How health clinics in Namibia are destigmatizing HIV and boosting efficiency

By Emma Mbekele

A partnership project between the United Nations Population Fund (UNFPA) and the Ministry of Health and Social Services, with funding from the European Union and the Swedish International Development Cooperation Agency, is being implemented in seven facilities across five regions of the country.

Success of the project has thus far lead to the scale-up of one-on-one attention to visitors at Epako Clinic at the town of Gobabis as a model for other health facilities. The clinic and other project sites have adopted a practice known as ‘one nurse, one patient, one room’, reflecting the quality and confidentiality of care.

“Further evidence from a client satisfaction survey suggests that HIV-related stigma and discrimination have reduced,” the Minister of Health and Social Services, Bernhard Haufiku told UNFPA. “In addition, young people are accessing services easily, and it’s evident in the increased uptake of first time family planning services, which have increased by an overall 14.7 %.”

The results have been so promising, that government has pledged to scale up the model to 73 health facilities in 2017.

Each morning, single mother Elizabeth Kazapua rises at 4:30 to begin her hour-long trek to work at Epako Clinic. There, at the site of a ground-breaking pilot project, she greets and directs visitors by name. Waiting time has been reduced. A measure that showed a decline from about five hours to three hours across the project sites.

“Even if the queue is long, people don’t need to wait that long,” Kazapua said. She makes sure that pregnant, seriously ill and elderly visitors are treated first. Kazapua says the positive results have also given her job satisfaction.

There have also been significant improvements in nurse productivity, and in communication between health providers and patients. Patients are now directed to nurses who can speak their language, and they see the same health staff during each visit, promoting good rapport and follow-ups.

“I am also glad patients are no longer alienated by what they suffer from. This integration process makes my job easier,” Kazapua said.

“I love it here. Every shift I feel motivated,” Kazapua said as she directed a young woman to the pharmacy. Kazapua could easily be mistaken for a nurse – yet she is actually a security guard, one who goes above and beyond her role to ensure that patients are safe and operations are orderly. And she is not alone.

All of the clinic staff are committed to providing sensitive and efficient care, adapting their behaviour as part of a programme designed to increase access to sexual and reproductive health care, including HIV diagnosis and treatment. But conditions at the clinic were not always this way.

For years, the clinic separated out the care provided to HIV patients. HIV care was implemented quickly, and provided apart from other health services. Kazapua said this has gradually lead to destigmatizing of care given and in this case at many other health facilities in Namibia – a practice arising from the influx of donor funding for HIV services that followed the outbreak of the epidemic in the 1980s.

Yet this ended up compromising the confidentiality of HIV-positive patients, who could be easily identified by their visits to HIV-specific clinics and exam rooms. As a result, many people living with the virus were reluctant to seek care.

Today, the HIV epidemic in Namibia remains a serious concern. Among adults, aged 15-49, HIV prevalence is estimated at 13.3 per cent, according to UNAIDS(or 14 per cent, according to a2013 national survey).

And there are challenges in providing sexual and reproductive health care, as well. As maternal death rates rise, with women facing a 1 in 100 lifetime risk of dying from causes related to pregnancy. By comparison, women in Sweden have a 1 in 12,900 risk of dying from maternal causes.

To address these challenges, a major project has been launched to integrate HIV into other sexual and reproductive health care, increasing the number of people served.

Those seeking antenatal care, family planning and other reproductive health services are reached with HIV prevention information and testing, while people seeking HIV information, testing and treatment are reached with other reproductive health care.