Mirjam Shihepo
Namibia’s health system in its current form is fragmented, with evident disparities and bears high administrative costs amidst limited fiscal pooling. Her excellency Dr Netumbo Nandi-Ndaitwah’s commitment to promoting equality, social justice, and inclusive development reflects national discourse around Universal Health Coverage (UHC) and social solidarity. While there have been several efforts to revamp public healthcare, including implementation of “Vision April” Phase 1, there has been public outcry regarding the implementation process and sustainability. Many fear that without concrete steps, this vision may risk perpetuating existing disparities within the already bleeding health system. These concerns yearn for a transparent, well-structured approach that bridges aspirations with actionable policies. The desire for transformative change and social cohesion is commendable and requires collective effort to achieve desirable results.
In a move to redefine the social contract, a passionate health professional proposes a transformative healthcare framework titled Shared Prosperity Health Covenant (SPHC) to bridge the gap between national aspirations and the reality of medical access. The framework aims to transform Namibia’s healthcare system from its current fragmented state into a unified, equitable and digitally enabled ecosystem.
This proposed model can leverage strengths and opportunities already existing within relevant offices, ministries and agencies (OMAs) by ensuring no major financial implications are caused to the national budget. The long-term plan for this plan is to gradually transform the Public Service Medical Aid Scheme (PSEMAS) into a National Health Solidarity Fund (NHSF) by establishing a unified, efficient, digitally enabled health ecosystem that will pool resources from government budgets, taxes, and health-specific levies.
The eight (8) paged proposal comprising a revenue generation formula and a phased approach implementation strategy will adopt some of the concepts from two global models, namely India’s Ayushman Bharat and South Africa’s National Health Insurance (NHI) policy, while tailoring it to suit Namibia’s unique needs and economic status.
Drawing aspiration from two global models is not merely a copy and paste but a science of integrating credible models while fine-tuning it to the Namibian context by our local experts through stakeholder engagement and economic projection. These models, when combined, offer scalable, resource-sensitive frameworks adaptable to Namibia’s socio-economic context.
India’s Ayushman Bharat was launched in 2018 and has reportedly redefined digital health capture for a population of over 1.37 billion at the time (now estimated at 1.47 billion). Its core innovation is the establishment of a “Digital Health Stack”, anchored by the National Health ID (NHID). This biometric-linked digital identity creates a longitudinal, portable medical record accessible across all health facilities in rural clinics, district hospitals, and tertiary centres. The digital infrastructure reduced diagnostic redundancies, lowered administrative costs and facilitated data-driven decision-making. It shows that with proper digital infrastructure even resource-constrained settings can deliver extensive health coverage.
Implementing a similar digital backbone in Namibia would involve integrating biometric registration with existing civil registration and biometric systems managed by the Ministry of Home Affairs, Immigration, Safety and Security. This would facilitate seamless health record access, streamline patient management, and enable real-time data collection for monitoring and evaluation purposes. It is recommended that there be coordination between the relevant OMAs, particularly the Office of the Prime Minister, the Ministry of Information, Communication and Technology, the Ministry of Finance and the Ministry of Health and Social Services.
It is commendable that the Ministry of Health and Social Services has launched the National Digital Health Policy (2026-2036). With proper and timely coordination with the legislative arm, implementation of a digital system will not only cut administrative costs, but it will also result in efficiency, data retention, ease of access, and timely treatment and monitoring of the patients. Data will be easily retrievable for proper and accurate decision-making.
South Africa’s NHI bill, which was passed in parliament in 2023, although not yet fully fledged, its intention exemplifies the social solidarity principle, emphasising risk pooling through a single-payer system. It shifts the government’s role from passive provider to active purchaser, leveraging bargaining power to negotiate lower prices for medicines and private hospital services. The aim of South Africa’s NHI is “strategic purchasing”, a concept rooted in health economics that emphasises the government’s role in allocating resources efficiently to maximise health outcomes.
SPHC seeks to emulate this model by consolidating existing health budget allocations of the PSEMAS budget into an autonomous National Health Solidarity Fund. This will be a single-payer entity, pooling resources from general taxation, employer contributions, and health-specific levies. Part of the reform is to negotiate rates with private healthcare providers, contract private facilities that can provide long-term service to the government and ensure equitable access regardless of the socio-economic status of the citizens. This arrangement will ensure the existing gap does not negatively affect patients seeking healthcare, while the government is strengthening its healthcare systems.
Combining these two models provides a pragmatic pathway for Namibia by utilising cost-effective technological infrastructure while ensuring fiscal sustainability and social justice. A stakeholder and technology-inclusive framework like SPHC will improve equity, reduce cost and expand access to quality healthcare for all Namibians, subsequently aligning with national development goals, including economic diversification through natural resource beneficiation, NDP6 goals and Africa Agenda 2063. A successful implementation will lead to a sustainable, efficient, and equitable framework signifying health as a fundamental human right.
*Mirjam is a medical technologist, passionate about public health policy reform and strategic governance. She holds multiple degrees and certificates, such as a BSc in Biomedical Sciences, a Postgraduate Diploma in Clinical Research, an MSc in Medical Pharmacology and an MBA in Management Strategy and is currently completing her PhD in Medical Microbiology at the University of Namibia, focusing on the antimicrobial effects of indigenous medicinal plants. She has over a decade of experience in public healthcare, having worked as a medical laboratory technologist and technical procurement officer at the Namibia Institute of Pathology. Always determined to make a positive change in the healthcare system through collaborative networks. She writes in her personal capacity.
