Diseases are among the major factors limiting livestock productivity in many African pastoral systems. This study examined communal farmers’ perceptions of cattle health challenges and of veterinary extension services in the Kabbe area of the Zambezi Region, Namibia. Semi-structured questionnaires were administered to randomly selected communal cattle farmers in villages (n = 73) and key informants (n = 3). Most cattle farmers (61.6%, n = 45) sought veterinary intervention for diseased cattle, but the veterinary services were ‘inaccessible’ (68.5%, n = 50). Approximately 88.9% (40/45) of the farmers sought help only for emergency cases. The top five conditions reported by farmers in the dry and wet seasons were wounds, fractures, anthrax, abscesses, and lumpy skin disease (LSD), in descending order. The farmers highlighted a multiplicity of other disease conditions associated with both seasons. Treatment of cattle relied on oxytetracycline (57.5%, n = 42) and ivermectin (66.7%, n = 30) preparations, while the vaccination rate was low (12.3%, n = 9). The wildlife-cattle interface was implicated as a major factor contributing to high disease incidence in cattle (49.3%, n = 36). Cattle diseases decreased income from cattle sales (94.5%, n = 69), money for school fees (78.1%, n = 57), household milk consumption (75.3%, n = 55), and increased veterinary treatment expenses (74.0%, n = 54). The annual investment in herd disease control was relatively low (US$55-US$550). The majority of the disease conditions emphasised by farmers can be managed through an effective primary healthcare system. Therefore, establishing a community-based animal healthcare system is recommended to bring veterinary extension services and knowledge closer to communities, thereby improving animal health and livelihoods.