By Prime Shaapopi
As Namibia charts its path toward a more just and equitable society one urgent question arises: Should the country introduce a National Insurance Tax to fund universal healthcare for all citizens? And this should not be an economic or fiscal debate.
It should be a further questioning of what kind of Namibia do we want to build? Who deserves access to healthcare? How do we sustainably finance a health system that leaves no one behind, including healthcare workers who often operate under resource constraints? And more importantly how do we ensure all healthcare professionals (workers) are employed without the question of diluting national budget?
Since independence, Namibia has made notable progress in healthcare. The government spends approximately 9% of GDP on health among the highest in Sub-Saharan Africa, demonstrating strong commitment to public health.
One can opine that public hospitals and clinics has now reached many remote communities yet stark inequalities remain. Rural areas often suffer from staff shortages, outdated equipment and unreliable access to medicine.
Meanwhile private healthcare although world-class is accessible only to a privileged few, meaning for many Namibians one serious illness could result in financial catastrophe especially with out-of-pocket spending remaining alarmingly high. What is even more concerning is that even the most basic and universal medical needs like childbirth have become increasingly unaffordable for many families.
Bringing new life into the world, once considered a deeply communal and accessible experience, now carries a heavy financial burden. Costs for maternal care, hospital stays and delivery continue to rise, often pushing families into debt.
This not only undermines the principle of equitable healthcare but raises serious questions about how a society values the health and dignity of its people especially women and children.
The COVID-19 pandemic exposed deep vulnerabilities in the system by stretching the system to the breaking point, highlighting inefficiencies and the consequences of unequal access. It showed that health emergencies do not discriminate by income or geography, making the case for universal coverage even more urgent.
Across the country thousands still die of preventable diseases and the rise of non-communicable diseases like cancer, diabetes and hypertension demands more structured and long-term care models.
A National Insurance Tax is a dedicated, ring-fenced social contribution usually paid by both employees and employers to fund healthcare for all. It is not merely a tax; it is a solidarity mechanism, a social contract that says, “Your health is my concern.” For Namibia, this could mark a shift towards inclusive growth, where healthcare is not a privilege but a right.
This would allow all citizens, regardless of income to access basic healthcare. It would reduce reliance on out-of-pocket payments which are the most regressive form of health financing. Instead of relying on volatile donor aid or shifting budget allocations, Namibia could create a resilient healthcare fund.
Healthy populations make for strong economies and a system that ensures early diagnosis, treatment and preventive care can reduce absenteeism, improve productivity and avoid costly late-stage interventions. Moreover, if citizens see their contributions directly funding quality healthcare, it could help rebuild public trust in government institutions, something Namibia and many other African nations desperately need.
Namibia’s current moment of reflection also presents a chance to reimagine what a resilient and future-ready healthcare system could look like. In a recent interview with the Evening Review host Toivo Ndjebela, Minister of Health and Social Services Esperance Luvindao emphasized that health education is just as important as the clinical or practical aspects of care.
She argued that rethinking healthcare delivery must include making health education a bedrock of the system, empowering communities with knowledge, prevention and long-term behavioural change. According to the Minister, expanding hospital infrastructure and increasing access to essential facilities must go hand-in-hand with public education and awareness campaigns.
This dual approach can reduce the burden on emergency care, promote early interventions and foster a culture of health ownership among citizens especially in underserved regions. The National Insurance Tax, if implemented, could become the financial backbone for such a holistic transformation.
Namibia doesn’t have to reinvent the wheel to start from scratch. Many developed countries like UK, Germany, France, Japan etc successfully fund healthcare through national insurance systems.
These systems aren’t perfect, but they work and prove that universal healthcare is achievable through shared financing and political will. Now the further question is: Why not in Namibia? Namibia can learn from these countries by adopting what works and avoiding what doesn’t.
Central to any successful implementation will be the role of the tax authority. In Namibia, that responsibility falls to the Namibia Revenue Agency (NamRA). In countries like the UK, tax authorities collect and manage health contributions, integrating tax and social policy. NamRA could play a similar role in Namibia, collecting health contributions via the existing PAYE system, ensuring compliance among employers and coordinating with the Ministry of Health and the Social Security Commission to ensure funds are used effectively.
Of course, this would require robust systems and transparency, but it is entirely possible considering how efficient and effective NamRA has been since Sam Shivute took over as Commissioner in April 2021 making such a transformation not just possible but practical. Namibia is entering a new era of political and institutional renewal.
The election of the country’s first female president and a more vibrant accountable Parliament suggest a maturing democracy one capable of bold policy reforms. A National Insurance Tax could become a cornerstone of Namibia’s Vision 2030.
Of course, the road will be challenging considering high unemployment and a large informal sector reduce the tax base. New deductions from salaries might be met with scepticism unless the benefits are tangible. The system must just be corruption-proof, transparent and gradually implemented with clear and concise public communication. But these are just challenges not reasons to delay but reasons to plan decisively and inclusively.
Maybe let this be the beginning of a new conversation for her excellency the President, her cabinet, Parliament and NamRA, to reimagine a future where no one is birthed or dies because they could not afford treatment. The health of a nation is not a luxury; it is a right and the time to act is now.
* Prime Shaapopi is a Namibian Chartered Accountant with interest in taxation. These are his personal views.
