'Malaria is a thing of the past' - Kamwi
By Paul T. Shipale
Question: Cde Kamwi, what strategies has the Ministry of Health and Social Services used to almost wipe out malaria in the country?
At independence in
1990, we were faced with a devastating
malaria epidemic, never to
have been registered. We checked
the records from the defunct administration,
the so-called Department of
Health. They had some good records,
but they had never registered such a
worst malaria epidemic. That was the
situation. At that time, I was a young
man with a national diploma in public
I was tasked to tackle malaria control.
I was appointed Chief Health
Inspector for the four northern regions,
called North-West Health Directorate.
With the help of the World
Health Organizatio, WHO, we put
in place a multi-sectoral approach.
We had to confront the adult mosquitoes.
Our main stay was using
indoor residual spraying, using 75
percent DDT water-able powder, targeting
the roofs and the walls. We
were not spraying outside.
At that time, we had malaria vectors.
These are anopheles gambiae,
anopheles funestus and anopheles
arabiensis. WHO gave us the technical
support. The newly established
SWAPO Party government provided
the resources to fight this epidemic.
I was charged with that programme.
By the end of May 1990, we brought
down that epidemic.
Since then, I was identified to go
and study at the University of
Liverpool. When I came back, I was
tasked to set up and manage the National
Programme, primarily to fight all
vector-born diseases. I was tasked to
come up with a national policy for
malaria control programme. That
policy, as you see it today, went
through my hands. That policy has
only been amended twice.
I came up with a formidable team.
We covered all malaria areas in this
country. That is the whole northern
part of Namibia, plus the Central
Region, Otjozondjupa, and now
Omaheke. We faced this disease
head-on. In 1991, Namibia's first
Minister of Health, Dr Nickey
Iyambo, decided to reward me.
Through WHO, I received my Fellowship
Award to go and study, specializing
in malaria. When I came
back, I put more fire. I had a team
that listened and worked with the sole
objective to see to it that we eliminated
malaria from Namibia. That
was my objective.
Let us look at the data. In 1990
alone, malaria killed 7000
Namibians in the whole country. In
the North-West Health Directorate
alone, malaria killed 5000 people that
year. At that point too, we registered
400 000 clinical cases of malaria.
That data is with us. Because of hardwork
and commitment, responding
to what we fought for, the intended
objective had been met.
In 2001, countrywide, outpatient
malaria cases was 521 067. By 2010,
we brought that figure to 22 359. Those
are the cases that went through laboratories.
Those are outpatient malaria
cases. In 2001, malaria admissions in
Namibia stood at 41, 636 down from
400 000 cases at independence. By
2010, we brought down that 41 000 to
1 505. Who was coordinating? Nchabi
I was identified by Founding President,
Dr Sam Nujoma, who appointed
me as Deputy Minister of Health and
Social Services. I still maintain that I
am not yet done with my intended
objective - that is to eliminate malaria
in Namibia by all means.
Question: Cde Minister, where do
we stand now?
Remember that we had
over 7000 deaths caused by malaria
in 1990. By 2001, we brought that figure
down to 1 747. By 2010, we
brought down deaths due to malaria
to 45. Where do we stand today? Last
year, 2012, we managed to bring down
deaths due to malaria to four cases
countrywide. With regard to clinical
cases, we brought them down from
521 067 at independence to 3 163 in
2012. With regard to malaria admission
cases, there were only 50 confirmed
malaria cases in the whole
country last year. That is no mean
But, again, if you check the history
of these 50 cases, they were imported
cases. Even the four cases of death I
have earlier mentioned were imported
from Angola. Let us look at the vectors.
We had anopheles gambiae,
anopheles funestus and anopheles
arabiensis. These are major ones and
very lethal. Where do we stand today?
Do we still have these killer mosquitoes
in this country? I am saying no.
The answer is no. We don't have them
anymore. I hold my Phd in malariology.
I did my research on malaria in
Namibia, the whole country.
I recall in 1998, I was with Dr
Abraham Mzavaa, who was one of
my external supervisors for my Phd.
We were doing what we call "knock
down," which meant you closed
down all the windows and sprayed,
checking all the vectors.
We went to Omahenene in Omusati
Region in 1998, we looked around in
several huts. There was not a single
vector mosquito we could find on the
Namibian side, not a single one. We
could not find a single anopheles
gambiae nor a anopheles funestus.
We had a few anopheles arabiensis.
That was then. As we speak today, we
no longer have malaria vectors in this
country other than imported ones.
Even those ones are a few and far between.
Question: Where do we stand as a
country in the Southern African
Development Community, SADC,
as far as malaria is concerned?
These are major achievements
par excellence, well documented
not only in Namibia, but also
by WHO. This means we are serious.
Now, regionally, our neighbours have
been following these achievements.
Five years ago, WHO was looking for
countries to be earmarked for malaria
elimination. In SADC, eight countries
were identified. Four for a total malaria
elimination, and another four to
follow. That is what is now termed
the E-8 malaria elimination.
Question: Which are those countries?
They are Botswana,
Namibia, South Africa and Swaziland.
These four countries are looking at
total elimination. The other four are
Angola, Zambia, Zimbabwe and
Mozambique. In SADC, the chairmanship
of any SADC structures rotates.
But this is not the case with the
E-Eight. What I am telling you now
is a very interesting picture.
The first meeting was held here four years ago. Obviously, as a host
country, we had to be the Chair.
We had experts from as far as
San Francisco in the US and
WHO. We served our term.
Two years ago, we went to
Botswana for the E-8 countries'
meeting. We were to hand over
the chairmanship to Botswana.
All the E-8 member states refused.
They insisted that
Namibia should still be the
Chair. Don't ask me why.
We argued and asked why
Namibia? In SADC, the Chairmanship
rotates! Why only
Namibia? This matter was left
to the main body to make a decision.
The health ministers met
in Mozambique. I did not attend
that meeting. My Deputy,
Cde Petrina Haingura, went.
What happened? They still
unanimously said Namibia
should continue to be the Chair
of the E-8. A year ago, we went
again to Polokwane, South Africa,
for the E-8 summit. It was
the same thing. The summit
unanimously said that Namibia
should continue to chair the E-
8. Obviously, South Africa,
could have become the Chair.
South Africa is a giant.
They could have taken the
Chair. This time it was unanimously
decided that the Headquarters
of the E-8 should be in
Namibia, and not in Gaborone,
Botswana. And the Chair?
Namibia again. The whys are
in the documents we produce
and how we have managed to
bring down malaria in this
country. Our neighbours are
impressed. Just look at how our
graph has moved down dramatically,
from close to 2 000
malaria related deaths in 2001
to just four in 2012.
This is what we are capable
of doing. This is not just
Nchabi Kamwi. This is teamwork.
I have been at the steering
of this exercise, entrusted
to me and my team by the
Namibian government. I remain
extremely grateful to both
Founding President, Dr
Nujoma, and President
Hifikepunye Pohamba. I am
also extremely grateful to Dr
Nickey Iyambo and Dr Nestor
Shivute. They did all they could
for me to be what and where I
Last year, I received an invitation
from Harvard University
that I was one of the health ministers
who was identified for a
Harvard Ministerial Leadership
Award. I must admit it came at
a wrong time. It came at a time
when President Pohamba had
appointed a Presidential Commission
of Inquiry on the Public
Health Sector in Namibia. I
declined that offer. I kept quiet.
They wrote two letters. I did not
The third was a telephone call
from Harvard University, telling
me that in May 2012, I
would have gone to receive the
award. I turned it down. This
year they came in persons, and
extended an invitation to me to
go and receive the Award for my
contribution to improving the
health system in this country,
starting with establishing the
National Malaria Vector Disease
Control Programme. This
includes HIV/AIDS and TB.
Question: Some people and
newspapers have been calling
for your sacking. They have
called you one of the "most
useless ministers" in government.
With all these impressive
achievements noted not
only in Namibia, but outside
Namibia as well, what is your
pick on such people? How do
you feel when you are described
You are right. I have
been called all sorts of names.
This year, I was privileged to
head the Namibian delegation
to the World Health Assembly.
This is where the entire member
states of the WHO meet.
At that Assembly, Namibia was
elected in two major bodies for
the first time.
The first one was the General
Committee, which is like
parliament. On the last day of
that week, the Assembly met
to elect member states who
should serve on the Executive
Board. Namibia was one of
those countries elected to serve
in the Executive Board.
This was for the second time
during the course of my eight
years as Minister of Health and
Social Services. It is unusual
for a member state to serve as
an executive board member
within eight years two times. It
is unusual, but it has happed
because of our indicators.
Two weeks ago, Namibia
was invited by the US Secretary
of State, John Kerry. President
Pohamba permitted me to
go. I was the only minister from
Africa who was invited because
of the excellent indicators from
Namibia. Again, I recall, last
year, for the first time in this
country, the first ever internationalist,
Director General of
WHO, to address our Parliament,
Dr Margreth Chan. She
informed the Namibian people
about the quality leadership of
President Pohamba, whose
Health Minister was a shining
When we went to the WHO
Health Assembly last year, she
repeated her words. She visited
several countries, but she
singled out four, which included
Namibia. At the World
Aids Conference last year, I sat
there and listened to the US
Secretary of State, then Hillary
Clinton, singling out Namibia.
But as I listened, I knew back
home it was not all well.
When they are talking so bad,
internationally, people see what
we are doing. They look at the
indicators. But some people can
be jealous. In Oshiwambo you
say, "Ondumbo nayise," "Jealous
must die." Let us support
each other. It is for the betterment
of the country. Do you still
see convoys going to cemeteries
on a daily basis? It is no
longer the same.
The situation has changed.
We have significantly brought
down malaria deaths in this
country. It is not Kamwi who
is saying this. It is the data, the
figures, the indicators. It is pure
jealousy when they call me
names. True, we have challenges
in this country, but they
are not insurmountable. There
are people who talk out there,
criticizing us for not doing this
and that. Yes, it is their democratic
right to criticize.
One day, I appeared on One-
On-One on the Namibian
NBC. Today I want to respond.
One of the silly questions the
moderator asked me was:
"What do you say, with so
many deaths, people who are
dying in front of your eyes?"
He went on to mention names.
Sometimes it is painful when
people do not know. That is
why I always say to my team,
forgive them, because they do
He went on to mention the
names of those who had died,
some of whom I knew the
causes of their deaths. It was
very unethical. You don't ask a
person to reveal the cause of
death of a person without the
consent of family members.
One of those he mentioned died
from AIDS, full blown out. I
know. When a womb becomes
so defective, and such person
came so late, you try all your
best. Then this person dies,
must we say this person died
from AIDS? Is that ethical? It
is unethical. He even showed
me some photos of babies who
had died at birth.
We have maternal and neonatal
deaths in this country. I
took over this Ministry when
AIDS was at its peak. That explains
why it was so high at that
time. There were even attempts
to move this programme to the
Office of the President or the
But thanks to the wise leadership
of President Pohamba,
he refused. When I took over,
maternal death ratio was 449
per 100 000. Where do we
stand today? It has come down
to 108 per 100 000. Our latest
quarterly report shows that
maternal deaths have decreased
from 118/100 000 to 100/100
000. If anyone says, Kamwi,
why is he still there?
I am saying it is unfortunate.
My prayer is he or she should
be forgiven for his or her sins.
Internationally, the recognition
is there. The world recognizes
what we are doing. If we can
manage to do this much with
so little, and there are people
who do not appreciate this, my
good Lord, may you forgive
This is the best that we can
do under the circumstances. We
cannot be compared with private
hospitals. Ours are public
health institutions. We do not
have the financial means. The
know-how is there, but the resources
are not enough. With
the little that we have, we are
able to showcase internationally.
When my term is over, I will
leave this Office as a happy
man. When I look back, we
have built more primary
healthcare clinics than at any
other point in time since independence.
We have renovated
health infrastructure than at any
other time of our independence.
I am most grateful to the team
that I work with. My Deputy,
Petrina Haingura, my Permanent
Ndishishi are doing their best.
So are my advisors and the entire
If I had been given a man like
Andrew Ndishishi right from
the beginning, we would have
gone a long way. He is one of
the best managers in this country.
He is hands-on. I am also
most grateful to the spray men
and women out there who have
managed to wipe out malaria
in Namibia. It is not only malaria.
We had polio in this country.
We wiped it out too, under
my leadership without external
support, apart from technical
support from WHO. Plague
(Okatumba) devastated villages
in the northern regions, killing
people. Do you hear it today?
We no longer have it in this
country. To those who say I am
doing nothing, I say "May the
living God forgive them."
I am sorry that some people
have died during my tenure of
office. It was not our own making.
We have done our best.
There are some cases of negligence.
In any system, they are
there. But they are dealt with as
such. My appeal is this. When
Namibians criticize, please,
blanket criticism does not help.
Let us be more specific and