Strengthening Namibia’s Health System for a Sustainable HIV Response

Namibia has made great progress in its long journey to end HIV as a public health threat. It is one of the first high-burden countries to nearly control the epidemic, has almost met the UNAIDS 95-95-95 targets, and recently celebrated eliminating mother-to-child HIV transmission. 

With USAID support, Namibia achieved these milestones through strong policies and a focus on sustainable HIV interventions. The U.S. Department of State’s Bureau of Global Health Security and Diplomacy, at the 2024 PEPFAR Annual Meeting, honored Namibia for its leadership and success in the HIV response.

USAID and PEPFAR are helping Namibia achieve and maintain epidemic control, in part, by supporting the government in strengthening its health systems that support the HIV response. Three key areas where health system strengthening and HIV work overlap in Namibia are country leadership, data-informed decision-making, and financial sustainability. 

Country Leadership to Sustain the Response

Countries leading their HIV programs are better positioned to sustain efforts even if external funding or support decreases. The Namibian government leads the planning and implementation of key strategies and reforms for its health system as well as its HIV response. USAID supports these efforts by embedding technical advisors within the Ministry of Health and Social Services.

The advisors, working with USAID projects like the Local Health System Sustainability Project (LHSS) and Meeting Targets and Maintaining Epidemic Control (EpiC,) work alongside government staff, providing hands-on support that incorporates their expertise into the local context. Together, they prioritize the areas of support needed, with the advisors providing essential inputs for senior leaders to make critical decisions. This technical support helps the government build a stronger, more sustainable health system and improve the leadership and management of Namibia's HIV response.

Data-Informed Decision-Making for a Sustainable Health Workforce

Strong data systems assist health managers to assess staffing needs, identify training gaps, and strategically allocate support, equipping and empowering the workforce to advance the HIV response. 

Through USAID support, the Namibian government is using the Integrated Human Resource Information System (iHRIS), a digitized information system for managing the health workforce. Implemented in Namibia by USAID partner Open Development, iHRIS is a scalable and adaptable tool that is interoperable with other information systems, allowing for sustainable improvements in workforce management, even as health demands change. iHRIS has improved the ways the Namibian government plans, hires, deploys, and manages resources across the country, from the use of a paper-based system to a digital, modernized one.

Since its adoption of the system, human resource management and information technology personnel from all 14 regions of the country and all five major public hospitals have received training to use iHRIS for health workforce planning and decision-making. Health managers and planners can now more easily identify the greatest needs, equitably distribute resources, and advance the country’s push for HIV epidemic control.

Sustainable Financing for Health Service Delivery

As Namibia approaches epidemic control, it needs to mobilize sufficient and stable funding from Namibian sources.

USAID’s support for sustainable health financing, via the Abt Global-implemented LHSS project, includes the introduction of social contracting, a way for governments to fund civil society organizations to implement HIV services. Social contracting, once operationalized in Namibia, will be employed to increase access to quality care among communities that are vulnerable to HIV and that may be hard to reach. This will help Namibia to sustain HIV interventions that have typically been funded by donors, like USAID.

USAID is also now working with Namibia’s Ministry of Finance and Public Enterprises to help expand social contracting to other ministries. This includes those that currently receive funding from USAID to address the social determinants of HIV.

Social contracting will enhance the efficiency, effectiveness, and sustainability of HIV and other health interventions in Namibia, contributing to improved health outcomes and a sustainable, resilient health system. 

USAID’s support, through PEPFAR, in strengthening the health system in Namibia helps lay the foundation for sustaining the HIV response, as the country continues to work towards epidemic control. The country is making progress in reaching its HIV goals, with 93% of people knowing their HIV status, 95% of those diagnosed getting treatment, and 98% of those on treatment having their viral load controlled.

Investments to improve health system performance and financial sustainability will help the Namibian government continue to both lead and deliver HIV prevention, care, and treatment programs. These programs continue to reduce transmission, maintain access to treatment, and continue to improve health outcomes for people living with HIV.

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ABOUT THE AUTHORS: Jennifer Jackson is the Senior Communications Advisor in USAID’s Office of Health Systems. Ellen Langhans is the Communications Branch Chief in USAID’s Office of HIV/AIDS.