Current situation 
Namibia reported its first confirmed COVID-19 cases on 13 March 2020 and the Ministry declared the COVID-19 outbreak on 14 March 2020. Since then (as of 6 July 2020) Namibia has had several hundred sporadic cases (539 confirmed) and no recorded deaths. Until recently (the last two weeks), most (approximately 87%) of the confirmed cases have been found in travelers entering the country held in routine quarantine facilities. 

Namibian Government’s responds rapidly to COVID-19, in collaboration with WHO 
A key success factor in containing the epidemic was the prompt action taken by a government who had already began strengthening its preparedness and emergency response capacities. The Government of Namibia requested WHO’s support to strengthen its emergency preparedness and response through a Joint External Evaluation (JEE) of the International Health regulations (IHR). Following a series of inspections and workshops, the country conducted the JEE in November-December 2016 which led to the finalization of the National Action Plan for Health Security (NAPHS), which is yet to be launched. 

When COVID-19 emerged, the government showed strong leadership and ownership of the situation by activating a National Health Emergency Coordination Committee under the Ministry of Health and Social Services (MOHSS). The Namibian government has furthermore introduced the Incident Management System (IMS) and strengthened the functionality of the National Public Health Emergency Operation Centre (NPHEOC), which has become the central base from where all COVID-19 responders at the national level are operating from. The government brought all government sectors, development partners, private sector and civil society on board and developed a Multi-sectoral National Response Plan for COVID-19 in Namibia, which resulted into a whole-of-government, whole-of-society response campaign led by the Head of State, His Excellency Dr. Hage Geingob, with senior leadership of numerous government ministries. This response campaign is comprised of several technical pillars, including the Country Co-ordination and Planning, Risk Communication and Community Engagement; Surveillance, Case investigation and rapid response; Points of Entry; National laboratory, Infection Prevention and Control; Case Management, Operations, Logistics and procurement; and Mental Health and Psychosocial support, Security and provision of essential services. Efforts have been put in place to make sure all interventions are well coordinated, communicated for effective implementation. 

The Government declared a State of Emergency on 17 March 2020 and rapidly implemented several critical public health and safety measures. The government opted for a phased approach to the lockdown procedures. Early measures included a ban on international travel, mass gatherings and mandatory quarantine measures. A lockdown was enforced in the regions of Khomas and Erongo with the closing of non-essential services and tightening of immigration control. From mid-April, these restrictions were then implemented nation-wide following further consultations with non-health sectors, ensuring that labour and social protection concerns were addressed. 

WHO worked in close partnership with the government of Namibia and MOHSS, providing data and information to plan the country’s response to the pandemic. WHO provided technical guidance to support the health sector in decision-making and increased the ministry’s capacity in coordination, surveillance, IPC, PoE, laboratory, logistics and case management. A national team of experts made up of WHO and other partners has been established to work closely with the MOHSS and government to develop the public health and safety measures for cabinet submission and endorsement by the President. These measures are based on scenarios using various WHO guidance and tools, including WHO modelling databases. The experts involved include lawyers who guide the process leading to the rapid promulgation of new public health and safety measures into law, backed by specific directives and guidelines per ministry/sector. Communication and coordination of various aspects of the response have improved during the past few months with the support of technical expertise. 

While the epidemic in Namibia appears to be under control, the government remains very cautious with respect to easing public health and social measures and continues to improve its readiness and response to the outbreak. The President of Namibia commissioned two COVID-19 treatment units on 5 June; one 9-bed high dependence unit with 6 beds for ventilation intensive care unit, and one 10-bed isolation facility. Both are situated at the Windhoek Central Hospital. Plans to develop similar facilities across the country with varying bed capacity are underway. The infrastructural development of the COVID-19 treatment centres in Windhoek and throughout the country has been under the leadership of the case management pillar, supported by extensive technical guidance from WHO and the Centre for Disease Control (CDC-US). In addition to equipping facilities, health workforce capacity development for case management remains a high priority for public and private health care providers. 

Nationwide testing strategy is allowing the country to contain the outbreak 
During the early stages of the pandemic, the national testing strategy was limited to suspected cases that strictly met the WHO’s case definition for COVID-19: travel history or contact with a person with travel history while overlooking the third suspected case definition criteria: persons with respiratory symptoms of unknown aetiology. An initial low-testing rate was a concern for the government, however, existing infrastructure did not allow for a significant increase in tests. Initially, samples were sent to the National Institute of Communicable Diseases (NICD), a WHO Collaborating Laboratory in South Africa, while capacity building was taking place in Namibia. WHO engaged in a partnership with the National Institute of Pathology (NIP) in Namibia and other government institutions like University of Namibia and veterinary services in securing support of laboratory staff in molecular testing for COVID-19. WHO has provided reagents and swabs to the NIP and through a partnership with a private laboratory testing service provider, Pathcare, and other laboratories who have provided supplies, WHO has helped to increase national testing capacity. 

Currently, two laboratories in Namibia are undertaking COVID-19 testing; the National Institute of Pathology (NIP) and Pathcare (private laboratory). Testing at point of entry into the country is also being undertaken, with two testing sites currently in place. Samples with indeterminant results are being sent to the National Institute of Communicable Diseases (NICD) in South Africa for confirmation. 
With Namibia’s COVID-19 cases rapidly increasing from 32 to 196 in the two weeks up to 29 June 2020 mostly in the harbour towns of Walvisbay in Erongo Region (which carries 90% of Namibia’s COVID-19 cases as of 6 July 2020), the Ministry of Health and Social Services and WHO embarked on a targeted testing campaign to test 2,000 people at 10 selected sites and ensure that no case is missed. 

As a result of these efforts, the number of tests per day has increased from 20 on 13 March 2020 date to 450 as of 7 July 

Namibia launches the “COVID-19 Communication Centre” 
On 2 April 2020, the Government of Namibia, in collaboration with UN agencies and WHO, launched a COVID-19 Communication Centre, providing a platform for all sectors to engage the public on key issues affecting their respective sector in relation to the COVID-19 lockdown guidelines. WHO has influenced themes for the health sessions and participated in some of the sessions. WHO provided training to the management of the Communication Centre on instituting social distancing measures at the Centre to reduce risk of transmission. Press conferences are taking place daily, with a presentation from the Minister of Health to ensure that the public remains fully informed of the evolving situation. The morning briefing addresses issues related to non-health sectors while the afternoon briefing informs on the health sector response. The communication is highly interactive, and journalists are given the opportunity to ask questions during the daily press conference and through a dedicated email address. This is also an opportunity for the authorities to debunk rumours and misinformation. 

To further support risk communication and community engagement, WHO has been working closely with other agencies in developing communications strategies, messages and materials for the general public and targeted communities. This support will be scaled up to include sub-national levels and ensure the whole country, especially vulnerable populations with limited access to technology and electricity, can be reached with the right information. 

WHO is leading the UN response to contain the outbreak in Namibia and secure supplies for front line health workers 

WCO in Namibia has a long-standing partnership with the UN and other multilateral agencies and is providing guidance on the COVID-19 response plan through WHO headquarters and African Regional Offices. Since the cases were first diagnosed in the country, WHO Country Office (WCO) has been completely repurposed to support the action plan. 

In April, WCO Namibia took urgent action to protect front line workers and provided essential medical supplies with the MOHSS to support the Namibian Governments’ ongoing efforts. The supplies were part of the first United Nation’s ‘Solidarity’ flight delivering vital medical supplies. The flight was facilitated by the World Food Programme and included WHO-procured supplies. The donation included personal protective equipment (PPE) for over 1,000 health workers with facial shields, masks, gloves, gowns, laboratory swabs and goggles. The handover took place on 20 April along with a live panel discussion focusing on the “Protection of the Health force” which was hosted at the COVID-19 Communication Centre and nationally televised by all media houses. 

Capacity development of frontline health workers for COVID-19 
Capacity development in the form of training and information sharing with front-line health workers is essential in addressing the COVID-19 pandemic. WHO worked with MOHSS to provide a virtual integrated training during two weeks in May to prepare regions in responding effectively to the outbreak. The number of people trained was extended to include close to 1,000 participants from outbreak preparedness and response teams at regional and district levels; regional health emergency management and district health; emergency management committee members; and operational levels including countrywide staff from government, UN and NGOs staff and academia. WHO and MOHSS also conducted a simulation on case management and infection prevention and control at the intensive care unit for COVID-19 patients at the Windhoek Central Hospital. A second phase of the training is being planned which will include simulations and more practical sessions. 

Continuation of essential health services including the management of people living with HIV/AIDS (PLWH) in Namibia and the Expanded Programme on Immunization (EPI) 
Ensuring continuity of essential health services is a priority for WHO, particularly for people living with HIV/AIDs who are reluctant to visit health facilities due to risk of infections, and those living with chronic diseases or needing vaccines. 

WHO is working with the Directorate of Special Programmes from the MOHSS and other partners to ensure continuity of anti-retroviral therapy while ensuring that infection prevention and control measures, and social distancing are strictly observed. To decongest ART facilities during the COVID19 outbreak, differentiated service delivery models are being used including multi-month dispensing, primary health care outreach, comprehensive community-based health services (CCBHS), community adherence groups, and the establishment of new ART distribution points to promote accessibility and ensure social distancing. 

Regarding the Expanded program on routine immunization, WHO is working in close collaboration with the government to ensure routine immunization services continue to be provided in the country. There has been no measles outbreak, but coverage for 2019 at national level for MR 1 was 79% and MR2 56% which indicates a drop out of more than 20% and this was the main reason that WHO and the government ensured the African vaccination week for Namibia would be held. This drop is mainly due to vaccine stock outs and children not being brought back for the second WR dose. All districts started to implement immunization activities at the beginning of June. WHO, along with UNICEF provided financial support to the districts to continue routine immunization, including integrated expanded outreach services such as nutrition assessment and vitamin A supplementation. 

The WHO Representative in Namibia, Dr. Charles Sagoe-Moses, underscored that health workers are critical to deliver on the promise of “leaving no one behind” and be part of the global effort to achieve the Sustainable Development Goals (SDGs). They make a vital contribution to national and global targets related to a range of COVID-19  health priorities, including universal health coverage, mental health and noncommunicable diseases, emergency preparedness and response, patient safety, and the delivery of integrated, people-centred care.