Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1698835176946.pdf (Namibia)
Honourable Chairperson of the Whole House Committee , Han Members Allow me firstly to sincerely extend a word of gratitude to the Hon.. Minister of Finance, Hon.

Calle Schlettwein as well to Hon Tom in the Presidency of Economic Planning and Alweendo, Minister ·Director General of the National Planning Commission and their staff for preparing and presenting this unique budget for the Financial year is an is unique in the sense that !

2017/2018.
2017/2018.

expenditure - containment budget while still remain pro poor.

in my view it It to moan and groan we see In every threat we will be the least challenges as opportunities.

In this case the Ministry of Health and Social Services is presented with an opportunity to review and re - align our operations and strategies.
There is no doubt that optimal use of available resources shall advance the socio-economic development of Namibia as envisioned in Vision 2030, the 5th ·National Development Plan, the Swapo Party Election Manifesto ·2014 and the Harambee Prosperity Plan.

Honourable Members Despite the challenging economic times and the many competing.
·needs in the health and social welfare sectors, I thought it is prudent :to start my motivation of Vote 13 with some of the gains we have made and the work in progress: The Ministry is in the process of reviewing a number of laws that governs the Health Professional Council, Food and Safety, Blood Related and Human Tissue, Hospitals and Health Facilities, Prevention and Treatment of Substance Abuse, Mental Health and In addition we are anticipating to hold Welfare Organizations.
consultations on the much spoken about Sterilization and Abortion and objective Act of 1975, where we expect comprehensive discussions on th is matter.

To ensure that the Ministry expands its basic service delivery to everyone in Namibia, we have entered in to a number of Memoranda Individuals and of Understanding with Civil Society Organizations, Health Professional Organizations.
These partnerships will address the emerging non- communicable diseases, as well as Road Traffic Accidents, Alcohol and other drug abuses and their consequences.

Through our collaboration with the Ministry of Education, Arts and Culture, we are optimistic that we will be able to further strengthen the school health programmes, which we will impact the prevention, early detection and treatment of diseases among the school going children.
To ensure that Namibia has health professional for the future and to improve service delivery, the Ministry implemented the Human Resource for Health as follows; • Coordinated the placement of eleven (11) Medical Doctors to pursue various Medical Specializations in Tanzania.

• Coordinated applications for fourteen (14) Registered Nurses to in emergency nursing specialization pursue postgraduate paediatric care in South Africa.
1 • Furthermore, a total of 252 students were successfully placed in Cuba to pursue Medicine and Dentistry through our bilateral agreement.

• More than 200 medical graduates completed their trai ning at various medical schools around the world and are expected to commence their internship at our facilities, only if they meet the standards set by the Namibia Health Professional Council.

This standard is to ensure uniformity in terms of both theory and practice of each Graduate.
The ones that might fail to meet the set remedial programme at our hospitals and the UNAM School of Medicine.

requirements will have to undergo a year Honourable Members It is a well - known and much deliberated fact that our health facilities have seen better days and in some instances severely dilapidated.

During the 2016/2017 financial year Windhoek Central Hospital theatre has been upgraded to a world class standard.
Other facilities that receive a facelift are: • Clinics (Queen Sofia, lipandayamiti, Maxwilili, Ngoma, Lusese, Aranos, Utuseb, Ndamono, Omauni and Onangulo) • Aranos and Sesfotein health centers • Usakos outpatient department, Andara Oxidation Ponds, St Mary, Okahandja, Katutura hospital Dental Clinic, Onandjokwe, Keetmanshoop TB unit, Oshakati hospital Ward renovations) We manage to save millions of the taxpayers' money on ART, when we decided to buy directly from the manufacturers, cutting out the 2 middlemen who were charging the government three times compare to our neighbouring countries with similar economic status.
The Ministry continues to ensure implementation of high quality In Prevention of Mother to Child Transmission (PMTCT) services.

line with WHO recommendation lifelong ART for PMTCT (OPTION B+) for all HIV positive pregnant and breastfeeding women.

As a result of PMTCT services, mother-to-child transmission rate in Namibia has been reduced by 1.89%> at 6 weeks and 4.1 % overall including breastfeeding period.
The success of PMTCT programme has resulted in 76%> reduction in new paediatric HIV infections in the country.

On HIV/AIDS the Ministry has managed to maintain 860/0 ART coverage as per National Strategic Framework set targets.

The Ministry conducted the Coalition on Reduction of Harmful Drinking (CORD) Cluster training with 45 regional social workers in treatment and aftercare of alcohol and drug the prevention, dependency programs.
Alcohol and drug abuse remained one of the top social problems attended to by social workers in the MoHSS The Ministry is also tasked with -the administration of the Atomic Energy & Radiation Protection Act.

Out of a total of 261 facilities and practices, with various amounts of radiation sources, radioactive and the Ministry has achieved 700/0 to date in terms of nuclear material, overall assessment for compliance with regulatory requirements.

This is an improvement of 56 % from the preceding years.
With assistance of the Global Fund, we are in the process to revamp the Central Medical Stores and to improve the supply chain of and consumable for health facilities.

Private pharmaceuticals 3 expertise's will design the systems, processes and oversee the thereof and this will enhance the accessibility and management supply of whatever medicine to patient everywhere.

This will curb the massive wastage of pharmaceuticals.
The health sector despite these successes had equally its bits in terms of challenges that hampered the levels of health service delivery in the last financial year: Due to non - performance of contractors there has been delays in practical completion of projects.

For the projects which the Ministry these tenders had to be put on hold for had gone out on tender, prioritization due to the downward revision of expenditure as per the Mid-Year Budget Review.
Service level is an indicator of the Central Medical Stores (CMS) ability to meet the demand for medicines and related products by the health facilities.

During 2016/17 a global service level of 600/0was recorded.

The main reasons which have impeded CMS from achieving the mandate include the following: • Poor supplier performance - mainly failure to meet due dates, which many times results in running out of stock.
• Exchange rate fluctuations - has been cited by suppliers as a failure to meet obligations when the major fluctuations lead to higher cost on their part.

reason for The current personnel structure of the Ministry is 26 years old and is not responsive to the growing population, new and emerging diseases.

Due to lack of funding the Ministry maintained an 890/0of posts filled rate of the very lean current staff establishment.
Through 4 a restructuring process, the Ministry came up with a new structure which was develop through the guidance of scientific tools provided by the World Health Organization.

It is unfortunate that we are still witnessing negative attitudes among the health workers towards the patients.

In addition to the orientation and training of existing staff, the Ministry will continue to engage the training institutions to put greater emphasize on professionalism, empathy and respect of human rights.
Cleanliness of our facilities remains a bone of contention and compromise of hygiene of health facilities.

The Ministry is spending much time and energy on rectifying the situation and encouraging the cleaning staff to perform their duties appropriately with due diligence.

Hon Members, This appropriation will enable us to achieve the following: Due to the huge number of medical graduates, we saw the need to upgrade six additional hospitals to training hospitals.
For these hospitals to be accredited as such we will need to recruit Specialists and equip them with the necessary medical equipment's.

The Casualty Department at the Central Hospital will be revamped and turn into Level 2 Trauma Center.
The Ministry is embarking upon a re-engineering process to streamline service provision from the patient's registration, diagnosis, 5 treatment, of medicine comprehensive software termed E-Health dispensing to discharge, through the Presidential Guided by the recommendation in the Report of Commission on the state of Health in the country we are continuously investing in training of essential health workers in general health care and various specialties.
The Ministry is allocated an amount of six billion, five hundred and fourteen million, five hundred and seventy nine thousand Namibian dollars (N$6,514,579,OOO)of which: Six billion, one hundred and ninety four million, nine hundred and is for eighty tow thousand Namibian dollars (N$ 6,194,982,000) operational expenditure and three hundred and ninety million, five dollars hundred (N$319,597,000) for development expenditure.

This represents 110 of overall government expenditure.
Namibian thousand ninety seven and /0 In respect of revenue collection, for the 2017/2018 FY an amount of Seventy one million four hundred fifty six Thousand Namibian Dollars (N$71 456 000) is estimated, which mainly represents health service fees paid by patients or clients.
The Ministerial strategic pillars for the MTEF period are; talent development and wellbeing, Effective governance Improve infrastructure people Ensure and Communication and resource management, management, Accelerate health 6 stakeholder engagement.
These strategic pillars for implementation are encompassed within the following 4 programmes; PROGRAM 1: PUBLIC HEALTH This programme intends to improve capacity and systems for disease surveillance, epidemiology analysis, data management and control measures including the study of the distribution and patterns of health events, and health characteristics.

The objective is to families and improve and protect communities.
There are specific activities that are aimed at reducing maternal, improve nutrition, mental health, and community based health care, among others.

A total amount of ninety two million, two hundred and one thousand is allocated to this program for Namibian dollars (N$92,201,000) operational expenditures.
infant and child mortality, morbidity, the health and nutrition of PROGRAM 2: CURATIVE AND CLINICAL HEALTH CARE SERVICES The activities under this programme include provision of minimum service package for in-patient and outpatient health care services to match the need of the communities.

The budget allocation to this program is five billion, four hundred and thirty five million, twenty nine thousand Namibian dollars (N$5,435,029,000).
PROGRAM 3: HEALTH SYSTEM PLANNING AND MANAGEMENT The following are the activities that will be addressed under this program: Financial and resource management; human resources and performance management; policy planning, health infrastructure development, health information systems, research and development 7 as well as health technology resort under this programme.
An amount of eight hundred and sixty two million, nine hundred and forty one thousand Namibian dollars (N$862,941,000) is allocated to the program.

Taking into account the state of our health facilities physical infrastructure and the public expectations with regard to improvement of the physical status of health infrastructure, The Ministry will have the challenges expectations within the MTEF period.
in managing these limited resources to meet PROGRAM 4: DEVELOPMENTAL SOCIAL WELFARE The programme is designed to provide activities geared towards the the care for society to leave a dignified life.

The activities include promotion of abuse prevention and treatment, family wellbeing, statutory residential and institutional care.
the destitute, vulnerable and targeted members of substance To address the above activities, an amount of eighteen million, one hundred and eight thousand Namibian dollars (N$18,1 08,000) have been allocated to the program.

Hon Chairperson of the Whole House Committee The motto of doing more with less is our driving force towards continuous provision of affordable, quality health care for all.
The Ministry therefore took the following drastic measures to ensure that quality health care remain our priority; • We reduced the Daily Subsistence Allowance (DSA) budget by 80%, cutting down on international trips and only approve 8 trips that are fully sponsored and attendance of international commitments • We reduced overtime by 80% as we will ensure that all vacant position nursing positions are filled • Pharmaceuticals are reduced by 23%, as we will keep on buying most of our pharmaceuticals in bulk and directly from the manufacturers, while working on how to do away with buy outs • National is reduced by 210/0, we will implement a strict specimen testing requesting regimes which will be done according to the ranks and expertise of the Health Worker Institute of Pathology (NIP) account • No purchasing of new furniture's at all • 600/0 reduction in buying vehicles excluding Ambulances • No newspapers will be bought for staff In conclusion, I would like to thank our development partners and donors namely: The Global Fund, the UN Agencies which include UNAIDS, WHO, UNICEF, UNFPA.
Our gratitude goes to the government and the people of the United stated of American through the following programmes: CDC, PEPFAR and USAID.

Furthermore Individual countries and all other allow me to thank the EU, to our Ministry.

Lastly my stakeholders for their continuous support outmost thanks go to the entire staff of the Ministry of Health and Social Services under the stewardship of the Permanent Secretary.
You are truly in the business of saving lives, healing, caring and with that come great responsibility, diligence and sacrifices.

I wish you all the strength and courage amidst the many challenges.

9 " I now have the honour and privilege to present before you a sum of six billion, five hundred and fourteen million five hundred and seventy nine thousand Namibian dollars (N$6,514,579,OOO)for Vote 13 for your consideration.

I thank you.

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