Overview of health system in Namibia
Namibia has a third world and a first world system in the same country. The State/Government health system is used by 90 % of the population. There are state employed doctors, the cost is minimal, and the service is poor. The other 10% of the population uses the private health system, but it’s much more expensive. The private system is good in comparison with other western countries.

What happens if you need to see a doctor?
Most people who are sick attend the state facility. If you want to see a doctor in the private sector you make an appointment with them. In the public sector when you go to the state hospital you often wait in a queue for hours.

Who decides what doctors can prescribe?
The Namibian Medicines Regulatory Council decides which medicines are "allowed" and registered in Namibia. Namibia is often behind in the times. New medicines are often only registered in Namibia a year or two after they have been approved in Europe, for example. The ministry of health is in charge of all state hospitals and clinics. They pay the nurses and doctors salaries. They only have certain medicines available. For example, the only state insulins available are actraphane, protaphane, and actrapid (which are free to state patients). Private practising doctors can prescribe anything available. Medical aid (health insurance) decides what they are willing to fund.

Practically, what is it like to live with type 1 diabetes in Namibia?
In general, it is very difficult and challenging. Medicines are not always available, often there are long waiting times in queues to obtain medicines, and there are often long distances to travel to the nearest clinic or hospital. Hospitals and clinics are often overcrowded and whole days need to be given up to see the doctor. This is made more difficult by poverty and low food availability. Patients cannot afford to have a variety of foods (only basics).

People living with type 1 diabetes on the state system usually do not have any blood sugar meters or test strips. They do not do HbA1c tests. The most important resources are all available, but health insurance is expensive and often people will still have to pay a part of the cost of their medication and consumables, especially at the end of the year when benefits are depleted.Most people cannot afford pumps and we do not really have separate CGM systems available.

Type 1 diabetes would be so much easier to manage if there were more support, education and knowledge about diabetes, and more affordable insulin, test strips, CGM's, etc. The people here are often very poor. They really need contact with other type 1 kids that they can share and exchange and just not feel like they are the only ones.

What about getting admitted to hospital?
The doctors decide when someone is admitted to hospital. If you use the state system you’ll go to the state hospital and if you have private insurance you can go to a private hospital, which is more expensive. Diabetes knowledge in hospitals is not good. Nurses knowledge is usually very poor in private as well as public sector. For example, a patient was admitted to a public hospital at the beginning of this year for an epileptic fit. They put her on a sliding scale and then completely different insulin that not her own type. Her blood sugar level is usually relatively well controlled but there it was crazy up and down. Eventually, we managed to convince them to let her inject her own insulin again.

How does diabetes care vary throughout Namibia?
Diabetes care is the best in Windhoek (the capital city). There is access to more and better support such educators, support groups, etc. We have all the insulin, test strips, glucometers etc. available in the rural areas as well, but it’s mostly available through the private sector. Most patients have not had basic diabetes education; they are not aware of what their condition means and are not aware of the role and necessity of their medications. We do not have enough diabetes educators in Namibia. I think there are only four or five in the whole country. Finally, we have no podiatrists in the whole of Namibia.

A huge thanks to Lore Wormsbächer and Inge Stolk for helping us with this information.