Partnerships for health development
There is a tension between the often short-term goals of donors, who require quick and measurable results on their investments, and the longer-term needs of the health system. That tension has only heightened in recent years, where the surge in international aid for particular diseases has come with ambitious coverage targets and intense scale-up efforts oriented much more to short-term than long-term goals. Though additional funding is particularly welcome in low-income contexts, it can often greatly reduce the negotiating power of national health system leaders in modifying proposed interventions or requesting simultaneous independent evaluations of these interventions as they roll out.
Harmonizing the policies, priorities and perspectives of donors with those of national policy-makers is an immediate and pressing concern – though with apparent solutions. In addition, the selective nature of these funding mechanisms (e.g. targeting only specific diseases and subsequent support strategies) may undermine progress towards the long-term goals of effective, high-quality and inclusive health systems.
Even where this funding has strengthened components of the health system specifically linked to service delivery in disease prevention and control – such as specific on-the-job staff training – the selective nature of these health systems strengthening strategies has sometimes been unsustainable, interruptive and duplicative. This puts great strain on the already limited and overstretched health workforce. In addition, focusing on "rapid-impact" treatment interventions for specific diseases and ignoring investments in prevention may also send sharply negative effects across the system’s building blocks, including, paradoxically, deteriorating outcome on the targeted diseases themselves.
Many of these issues have been recognized internationally, and a number of donors have agreed to better harmonize their efforts and align with country-led priorities – as outlined in the 2005 Paris Declaration on Aid Effectiveness (see figure). However, although some progress has been made in applying the Paris Declaration principles, it has been slow and uneven. Change in the process and the nature of the relationship between donors and countries requires time, focused attention at all levels, and a determined political will.
This section on Partnerships for health development is structured as follows:
Partner coordination in Namibia is governed by the Partnership Policy of 2005. The Ministry of Health and Social Services (MoHSS) plays a stewardship role in the health sector. Currently, donor coordination in the MoHSS is facilitated by a subdivision: Development Cooperation (SDC) within the division Policy and Planning, directorate: Human Resources Development, Policy & Planning (HRD, P&P) as well as subdivision: Resource Mobilisation and Development Coordination in the Directorate Special Programmes.
HIV, malaria and TB interventions are coordinated by the Directorate of Special Programmes (DSP) Overall, there is inadequate coordination between the various vertical programmes involving partner agencies, as evident in the parallel management of HIV/AIDS and other Primary Health Care programmes . (MoHSS, 2008)
The current approach is built on a number of structures that bring stakeholders with common interests together. These include the quarterly review meetings of the MOHSS and UN Agencies, MOHSS-USG Agencies (PEPFAR) Review meetings, the Inter-Agency Coordination Committee that brings stakeholders together on immunisation, Namibia Coordinating Committee on AIDS, Tuberculosis and Malaria (NaCCATuM), the Country Coordinating Mechanism for Global Fund, the National Alliance for Improved Nutrition (NAFIN) and various technical working groups and task forces, mainly in the area of HIV/AIDS and maternal and child health.
Under the current approach the working system of the various development partners are fragmented with an inevitable duplication of programmes and in some cases in certain regions only. Efforts are underway to establish formal coordination mechanisms in the health sector to ensure that resources are optimally mobilised through sustainable means, effectively coordinated, equally distributed and efficiently utilised in accordance with the MoHSS Policy Framework. (WHO Namibia, 2011; MoHSS, 2008)
United Nations (UN) agencies working in Namibia coordinate their programming through the United Nations Development Assistance Framework (UNDAF) 2006‐10/2010-12, and through the Joint United Nations Team on HIV/AIDS (JUTA). Other coordination mechanisms include the Development Partners Group which brings together bilateral partners, the UN and Government under the co‐leadership of the National Planning Commission (NPC) and the UN.
In 2011 WHO initiated the Health Development Partners Group (HPDG) to improve information sharing, coordination and collaboration in the provision of support to the MOHSS by health development partners and to collectively address critical roadblocks. (WHO Namibia, 2011)
There are two umbrella bodies for NGOs in Namibia: Namibia Non-Governmental Organisation Forum Trust (NANGOF Trust), and Namibia National Aids Support Organisation (NANASO). There is, however, a need to strengthen the coordinating role of these and improve collaboration between them and the Ministry of Health and Social Services.
Currently the largest contributors among the donors and their implementing agencies in the health sector are the President’s Emergency Plan for Aids Relief (PEPFAR), GFATM, UN agencies, Spanish Cooperation, German Technical Cooperation (GTZ), the Finnish Embassy, Synergos and others.
Major health actions carried out through inter-sectoral collaboration include the mainstreaming of HIV, nutrition, environmental health and emergency preparedness and response. Improved coordination between ministries and other sector players is needed in all these areas.
Multi-donor budget support between 2009 and 2012 included substantial funding from Global Fund (over N$ 288 million) and smaller amounts from WHO, UNFPA, and UNICEF, which concentrate on technical support. Namibia’s South-South cooperation agreements for health include those with the Chinese Medical Programme, Cuban Embassy, and Egyptian Embassy. Cuba provides pre-service training for Namibian doctors in Cuba and supplies Cuban doctors who receive an allowance from the Namibian Government.
To date a total number of 844 private health facilities are registered or licensed with the MoHSS and are regulated by the MoHSS 1994 Hospital and Health Facilities Act. The act contains some loopholes and regulations for its implementation are not in place. This allows for the uncoordinated mushrooming of private practices. The private health sector is also guided by the MoHSS policies and guidelines.
Private health facilities include 13 hospitals, 75 primary care clinics, 8 health centres, 557 medical practitioners, which is inclusive of dentists, psychologists and physiotherapist and 75 pharmacies.
The Blood Transfusion Service of Namibia (NAMBTS) is a licensed association (registered under section 21 Company, Association not for gain) that collects and processes blood as stipulated by the National Blood Policy (2007) of the MoHSS.
The Namibia Institute of Pathology (NIP) functions as the national medical laboratory and is the only provider of laboratory testing for the public sector. In general, the private sector and businesses such as Namdeb, Old Mutual, Rotary International, and Standard Bank provide significant technical support, especially during emergency outbreaks or national health events. (MoHSS, 2008)
The National Health Policy Framework 2010-2020 recommends the public-private partnership model to avail new services and technology for the public health system. (MoHSS, July 2010)
Churches and NGOs play a significant role in protecting and promoting the health and social welfare of the Namibian people, as well as operating services on an outsourcing basis. For example, Catholic Health Services (CHS) serves a catchment population of 300,000-350,000 primarily in the rural communities through the operation of 16 health facilities.
More info on FBO and its services would be useful here -- even if only 1-2 lines.