African Collaborative for Health Financing Solutions Policy brief: Assessment of Health Financing Options in Namibia

UHC is a priority for the government, which seeks to address the country's significant health inequalities. Despite progress in certain health areas, such as a reduction in HIV incidence and tuberculosis prevalence, Namibia's health outcomes are still behind other African upper-middle-income countries in terms of maternal and infant mortality rates. The country's health system is characterized by a parallel health system, where access to well-resourced private healthcare services is limited to those with private medical aid coverage, public service employees, and those who can afford to pay out-of-pocket. The unemployed, poor, and vulnerable populations are restricted to overburdened public healthcare services, which provide health services to 80% of the population with only 49% of total health expenditures. The government's key policy objectives for health financing include improving equity in access to and utilization of quality health services, improving efficiency and effectiveness in the allocation and utilization of scarce resources, and equitable mobilization of health financing. To achieve these objectives, the government can consider various health financing options, including contracting private providers through Public Private Partnerships (PPPs), social contracting, and introducing price regulation in the private sector. Contracting private providers through PPPs can leverage the resources of the private sector to provide services to public sector patients, ensuring equitable access to high-quality health services. This option is highly feasible in Namibia, given the capacity of the well-established private sector and the government's commitment to PPPs. However, it requires the establishment of a PPP unit within the Ministry of Health and Social Services (MoHSS) with the necessary human and institutional capacity to effectively manage and govern PPPs. Social contracting involves delegating the provision of services to NGOs, which can target poor and vulnerable populations living in rural and sparsely populated areas. This option is highly feasible in Namibia, given the country's experience in donors contracting for HIV/AIDS services. However, it requires the establishment of a social contracting unit within the MoHSS with the necessary human and institutional capacity to effectively manage and govern social contracting. Introducing price regulation in the private sector can manage escalating and partially exorbitant fees charged for health services, making private high-quality health services more affordable to poorer populations. This option requires collaboration between the MoHSS and the Namibia Medical and Health Professions Council (NAMAF) to introduce price regulations and ensure that private providers adopt a case-based or capitation system to ensure quality of health services. The implementation of these health financing options requires careful consideration of the opportunities and challenges, as well as the necessary implementation requirements. Phasing implementation based on political negotiations and sequencing is essential to ensure intra-governmental alignment and buy-in, while enabling the MoHSS to play a stewardship role to drive the entire reform agenda.