VZCZCXRO1534
PP RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHWD #0283/01 2561114
ZNR UUUUU ZZH
P 121114Z SEP 08
FM AMEMBASSY WINDHOEK
TO RUEHC/SECSTATE WASHDC PRIORITY 0061
INFO RUCNSAD/SOUTHERN AFRICAN DEVELOPMENT COMMUNITY PRIORITY

UNCLAS SECTION 01 OF 03 WINDHOEK 000283 
 
SENSITIVE 
SIPDIS 
 
STATE FOR AF/S, S/GAC 
STATE PASS TO USAID 
STATE PASS TO PEACE CORPS 
STATE PASS TO CDC 
 
E.O. 12958: N/A 
TAGS: PREL PGOV KHIV WA
SUBJECT: AMBASSADOR DYBUL VISIT TO NAMIBIA 
 
- - - - 
Summary 
- - - - 
 
¶1.  (SBU)  U.S. Global AIDS Coordinator Ambassador Mark Dybul 
recently completed a three day official visit (September 
8-10) to Namibia.  The visit's main purpose was to underscore 
the USG's partnership with Namibia in its fight against 
HIV/AIDS.  During his meetings with Namibian government (GRN) 
officials Dybul discussed the desirability for a Partnership 
Compact for the second phase of the President's Emergency 
Plan for AIDS Relief (PEPFAR); underscored the U.S. 
legislative requirement that U.S. development assistance be 
exempt from local taxation; and expressed his support for 
Namibia to host the next PEPFAR Implementing Partners 
conference.  Namibian President Hifikepunye Pohamba, Prime 
Minister Nahas Angula and other senior government officials 
thanked the USG for the PEPFAR program and made a commitment 
to resolve the issue of the payment of VAT taxes by the USG's 
local PEPFAR implementing partners.  Dybul also met with 
leaders of corporations which have developed strong workplace 
programs; discussed the status of PEPFAR activities with 
implementing partners and key donor organizations, and 
visited PEPFAR-funded projects in both Windhoek and Namibia's 
Caprivi region.  Dybul's visit received significant and 
positive media coverage.   End Summary. 
 
- - - - - - - - - - - - - - - - - 
Government to Government Meetings 
- - - - - - - - - - - - - - - - - 
 
¶2.  (SBU)  U.S. Global Aids Coordinator Ambassador Mark Dybul 
began his visit to Namibia with a call on President 
Hifikepunye Pohamba on September 8.  Also in attendance were 
the Minister of Health Richard Kamwi, the Deputy Permanent 
Secretary for Health Dr. Norbert Forster, and the Director 
General of the National Planning Commission Peter Katjavivi. 
Ambassador Mathieu, the directors of USAID, CDC, and Peace 
Corps, the PEPFAR Coordinator and Econoff also attended. 
 
¶3.  (SBU)  President Pohamba started by thanking Ambassador 
Mathieu, Ambassador Dybul and the USG on behalf of his 
government and the Namibian people for PEPFAR's "wonderful 
work" in "keeping us (Namibia) going" and helping to 
"prolong" the lives of his countrymen.  The President 
emphasized that HIV/AIDS has destroyed Namibian families, but 
that, with PEPFAR funded anti-retroviral (ARV) treatments, 
people who were once ill are now returning to work and taking 
care of their families again.  "Everyone" has noticed the 
marked decline in the number of dead and sick from HIV/AIDS, 
Pohamba stated. 
 
¶4.  (SBU)  President Pohamba expressed concern that a change 
in U.S. administration would result in a diminished U.S. 
commitment to PEPFAR in Namibia.  Ambassador Dybul responded 
that PEPFAR enjoys deep bipartisan support and that both 
candidates for U.S. President had supported the five-year 
PEPFAR reauthorization.  Dybul congratulated the President on 
Namibia's progress in fighting HIV/AIDS, stressing Pohamba's 
leadership role and that of his government ministers.  Dybul 
informed Pohamba that the USG ) in light of Namibia's 
sustained leadership - supported Namibia's interest in 
hosting next year's PEPFAR Implementing Partners conference. 
 
 
¶5.  (SBU)  Dybul then explained that the United States is 
moving toward new PEPFAR partnership arrangements (compacts) 
built on transparency and sustainability that would entail 
Namibia assuming responsibility for an increasing percentage 
of HIV/AIDS programs.  Pohamba also embraced this idea. 
Pohamba closed the meeting by thanking the USG once again, 
and especially noted the dedication of many Peace Corps 
Volunteer teachers who are "living (and teaching) in the 
bush."  He remarked that he had visited many of them when he 
was a minister. 
 
¶6.  (SBU)  A later meeting with Prime Minister Nahas Angula 
echoed many of the themes discussed during Dybul's visit with 
the President.  As he did with the President, Ambassador 
Dybul expressed concern  that some U.S. implementing partners 
had been subjected to payment of VAT taxes, and he 
underscored the requirement of the U.S. Congress that PEPFAR 
funds (and U.S. development assistance in general) be exempt 
from taxation.  The Prime Minister responded that during 
Millennium Challenge Account (MCA) compact negotiations the 
GRN had positively resolved similar U.S. concerns, and he 
expressed confidence that a similar arrangement could be 
 
WINDHOEK 00000283  002 OF 003 
 
 
reached regarding PEPFAR activities. 
 
¶7.  (SBU)  Angula stressed the need for improved evaluation 
and measurement of Namibia's HIV/AIDS activities, as well as 
reduced administrative (overhead) costs.  Dybul agreed, 
saying both sides should include strong results-oriented 
metrics when negotiating the new partnership compact.  The 
Prime Minister remarked that inadequate access to proper 
nutrition remains an impediment to HIV/AIDS efforts and 
stressed the need for Namibia to become more food independent 
to ensure uninterrupted access to reasonably priced food. 
Dybul acknowledged that malnutrition is detrimental to the 
effectiveness of HIV/AIDS prevention and treatment, but 
pointed out that PEPFAR's mandate does not cover nutrition 
(food development and distribution).  He added, however, that 
PEPFAR encourages host governments to seek synergies between 
their HIV/AIDS programs and other initiatives as much as 
possible. 
 
¶8.  (SBU)  In a separate meeting, Minister of Health Kamwi 
told Dybul that the focus of the GRN's HIV/AIDS-related 
efforts has been on ARVs, human resources (training for 
doctors and other medical staff), and infrastructure 
(clinics). Kamwi cited many of Namibia's successes, 
highlighting that mother-to-child HIV transmission has been 
cut dramatically; more than 80 percent of babies born from 
infected mothers today are HIV negative.  Nevertheless, Kamwi 
agreed with a point Dybul stressed with the President that 
future efforts will need to focus on prevention activities 
that target behavior modification.  Kamwi mentioned that 
Namibia wants to promote male circumcision (a procedure that 
significantly reduces a man's risk of contracting HIV), and 
noted the importance of working with traditional 
practitioners. Kamwi explained that one traditional doctor 
had performed 3000 male circumcisions last year. 
 
¶9.  (SBU)  Kamwi agreed with Dybul that the GRN's HIV/AIDS 
program must cross ministerial boundaries, not just fall 
under his Health Ministry's domain.  (Note: Dybul stressed 
the need for inter-ministerial cooperation at all of his 
meetings with GRN officials.  End Note).  He pointed out that 
the Ministry of Education has incorporated HIV/AIDS training 
into its curricula, and the Ministry of Defense was 
proactive, but he acknowledged that there was room for 
greater collaboration.  Kamwi's deputy permanent secretary 
Dr. Norbert Forster noted that HIV prevalence rates rise 
sharply once students leave school, reflecting that while 
schools have successfully delivered HIV/AIDS education, 
unemployed youth and school dropouts no longer hear (or 
embrace) the message.  Forster remarked that the GRN and 
private sector (and not just workplace programs) need to 
consider targeting prevention efforts for the unemployed. 
Kamwi noted that one challenge that has emerged amongst the 
Namibian AIDS community is the demand for payment by 
volunteers who provide home-based care and other services to 
HIV/AIDS patients. 
 
- - - - - - - - - - - - 
Private Sector Meetings 
- - - - - - - - - - - - 
 
¶10.  (SBU)  A group of private sector leaders shared their 
views on the shortcomings of their current workplace efforts 
as well as the possibility for some new innovative solutions. 
 The group agreed that the Namibian Business Coalition on 
HIV/AIDS (NABCOA), as it is currently structured, has been 
less than effective.  They noted that NABCOA's "one size fits 
all" programming had failed to adequately serve its members. 
Large companies find training sessions less than useful 
because they already have sophisticated programs in place, 
while small to medium enterprises (SMEs) find such sessions 
overly complex and not relevant to their experiences.  The 
group also agreed that much of NABCOA's programs had become 
too "donor-centric." NABCOA, some argued, had focused less on 
responding to the needs of the business community and more to 
the projects proposed and funded by foreign assistance 
donors.  Most concurred that many SMEs did not fully 
understand the costs associated with HIV/AIDS-related 
absenteeism and reduced productivity. 
 
¶11.  (SBU)  Following Dybul's suggestion that 
business-sponsored HIV/AIDS programs should focus on the 
private sector's core competency ) the efficient delivery of 
goods and services ) the group then brain-stormed on 
potential new initiatives.  The most promising idea came from 
NAMDEB CEO Inge Zaamwani, who mentioned her company had 
investigated an insurance pooling scheme.  The scheme would 
 
WINDHOEK 00000283  003 OF 003 
 
 
allow many of NAMDEB's small vendors the opportunity to 
provide insurance to their employees.  Zaamwani noted that 
NAMDEB had already determined the costs of such a program and 
the number of participants required, but NAMDEB was not able 
to pull together a large enough pool to make it viable. 
Other participants around the table responded that they were 
not aware that insurance pooling was an option, but that it 
would definitely interest them as a way for their suppliers 
to provide coverage. 
 
- - - - - - - - 
Press Coverage 
- - - - - - - - 
 
¶12.  (U)  Ambassador Dybul's visit garnered significant 
television coverage on the state-owned Namibian Broadcasting 
Corporation's (NBC) television chaQ.  Dybul's call on 
President Pohamba was the lead story on the evening news 
program, September 8; the story replayed later that night. 
Dybul also appeared the same evening on NBC's flagship 
program "Talk of the Nation."  The program focused on 
PEPFAR's partnership with the GRN, academic, nongovernmental, 
and faith-based partners to increase Namibia's human resource 
skills in many different areas ) health counseling, 
financial management, etc., to fight the epidemic.  Dybul 
praised Namibia's progress in fighting the disease and also 
pointed out areas in need of improvement.  He was joined by 
Dr. Forster, the Rector of the Namibia Polytechnic and the 
Director of the Church Alliance for Orphans, a key local 
partner.  Dybul also appeared on NBC's "Good Morning Namibia" 
on September 10. 
 
¶13.  (U)  NBC Television estimates that its signal reaches 64 
percent of Namibia.  Ambassador Dybul appeared on the 
network's most popular news programs.  Opinion leaders and 
average Namibians regularly follow NBC coverage to keep up 
with key national issues. 
 
- - - - - - 
Site Visits 
- - - - - - 
 
¶14.  (SBU)  On September 9-10, Ambassador Dybul, and the 
Windhoek PEPFAR team visited a number of PEPFAR-funded sites 
in both Windhoek and in Namibia's northeastern Caprivi 
region.  The sites illustrated the impressive results Namibia 
has achieved under the PEPFAR program ) results such as ARV 
clinics, laboratories, and healthy HIV  patients. 
Nevertheless, the site visits also illustrated the need to 
improve local (Namibian) capacity as each location had 
sizeable clinic populations being served by non-Namibian 
health care professionals who are responsible for 
implementing programs. 
 
- - - - 
Comment 
- - - - 
 
¶15.  (SBU)  Ambassador Dybul had a number of goals he wished 
to accomplish during his visit to Namibia: 
 
- praise the GRN on its leadership in the fight against 
HIV/AIDS; 
- express support for Windhoek as the site of the next global 
HIV/AIDS conference; 
- emphasize the need for exempting U.S. assistance from 
taxation; 
- discuss the upcoming negotiations on a new PEPFAR compact; 
and, 
- urge inter-ministerial coordination in the fight against 
HIV/AIDS. 
 
¶16.  (SBU)  All of the primary goals were accomplished.  The 
President and PM both seem genuinely honored and interested 
in having Namibia showcased at the next PEPFAR Implementing 
Partners conference by acting as host.  Both acknowledged 
that the taxation issue had to be addressed.  From the 
President down, GRN officials appeared to understand and 
embrace the need for better cooperation and coordination 
amongst the government's ministries.  Post will follow up 
with NAMDEB on the proposed insurance pool scheme to 
ascertain whether there would be a role for PEPFAR in 
facilitating its establishment.  End Comment. 
MATHIEU