The health ministry has confirmed a shortage of medicine and drugs at public hospitals, a situation that has left patients distressed, in limbo, and some at the mercy of private health facilities.
The situation has led to calls for improved regulation and overhauled delivery models.
Selma Nghipunya is a 70-year-old pensioner, who has been living with chronic hypertension for 15 years.
She finds herself travelling between hospitals to obtain her complete medication regimen due to shortages at her nearest hospital in Eenhana.
This patient, like many others reliant on public healthcare, has been unable to secure her full suite of necessary medications for two months now.
This has forced her to either pay out of pocket at pharmacies, or face long queues at alternate facilities, away from Eenhana.
Like Nghipunya, many Namibians who rely on prescription medications are grappling with unprecedented challenges.
Over 80% of the Namibian populace relies on public health for their medical needs.
The shortage, affecting everything from anti-retroviral drugs and antibiotics to essential diabetes medications, has stretched across urban and rural areas alike, leaving many patients in distress.
Naemi Michael, a 64-year-old diabetic from Katutura, shares a similar plight.
The pensioner shares her daily struggle with managing her diabetes without consistent access to insulin.
“Some days, I go to the hospital, not knowing if I’ll find my medication,” she said.
Many, like Michael, spend most of their days trying to source medication.
“I have to travel from pharmacy to pharmacy,” Michael said, with a sad face.
Daily risks
The drug shortage, which is attributed to supply chain disruptions and bureaucratic inefficiencies, has had a crippling effect on the nation’s healthcare system.
In some cases, patients like James Shilimela, who suffers from a heart condition, resort to rationing their medications, a risky practice that could lead to severe health consequences.
“I try to spread out my medication to make it last longer, knowing the next batch might be delayed or unavailable,” Shilimela explains.
His doctor has warned him of the risks of skipping medication, but with the current shortages, he feels he has no other choice.
The issue of drug shortages is not confined to chronic medications alone.
Patrick Moses*, a medical professional at Engela District Hospital, said the shortages are unpredictable and vary weekly, which complicates treatment plans and strains the already overstretched healthcare workers.
“We sometimes have to mix medication manually or send patients to buy drugs from private pharmacies, which they can hardly afford,” she added, highlighting the moral and professional dilemmas faced by many medical staff.
Financial implications
The financial implications are severe for patients.
Mercia Goagoses, a patient suffering from alopecia, recounted spending about N$3000 out of her own pocket for prescribed medications unavailable at public hospitals.
“For example, a bottle of Minoxidil [a prescribed medicine] is N$400, and I continuously had to buy it until I saw the results,” she added.
Unemployed and financially strained, Goagoses’ situation illustrates the broader socio-economic impact of the healthcare challenge.
Moses said other times when they run out of options, they buy medication for the patients from private pharmacies.
“This is not an obligation, but we do it from the heart, as we cannot risk the lives of our patients,” she added.
Moses has observed patients experiencing complications due to irregular medication.
“We are seeing more cases of patients coming in with severe complications because they haven’t been able to take their regular doses,” the doctor explains.
“It’s heartbreaking to see, especially knowing that many of these complications could be prevented with consistent treatment,” he added.
Procurement flaws
On the policy and legal fronts, the crisis is exacerbated by the cumbersome procurement process.
Brian Smith, a local physician, criticised the new procurement system as “tedious” and not fit for the urgent needs of the health sector.
“The new procurement process is very tedious. I now have to wait for the new budget to come out – and once it’s out, you need to budget for everything you are going to procure in the next financial year. With health, that can be a bit challenging because I don’t foresee that a generator will break down or medicine will be in shortage before the next supply,” he explained.
The problems extend beyond mere procurement.
“We are facing problems bigger than us,” the doctor continued.
“Poor maintenance of the facilities is a significant issue. For instance, in the case of power outages, not only are you risking decomposed bodies and compromised oxygen supply, but also non-operational kitchens and aggravated conditions for psychotic patients.
“Sometimes, the generator isn’t working, and we have no maintenance system in place. Now we must run around like headless chickens trying to get solutions through emergency procurement,” he added.
These procedural delays and maintenance failures lead not only to drug shortages but also to a broader range of complications within healthcare facilities, according to the doctor.
“Currently, the ministry of health is not recognised as an essential service, which is ironic because during the Covid-19 pandemic, we were regarded as essential workers,” the doctor lamented.
“If we were recognised as such, we could procure ourselves with our own budgets and prioritise better,” he said.
The absence of an effective system means hospitals often find themselves unprepared for emergencies.
“There was an incident where a patient was stung by a scorpion, and they had systemic envenomation. We didn’t have the necessary scorpion venom antidote, so we had to refer them to a specialist, which involved more expenses and logistical challenges due to a lack of available ambulances,” he explained.
Red tape
The situation has not only left patients in distress, but health minister Kalumbi Shangula too.
Shangula acknowledged the challenges posed by the current procurement laws, highlighting how bureaucratic red tape hampers timely service delivery.
“We are left with no suppliers because the bidding process, managed by the Central Procurement Board of Namibia (CPBN), takes so long, and decisions are often contested, leading to further delays,” Shangula explained.
Before the CPBN’s establishment, public procurement was managed by the Tender Board of Namibia.
However, this system faced numerous challenges, including allegations of corruption, inefficiencies and a lack of transparency.
While the new procurement system might have enhanced transparency, Shangula noted its lengthy nature impedes service delivery in his ministry.
“Currently, we don’t have suppliers from whom to buy because the bidding is conducted by the CPBN. It takes so long, and when a decision is made, other bidders investigate the offers, escalating it to the review panel and later to the court,” Shangula said.
Consequently, the ministry is left without any suppliers for medicines.
Court brawls
Recently, the ministry’s supply of anti-retroviral medication was delayed after a local company, Africure Pharmaceuticals, sought a court order to prevent CPBN and the health ministry from entering into a contract with any supplier of anti-retroviral medication.
Shangula said the bureaucratic maze not only delays the procurement of essential medicines but also leaves the healthcare system in a bind.
The health ministry’s hands are tight.
“We only wait to be told that you can order from this or that company. There is nothing we can do right now because we can’t change the law,” he said.
The ministry also faces high costs and logistical challenges associated with emergency procurement.
“We buy them at emergency procurement at a very high cost, in small quantities and they last for just a week before running out again,” he detailed.
Middlemen
Adding to this discourse, former health minister Bernhard Haufiku highlighted another dimension of the problem – the role of medical middlemen, also known as tenderpreneurs.
He has been an ardent critic and opponent of the involvement of tenderpreneurs in public procurement.
While he supports local businesses participating in government bids, he said the involvement of middlemen has often led to inflated prices and raised ethical concerns.
Haufiku is convinced the ministry is well-positioned to directly engage with pharmaceutical manufacturers worldwide to purchase most, if not all, of their essential medicines.
“Vaccines can also be directly purchased from manufacturers at a negotiated price,” he added, noting that most pharmaceutical manufacturers recognise the public sector’s significant role in health.
“Unlike middlemen, who are there to create unreasonable profit margins,” he explained.
He also highlighted the financial implications of the current system, where public hospitals often refer patients to private facilities due to inadequate services.
“The cost of care in the private sector seems to have no ceiling,” he commented, suggesting that investment in public healthcare capacity could reduce reliance on the private sector and save substantial amounts of public funds.
For example, Haufiku explained, if a state patient requires magnetic resonance imaging (MRI), which is now a standard part of care, it costs around N$20000 per patient in the private sector.
“Some of these tests are performed two to three times, for instance, if a patient is suspected of or diagnosed with intracranial bleeding that does not immediately require surgery (craniotomy),” he said.
This can amount to N$60 000 for one patient, which he said is unsustainable.
The former minister proposed a hybrid system for pharmaceutical procurement that combines direct purchases from manufacturers for essential drugs with a transparent local bidding process for other medical supplies.
Dose
Health executive director Ben Nangombe also highlighted the inherent complexities of the procurement process.
“Procuring medicine is quite complex due to various factors that may delay the timely availability of required medicines,” Nangombe said.
He detailed issues such as suppliers failing to deliver after being awarded contracts and last-minute price changes by manufacturers, which often lie outside the ministry’s control.
To address these non-delivery issues, the ministry has begun imposing liquidated damages on suppliers who fail to meet their contractual obligations.
“We charge a penalty for each day you are late, and we deduct this from the payment due to you,” he stated, hoping to incentivise timeliness and reliability among suppliers.
Like Shangula, Nangombe also reiterated the ongoing challenges with legal disputes over procurement processes.
“When procurement activities are initiated and bids are received and evaluated, awards are granted to a particular company. Then, if the process is challenged in court, the delivery of medicine is delayed until the matter is resolved,” he said.
In discussing strategies to overcome these procurement challenges, Nangombe mentioned initiatives for direct purchasing from manufacturers, especially in countries like Egypt and Kenya.
“We are currently in the process of signing a memorandum of understanding with the Egyptian counterpart to the Namibia Medicine Regulatory Council to explore direct purchases of medicines from that country rather than sourcing from outside the continent,” he revealed.
While this approach may bypass various middlemen, he noted their services would still be required in some instances.
“You don’t visit a Toyota factory in Japan to buy a vehicle. Similarly, sometimes you have to purchase medicines from local companies. That’s just the nature of the market,” he explained, highlighting the practical challenges of direct procurement given Namibia’s relatively small market.
Furthermore, the executive director said the ministry is actively investing in local healthcare infrastructure to lessen dependency on costly private sector referrals.
“We have begun establishing dialysis centres across the country and are expanding ICU capacities in district hospitals,” he added.
This initiative is part of a broader N$16 billion five-year plan aimed at strengthening the public health sector to make healthcare more accessible and affordable for all Namibians.
NB: Pseudonyms were used to ensure the anonymity of the doctors, as they are not permitted to speak to the media.
This work was produced with support provided by the Wits Centre for Journalism’s African Investigative Journalism Conference and supported by the Bill and Melinda Gates Foundation.
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