Nearly three decades after achieving independence, Namibia’s healthcare system had been significantly weakened by HIV/AIDS. And as resources were being shifted to fight the disease, maternal and child mortality rates were rising to concerningly levels. For more than a decade, Synergos has been working in Namibia to strengthen the country’s public health system – from beginning in 2007 with maternal and child health and nutrition and framing a plan for Universal Health Coverage (UHC) today.

A track record of systems transformation

In part due to interest at the Bill and Melinda Gates Foundation to improve the performance of public health systems in developing countries, especially across the African continent, Synergos conceived the African Public Health Initiative in 2007, as part of a consortium that also included the Presencing Institute and McKinsey and Company.

Operating from 2008 to 2011, the project improved collaboration and mutual understanding across Namibia’s Ministry of Health and Social Services. And ultimately contributed to a decline in maternal mortality across the country and lead to the Leadership Development Forum that strengthened the leadership capacities of the 25 most senior leaders of the Namibian Ministry and Child Health project. One of Synergos’ most notable contributions was the application of inner work practices to improve working relationships across the sector, helping to deliver health services more effectively.

From 2010 to 2016, Synergos Namibia coordinated partnerships between local funders and government to deploy seven innovative container clinics focused on maternal and women’s health in underserved rural areas across four regions. Recognizing the success of this program, Elma SA Foundation supported us installing and activating 29 government health clinics. We expanded this effort from centering on women to also improving the health of infants and young children.

With funding from a Global Philanthropists Circle member, our Namibia team piloted nutrition interventions in the Omaheke region, where undernutrition has been a root cause of high neonatal mortality. A systemic view underscored the often overlooked and vital role healthcare workers play providing indigenous communities with access to available programs. Applying this knowledge, we provided training to regional health workers to better identify and refer cases of under-nutrition and other maternal and child health issues. To ensure marginalized communities had a voice and to cultivate a shared sense of purpose and response, Synergos also established a civil society network to liaise between government and communities on nutrition projects and programs.

Matching gaps to resources

In 2019, Synergos collaborated with Results for Development (R4D) as an implementing partner for the African Collaborative for Health Financing Solutions (ACS) project. The project, which was US Agency for International Development (USAID) funded through Sustainable Health Financing Initiative (SFI), focused on helping the Namibia health system reach its greatest milestone yet: achieving universal health coverage for all citizens.

Alongside USAID, the Duke Global Health Innovation Center, Feed the Children, and AMREF Health Africa, Synergos is exploring and supporting the MoHSS to advance the broader UHC agenda.

Synergos’ assessment has informed the three core objectives:

• Support to multi-stakeholder platforms for accountability and application of knowledge in a subset of Sub-Saharan African countries
• Facilitate a knowledge exchange and implementation support between African countries on essential topics like health financing, technical implementation, and administration
• Support regional bodies, networks and NGO coalitions as they advocate to and partner with government entities.

Laying the groundwork for sustainable change

Structuring a national universal healthcare system-let alone implementing one-is a mammoth undertaking that will take years of intra-sector partnership and additional funding commitments. And Synergos has made several contributions necessary to lay the groundwork for this:

• We led a series of meetings with government and health sector leaders to draft a high-level plan for Namibia’s UHC system.
• We provided support to the Ministry of Health and Social Services (MoHSS) to re-constitute existing structures and establish new ones to carry the UHC plan forward.
• We facilitated a three-day leadership workshop that strengthened the MoHSS’s capacity to carry the UHC plan forward. Workshop attendees included Ministry executives and the lead staff members of the working groups. The workshop aimed to broker consensus on what defines UHC in the Namibian context and build leadership capacity through reflective exercises and sharing of the experiences of leaders from other African countries with more experience implementing UHC programs, such as Ghana and Kenya.

Using the Synergos bridging leadership approach, today we are framing a common understanding and further engaging stakeholders in in clarifying a vision for UHC in the Namibian context.

Planning for long-term funding and real systems change

Synergos and other partners are currently defining the minimum health services package that Namibia’s UHC plan should guarantee as well as conducting an essential costing study. To secure their endorsement, our Namibia team is developing a package for HIV/AIDS epidemic control that includes both prevention and treatment with the MoHSS. Like many of its neighbors, Namibia has been historically devastated by epidemic levels of HIV/AIDS infection, with 12 percent of its population still HIV positive in 2018.

Further, we recently completed a landscape analysis of sustainable health financing strategies that can fund HIV/AIDS response services long-term. Next steps include aiding the government as it institutes methods to track and manage health expenditures and reduce inefficiencies in the system, especially those in its HIV/AIDS response efforts.