Browsing by Author "Van Rooy, Gert"

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    Combining survey data, GIS and qualitative interviews in the analysis of health service access for persons with disabilities
    (2018) Eide, Arne H.; Dyrstad, Karin; Muthali, Alister; Van Rooy, Gert; Braathen, Stine H.; Halvorsen, Thomas; Persendt, Frans C.; Mvula, Peter; Rod, Jan Ketil
    Background: Equitable access to health services is a key ingredient in reaching health for persons with disabilities and other vulnerable groups. So far, research on access to health services in low- and middle-income countries has largely relied on self-reported survey data. Realizing that there may be substantial discrepancies between perceived and actual access, other methods are needed for more precise knowledge to guide health policy and planning. The objective of this article is to describe and discuss an innovative methodological triangulation where statistical and spatial analysis of perceived distance and objective measures of access is combined with qualitative evidence. Methods: The data for the study was drawn from a large household and individual questionnaire based survey carried out in Namibia and Malawi. The survey data was combined with spatial data of respondents and health facilities, key informant interviews and focus group discussions. To analyse access and barriers to access, a model is developed that takes into account both measured and perceived access. The geo-referenced survey data is used to establish four outcome categories of perceived and measured access as either good or poor. Combined with analyses of the terrain and the actual distance from where the respondents live to the health facility they go to, the data allows for categorising areas and respondents according to the four outcome categories. The four groups are subsequently analysed with respect to variation in individual characteristics and vulnerability factors. The qualitative component includes participatory map drawing and is used to gain further insight into the mechanisms behind the different combinations of perceived and actual access. Results: Preliminary results show that there are substantial discrepancies between perceived and actual access to health services and the qualitative study provides insight into mechanisms behind such divergences. Conclusion: The novel combination of survey data, geographical data and qualitative data will generate a model on access to health services in poor contexts that will feed into efforts to improve access for the most vulnerable people in underserved areas.
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    Core concepts of human rights and inclusion of vulnerable groups in the disability and rehabilitation policies of Malawi, Namibia, Sudan and South Africa
    (Journal of Disability Policy Studies, 2012) Van Rooy, Gert
    In recent decades, there has been a push to incorporate the World Health Organization “Health for All” principles in national, regional, and local health policy documents. However, there is still no methodology guiding the appraisal of such policies with regard to the extent that they address social inclusion. In this article, the authors report on the development of EquiFrame, a novel policy analysis framework that was used to evaluate the disability and rehabilitation policies of Malawi, Namibia, Sudan, and South Africa. The policies were assessed in terms of their commitment to 21 predefined core concepts of human rights and inclusion of 12 vulnerable groups. Substantial variability was identified in the degree to which the core concepts and vulnerable groups were featured in these policy documents. The overall summary rankings for the disability policies of the countries studied were as follows: Namibia–High, Malawi–Low, and Sudan–Low. The rehabilitation policy of South Africa was ranked as Low. The results support the idea that adequate disability and rehabilitation policies remain mostly undefined. EquiFrame may offer a useful methodology for evaluating and comparing human rights and social inclusion across policy documents.
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    Core concepts of human rights and inclusion of vulnerable groups in the disability and rehabilitation policies of Malawi, Namibia, Sudan, and South Africa
    (2012) Mannan, Hasheem; McVeigh, Joanne; Amin, Mutamad; MacLachlam, Malcolm; Swartz, Leslie; Munthali, Alister; Van Rooy, Gert
    In recent decades, there has been a push to incorporate the World Health Organization “Health for All” principles in national, regional, and local health policy documents. However, there is still no methodology guiding the appraisal of such policies with regard to the extent that they address social inclusion. In this article, the authors report on the development of EquiFrame, a novel policy analysis framework that was used to evaluate the disability and rehabilitation policies of Malawi, Namibia, Sudan, and South Africa. The policies were assessed in terms of their commitment to 21 predefined core concepts of human rights and inclusion of 12 vulnerable groups. Substantial variability was identified in the degree to which the core concepts and vulnerable groups were featured in these policy documents. The overall summary rankings for the disability policies of the countries studied were as follows: Namibia–High, Malawi–Low, and Sudan–Low. The rehabilitation policy of South Africa was ranked as Low. The results support the idea that adequate disability and rehabilitation policies remain mostly undefined.
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    Core concepts of human rights and inclusion of vulnerable groups in the mental health policies of Malawi, Namibia, and Sudan
    (2013) Mannan, Hasheem; ElTayeb, Shahla; MacLachlan, Malcolm; Amin, Mutamad; McVeigh, Joanne; Munthali, Alister; Van Rooy, Gert
    BACKGROUND: One of the most crucial steps towards delivering judicious and comprehensive mental health care is the formulation of a policy and plan that will navigate mental health systems. For policy-makers, the challenges of a high-quality mental health system are considerable: the provision of mental health services to all who need them, in an equitable way, in a mode that promotes human rights and health outcomes. METHOD: EquiFrame, a novel policy analysis framework, was used to evaluate the mental health policies of Malawi, Namibia, and Sudan. The health policies were assessed in terms of their coverage of 21 predefined Core Concepts of human rights (Core Concept Coverage), their stated quality of commitment to said Core Concepts (Core Concept Quality), and their inclusion of 12 Vulnerable Groups (Vulnerable Group Coverage). In relation to these summary indices, each policy was also assigned an Overall Summary Ranking, in terms of it being of High, Moderate, or Low quality. RESULTS: Substantial variability was identified across EquiFrame’s summary indices for the mental health policies of Malawi, Namibia, and Sudan. However, all three mental health policies scored high on Core Concept Coverage. Particularly noteworthy was the Sudanese policy, which scored 86% on Core Concept Coverage, and 92% on Vulnerable Group Coverage. Particular deficits were evident in the Malawian mental health policy, which scored 33% on Vulnerable Group Coverage and 47% on Core Concept Quality, and was assigned an Overall Summary Ranking of Low accordingly. The Overall Summary Ranking for the Namibian Mental Health Policy was High; for the Sudanese Mental Health Policy was Moderate; and for the Malawian Mental Health Policy was Low. CONCLUSIONS: If human rights and equity underpin policy formation, it is more likely that they will be inculcated in health service delivery. EquiFrame may provide a novel and valuable tool for mental health policy analysis in relation to core concepts of human rights and inclusion of vulnerable groups, a key practical step in the successful realization of the Millennium Development Goals.
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    Core concepts of human rights and inclusion of vulnerable groups in the Namibian policy on Orthopaedic technical services
    (2012) Van Rooy, Gert; Amadhila, Elina; Mannan, Hasheem; McVeigh, Joanne; MacLachlan, Malcolm; Amin, Mutamad
    Purpose: Despite a highly progressive legislation and clear governmental commitment, living conditions among persons with disabilities in Namibia are systematically lower than among persons without disabilities. This implies that persons with disabilities are denied equal opportunities to participate and contribute to society, and consequently are denied their human rights. Methods: EquiFrame, an innovative policy analysis framework, was used to analyse Namibian Policy on Orthopaedic Technical Services. EquiFrame evaluates the degree of stated commitment of an existing health policy to 21 Core Concepts of human rights and to 12 Vulnerable Groups, guided by the ethos of universal, equitable and accessible health services. Results: A number of Core Concepts of human rights and Vulnerable Groups were found to be absent in the Namibian Policy on Orthopaedic Technical Services, and its Overall Summary Ranking was assessed as Moderate. Conclusion and Implications: The Namibian health sector faces significant challenges in addressing inequities with respect to its policy on Orthopaedic Technical Services. If policy content, or policy ‘on the books’, is not inclusive of vulnerable groups and observant of core concepts of human rights, then health practices are also unlikely to do so. This paper illustrates that EquiFrame can provide the strategic guidance for the reform of Namibian Orthopaedic Technical Services policy, leading to universal and equitable access to healthcare.
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    Disaster risk reduction in the Omusati and Oshana regions of Namibia
    (2013) Amadhila, Elina; Shaamhula, Loide; Van Rooy, Gert; Siyambango, Nguza
    Namibia often experiences heavy rains in the north and north-eastern parts of the country, which results in severe flooding. For this reason, the country has endorsed the Hyogo Framework for Action (HFA) which seeks to develop the resilience of nations and communities to disasters and to assist countries to move away from the approach of emergency response to one of integrated disaster risk reduction. The aim of this article is to assess the resilience of the communities within the identified regions. A quantitative questionnaire was designed to assess people at risk of disaster related impacts. The questionnaire used 20 indicators to measure the level of progress at local level and how local governance plays a role in the mitigation and management of disasters. Analysis of data was done on a limited number of descriptors such as age, gender and local governance involvement, amongst others. There was generally a very high perception of threat (38%) in the study regions. Women perceived threat more accurately (mean = 4.09) than men. The community perceived threat more accurately than local government and civil society (mean = 4.08).
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    Dislike for schooling as risk factor for teenage pregnancy: Development of a hypothesis using data from a study conducted on understanding factors associated with teenage pregnancy
    (African Journal of Reproductive Health, 2022) Van Rooy, Gert
    This paper is informed by the data extracted from a study conducted by the Multidisciplinary Research Centre (MRC) in 2014, titled, ‘Understanding Factors Associated with Teenage Pregnancy in Namibia’ that focused on 602 boys and 2875 girls aged between 14 to 22 years of age. The aim of the paper was to test the hypothesis of dislike of school as a catalyst to teenage pregnancy. The analysis of the paper is based on 1,393 school learners that were all female. In testing the hypothesis both univariate and multivariate regression analysis were used. No clear associations were found between dislike of school and attitudes and behaviours (outcome measures) which may predict the risk of subsequent teenage pregnancy except for alcohol use and parental employment. Parental employment as proxy for socio-economic status emerged as a significant predictor of unhappiness at school while higher levels of alcohol use predicted higher odds of dislike of school. Interventions to promote youth satisfaction with schooling should be based on longitudinal research to inform effective policy and practice.. (Afr J Reprod Health 2021; 25[6]: 58-67).
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    EquiFrame: A framework for analysis of the inclusion of human rights and vulnerable groups in health policies
    (2011) Amin, Mutamad; MacLachlan, Malcolm; El Tayeb, Shahla; El Khatim, Amani; Swartz, Leslie; Munthali, Alister; Van Rooy, Gert; McVeigh, Joanne; Eide, Arne H.; Schneider, Marguerite
    Ensuring that health policies uphold core concepts of human rights and are inclusive of vulnerable groups are imperative aspects of providing equity in health care, and of realizing the United Nations’ call for Health for All. We outline the process of extensive consultation undertaken across countries and stakeholders culminating in the development of EquiFrame, in conjunction with its associated definitions of core concepts of human rights and vulnerability. EquiFrame is a systematic policy analysis framework that assesses the degree to which 21 core concepts of human rights and 12 vulnerable groups are mentioned and endorsed in health policy documents. We illustrate the scope of the framework by reporting the results of its application to two health policy documents from (Northern) Sudan: the rather generalist Health Policy of (Northern) Sudan, and the more specific National Drug Policy of (Northern) Sudan. We outline some limitations of the framework and highlight issues for consideration in its interpretation. EquiFrame offers a systematic approach to analyzing and facilitating the inclusion of core concepts of human rights and vulnerability in existing or developing health policies and ultimately to promoting greater equity in health care.
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    Equitable access to healthcare services for people with disability in the regions of Khomas and Kunene
    (University of Namibia, 2018) Van Rooy, Gert
    This dissertation investigated equitable access to healthcare services for people with disabilities in selected health facilities in both the Khomas and Kunene regions of Namibia. The research question guiding the analysis was based on factors that hamper equitable access to health care for people with and without disability. This was done by addressing some contextual and personal factors within the parameters of the International Classification of Functional Disability and Health (ICF) model with a specific intention to establish if those factors inhibit access to healthcare. The mixed approach was used for data collection. A thematic analysis was used for the qualitative data collection, while household surveys were used, based on the themes that emerged from the qualitative data, for the quantitative approach. Participants of the study were drawn from health care facilities of selected clinics in the catchment area (the Khomas and Kunene regions). Each of the 947 cases included an individual with a disability and an individual with no disability, referred to as the control. By using the equitable framework (based on the ICF model), for analysis, the findings of the dissertation indicate that there are no major problems for vulnerable groups in receiving healthcare, since everyone had access to it, instead access to health care is limited by some major barriers for some people with disabilities (PWD). On the other hand, not only are PWD faced with barriers, they also experience activity limitation, in seeing, hearing, walking, remembering, self-care and communication, factors that are treated as independent variables in this study. Of these factors, seeing was recorded as the main barrier for those PWD who had ‘some difficulty’ (36.1%) or ‘a lot of difficulty’ (22.6%). In terms of dependent variables, ‘lack of transport from home to the healthcare facility’ scored the highest in Kunene, followed by ‘affordability of transport’. ‘Negative attitudes of healthcare workers’, ‘standard of healthcare facility’, and ‘inadequacy of drugs and equipment at healthcare facility’ were also among the ‘serious/insurmountable’ problems cited by PWD in the Kunene region. PWD also reported satisfaction with the time spent waiting, confidentiality and knowledge of healthcare providers at the health care facilities. In conclusion, the combination of many factors (contextual and personal) as per the ICF model, created barriers to accessing healthcare services. These could be too challenging to overcome, even with well-functioning, locally-based healthcare services in a given area. The availability of good healthcare tends to vary inversely with the population it serves. The study presents a modified access barriers and satisfaction model that support vertical equity for PWD. This was because PWD did have greater health care needs when they visited the health care facilities.
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    Equity and core concepts of human rights in Namibian health policies
    (2013) Amadhila, Elina; Van Rooy, Gert; McVeigh, Joanne; Mannan, Hasheem; MacLachlan, Malcolm; Amin, Mutamad
    Delivering health services to vulnerable populations is a significant challenge in many countries. Groups vulnerable to social, economic, and environmental challenges may not be considered or may be impacted adversely by the health policies that guide such services.We report on the application of EquiFrame, a novel policy analysis framework, to ten Namibian health policies, representing the top ten health conditions in Namibia identified by the World Health Organization. Health policies were assessed with respect to their commitment to 21 Core Concepts of human rights and their inclusion of 12 Vulnerable Groups. Substantial variation was identified in the extent to which Core Concepts of human rights and Vulnerable Groups are explicitly mentioned and addressed in these health policies. Four health policies received an Overall Summary Ranking of High quality; three policies were scored as having Moderate quality; while three were assessed to be of Low quality. Health service provision that is equitable, universal, and accessible is instigated by policy content of the same. EquiFrame may provide a novel and valuable tool for health policy appraisal, revision, and development.
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    Experiences and perceptions of barriers to health services for elderly in rural Namibia: A qualitative study
    (2015) Van Rooy, Gert; Mufune, Pempelani; Amadhila, Elina
    We investigate barriers to accessing health facilities (e.g., transportation and cost of services) and health service delivery barriers (e.g., timeliness of services scheduling of appointments, language) that the literature suggest are operative. Semistructured interviews were utilized with respondents in three purposefully selected regional research sites in Namibia. All questions were translated into local languages. It is found that although many senior citizens appreciate the use of modern health care and are exempted from paying health care consultation fees, they still prefer to use traditional health medicine because of the long distance to health care facilities, which when they decide to travel translates into high transportation costs. Referrals to hospitals become very expensive. There is a need to consider the unique issues (extended family system) affecting access to health care for elderly people in Namibia to achieve equitable access to health care services
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    Experiences and perceptions of HIV/AIDS and sex among people with disabilities in Windhoek, Namibia
    (Springer, 2014) Van Rooy, Gert
    The aim of this study was to investigate the experiences of people with disabilities (PWD) with regard to issues of sexuality and HIV/AIDS. More specifically, we investigate how PWD perceive social and sexual relationships, how they experience sexual and reproductive health (SRH) care including HIV/AIDS. This study relied on key informant (5) interviews and focused group interviews (FGDs). The three FGDs consisted of midlevel to senior officials (5), females with disabilities (5) and a mixed group of males and females with disabilities (12). The study supports the view that PWD experience differential treatment within extended families. The public has negative attitudes towards PWD who engage in sex in general and female PWD who fall pregnant particularly. It largely supports the literature that PWD are at great risk of physical and sexual abuse and are often denied reproductive rights. It points to the difficulties PWD find with HIV/AIDS education as a lot of the materials is not written in Braille or otherwise fail to take into account the different disabilities. People with disability also face problems accessing reproductive health services because of the negative attitudes of healthcare providers. There is a need for the government and society to focus on the SRH of PWD if the fight against HIV/AIDS is to succeed. There is also need to focus on PWD in the context of sexuality if the inalienable human rights and freedoms of all its citizens including PWD is to be realized.
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    Factors affecting safe sex practices among first year students at the University of Namibia: A health belief model perspective
    (2014) Van Rooy, Gert; Mufune, Pempelani; Indongo, Nelago; Matengu, Keneth K.; Libuku, Erica; Schier, Christa
    The aim of the study was to investigate the level of awareness of condom usage among first year’s students at the University of Namibia. Data was collected among 578 students within the various disciplines of the university through self-administered questionnaires that tested their knowledge, attitude and beliefs regarding HIV and AIDS. Research assistants were at hand clarifying ambiguities during the completion of the questionnaire. To ensure a good response rate, the researcher arranged with lecturers for students to complete questionnaires during lecture periods. A multi-stage sampling technique was used - in the first instances the number of campuses were purposefully recorded and stratified in accordance with the subjects offered and then students were randomly selected from the various faculties. Data was analysed using SPSS version 21. Results indicate that 80.1 % of the students are using condoms with their partner (s) while 76.3% used a condom during the past 12 month’s preceding the survey.
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    Factors related to environmental barriers experienced by persons with and without disabilities in diverse African settings
    (2017) Visagie, Surona; Eide, Arne H.; Dyrstad, Karin; Mannan, Hasheem; Swartz, Leslie; Schneider, Marguerite; Mji, Gubela; Munthali, Alister; Khogali, Mustafa; Van Rooy, Gert; Hem, Karl G.; MacLachlan, Malcolm
    This paper explores differences in experienced environmental barriers between individuals with and without disabilities and the impact of additional factors on experienced environmental barriers. Data was collected in 2011±2012 by means of a two-stage cluster sampling and comprised 400±500 households in different sites in South Africa, Sudan Malawi and Namibia. Data were collected through self-report survey questionnaires. In addition to descriptive statistics and simple statistical tests a structural equation model was developed and tested. The combined file comprised 9,307 participants. The Craig Hospital Inventory of Environmental Factors was used to assess the level of environmental barriers. Transportation, the natural environment and access to health care services created the biggest barriers. An exploratory factor analysis yielded support for a one component solution for environmental barriers. A scale was constructed by adding the items together and dividing by number of items, yielding a range from one to five with five representing the highest level of environmental barriers and one the lowest. An overall mean value of 1.51 was found. Persons with disabilities scored 1.66 and persons without disabilities 1.36 (F = 466.89, p < .001). Bivariate regression analyses revealed environmental barriers to be higher among rural respondents, increasing with age and severity of disability, and lower for those with a higher level of education and with better physical and mental health. Gender had an impact only among persons without disabilities, where women report more barriers than men. Structural equation model analysis showed that socioeconomic status was significantly and negatively associated with environmental barriers. Activity limitation is significantly associated with environmental barriers when controlling for a number of other individual characteristics. Reducing barriers for the general population would go some way to reduce the impact of these for persons with activity limitations, but additional and specific adaptations will be required to ensure an inclusive society.
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    Here comes the water: Risk assessments, observation and knowledge of Ompundja village
    (2019) Shaamhula, Loide; Van Rooy, Gert
    Floods in Namibia are more pronounced than drought or any other natural disaster. Ompundja village in northern central Namibia has experienced severe flooding over the last decade since the village is a catchment area of water from two distinct sources, that is, the Cuvelai system and the Efundja. Data were collected from households based on an action learning cycle. The cycle starts from context, observation, knowledge and action. A questionnaire based on 14 indicators of the action learning cycle was used to collect the needed information. Answers were recorded on a scale of 1–5, with 1 = not at all and 5 = comprehensively. In terms of the scoring, results indicate that disasters are a common phenomenon in this area. The main contributing factor is not so much of high levels of rainfall but water from the flooding basin. The flooding basin in this regard is mostly the catchment area of water from the two distinct sources, that is, Cuvelai system and the Efundja. In addition, the village also gets flooded because of the poor strategic planning and the lack of resources that would enhance fundamental changes in the livelihood of the local community. For the community to tackle disaster issues, their average score was 3.325. In terms of observation, they scored 3.667. For their involvement in risk assessments, for knowledge (traditional) and for disaster management, the score was 3.25. The same score (3.25) was observed for action and disaster mitigation as well. Based on the findings of this study, it can be concluded that communities struggle to deal with floods whenever they occur. They experience difficulties in obtaining resources as in most cases disaster is mostly viewed as a top-down approach. Communities cannot make their own decisions and in most cases traditional knowledge is discarded. Thus, it is recommended that traditional knowledge should be explored extensively in order for the community to become self-reliant.
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    Hypertension in sub-saharan Africa: cross-sectional surveys in four rural and urban communities
    (2012) Hendriks, Marleen E.; Wit, F.W.; Roos, Marijke T.; Brewster, Lizzy M.; Akande, Tanimola M.; De Beer, Ingrid H.; Mfinanga, Sayoki G.; Kahwa, A.M.; Gatongi, Peter; Van Rooy, Gert; Janssens, Wendy; Lammers, Judith; Kramer, Berber; Bonfrer, Igna; Gaeb, Esegiel; Van der Gaag, Jacques; Wit, T.F.; Lange, Joep M.; Schultsz, C.
    BACKGROUND: Cardiovascular disease (CVD) is the leading cause of adult mortality in low-income countries but data on the prevalence of cardiovascular risk factors such as hypertension are scarce, especially in sub-Saharan Africa (SSA). This study aims to assess the prevalence of hypertension and determinants of blood pressure in four SSA populations in rural Nigeria and Kenya, and urban Namibia and Tanzania. METHODS AND FINDINGS: We performed four cross-sectional household surveys in Kwara State, Nigeria; Nandi district, Kenya; Dar es Salaam, Tanzania and Greater Windhoek, Namibia, between 2009–2011. Representative population-based samples were drawn in Nigeria and Namibia. The Kenya and Tanzania study populations consisted of specific target groups. Within a final sample size of 5,500 households, 9,857 non-pregnant adults were eligible for analysis on hypertension. Of those, 7,568 respondents $18 years were included. The primary outcome measure was the prevalence of hypertension in each of the populations under study. The age-standardized prevalence of hypertension was 19.3% (95%CI:17.3–21.3) in rural Nigeria, 21.4% (19.8–23.0) in rural Kenya, 23.7% (21.3–26.2) in urban Tanzania, and 38.0% (35.9–40.1) in urban Namibia. In individuals with hypertension, the proportion of grade 2 ($160/100 mmHg) or grade 3 hypertension ($180/110 mmHg) ranged from 29.2% (Namibia) to 43.3% (Nigeria). Control of hypertension ranged from 2.6% in Kenya to 17.8% in Namibia. Obesity prevalence (BMI $30) ranged from 6.1% (Nigeria) to 17.4% (Tanzania) and together with age and gender, BMI independently predicted blood pressure level in all study populations. Diabetes prevalence ranged from 2.1% (Namibia) to 3.7% (Tanzania). CONCLUSION: Hypertension was the most frequently observed risk factor for CVD in both urban and rural communities in SSA and will contribute to the growing burden of CVD in SSA. Low levels of control of hypertension are alarming. Strengthening of health care systems in SSA to contain the emerging epidemic of CVD is urgently needed.
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    Incidence of HIV in Windhoek, Namibia: Demographic and socio-economic associations
    (2011) Aulagnier, Mariele; Janssens, Wendy; De Beer, Ingrid H.; Van Rooy, Gert; Gaeb, Esegiel; Hesp, Cees; Van der Gaag, Jacques; Tobias, Rinke
    OBJECTIVE: To estimate HIV incidence and prevalence in Windhoek, Namibia and to analyze socio-economic factors related to HIV infection. METHOD: In 2006/7, baseline surveys were performed with 1,753 private households living in the greater Windhoek area; follow-up visits took place in 2008 and 2009. Face-to-face socio-economic questionnaires were administrated by trained interviewers; biomedical markers were collected by nurses; GPS codes of household residences were recorded. RESULTS: The HIV prevalence in the population (aged.12 years) was 11.8% in 2006/7 and 14.6% in 2009. HIV incidence between 2007 and 2009 was 2.4 per 100 person year (95%CI = 1.9–2.9). HIV incidence and prevalence were higher in female populations. HIV incidence appeared non-associated with any socioeconomic factor, indicating universal risk for the population. For women a positive trend was found between low per-capita consumption and HIV acquisition. A HIV knowledge score was strongly associated with HIV incidence for both men and women. High HIV prevalence and incidence was concentrated in the north-western part of the city, an area with lower HIV knowledge, higher HIV risk perception and lower per-capita consumption. DISCUSSION: The HIV incidence and prevalence figures do not suggest a declining epidemic in Windhoek. Higher vulnerability of women is recorded, most likely related to economic dependency and increasing transactional sex in Namibia. The lack of relation between HIV incidence and socio-economic factors confirms HIV risks for the overall urban community. Appropriate knowledge is strongly associated to lower HIV incidence and prevalence, underscoring the importance of continuous information and education activities for prevention of infection. Geographical areas were identified that would require prioritized HIV campaigning.
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    Inclusion and human rights in health policies: Comparative and bench-marking analysis of 51 policies from Malawi, Sudan, South Africa and Namibia
    (2012) MacLachlan, Malcolm; Amin, Mutamad; Mannan, Hasheem; ElTayeb, Shahla; Bedri, Nafisa; Swartz, Leslie; Munthali, Alister; Van Rooy, Gert; McVeigh, Joanne
    While many health services strive to be equitable, accessible and inclusive, peoples’ right to health often goes unrealized, particularly among vulnerable groups. The extent to which health policies explicitly seek to achieve such goals sets the policy context in which services are delivered and evaluated. An analytical framework was developed – EquiFrame – to evaluate 1) the extent to which 21 Core Concepts of human rights were addressed in policy documents, and 2) coverage of 12 Vulnerable Groups who might benefit from such policies. Using this framework, analysis of 51 policies across Malawi, Namibia, South Africa and Sudan, confirmed the relevance of all Core Concepts and Vulnerable Groups. Further, our analysis highlighted some very strong policies, serious shortcomings in others as well as country-specific patterns. If social inclusion and human rights do not underpin policy formation, it is unlikely they will be inculcated in service delivery. EquiFrame facilitates policy analysis and benchmarking, and provides a means for evaluating policy revision and development.
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    Income poverty and inequality in Namibia
    (2007) Van Rooy, Gert
    In this paper a national income poverty line for Namibia is derived based on estimated expenditures required to sustain a minimum calorific intake (food poverty line) as well as other basic necessities such as clothing and shelter (non-food poverty line). Estimates are based on actual consumption patterns of the poorest as recorded by the Namibia Household Income and Expenditure Survey conducted in 1993/94. This method is preferred over the previously applied food-share method. The overall poverty line is estimated at N$107 per capita per month in 1993/94 prices or approximately N$212 per capita per month in 2003 prices. According to this definition 53% of households and 65% of individuals in Namibia live below the income poverty line at the time of the survey. The analysis confirms tremendous inequalities in the way income and poverty is distributed. The poorest 20% of the population receives 2.5% of total expenditure, while the top 20% receives 71%. The standard measure of inequality, the Gini-coefficient, is estimated to be 0.697, which is probably the highest in the world. The methods and analysis presented in the paper should serve as a bench-mark for the analysis of the ongoing 2003/04 income and expenditure survey in particular and as a key tool for designing, implementing and monitoring policies that can effectively combat income poverty and inequality in Namibia in line with Vision 2030 and the Millennium Development Goals.
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    Perceived barriers for accessing health services among individuals with disability in four African countries
    (2015) Eide, Arne H.; Mannan, Hasheem; Khogali, Mustafa; Van Rooy, Gert; Swartz, Leslie; Munthali, Alister; Hem, Karl G.; MacLachlan, Malcolm; Dyrstad, Karin
    There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality.