Cardiovascular Journal of Africa: Vol 31 No 4 Supplement (July 2020)

AFRICA

Cardiovascular Journal of Africa • Volume 31, No 4 August 2020

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have been developed, with a unit in the MoHSS responsible

for these diseases or conditions.

However, no dedicated

budget is available to ensure its implementation. Although a

prevention and control strategy for RHD has been introduced,

and a national advisory committee established, progress

has been slow.

16,17

A national surveillance programme, the

Demographic and Health Survey, has been reported but with

very little information on CVD. The warfarin education/

surveillance programme is ongoing and has reported successes

(SF, pers commun). Windhoek Central Hospital is the only

public health facility in Namibia with a warfarin clinic.

Namibia follows the WHO best-buy policies regarding

tobacco use and has formulated a national tobacco control

plan and multi-sectoral co-ordination mechanism for

tobacco control.

The Ministries of Health and Education, along with other

organisations, implemented the Health Promoting Schools

Initiative, which has successfully improved the health of

all people from the school environment.

In Namibia, CVD

consumed the largest proportion of total spending on NCD,

which was 22% in the 2015/16 and 18% in the 2016/17

fiscal years.

Namibia was part of the WHO-CHOICE project, which

incorporated a cost-effectiveness modelling tool that gathers

national data to be used for developing the most effective

interventions for leading causes of disease burden. The

model can be adjusted according to the specific needs of the

country and assist policymakers in planning and prioritising

services at a national level.

Assessment of policy response

Legislation mandating health financing for CVD/NCD has

been recommended as the government is aware that CVD

costs can be high and consume a large portion of a country’s

health expenditure.

In the Namibian Essential Medicines

list of the MoHSS, essential CVD medicines on the list have

to be purchased from suppliers at the lowest possible prices

and provided at affordable costs.

However, medicine is

heavily commercialised and the government spends more

than R100 million outsourcing services from the private

sector, downplaying services that ought to serve masses

(FS, pers commun).

The country has policies that ensure equitable nationwide

access to healthcare professionals and facilities

but none

that address the screening of high-risk CVD individuals.

Yet no judicial orders protecting patients’ rights and

mandating improved CVD interventions, facilities, health-

system procedures or resources have been implemented. A

few policies do address individual interventions, such as

tobacco and alcohol use, and PA.

Since October 2011, Namibia has not yet submitted

another framework convention on tobacco control (FCTC)

report.

At that time the country reported having banned

smoking in all public places including indoor workplaces

and all forms of tobacco advertising, through the policy.

Clear and visible warnings according to requirements and

measures to protect tobacco control policies from tobacco

industry interference were also mandated.

No sustainable

funding is available for CVD from taxation of tobacco

or other sin products, and also no excise tax of the final

consumer price of tobacco products in Namibia.

There are no taxes on unhealthy foods or sugar-

sweetened beverages. Although no information was found

for the percentage of excise tax of the final consumer price

of alcohol products, excise taxes were increased from 22

February 2018 on ciders, alcoholic fruit beverages, malt

beer and sparkling wine by 10%, unfortified wine and

spirits by 8.5% and fortified wine by 6.0%. These alcoholic

beverages are classified under ‘sin’ taxes. An additional 5%

national ‘sin’ tax on alcohol and tobacco products will also

be introduced for national revenue purposes.

Legislation exists on banning the marketing of unhealthy

foods to minors

but none mandating clear and noticeable

warnings on foods that are high in calories, sugar or saturated

fats. Namibia developed a food and nutrition policy to

improve food and nutrition,

as well as one that addressed

physical inactivity through mass media awareness.

Stakeholder action

In Namibia, non-governmental organisation (NGO)

advocacy for CVD policies and programmes as such has not

been demonstrated. However, NGO involvement through

NCD and related risk factors has indirectly been reported.

Although no involvement of patients’ organisations in the

advocacy for CVD/NCD prevention and management has

been reported, there is a patient-led ambassador/advocacy

group Namibia for rheumatic fever and RHD.

Involvement of civil society organisations (CSO) in the

development and implementation of a national tobacco

control plan and CVD prevention and control plan was

also reported in the FCTC report.

24,29

No CSO involvement

in the national multi-sectoral co-ordination mechanism

for NCD/CVD was documented. No specific activities by

cardiology professional associations were reported that aim

at a 25% reduction in premature CVD mortality by 2025,

although Namibia was represented at the 65th World Health

Assembly in 2012.

Hypertension screening by businesses at

workplaces have been addressed.

As part of the data collected for Namibia, the following

strengths, threats, weaknesses and priorities are summarised.

Strengths

Namibia has a strong political will, with legislation and

policies such as the FCTC in place. The MoHSS supported

the training of several Namibian doctors and allied staff in

cardiovascular care. At the World Health Assembly in 2018,

Namibia endorsed the adoptionof theResolutiononRheumatic

Fever and Rheumatic Heart Disease.

Implementation of

programmes in response to the NCD disease burden is being

addressed through innovative interventions, and there is good

infrastructure. Central and regional medical stores are also

available to ensure the availability of safe and efficacious

medicines. However, many essential drugs are still not

available in government pharmacies.

A patient-driven awareness campaign, the Namibian RHD

Ambassador programme, aims to empower people with