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Cablegate: Ambassador Dybul Visit to Namibia

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E.O. 12958: N/A

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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.

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Government to Government Meetings
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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

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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

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.

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Private Sector Meetings
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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

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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.

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Press Coverage
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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.

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Site Visits
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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.

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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
- express support for Windhoek as the site of the next global
HIV/AIDS conference;
- emphasize the need for exempting U.S. assistance from
- discuss the upcoming negotiations on a new PEPFAR compact;
- urge inter-ministerial coordination in the fight against

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.

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