Namibia: Interview with MS. T. K. Angula

MS. T. K. Angula

CEO of the Namibia Institute of Pathology (Namibia Institute of Pathology)

MS. T. K. Angula

Q1/ Could you please give us your thoughts about the evolution of NIP since its inception?

A1/ Namibia Institute of Pathology (NIP) is a state-owned company that was established by an Act of Parliament on 01 December 2001. It provides pathology services to the public and private sector on a commercial basis. Before its establishment, these services were fully integrated in the public service as part of the Ministry of Health and Social Services (MOHSS). As such it was financed fully through the Central Government like any other public services. There were 203 staff members at the beginning as compared to the current 270 approximately.

Many constraints were experienced as a result of this public service-based set up. These were highlighted in a feasibility study that was undertaken in 1996 with the purpose of identifying a possibly more cost-effective institutional and operational structure of these services. This study came at a time when government Ministries were instructed by the Office of the Prime Minister to identify government services that could be rendered independently from the public service. Although medical laboratory or pathology services were identified as essential, they were classified as a non-core function of the MOHSS, and were hence a candidate for outsourcing.
Now I want to come back to the constraints of that time, which included, among others: the shortage of technical staff, inadequate budget allocation and compromised quality of services.

On shortage of technical staff, there was, and still is the case, no local training for medical laboratory professionals and these services were and still are, rendered by a limited number of graduates who were trained mostly in South Africa and those who came from exile in the early 1990s. There were only a few students who could manage to get study grants or loans from the Ministry of Education to go and study outside the country, predominantly in South Africa.

The laboratory services which are both labour and technology intensive had to compete for financial resources with other essential services of the MOHSS such as hospital and primary health care services. As a result the budget was never adequate to procure the necessary instruments and supplies or to address the structural and logistical shortcomings that continued hampering the delivery of these services. With the abovementioned shortcomings, the result was a deterioration of the technical as well as service quality in our laboratories. This resulted in further resignation of professionals out of frustration. By the time of commercialisation, no single pathologist was left.

Several options of commercialisation were considered to ensure that while such move addressed the many shortcomings that were experienced, it would also not result in abandonment of the social responsibility of the MOHSS towards the public. Consequently an act of Parliament was promulgated in October 1999, a performance contract between the Ministry and NIP was drawn up and the company was eventually launched on 01 December 2000.

Q2/ Could you give us some key figures of your institution, for instance what is you annual budget?

A2/ Our budget for the current financial year is roughly NAD110million. This is mostly derived from our own revenue and only a small portion (approximately NAD3 million) is contributed by our developmental partners, the biggest of which is the US President’s Emergency Plan for AIDS Relief (PEPFAR).

Q3/ What kind of services is NIP rendering?

A3/ Since its inception, NIP has taken over the whole network of government laboratories situated all over Namibia. There were 25 at that time and we have gradually increased the number to the current 34. Our functions include: performance of routine diagnostic tests; assisting in the necessary screening of the population for specific problems ( eg. Every two years, we together with the MOHSS, conduct the HIV sero-prevalence studies among the pregnant women); monitor treatment effectiveness eg. therapeutic drug monitoring, and we are about to undertake the monitoring of HIV drug resistance, etc.; provide practical training to medical technology students including interns; conduct operational research applicable to Namibia’s health care system and advice the MOHSS accordingly (eg. validation of several HIV rapid tests.)

Q4/ What are the future plans of the NIP?

A4/ The biggest part of programmes of NIP is heavily dependent on the national health needs as determined by the Ministry of Health and Social Services. At least 70 % of our revenue is earned from services rendered to the public sector. Our concern is about what will happen when donor support to the MOHSS, which contributed immensely to the Ministry’s ability to produce a big volume of services from NIP, comes to an end. Our future plans therefore include the expansion of our client base, both locally and outside Namibia as part of assuring financial sustainability. This is particularly crucial for the MOHSS and NIP in order to continue fulfilling the social responsibility that we accepted at the inception of the company.

Furthermore, it is our intention to have as many of our laboratories attain international accreditation as possible and we have plans to prepare 2-3 of them per year for that purpose. Two of our laboratories have been evaluated recently and according to preliminary reports, we have been given accreditation in accordance with ISO 17025 requirements for medical laboratories. It is an intensive process to come this far but it is even more to sustain the conditions of accreditation. Our plan is therefore to develop our technical staff, especially those who are responsible for managing the laboratories to be able to operate at the level that is dictated by the accreditation authorities. This will require input from our other partners in the form of attachments etc.

Another one of our future plans is the infrastructural development of our services. There are many reasons for this. The most important one is the fact that almost all our laboratories are situated in the state hospitals, in spaces that were designed a long time ago before the HIV/AIDS pandemic with its heavy pressure on health care services countrywide. Most of these laboratories need extensive renovation to be able to carry out investigation in line with the current health care needs. In addition to this, with Namibia’s long distances and sparse population, it is important for us to strengthen our logistic support to facilitate the inter-laboratory referral system, and external support in this area will be required.

In addition to the space constraints, there is that notion in this country that a “ public service is always bad”. Having almost all NIP laboratories situated in government hospitals does not help us much in our drive to popularise our services, even with the currently highly improved technical and service quality. It is therefore our plan to gradually invest in NIP’s own fixed facilities in strategic towns in order to beat this notion.

Q5/ Do you have a partnership strategy, would you like to get partners in the USA?

A5/ Yes, with some limitations. NIP is a fully government–owned laboratory organisation, which means any partners who will join us will do so with an understanding that they also accept the social responsibility that we are carrying. We currently only have partners who come in with public interventions, e.g. PEPFAR and other US related organizations that assist us with the strengthening our capacity to address HIV-related issues. We also have some ad hoc partners who would come to work with us for instance on specific research programs. We are currently planning one such research with a view to establishing the linkage between socio-economic status and HIV/AIDS, and for this one we are working together with an external non-governmental organization in the Netherlands and the University of Namibia. Other such partnerships are useful for us as well as for the other parties.

Q6/ What will you be able to offer to those partners?

A6/ Well, certain partners could benefit in terms of gaining the ground for research and publishing the research work, thereby enriching themselves academically. Furthermore, we have a number of well-equipped and well-staffed laboratories where other people can learn. Potential partners can therefore benefit in terms of exchange/attachment programmes, whereby employees of partner organisation exchange ideas and practices to the benefit of the respective organisations.

Q7/ We are interested in the person behind the position so could you also tell us about your personal background?

A7/ I am actually a pharmacist by profession. I am not a laboratory professional. I am here particularly because of my management skills and experience, which spill over from the Ministry of Health and Social Services where I was managing these laboratory services for years before they were commercialised. I started training as pharmacist in the United Kingdom and then I moved over to the United States of America where I graduated with my Bachelor of Pharmacist in the college with probably the longest name, “Arnold & Marie Schwartz College of Pharmacy and Health Sciences of Long Island University in Brooklyn” in New York, and that was in 1983. I then continued with my M.Sc. degree at the same college which I finished in 1984. I did my internship in Zambia in 1985 and thereafter worked for 5 years in the Zambian Central Medical store. That was before Namibia’s independence. I then came home in 1989, where after I worked for one year at a hospital pharmacy before I became the Director of Pharmaceutical Services in the Ministry of Health in 1991. Since then I was in management positions until I came here at the end of 2004. I have attended a number of management courses, and I am currently pursuing a master’s degree in business management (MBA).

Q8/ What has been your biggest satisfaction as the CEO?

A8/ I have occupied this position only for slightly over a year. I have to admit that at that time there was an extremely high level of dissatisfaction among medical practitioners and other clients both in private and public sectors about our services. At that time our competitors were positioning themselves to take over certain selected profitable services that were financed by a particular external donor. Some of the highly qualified staff were showing signs of demoralisation. When I took over I conducted an in-depth analysis of the problems, restructured the technical services in line with the findings and these moves are now bearing positive fruits. I am observing a clear change, and I continue receiving positive comments and encouragement from our service users. This has clearly been my biggest cause of satisfaction.

However, achieving satisfactory standard of operation alone is not as challenging as maintaining that status. It is for this reason that I emphasise on training especially targeting our laboratory managers so that they can facilitate the maintenance and further improvement of our quality standards.

Q9/ What is your final message to the American readers and investors?

A9/ One of our development partners has been the USA through the President’s Emergency Plan for AIDS Relief (PEPFAR). Apart from the funding that this program makes on behalf of the MOHSS for the bio-clinical monitoring of the HIV/AIDS program, PEPFAR has also been assisting NIP in providing training support for the laboratory quality system. This support has contributed immensely to the achievement of the quality standards that I mentioned earlier.

My message to the American public therefore is of appreciation and encouragement to continue supporting this noble cause. I should add that it is not only a noble cause, but a bigger service of excellence in the making for the international community, I mean the world has become small these days and I am sure an American visiting Namibia will feel comfortable to know that should they need a health care service, there is a diagnostic service such as NIP that they have helped to build, of a quality that is comparable to the international standard which will not only benefit Namibians but also Americans as well as other international visitors.