic level) to N$ 30 (national referral) for state outpatient patients, inclusive of all services received. Foreigners are classified as private patients and this has become problematic especially in regions bordering other countries as people visiting the nearby facilities from our neighbouring countries do not have the means of payment for private services.
Exemption for the payment of user fees is provided for certain services i.e. notifiable diseases, preventive and promotive services and for vulnerable groups such as children under five and pregnant women. Furthermore, its government policy not to turn away patients that are unable to pay and waiver mechanisms is in place. However, the implementation is problematic as the mechanisms for waiver are cumbersome and may deter patients in need of care.
The data series in the 2010 NHA reveal the burden of financing and illuminates fairness of health financing and financial protection particularly with regard to household out-of-pocket expenditures. There is an insurance scheme providing health insurance for public sector employees. Private insurance companies provide health insurance policies for private sector employees. Endnotes: sources, methods, abbreviations, etc.