Health care options for commercial farm workers in Namibia

Introduction: Limited access to health care in rural areas is a challenge in Namibia. In 2007 a survey was conducted among employers of commercial farms to assess the feasibility of introducing private, affordable health insurance that including HIV/AIDS coverage for commercial farm workers in Namibia. Healthcare access and utilization by people living and working on commercial farms were evaluated to gain insight into the possibility to strengthen health service delivery in this sector. Method: A cross-sectional survey of all members of the Agricultural Employers' Association was conducted by telephone interview in a one-year period from 2006. The population sampled included 1708 employers in farms throughout 8 regions of Namibia. Results: In total, 1402 farm employers (82%) agreed to participate, representing 1414 farms and an average of 10.2 employees (range 0-342; 95% CI: 9.50, 10.94) per farm. Employers surveyed reported 95% of farms (95% CI: 93.6, 95.9) had access to at least one medical facility. Employers on the majority of farms (94.7%; 95% CI: 93.6, 95.9) reported that employees had visited at least one medical facility, most frequently using clinics (79.2%, 95% CI: 77.09, 81.32), doctors (50.1%; 95% CI: 47.53, 52.74) and mobile clinics (45.7%; 95% CI: 43.10, 48.28). Employers were significantly more likely to use private doctors (chi(2) = 616.2, df=1, p<0.0003), travel longer distances (t=-11.34, df=1,470.5, p<0.0003) to reach them, and more likely to have health insurance coverage than employees (chi(2) = 1,098, df=1, p<0.0003). Employers on several farms reported covering costs for health-related transport (92.1%; 95% CI: 90.7, 93.5), medical consultations (62.2%; 95% CI: 59.7, 64.8), and providing free medications (88%; 95% CI: 86.2, 89.7). Only 0.85% of farms (95% CI: 0.37, 1.33) reported having employees enrolled in health insurance, but 77.1% (95% CI: 74.6, 79.4) of employers not providing insurance said they were willing to share costs for health insurance for employees. In addition, 148 farms had persons with formal medical training on site. Conclusions: Employees on commercial farms in Namibia and their dependants do not have adequate access to formal health care and in particular to HIV/AIDS-related services. Access could be improved by strengthening and expanding the on-site health services provided by some farmers, including basic care and support for on-site health professionals. While few employees were covered by health insurance, employers expressed great willingness to co-pay for a basic plan that would include outpatient care