The HI virus is reversing strides Namibia has made in improving children’s health. The country was well on its way to reducing child mortality, but over the past decade the pandemic has annulled previous gains.
Experts believe HIV/Aids will delay Namibia’s child health development by at least six years. As a result, Namibia is highly unlikely to decrease child mortality by two-thirds by 2015, a target the country set itself when it committed to reaching the Millennium Development Goals (MDGs).
To bring the country back on track, civil society organisations have called for improved access to basic health care services, better maternal and neonatal care and urgent programmes to fight poverty and hunger.
Although child mortality decreased slightly several years ago, the positive trend started to turn around in 2000. Child mortality went up from 62 per 1 000 live births in 2000 to 69 per 1 000 live births in 2006, while infant mortality went up from 38 per 1 000 live births to 46 per 1 000 live births in the same time period, according to the country’s 2006/07 Demographic Health Survey.
”Based on current trends, it is unlikely that Namibia will reach the MDG 4 target of reducing child mortality,” said Olivia Lawe-Davies, the communications officer of the World Health Organisation (WHO) child and adolescent health and development department.
The setback is mainly caused by HIV/Aids.
”Half of all deaths of children under five happen due to HIV-related symptoms, such as immune deficiency, diarrhoea, pneumonia, malnutrition, low birth weight and pre-maturity,” explained United Nations children’s fund (Unicef) Namibia country representative Ian McCleod.
He believes it will take ”at least until 2021” for the country to reach MDG 4. ”Namibia would have been able to meet the goal if particular attention had been paid to neonatal health once the HIV pandemic hit the country,” McCleod said.
The impact of HIV on child health is particularly strong because of lack of access to health care services and high poverty levels, according to NANGOF, a Windhoek-based NGO consortium.
”Namibia has a good health policy framework, but our failure is to translate it into practice and enforce it. Our health system is not prepared to handle the HIV epidemic,” said NANGOF executive director Anna Beukes. ”We are losing all the good work that has been done so far.”
Access to primary health care remains highly unequal in the country, leaving the poorest parts of society without meaningful basic health care provision and causing high rates of poverty-related preventable deaths, especially among expectant mothers and children under five.
”Socio-economic indicators have a gender and age dimension, affecting women and children more severely,” said Beukes.
Yet Namibia spends a considerable part of its annual budget on health. Six percent of the country’s gross domestic product — about $77 per capita — goes towards health care. This is far above the WHO recommended $34 per capita for low- and middle-income countries.
However, Namibia’s Health Department spends the bulk of its budget on administration. ”From 10 000 health workers in the country, only 3 000 are doctors and nurses, with the remaining 7 000 being people employed as ancillary staff and administrators,” said Beukes.
As a result Namibia is ranked 189th out of 191 countries in a WHO global assessment of health sector efficiency, which compared health spending with actual service delivery.
”The health care sector is deteriorating. People in rural areas, which make up 85% of the population, lack access to basic and maternal health care,” explained Beukes.
Another reason for rising child mortality has been an upsurge in maternal mortality, which has had a direct, negative impact on children’s ability to survive. The number of Namibian women who died during pregnancy, delivery or shortly after giving birth has doubled within only six years. Maternal mortality went up from 227 per 100 000 live births in 2000 to 449 per 100 000 live births in 2006, a Department of Health and Social Services study found.
A parent’s death has a direct impact on a child’s ability to survive. ”There is a three- to tenfold increase in the risk of a child dying within five years of being orphaned,” said McCleod. ”If more parents stay alive, more children are likely to stay alive, too.”
In 2006 the country, which has a population of two million, was home to 250 000 orphans and vulnerable children, a number that more than tripled within just five years. Half of Namibia’s orphans have lost their parents to Aids.
This is why civil society organisations point out that child health cannot be treated as an issue independent from social ills, such as poverty, unemployment, hunger and sanitation. ”The impact of HIV and Aids has been greater than is recognised, especially on the rural population,” said independent consultant Andrew Harris.
The death or illness of breadwinners has had huge impact on families who depend on subsistence farming, plunging them into poverty, he explained: ”People are struggling to feed themselves, and HIV has had a direct impact on this.”
NANGOF agrees with Harris’ call for better services and social safety nets to support communities weakened by HIV/Aids. ”Only if a person’s basic needs are fulfilled is there a basis for health development,” said Beukes. ”If a child is integrated in a strong community structure, it has much higher chances to survive.”