Global Summit of Women 2003
 Marrakech, Morocco

THE ECONOMIC IMPACT OF HIV/AIDS
Clara Bohitile, Deputy Minister for Basic Education, Sport, and Culture

Namibia is a vast, predominantly arid country  in Southern Africa with a population of 1.8m. More than 70% of the population lives in the rural area.  After initial colonization by the Germans in the late 19^th century, the country was run as a province of South Africa for 70 years.  After a long liberation struggle, the country gained its independence in March 1990.

Economically, it is indicated that the Gross Domestic Product (GDP) is estimated at US Dollars 1 460 million in 2001.  The Per Capita Income is estimated at US$ 1 459, Which by world standards would qualify it as a "middle income' country.  However, Namibia inherited one of the most dualistic economies in the world.  The most affluent 10% of the society receives 65% of income and conversely, the remaining 90% receives 35% of the national income.

The Namibian economy is small in size, extremely open and characterized by considerable reliance on the production of primary commodities for export.  The economy is also dualistic in nature, with a modern sector co-existing hand in hand with a subsistence component.  A large portion of the Namibian population is living under subsistence conditions.

The priority sectors of our economy are Education Health Housing and Agriculture.  The first three sectors constitutes part of the overall social sectors and the government is convinced  that in order to address burning questions of employment generation, poverty reduction and reduction of inequalities in terms of income distribution to ensure quality of the overall living standard, the best way to go was to empower the previously disadvantaged citizens by improving their skills.  Provision was also made to ensure that access to both housing and health facilities was improved.

While the government was busy addressing the four priorities, a new threat emerged.  It is threatening to wipe out all the benefits of development efforts since independence.  This threat is HIV/AIDS.

Namibia ranks as one of the three countries most-affected by HIV/AIDS in the world with an overall prevalence of 22% among the sexually active adults.  This means that one in five Namibians aged 15-49 is infected.  Our Ministry of Health and Social Services and UNAIDS/WHO estimate that about 150 000 out of a population of 1.8 million are infected with the virus.

When costs associated with the rapidly increasing burden of medical care are added to the cost years of productive economic life forgone, the financial burden of the epidemic is staggering.  It is estimated that the indirect costs of HIV/AIDS added to the direct costs of medical care means a loss of over N$ 8 billion to the Namibian economy, which is equivalent to about 20% of the GDP.

It is acknowledged that education is the cornerstone for achieving lasting and sustainable development.  It is the sector that provides the skills and builds the necessary human capital vital for economic and social development.  The HIV/AIDS pandemic affects people of all ages.  However it is more prevalent among the young population between the ages of 15-29 years.  This is the group that is school-going, trainable and at its most productive stage.  Moreover, it is this section of the population which is also at the peak of child bearing, particularly for females.  Thus, HIV/AIDS is eroding, not only the hard-built human capital, hence depriving families communities and societies of experienced, skilled and active members, but also hits hard at families, leaving children orphaned and without support.

In Namibia, the education sector is the largest employer.  Much of the teaching force is relatively young and inexperienced.  Most HIV-infected educators and other staff can be expected to remain well and lead fulfilling, productive lives for many years before they develop more severe complications associated with AIDS.  The length and quality of their lives can be enhanced by antiretroviral treatment which is already available to public service employees who are on the medical aid scheme.  The treatment will be available in the hospitals for the general public in the near future. 

It is possible to actively reduce negative effects of AIDS illness and death through better understanding of the impacts of HIV/AIDS on employees and students.  The education sector has embarked on an all out fight to prevent the further spread of the virus, and mitigate the effects the virus is already having on the nation. 

HIV/AIDS clearly imposes large human costs on employees in all workplaces.  From an employer's viewpoint, HIV/AIDS imposes both direct and indirect costs on organizations.  In some cases these result in clearly recognizable financial costs.  In others, they may lead to hidden costs, including increasing inefficiency and lower performance of an organization.  Particularly in the public service environment, with budgets which are relatively fixed, and their inability to increase spending, these indirect costs have the potential to be or greater significance.

Direct costs result firstly from increasing costs of medical care for employees and dependants with HIV/AIDS.  Other direct costs can arise from increasing claims on pension, life and disability insurance cover by employees with HIV/AIDS.  Indirect costs arise from the following impacts:

¨     Employee absenteeism due to illness, funeral attendance or calling for sick family members.

¨     Higher recruitment and training costs.

¨     Loss of skilled employees due to HIV/AIDS illness and deaths.

¨     Reduced job performance due to physical disability or increased stress created by knowledge of diagnosis and stigmatization.

¨     Stress and reduced morale caused by illness and death of fellow employees, friends and family members. 

Some indirect costs may be experienced as increases in budgets or expenditure, but many manifest as declining efficiency and education quality.  This is most likely when budgets are not available to increase spending in response to impacts.

THE EDUCATION SECTOR RESPONSE

Namibia's response to the HIV/AIDS pandemic has benefited from increasingly committed leadership at the highest and other levels.  Political will is internationally recognized as a distinguishing feature of all successful, sustainable efforts to combat the pandemic.  Initial focus of responsibility and activities around HIV/AIDS were located in the health sector.  A multi-sectoral response is now in place.  The Education Sector developed a ground-breaking strategic and operational plan on HIV/AIDS in 2001 and its implementation is on track.  An impact study was undertaken in 2002 to provide more information to the sector about ways in which HIV and AIDS undermines the sector's mandate to provide high quality, relevant education.  The study involved a survey of schools, visits to schools and other institutions to discuss issues with learners, teachers and other key role players; review data; and use projections to clarify how the pandemic and its impacts will affected education in future. 

It must be noted that the HIV/AIDS pandemic has profoundly changed the external and internal environment of the education sector in Namibia.  Most importantly, over one quarter of the nation's investment in education could be lost through premature illness and deaths among learners.  In any single year, HIV/AIDS seems unlikely to destabilize the whole system.  However, this hides gradually  increasing effects on quality and access, as well as severe impacts on many schools and many thousands of infected and affected employees, learners and  students.  Impacts are likely to disproportionately affect communities and individuals that are already disadvantaged, thus obstructing attempts to improve equity.

HIV/AIDS had been recognized as "core business" for the education sector.  Evaluation of all components of the sector indicates that they are all affected and have roles to play in protecting education from HIV/AIDS impacts 

NATIONAL RESPONSE

Increasing concern among the national authorities and the general public has led to more urgent calls for acceleration of national prevention and care efforts.  Our Ministry of Health and Social Services led the development of a national plan for a multi-sectoral plan of action.  These efforts have resulted in an extensive national plan for a multi-sectoral, decentralized national program along seven strategic lines:

¨     Social mobilization;

¨     Access to medical, legal and social services;

¨     Reduction of impact, including discrimination;

¨     Program management and co-ordination;

¨     Policy formulation; and

¨     Research and human resource development 

Together with the development of this plan, other efforts to strengthen the other ministries' basis for implementation have been carried out.  For instance, the Ministry of Health and Social Services undertook a major Ministry-wide restructuring that included the elevation of the HIV/AIDS program within its structure.  The education sector has established an HIV/AIDS unit to spearhead its efforts.  Cabinet approved the formation of the national AIDS co-ordination program (including a high-level National AIDS Committee).  The government policy of decentralization is lending a hand to strengthen the position of the administrative provinces to implement programs at provincial level.

The prevention component of the national plan of action entails the following:

¨     An active search for and cure for every case of sexually transmitted decease;

¨     The promotion of easily accessible an affordable condoms;

¨     Life-skills training for each and every young person in the country;

¨     Health centres with a youth-friendly prevention and treatment package;

¨     Work-based AIDS education campaigns which reach all government and private sector employees;

¨     A rural AIDS education campaign program that reaches every household, through radio, school children and extension workers;

¨     The continuing management of a safe blood supply.

The Care and Support section of the National Plan includes care support for Namibians living with HIV and AIDS.  These components include: a confidential and caring testing and counseling program in all hospitals and health centres, a network of trained community-based support groups in every constituency and town in Namibia, a coherent national policy to deal with the ethical issues of HIV and Aids; and support to children orphaned by aids.