A report on performance across several critical health areas in Okavango, including HIV/AIDS, maternal and child health, Non-Communicable Diseases (NCDs), Sexually Transmitted Infections (STIs), malaria, and community-based care have painted a dark picture of the district’s health status.
The Okavango District Council’s Primary Health Care Services recently conducted a comprehensive health review for the first quarter of 2025, aimed at strengthening health outcomes in alignment with national health targets.
In the area of HIV/AIDS, HIV Testing Services (HTS) continued to experience low uptake, with only approximately 34% of over 6,700 clients accepting testing. Male participation remained significantly lower than female, and the proportion of first-time testers was under 20%. A total of 63 new HIV cases were recorded over the past two quarters, underscoring ongoing transmission at the community level. Distribution and reporting of HIV self-testing kits remained limited, hampering follow-up and linkage to care.
The implementation of index testing and partner notification declined substantially, with fewer clients being offered or accepting these services. Currently, over 8,000 individuals are on ART, with viral suppression exceeding 99%. However, there were notable challenges including poor client retention, as 36 to 41 clients were lost to follow-up, and nine ART-related deaths were reported.
No male circumcision procedures were conducted in the last two quarters, signaling an urgent need to revitalise Voluntary Medical Male Circumcision (VMMC) services. Pre-exposure prophylaxis (PreP) remained underutilized, especially among high-risk populations.
Sexual and reproductive health indicators revealed persistent challenges. Teenage pregnancy stood at a concerning 22.6%, indicating inadequate reproductive health outreach. Seventeen cases of defilement were reported during the quarter, highlighting serious child protection concerns. The burden of STIs increased, with 1,154 reported cases and a significant rise in urethral and vaginal discharge syndromes. Syphilis prevalence rose from 0.3% to 3.3%. Condom distribution fell drastically following the withdrawal of NGO partners, which has weakened HIV/STI prevention efforts.
On maternal and child health, PMTCT testing coverage fell short of national targets, ranging from 87.5% to 90.4% due to missed testing opportunities during antenatal care. However, all eligible women were enrolled into PMTCT services, reflecting 100% uptake. All HIV-exposed infants tested negative, but early testing and formula feeding practices require further strengthening.
Immunization coverage declined for several antigens, with IPV at 53% and Polio at 63%, largely due to national stockouts and challenges in mobile service delivery. Diarrhoeal diseases remained prevalent among children under five, contributing to three reported deaths during the quarter. Coverage of zinc and ORS dropped, and underweight prevalence remained above the acceptable threshold at 3.9%.
In malaria control, only 29% of reported cases were fully investigated, and follow-up coverage stood at just 12%. The presence of gametocytes in confirmed cases indicates poor treatment adherence. Indoor Residual Spraying (IRS) coverage was below the required threshold at 51.8%, and utilization of long-lasting insecticide-treated nets remained suboptimal. Although verification and outbreak response activities were carried out, local transmission continues in some parts of the district.
For non-communicable diseases, hypertension and diabetes control rates were 87.3% and 94.5% respectively. Despite this, caseloads are increasing, with three deaths attributed to hypertension during the reporting period. Cervical cancer screening improved markedly, with pap smear coverage rising from 43% to 81%, and Visual Inspection with Acetic Acid (VIA) exceeding targets.
Community-Based Care (CHBC) registered a total of 196 clients, 41 of whom are HIV-positive. Clients were supported with home visits and food baskets. However, rehabilitation services remained unavailable, and very few clients were discharged, indicating slow clinical improvement. Psychosocial support services such as counselling have expanded.
In terms of drug and supply chain management, the availability of vital and essential drugs averaged below 80%, falling short of the national target of 97%. This shortfall is attributed to delays in supply chain logistics, a limited supplier base, and inadequate forecasting and procurement capacity.
The key implications of these findings are significant. Continued HIV transmission, underutilized prevention tools such as VMMC and PreP, and persistent gaps in testing and condom access all signal potential escalation in HIV incidence. Rising STI cases and teenage pregnancies further highlight the need for intensified reproductive health education.
Inadequate malaria surveillance and follow-up could allow local transmission to re-establish. Declines in immunization coverage and sustained diarrhoeal disease burden pose a serious threat to child survival. Drug shortages compromise the delivery of essential services.
To address these challenges, several strategic actions were recommended.
These include intensified community outreach targeting men, youth, and hard-to-reach populations, revitalization of male circumcision and expansion of PreP services and re-engagement of NGO partners to support condom distribution and community testing.
Further recommendation included strengthening of supply chain systems through diversification of suppliers and recruitment of dedicated logistics personnel, expansion of preventive health campaigns targeting children and mothers. and enhancement of real-time disease surveillance and reporting. Strengthened provider training and expanded patient tracing efforts were also regarded essential to maintain gains in NCD control and ART adherence.
