A recent study of health and health care in Namibia concludes that 'a fundamental reorientation' of the South African regime's present health policies and planning concepts will be required, if the needs of the population in an independent Namibia are to be adequately met.
Under SA's illegal occupation, the report argues, health care is inextricably bound up with the apartheid system. The causes of ill health and disease among the black majority can be found, on the one hand in the poverty, uncertain food-supplies, unsatisfactory housing, bad working conditions and inadequate infrastructure characteristic of black Namibian society and on the other, in the racial discrimination, urban bias and bureaucratic elitism which pervade the health services.
All the information in this article is derived from the report: Perspectives for Decolonising Health in Namibia by Gudrun Lachenmann (in Perspectives of Independent Development in Southern Africa – The Cases of Zimbabwe and Namibia, German Development Institute, Berlin, March 1980), and not by research undertaken by IDAF. The report illustrates the difficulties in obtaining accurate statistical information about the living conditions of black Namibians – a problem which is itself a consequence of South African occupation.
Facts and figures illustrating the health of Namibians are hard to come by; South Africa does not co-operate with the World Health Organisation (WHO), and it is not clear to what extent the statistical system for Namibia really functions. Data on morbidity, mortality and life expectancy are not published. The only figures available are overall figures for notifiable diseases (given in the annual White Papers on the activities of the SWA administration), and average figures for the numbers of hospital beds and the number of doctors in different areas (given in the South West Africa Survey published irregularly by the SA Department of Foreign Affairs, the last edition being for 1974).
The report is based on the little secondary health material that is available, supplemented by data collected by the author during a five week visit to Namibia and South Africa in July/August 1978.
Important problem areas identified by the report are: * Tuberculosis, where the incidence rate among blacks is ten times higher than among whites. The highest rate recorded by the report for the period 1974–77 is 10.08 per 1,000 black members of the population in Kavango and Bushmanland. Over Namibia as a whole it is 5.69 per 1,000 black members of the people and for whites, effectively nil.
Tuberculosis has in fact assumed 'alarming proportions' among black Namibians, according to the report. It is a 'typical poor-man's disease', exacerbated by undernutrition and malnutrition, overcrowded living conditions, particularly in urban areas, isolation and lack of treatment facilities. In some areas among the Bushmen, tuberculosis infection rates of 25% have been recorded.
Part of the explanation of the high incidence rates in Namibia lies in the migrant labour system. Contract labourers who contract tuberculosis while in the 'white areas' are obliged to return to the 'homelands'. Here they are cut off from facilities for adequate treatment, while tending to spread the infection further. Screening procedures are often a compulsory part of the process of applying for contract work, meaning that workers tend to look on preventive and curative measures as an 'unwelcome extension of the whole system of white control over their daily lives. Mass boycotts of X-ray and vaccination campaigns and failure to continue with out-patient on hospital treatment, are the result.
- Veneral disease, where although no figures or other official information are available, the problem appears to be quite serious. Rates as high as 10% in Kavango, and 2.1 to 3.78% for blacks in Swakopmund, are reported. 'The root cause of the problem is the contract labour system and the completely disordered social relationships that go with it', the report suggests.
- Infant mortality, where the same causal chain of poverty – malnutrition – bad hygiene and living conditions – ignorance, applies. Infant mortality is 7 to 8 times higher for blacks than for white. As with other health problems, the high infant mortality rate reflects the apartheid system and the complete breakdown of social relations to which it gives rise. Young girls have babies at a very early age, whom they are unable to care for adequately, when they migrate to the towns. Women working as domestic servants for white families have to leave their children with foster parents. The contract labour system prevents the formation of stable family relationships.
- Addictive diseases (drug dependency and alcoholism). Alcoholism is a very widespread problem. Alcohol consumption is directly promoted by the SA regime through state sales outlets and by payment of labourers in kind.
The health services, as in South Africa, are organised on racial lines and characterised by pervasive discrimination. Hospital facilities for whites, Africans and Coloureds are completely separate. In 1978, according to the report, there were between 5.47 and 7.65 hospital beds available per 1,000 blacks and between 9.64 and 9.87 beds per 1,000 whites. In principle, there is a state health service for the black population which provides out-patient and hospital treatment at minimal cost to the patient. Medical care of the white population is in the hands of doctors in private practice, many of whom, as part-time state-employed medical personnel, are also responsible for the care of black patients.
In practice, the lion's share of financial, material and personnel resources goes to the white areas, even though about one half of the population lives in the 'homelands'. Less than 20% of all doctors, for example practice in the 'homelands'. The worst-off sections of the black population in terms of health care, the report concludes, are those living in the peripheral 'homelands' of Kavango, Hereroland, Damaraland, Kaokoveld and Bushmanland. Here the health posts are still mostly mission-run, and the health situation as far as diseases such as tuberculosis and malaria are concerned appears to be stagnant or even worsening.
