The collaboration between the governments of the United States of America and the Republic of Namibia in combating the spread of HIV began more than ten years ago. That same collaboration continues today, with the U.S. government planning to spend more than US$67 million – or just over a billion Namibian dollars – this year in Namibia to achieve the goal we all seek: epidemic control.
As you all know, HIV is a complicated disease. Responding to it is equally complicated, and it has required us, working with our Namibian partners, to continually adjust what we are doing in order to have the greatest effect. What we learn about HIV here and in the other countries around the globe where the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, works helps us all to maximize the impact of the response.
That desire to have the greatest impact – to stay ahead of a complicated and deadly disease – has caused us in recent years to expand our global PEPFAR programming beyond the traditional methods of HIV prevention, testing and treatment, to include methods like voluntary medical male circumcision. As we’ve done so, we have also sought to intensify our focus on efficiency and on measurable results.
What all this means is that, alongside anti-retroviral treatment and HIV testing and counselling and prevention of mother-to-child transmission, we need to promote, expand and sustain voluntary medical male circumcision.
The reason seems pretty straightforward, even to someone like me who’s not a medical professional. VMMC has proven to be one of the most economical and effective methods of reducing HIV transmission. And reducing transmission is a key component of epidemic control. That’s why it is so encouraging to see the government’s proactive effort to scale up VMMC here in Namibia.
It is even more encouraging to see the Namibian government, as part of its effort, seeking to strengthen ties with the private sector. It’s a matter of mathematics. 72% — that’s nearly three out of four — of Namibia’s medical doctors are practicing in the private sector. An estimated 400,000 Namibians covered by private medical aid in Namibia get their medical services from private sector doctors. Those 400,000 people represent the most economically active segment of society, and just like the rest of the population, they are at risk of contracting HIV and should be protected.
One out of every four medical circumcisions performed in Namibia is performed by the private sector. That shows that the private sector is already an important partner in Namibia’s fight against HIV, and it can be even more important. For the Namibian government to build a functional and robust relationship with the private sector holds huge potential. Private sector healthcare capacity hasn’t traditionally been mobilized in the VMMC response.
But many private healthcare facilities can and do provide VMMC services. Taking advantage of the existing capacity of private healthcare facilities is a smart investment with potentially huge returns. The most significant returns are in increased access to HIV services for Namibians and increased sustainability in the medical interventions provided to them.
The estimated 94,000 eligible males who are covered by medical aid are an untapped, accessible beneficiary pool and represent an opportunity to make a lasting impact in the fight against HIV in Namibia.
Through the medical aid funds and with the support of local doctors, it may be possible to sustain the prevention gains made over the last 15 years. We have seen that possibility for some time, and since 2011 the U.S. government, with partners like SHOPS and now AIDSFree, has worked to leverage private investment to support national goals.
In terms of VMMC specifically, the United States has supported the establishment of the tariff through the Namibian Association for Medical Aid Funds (NAMAF). We have provided technical assistance in the form of facility assessments to ensure readiness to provide VMMC services. And we have provided VMMC training and male circumcision kits to ensure standardized care and reporting.
The U.S. government has also supported demand creation efforts within the Namibian private sector, because while making standardized, private sector VMMC services available is crucial, it won’t achieve our goal unless patients seek those services.
The equipment we are contributing today is part of this ongoing effort by the Namibian and U.S. governments, and by private healthcare providers in Namibia to improve the efficiency of VMMC services offered by the private sector in this country. In handing it over, I want to recognize the outstanding efforts of the private healthcare facilities that have been selected.
The private sector has clearly demonstrated its willingness and its ability to join the Namibian government’s efforts to scale up Voluntary Medical Male Circumcision in Namibia. They can be a formidable force in creating a sustainable HIV response, and ultimately epidemic control, here in Namibia.