The Ministry of Health and Wellness has today revealed it is considering submitting proposals for the amendment of the country’s abortion laws to make it easier to ‘kill unwanted babies.’ It however was not clear whether they will conduct a referendum or proceed unilaterally.
A paradigm shift has also been developed to shift towards greater utilization of the private sector in areas of Lab, Radiology, Facilities management, and Hotel services (e.g. cleaning, catering and laundry) to protect Government from mundane tasks and operational headaches.
Speaking to the local media at a press briefing at Masa Hotel in Gaborone, health officials unveiled a self-styled transformational agenda driven by 4 core focus areas:- Organizational Transformation; Sustainable Quality Health Care Services; Preventative Health Care Approach and Economic Diversification Drive. IHS will also be migrated to the Ministry of Tertiary Education.
“My Ministry Roadmap, set strategic priorities intended to guide the Ministry to meet service delivery expectations and also to position the health service for the transformation critical for sustainability and excellence,” said Dr. Alfred Rabashemi Madigele, Minister of Health and Wellness.
He said, “The seven (7) key focal areas for the roadmap are Decentralization, Universal Health Coverage, Tertiary Care, Strategic Leveraging on the Private Sector, Supply Chain, Research, and Staff Welfare and Accountability.”
According to officials, there is a holistic agreement that the best path for efficient and responsive governance of the public health system is to empower the DHMTs and transform them into fully-fledged regional health authorities through greater decentralization.
“As a country, we have done exceedingly well in ensuring that more than 90% of Batswana have access to a health facility within a short distance (i.e. radius of 5 km) from where they live. But true universal access also requires that the services offered should be of high quality and be essential in nature,” said Madigele.
He said, “It is imperative to note that in 2017, the top 5 causes of mortality in Botswana were HIV/AIDS, Ischemic heart disease; Stroke; Lower respiratory infections; and Diabetes.
The NCDs among these (i.e. Ischemic heart disease, Stroke, and Diabetes), had increased in burden by an average of 34%. The top 5 risk factors related to these causes of mortality were Unsafe sex; Poor diet; High blood pressure; Alcohol abuse; and Tobacco use.
According to officials, the main causes of mortality and their risk factors in Botswana are Primary Health Care issues. The Health Ministry is therefore focused on: Prevention; Comprehensive screening; Early treatment; and Surveillance at the community.
This requires revamped grassroots efforts in which health officials should deploy adequate numbers of community health workers through partnerships with the Non-governmental sector as necessary.
A number of interventions are expected to be rolled out to enhance access like Implementing NCD Strategy, Engaging Community Health Workers, Allowing Clinical Administrators to continue with dual roles, Conducting an Audit on Equipment, Consumables, HR etc., Enhancing and reviewing training plan (i.e. coming up with Health managers programs and Upscaling training), Implementing 2 Years internship for Doctors; and Developing outsourcing standards.
Government will also take control of referrals for specialized care and channel resources spent in a strategic manner that grows both public and private sector capacity like prioritizing supporting local private hospitals over external facilities.
“We have had our fair share of problems with referrals to RSA. Referrals to RSA have resulted in RSA being the most expensive destination in health,” said Dr. Alfred Rabashemi Madigele, Minister of Health and Wellness.
He said, “Sir Ketumile Masire Teaching Hospital is scheduled to be opened on 24th April 2019 and shall provide a highly specialized tertiary care.”
To enhance capacity there will be upgrades of 4 District Hospitals namely Letsholathebe Memorial Hgospital, Sekgoma, Mahalapye Primary Hospital and Scottish Livingstone Hospital.
In order to control cost and protect the incentive to develop capacity in the public sector, the focus of private sector involvement should be on the provision of scarce sub-specialty services (e.g. Vascular surgery, Surgical oncology, Pediatric hematology, and Ophthalmic surgery).
“In unique circumstances, basic specialized services (e.g. Gynaecology and General surgery) may be procured from the private sector to address service provision in underserved areas or to relieve critical backlogs. We should also devise innovative ways to utilize the private sector to augment our capacity to deliver strategic primary care interventions,” said Madigele.
The Ministry has revealed it will also install an electronic information management system (e-Pulse) to overcome challenges created by medicine shortages to allow for a better forecast in medicine requirements and strengthen inventory management.
The National Health Research Bill is under discussion to provide a legal framework for research on human subjects for the purpose of discovering or verifying the effects of investigational medicinal products used on human subjects during research.
The Bill will thus ensure conduct of ethical, scientific lawful research for protection of the welfare, wellbeing and safety of human participants as per the Revised National Health Policy of 2011.
“In recent times, there has been a notable decline in professionalism among some of our staff. In some instances, core cadres that are on the frontline of patient care no longer adhere to some age-old codes of conduct that are commensurate with the required empathy and respectability. As supervisors, it is incumbent upon us to lead by example on these issues,” observed Madigele.
He said, “Through the engagement of private securities in our facilities, it was envisaged that service will be improved. It has however become apparent that in most cases they lack training and appreciation of their role. The matter as you may be aware falls outside the mandate of our Ministry. We are therefore in consultation with the relevant Ministry of Defence, Justice and Security to address the issue of quality of service provided.”
The Ministry will during the 2018/19 budget, also explore ways of stepping up security which include installation of CCTV in passages and access cards in restricted areas.
“We agreed that in referral and district hospitals there should be call rooms that are appropriately furnished, while in clinics nurses should be transported while on call. We also discussed possibility of outsourcing the transport services,” said Madigele.
He said, “We agree that housing be provided within the proximity of the facility where possible and the Ministry will also approach Ministry of Infrastructure and Housing Development to explore possibility of sourcing housing from private market.”
The commissioning of Sir Ketumile Masire Teaching Hospital (SKMTH) is ongoing with the facility scheduled for opening in April 2019. This will be a phased approach commencing with some services including paediatric oncology, internal medicine, rheumatology and endocrinology, diagnostic radiology, laboratory services and pharmacy. A phased commissioning of SKMTH will reduce overdependence on South Africa for referrals, reduce costs and also institutionalise provision of super specialist services within Botswana.
The Botswana-Baylor Paediatric Centre of Excellence in partnership with the Global Hope Programme is assisting the Ministry to open and operationalize a Paediatric Oncology Ward and Clinic at the Sir Ketumile Masire Teaching Hospital. The objective of this partnership, is to strengthen oncology services in the country as well as reduce the cost of referrals.
The clinic will also facilitate the development of a Fellowship Programme between the University of Botswana and the Global Hope Programme. The intention of the Fellowship is to increase production of medical professionals and to strengthen the learning environment on health.
The Ministry restructuring has resulted in establishment of 18 Regional Health Management centres and the capacity building for Regional Health Management Teams will be in a phased manner due to budgetary constraints. Recruitment for the 18 Regional Health Management Coordinators is ongoing and also expected to be completed by May 2019.
The Regional Coordinators will have also authority to confirm and promote officers up to C1 level and recruit into the A and B scale. The threshold for minor works procurement has been increased from P50,000.00 to P300,000.00 to enable efficiency and effectiveness.
According to official sources, HIV incidence in the general population reduced from 1.45% in 2008 to 1.35% in 2013 and a new Botswana AIDS Impact Survey (BAIS V) is expected to be completed by the end of 2019, to provide more accurate current data.
Mother to Child Transmission (MTCT) rate has decreased from 1.6% in 2015 and has remained constant at 1.4% in 2016 to date and strategic innovations have helped increase the SMC coverage from 69.4% in the 2017/18 to 78.7% as at January 2019.
The Ministry of Health and Wellness has experienced a decline in Malaria incidence with 1 case per 1,000 population by 2018 and Botswana hopes to eliminate malaria by 2020.
Challenges include ssporadic and unstable nature of Malaria transmission, Importation of Malaria from endemic countries and Low uptake of vector control interventions in communities.
Treatment coverage of Tuberculosis has improved from 72% (2015) to 78% (2016) with HIV testing rate among patients with TB at 100% (2017). There however remain problems of poor compliance leading to increase in Multi drug resistance TB with TB notification highest in urban and rural poor communities owing to overcrowding, poor housing and inadequate nutrition.
Major causes of NCDs mortalities in Botswana are cardiovascular Diseases (18%), Cancers (7%), Diabetes (6%), and Chronic Respiratory Diseases (4%).
The 5-year Risk factor survey (STEPS) conducted in 2014 showed that: 18.3% of Batswana are current smokers; 26.4% are current drinkers; 94.8% do not take healthy diet (i.e. <5 combined servings per day); and 30.6% are obese due to sedentary lifestyle (BMI ≥25);
Most Cancers are diagnosed late and most probably after the disease has advanced. In 2017, 34.8% of cervical and breast cancers were diagnosed early (stage 0-2). Under 5 mortality decreased from 61.7/1000 live births to 37.6/1000 live births for 2007 and 2017 respectively.
This is attributed by Prematurity, Birth Asphyxia and neonatal Sepsis in neonates and Malnutrition, Diarrhoea and Pneumonia in infants.
According to officials out of P105,467,879.35 spent on manufactures, P92,943,660.74 was spent by Central Medical Stores(CMS) on procurement of drugs from local manufactures.
The remaining P12 Million was used to procure locally produced uniforms, food and food products and agricultural products.
The sector has made headways in the following, amongst others:
- Air Ambulance Services (engaging local companies for airlifting patients)
- Utilisation of ICU services at private hospitals
- Public to private referrals to specialists services – organ transplants, haematology, oncology, vitro-retinal, Dialysis, Cardiology services and Managed Care
- Currently processing outsourcing services to reduce backlog in obstetrics and gynaecology.
