RESOURCES: PUBLICATIONS

BEN Namibia report the first Namibian initiative to focus on the impact of transport on health service access

Read the report

Transport has a crucial role to play in increasing Namibian communities’ access to health services, particularly for people living with HIV/AIDS (PLWHA).

Research conducted by the Bicycling Empowerment Network Namibia in partnership with the International Community of Women Living With HIV/AIDS and the AIDS Law Unit from the Legal Assistance Centre, from August to October 2007, demonstrated that there is strong need for intersectoral initiatives to provide appropriate and affordable transport solutions to patients and health workers in the country.

Funded by Yelula/U-khâi, the National Paralegal Association, and with the technical support of GEO Business Solutions, the assessment took place in two regions. Omusati, a communal region on the northern border with Angola, is one of the most populated regions in the country, with more than 12 people per km². The southernmost region of Karas has less than one person per km², and is formed mostly of commercial farms.

The methodology combined qualitative data collected at local and national level, and existing quantitative data. Focus groups and semistructured
interviews were conducted with informants on the demand and service provision side, as well as with local authorities.

As the first Namibian initiative focusing on the impact of transport on health service access, the assessment raised a range of issues that can be addressed at different levels.

While the relationship between transport and health is clear, the route to solving transport problems is not so straightforward.

Although there is wide awareness in Namibia that lack of transport is a barrier to accessing services, transport itself has always been treated as a peripheral
issue. Since transport limitations have not been properly qualified or quantified, addressing them has never been a priority on the national agenda.

Lack of appropriate and affordable transport hinders individual access to health facilities. Transport costs combined with medical fees represent a burden to
PLWHA, particularly women, who spend between N$20 and N$40 every month to collect medications, directly affecting treatment adherence. Participants
in the research consider 5 km the reasonable distance to access treatment, however 77 per cent are more than 20 km away from the nearest health facility.

Lack of reliable transport is a barrier to emergency care, when transportation depends solely on patients’ capacity to access cash. Rural dwellers pay up to
N$400 to reach hospital in an emergency. Transport is also an important yet underestimated component in the drug distribution system. Initiatives to promote effective decentralisation such as mobile clinics and improved mobility for healthcare community volunteers are still ad hoc and uncoordinated.

Recommendations focus on the need to involve stakeholders at all levels of the supply and demand chain. Cooperation between health and transport
policy-makers, local communities, health workers and PLWHA are crucial in order to develop a holistic approach to access to health services.