‘Why should a woman die while giving life?’

With a population of just two million and a land mass of 824,269 square kilometres, the Southern African country of Namibia has a unique logistical challenge in getting primary health care to its citizens.

“You can drive for hundreds of kilometres and see no-one. Then suddenly, you will reach a village with a population of just 200,” explains Dr Richard Nchabi Kamwi, Namibia’s Minister of Health and Social Services. “They too want a clinic.”

This has particular implications for the infant and maternal death rates in his country, which they are determined to drive down before 2015, the target date for reaching the Millennium Development Goals (MDGs).

“The distances women have to walk from their villages to clinics to access health facilities are too long,” says Dr Kamwi.

Like many countries in Sub-Saharan Africa, Namibia is facing its greatest test in reaching Goals 4 and 5 covering child and maternal health. The maternal mortality ratio almost doubled since 1992, from 225 to 449 per 100,000 live births in 2006. Infant mortality also increased from 38 per 1,000 live births in 2000 to 46 per 1,000 in 2006.

To Dr Kamwi, this is intolerable. “Why should a woman die while giving life?” he asks.

When Namibia conducted a study to find out what was behind these figures, it became the foundation for a rigorous set of health initiatives that have slowly begun to reverse the trend, according to Dr Kamwi.

“The study found that too many women had to travel too far to access skilled health care. Namibia became independent 20 years ago and the health system we inherited was a challenge. The clinics were not local enough. In addition, ambulances were in short supply and only located at district hospitals.”

Dr Richard Nchabi Kamwi, Namibia’s Minister of Health and Social Services.

He explained that as the government began to establish clinics, it became clear that emergency obstetric equipment was also in short supply. And added to this was the limited number of skilled personnel to work in the new clinics and a non responsive minimum district health service package related to emergency obstetrics. With the support of its development partners, Namibia set about building modern health centres to cater for people living in remote areas. These included housing for nurses. Dr Kamwi believes that this is an important factor in attracting and retaining much-needed skilled staff. Ambulances were next on the list. In his own words, the Ministry of Health and Social Services “aggressively purchased” more emergency vehicles. Dr Kamwi says red and white ambulances can now be seen much more frequently on the roads that traverse the vast distances across his country.

“We also set about intensifying communications in almost all of our clinics, so that they can call for ambulances when they need them. And the ministry redoubled its efforts with training, including introducing a special two-year course which school leavers can take in basic nursing and midwifery. In addition, a medical school was established this year to address the chronic shortage of doctors.”

The majority of district hospitals, health centres, and some clinics now have emergency obstetric care equipment. The result of these efforts is that a decline in maternal and infant mortality is expected to be seen, says the Minister.

All this was being done at a time when the country was trying to deal with the devastating impact of HIV/AIDS. Namibia used to have one of the highest rates in the region. Four years ago, the government introduced a national strategic plan to address HIV/AIDS which has resulted in a 7 per cent decline since 2006. The rate is now 15 per cent.

“We used a multi-sectoral approach of governance, which included partnerships with the public and private sectors, the church, civil society and traditional leaders. With the support of the World Health Organization and PEPFAR, the US President’s Emergency Plan for AIDS Relief, we were able to train staff and open a number of clinics specialising in disease control,” says Dr Kamwi.

The Namibian President, Hifikepunye Pohamba, also issued a “clarion call” whereby all politicians received a directive to say something about HIV/AIDS each time they addressed a meeting or rally.

Two years earlier, Namibia had launched an aggressive programme to prevent mother to child transmission of HIV. Says Dr Kamwi, “That programme was the booster. As I speak, Namibia is experiencing transmission rates whereby 97 per cent of babies born to a mother who is HIV positive are born negative.” This is due to antiretrovirals (ARVs) now being available in all 34 district hospitals and all health centres. “There are plans to roll this out to more than 267 clinics. We want to see to it that they too are giving ARVs,” says Dr Kamwi. “All being equal, this is a goal where we have already surpassed targets.”

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• Spotlight on Namibia