In Namibia home based care provides the only service approximating to palliative care. The impetus for the development of these services has been the AIDS epidemic. It is estimated that 22.3% of all pregnant women in Namibia are HIV positive and that 16% of all children under the age of 15 have lost one or both parents.² There are an estimated 18000 registered orphans and vulnerable children (OVCs) in Namibia. In response to the AIDS prevalence in the country the US funded Population Services International (PSI) opened two New Start Voluntary Counselling and Testing (VCT) centres in 2003 with more planned for 2004.

What we have as palliative care so far in Namibia is really home-based care -- it is most often without a true end-of-life specialty. Oral morphine is rarely provided outside the hospital setting and that is what must be changed for this specialty to really take hold in this country. The good news is that oral morphine is schedule one drug and can move out of health facility into the community very easily.³

Catholic Aids Action (CAA)

This faith- based organization was established in 1998 and operates 14 offices nationally. It provides home based care, HIV prevention education, voluntary counselling and testing (VCT), support for orphans and vulnerable children, and community mobilization.⁴

The team networks widely with local agencies. Patients are referred to local clinics and district hospitals for treatment of opportunistic infections and ARV therapies. Referrals are made to government social workers for social welfare grants, while local pastors and churches are drawn on for spiritual support. Local non-governmental organizations provide material support. CAA advocates on behalf of its patients for school attendance, human rights and inheritance rights. Food remains the most significant issue to manage and soup kitchens are run by this organisation. CAA provides limited material support (such as school uniforms), advocacy for access to education, and experiential learning camps and Art Days for orphans and vulnerable children (OVC).

CAA reported the following service provision as at the third quarter of 2004:

• 313 VCT tests
• 6,009 HIV+ clients registered
• 2,554 OVC material assistance
• 1,727 OVC registered for activities
• 35,906 contacts for information, education and referral
• 17,085 meals to HIV affected people
• 2,836 participants in Stepping Stones (HIV education programme)
• Adventures Unlimited (Christian programme)⁵