Assessment of Health Financing Options in Namibia

The country has a parallel health system, with private healthcare services accessible to those with 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 over-stretched public healthcare services, which account for 80% of the population but only 49% of total health expenditures. The government is the major source of funding for non-HIV health services, but there is a critical need for sustainable domestic financial resource mobilization for HIV/AIDS. Donors provide substantial contributions for HIV/AIDS, but have indicated their intention to reduce funding support due to Namibia's upper middle-income status. To maintain control of the epidemic, Namibia needs to identify ways to mobilize more sustainable domestic financial resources or increase the efficiency and equity with which available resources are allocated and spent. The definition of universal health coverage (UHC) incorporates principles of equity, accessibility, efficiency, and quality, which align with the Namibian government's broader political goals. Health financing mechanisms can serve as tools to assist the government in achieving progress towards UHC, while leveraging broader political priorities. The key policy objectives identified through stakeholder consultations include improved equity in access to and utilization of quality health services, improved efficiency and effectiveness in the allocation and utilization of scarce resources, and equitable mobilization of health financing. The African Collaborative for Health Financing Solutions (ACS) was requested to perform an assessment of the health financing options available to the Namibian government. The assessment objectives include assessing health financing options, including revenue generation, pooling of resources, and purchasing arrangements, to determine their feasibility within the Namibian context. The assessment aims to evaluate the feasibility of these options in making progress towards the UHC agenda and contributing towards the country's priorities, while outlining requirements for the implementation of suitable health financing reforms. The assessment reviews a set of health financing options available to the Namibian government, including revenue generation, pooling of resources, and purchasing arrangements. The options are evaluated for their feasibility in achieving UHC and their impact on the priorities of improved equity, efficiency, and equitable mobilization of health financing. The assessment aims to provide recommendations for the implementation of suitable health financing reforms that can secure sufficient domestic resources to sustain the HIV/AIDS response and meet the broader health financing objectives of the government. The government allocations to health for the period 2021/22-2023/24 are outlined in Table 1, which shows a steady increase in allocations over the three-year period. The contributions to PSEMAS by government and civil servants are also presented in Table 2, which shows a significant increase in contributions over the period. The combined health insurance revenues and expenditures are presented in Table 3, which shows a steady increase in revenues and expenditures over the period. The assessment of health financing options in Namibia is critical to securing sufficient domestic resources to sustain the HIV/AIDS response and meet the broader health financing objectives of the government. The evaluation of these options will provide recommendations for the implementation of suitable health financing reforms that can improve equity, efficiency, and equitable mobilization of health financing.