Over the last few weeks, the Namibian media has highlighted the newly approved universal health coverage (UHC) policy for the country.
However, despite discussions surrounding the achievement of 100% UHC, there has been little to no inclusion around the importance of improving environmental health services and addressing challenges relating to environmental health that facilitate the occurrence of diseases in our communities. Environmental health is the branch of public health that addresses all aspects of the broader environment that can affect human health. This article aims to ignite those discussions and highlight the need for the newly appointed health leadership of the Netumbo Nandi-Ndaitwah administration to prioritise environmental health in their planning for the achievement of good health and well-being for the country, including the UHC goal.
UHC has long been considered fundamental for achieving any nation’s public health goals. Its core principle is enshrined in the 1948 United Nations Universal Declaration of Human Rights, which asserts that “everyone has a right to a standard of living adequate for the health and well-being of himself and his family.” Given its fundamental importance, UHC was identified and reaffirmed as a critical component of the 2030 sustainable development goals as agreed upon by the United Nations member states at the seventeenth session of the UN General Assembly in 2015, with Namibia being among the participating member states.
UHC aims to ensure that everyone, everywhere, can access the health services they need without the risk of financial hardship. This encompasses a comprehensive range of essential services, including health promotion, prevention, treatment and rehabilitation. UHC is a key component of Sustainable Development Goal (SDG) 3, Good Health and Well-being. It serves as the 8th target and an indicator to monitor member states progress towards achieving this goal. Namibia has made commendable strides in this area. In March 2025, the Namibian Cabinet announced the approval of a policy on UHC, which aims, among numerous objectives, to further reduce the healthcare costs for individuals and to bring the country closer to achieving UHC.
The cost of quality healthcare places a major strain on families. Therefore, this policy has been well received by citizens, as it is expected to optimise the provision of quality healthcare without placing a financial burden on Namibians. While the primary focus of achieving UHC is on clinical care, it is imperative that the health prevention and promotion pillars of UHC, particularly in the context of environmental health, do not continue to be overlooked. Strengthening and continuously building a robust environmental health system ensures that communities are proactively protected, targeting the unsafe conditions in our homes, schools or work which could lead to disease.
Environmental health and UHC – what is the connection?
Our environment is a major determinant of human health and well-being. The World Health Organisation (WHO) estimates that a significant proportion of human diseases are attributed to environmental exposures. The air we breathe, food we eat, water we drink and the places where we live, work and play all have an effect on our health.
If people are exposed to contaminated air, food or water in their environments, there is a high probability that this will lead to morbidity or mortality, whether acutely or in the long term. Environmental health and UHC are intrinsically linked. The primary goals of environmental health are the prevention of the occurrence of hazards in environments and the control of these hazards if they manifest. It is therefore rooted in the prevention of disease and the promotion of health, both of which are fundamental requirements of the UHC framework.
Namibia, like many other developing countries, faces challenges in mitigating risks associated with the environment. These challenges range from food safety, poor indoor air quality, poor hygiene and sanitation, solid waste management, vector management, and occupational health and safety hazards. These challenges are often exacerbated in informal and rural areas.
In June 2024, a family of six in the Kavango East Region was hospitalised following the consumption of what was described to be cassava roots, leading to the tragic death of one of the children. A similar incident occurred in the Kavango West Region earlier this year, where another family of six was hospitalised following the suspected consumption of cassava. These incidents form part of a troubling pattern of food safety issues in rural areas, which have resulted in illness and sometimes death.
The most tragic event was the death of thirteen members of a single-family unit following the consumption of porridge prepared from flour from the residue of traditional beer.
These recurring incidents highlight the need to improve food safety education, among other things, for the general population, especially in the rural areas and informal settlements. Teaching communities about the importance of handwashing, safe preparation, handling and storage of food to prevent spoilage; and using sound judgement prior to consuming food collected in their fields or from the wild if they are unsure about the fitness for human consumption is vital to preserving health.
Namibia also faces challenges with access to safe water and sanitation.
Despite evident progress, many rural and informal settlements still face the day-to-day challenges of this.
This issue leads to widespread open defecation, which can contaminate open water sources. Additionally, limited access to clean water leads to poor hygiene and sanitation. A notable example of how this can negatively affect health is the 2017 emergence and prolonging of the hepatitis E outbreak, which affected 13 out of 14 regions in Namibia and which lasted for an unfortunate four years, affecting many informal settlements.
These examples highlight how these challenges further strain the Namibian health system. Strengthening prevention strategies and improving health literacy about environmental health hazards among the general population can reduce the burden of diseases, morbidity and mortality, subsequently easing the demand for treatment and rehabilitation.
A UHC plan is seen as a beacon for increasing resources for health service provision, and health management researchers continue to advocate for a multi-sectoral approach towards achieving UHC – one which also ensures inclusion of environmental health services. Building capacity to reduce environmental health risks through research, policy and health promotion activities is fundamental to preventing health hazards.
To optimally support the goals of universal health coverage, environmental health policy and the capacity and capabilities of the environmental health workforce need to be strengthened.
Strengthening environmental health policy
Effective health promotion and disease prevention strategies require current policies grounded in up-to-date, evidence-based research. Identifying areas for legislative reform is crucial to enable better enforcement by practitioners and compliance from communities.
For instance, Namibia's food safety legislation needs reform to address advancements in food safety over the past half-century and to include clauses for stronger accountability for food producers and distributors who jeopardise community health.
It further needs to strengthen guidance on overall food safety practices for business establishments. The development of country-specific guidance documents surrounding environmental health matters is also crucial.
Strengthening the environmental health workforce
Environmental health practitioners are at the forefront of identifying and mitigating environmental health risks that arise in our environment.
As Namibian communities face increasing challenges from environmental hazards and emerging health threats, it is important that the professionals mitigating these risks are well-trained and resilient. Leadership within the Ministry of Health and Social Services should invest in initiatives aimed at understanding the needs, challenges and opportunities in the environmental health sector which will enable the optimal utilisation of services.
A notable example of such an initiative is the United States' (US) 'Uncover EH' research of 2017, led by the Centres for Disease Control and Prevention.
This project identified key workforce challenges and other issues impacting the environmental health field by gathering perspectives from approximately 1 700 environmental health professionals in the US through an online survey and in-person discussions.
The benefits of this research initiative were that it was able to identify the challenges being experienced by the professionals on the ground that hinder them from effectively safeguarding the health of their population, and it identified training and research needs for the strengthening of the sector. A similar initiative for Namibia would be fundamental, as the data collected could shape and strengthen the delivery of environmental health services throughout the country, shaped by our country-specific risks.
In conclusion, environmental health must become an active topic in discussions about achieving good health and well-being in Namibia.
Firstly, addressing the root challenges contributing to environmental health hazards, such as the lack of access to safe water and sanitation services and poor food safety literacy, is essential to support the goal of UHC.
Moreover, it is crucial to advance environmental health policies and build a workforce capable of continuously identifying, controlling and mitigating environmental health risks. In the absence of a strong and sustainable environmental health system which emphasises prevention and health promotion, we risk standing on a false sense of security that we are achieving the required health goals of the country, as hazards are not being addressed.
Sustainable health systems are built on the elimination of factors in the environment that cause ill health.
*Ndinelago Landi Moses is an environmental health practitioner by profession. She is currently employed as a public health manager by Carnival Maritime GmbH. She writes in her personal capacity.
However, despite discussions surrounding the achievement of 100% UHC, there has been little to no inclusion around the importance of improving environmental health services and addressing challenges relating to environmental health that facilitate the occurrence of diseases in our communities. Environmental health is the branch of public health that addresses all aspects of the broader environment that can affect human health. This article aims to ignite those discussions and highlight the need for the newly appointed health leadership of the Netumbo Nandi-Ndaitwah administration to prioritise environmental health in their planning for the achievement of good health and well-being for the country, including the UHC goal.
UHC has long been considered fundamental for achieving any nation’s public health goals. Its core principle is enshrined in the 1948 United Nations Universal Declaration of Human Rights, which asserts that “everyone has a right to a standard of living adequate for the health and well-being of himself and his family.” Given its fundamental importance, UHC was identified and reaffirmed as a critical component of the 2030 sustainable development goals as agreed upon by the United Nations member states at the seventeenth session of the UN General Assembly in 2015, with Namibia being among the participating member states.
UHC aims to ensure that everyone, everywhere, can access the health services they need without the risk of financial hardship. This encompasses a comprehensive range of essential services, including health promotion, prevention, treatment and rehabilitation. UHC is a key component of Sustainable Development Goal (SDG) 3, Good Health and Well-being. It serves as the 8th target and an indicator to monitor member states progress towards achieving this goal. Namibia has made commendable strides in this area. In March 2025, the Namibian Cabinet announced the approval of a policy on UHC, which aims, among numerous objectives, to further reduce the healthcare costs for individuals and to bring the country closer to achieving UHC.
The cost of quality healthcare places a major strain on families. Therefore, this policy has been well received by citizens, as it is expected to optimise the provision of quality healthcare without placing a financial burden on Namibians. While the primary focus of achieving UHC is on clinical care, it is imperative that the health prevention and promotion pillars of UHC, particularly in the context of environmental health, do not continue to be overlooked. Strengthening and continuously building a robust environmental health system ensures that communities are proactively protected, targeting the unsafe conditions in our homes, schools or work which could lead to disease.
Environmental health and UHC – what is the connection?
Our environment is a major determinant of human health and well-being. The World Health Organisation (WHO) estimates that a significant proportion of human diseases are attributed to environmental exposures. The air we breathe, food we eat, water we drink and the places where we live, work and play all have an effect on our health.
If people are exposed to contaminated air, food or water in their environments, there is a high probability that this will lead to morbidity or mortality, whether acutely or in the long term. Environmental health and UHC are intrinsically linked. The primary goals of environmental health are the prevention of the occurrence of hazards in environments and the control of these hazards if they manifest. It is therefore rooted in the prevention of disease and the promotion of health, both of which are fundamental requirements of the UHC framework.
Namibia, like many other developing countries, faces challenges in mitigating risks associated with the environment. These challenges range from food safety, poor indoor air quality, poor hygiene and sanitation, solid waste management, vector management, and occupational health and safety hazards. These challenges are often exacerbated in informal and rural areas.
In June 2024, a family of six in the Kavango East Region was hospitalised following the consumption of what was described to be cassava roots, leading to the tragic death of one of the children. A similar incident occurred in the Kavango West Region earlier this year, where another family of six was hospitalised following the suspected consumption of cassava. These incidents form part of a troubling pattern of food safety issues in rural areas, which have resulted in illness and sometimes death.
The most tragic event was the death of thirteen members of a single-family unit following the consumption of porridge prepared from flour from the residue of traditional beer.
These recurring incidents highlight the need to improve food safety education, among other things, for the general population, especially in the rural areas and informal settlements. Teaching communities about the importance of handwashing, safe preparation, handling and storage of food to prevent spoilage; and using sound judgement prior to consuming food collected in their fields or from the wild if they are unsure about the fitness for human consumption is vital to preserving health.
Namibia also faces challenges with access to safe water and sanitation.
Despite evident progress, many rural and informal settlements still face the day-to-day challenges of this.
This issue leads to widespread open defecation, which can contaminate open water sources. Additionally, limited access to clean water leads to poor hygiene and sanitation. A notable example of how this can negatively affect health is the 2017 emergence and prolonging of the hepatitis E outbreak, which affected 13 out of 14 regions in Namibia and which lasted for an unfortunate four years, affecting many informal settlements.
These examples highlight how these challenges further strain the Namibian health system. Strengthening prevention strategies and improving health literacy about environmental health hazards among the general population can reduce the burden of diseases, morbidity and mortality, subsequently easing the demand for treatment and rehabilitation.
A UHC plan is seen as a beacon for increasing resources for health service provision, and health management researchers continue to advocate for a multi-sectoral approach towards achieving UHC – one which also ensures inclusion of environmental health services. Building capacity to reduce environmental health risks through research, policy and health promotion activities is fundamental to preventing health hazards.
To optimally support the goals of universal health coverage, environmental health policy and the capacity and capabilities of the environmental health workforce need to be strengthened.
Strengthening environmental health policy
Effective health promotion and disease prevention strategies require current policies grounded in up-to-date, evidence-based research. Identifying areas for legislative reform is crucial to enable better enforcement by practitioners and compliance from communities.
For instance, Namibia's food safety legislation needs reform to address advancements in food safety over the past half-century and to include clauses for stronger accountability for food producers and distributors who jeopardise community health.
It further needs to strengthen guidance on overall food safety practices for business establishments. The development of country-specific guidance documents surrounding environmental health matters is also crucial.
Strengthening the environmental health workforce
Environmental health practitioners are at the forefront of identifying and mitigating environmental health risks that arise in our environment.
As Namibian communities face increasing challenges from environmental hazards and emerging health threats, it is important that the professionals mitigating these risks are well-trained and resilient. Leadership within the Ministry of Health and Social Services should invest in initiatives aimed at understanding the needs, challenges and opportunities in the environmental health sector which will enable the optimal utilisation of services.
A notable example of such an initiative is the United States' (US) 'Uncover EH' research of 2017, led by the Centres for Disease Control and Prevention.
This project identified key workforce challenges and other issues impacting the environmental health field by gathering perspectives from approximately 1 700 environmental health professionals in the US through an online survey and in-person discussions.
The benefits of this research initiative were that it was able to identify the challenges being experienced by the professionals on the ground that hinder them from effectively safeguarding the health of their population, and it identified training and research needs for the strengthening of the sector. A similar initiative for Namibia would be fundamental, as the data collected could shape and strengthen the delivery of environmental health services throughout the country, shaped by our country-specific risks.
In conclusion, environmental health must become an active topic in discussions about achieving good health and well-being in Namibia.
Firstly, addressing the root challenges contributing to environmental health hazards, such as the lack of access to safe water and sanitation services and poor food safety literacy, is essential to support the goal of UHC.
Moreover, it is crucial to advance environmental health policies and build a workforce capable of continuously identifying, controlling and mitigating environmental health risks. In the absence of a strong and sustainable environmental health system which emphasises prevention and health promotion, we risk standing on a false sense of security that we are achieving the required health goals of the country, as hazards are not being addressed.
Sustainable health systems are built on the elimination of factors in the environment that cause ill health.
*Ndinelago Landi Moses is an environmental health practitioner by profession. She is currently employed as a public health manager by Carnival Maritime GmbH. She writes in her personal capacity.
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