Patience Makwele
Former and current members of parliament have raised legal and practical concerns over a directive requiring senior civil servants to seek healthcare at public hospitals.
The directive came into effect on 1 April as part of President Netumbo Nandi-Ndaitwah’s Vision April 2026 reforms.
It targets 294 senior government officials, including political office-bearers, executive directors and security chiefs.
Under the arrangement, affected officials are expected to use public health facilities.
Those who opt out can retain access to private healthcare through a N$240 monthly allowance linked to the Public Service Employees Medical Aid Scheme (Psemas).
The government says the policy aims to reduce reliance on private healthcare funded by public money and to strengthen the public system, which serves more than 85% of Namibians.
Between N$3 billion and N$4 billion is spent each year through Psemas, covering about 100 000 civil servants, while about 2.5 million people depend on state facilities.
Affirmative Repositioning (AR) member of parliament Ester Haikola-Sakaria said state facilities are already under pressure.
“Our parents and grandparents go to the state. Mostly family members. We want hospitals and schools to be well-capacitated and to give Namibians the best,” she said.
Public hospitals face challenges such as overcrowding, staff shortages, equipment constraints and long waiting times.
Former cabinet minister Calle Schlettwein questioned the legal basis of the directive.
“Where does Her Excellency the President get the power to make a directive like that? Are we civil servants subject to her directive, or are we civil servants with rights?” he asked.
Former prime minister Nahas Angula said the directive may conflict with constitutional rights.
“As a citizen, the constitution gives me the right to choose. If I need medical attention, I shall myself decide which hospital to go to. The president can make declarations, but such declarations will never override my constitutionally guaranteed rights,” he said.
Health minister Esperance Luvindao said the directive is not compulsory.
“We cannot compel anybody to use the facilities. Any senior member, such as members of Parliament, should you feel not to, you are not compelled to,” she said.
She said those who opt out will receive a N$240 monthly allowance to access private healthcare.
Luvindao said the government is improving the health system through staffing and infrastructure investment.
More than 2 000 health personnel posts were funded in the 2025/26 Mid-Year Budget Review, with 1 262 filled by January 2026. Equipment worth N$239 million has also been procured.
Seven hospitals have been selected for the first phase. These include: Windhoek Central Hospital, Katutura Intermediate Hospital, Rundu Intermediate Hospital, Keetmanshoop District Hospital, Oshakati Intermediate Hospital, Walvis Bay State Hospital, and Onandjokwe Intermediate Hospital.
The government also plans to introduce patient flow systems to manage congestion.
Health expert Nalucha Buchane told the Windhoek Observer that the outcome will depend on how well the system improves.
“When decision-makers are required to use the same system as the public, it can improve accountability,” she said.
“But if the system is already under strain, it risks increasing pressure rather than improving outcomes.”
She said similar reforms in other countries worked only when supported by long-term investment.
“Healthcare reform is not about political symbolism. It is about life and death,” she said.
