28th August 2023
Own Correspondent
The biggest health challenge Botswana currently faces, is the epidemiological transition, from communicable diseases, to an increasing non-communicable disease burden.
These include heart diseases that have increased by 31%, Stroke, 19% and Diabetes by 40%.
“For this reason, we strongly urge the WHO to pay particular attention to tailor its support to the needs of countries that are faced with this double burden of communicable and non-communicable diseases,” said President Dr Mokgweetsi Masisi, in official opening remarks at the recognition of the Botswana National HIV Reference Laboratory as a WHO Collaborative Centre.
He said, “Even before the 1978 Declaration of Alma Ata which ushered in a new policy on Primary Health Care (PHC), Botswana implemented a homegrown program on the expansion of basic health services through the adoption of the Accelerated Rural Development Programme in 1972.”
In 1978, upon the adoption of the Alma Ata Declaration, Botswana expanded the basic health services to incorporate the Primary Health Care (PHC) approach to health service delivery. Botswana became the benchmark for other African countries in the PHC implementation.
“With respect to public health financing, the Government of Botswana is funding about 80% as a share of domestic health expenditure. For instance, for the 2023/24 national budget, the Ministry of Health was allocated the largest share of the recurrent budget at about 17.1%, which was particularly important in the wake of the COVID-19 pandemic,” said Masisi.
He said, “It will be noted that in Botswana, only about 4 % of the total health expenditure is generated through out-of-pocket payments, which remains one of the lowest globally.”
According to officials, Botswana has enjoyed some recent successes in combating health challenges such as winning a Silver Tier Award for Botswana on eliminating mother-to-child transmission of HIV by the World Health Organization. It has also achieved and by passed the UNAIDS 95‐95‐95 targets to help end the HIV epidemic by 2030. In Botswana 95.1% of adults (15‐64 years) living with HIV are aware of their HIV status; 98 % are on ART care and 97.9% are virally suppressed.
“We continue to be on the path to eliminate malaria, having sustained a low incidence rate of below 1 per 1000 population in the last five years. Through the WHO Global Malaria Programme of E-2025 initiative, Botswana is one of the countries that are fully committed to malaria elimination by 2025,” said Masisi.
He said, “We welcome the decision of the Special Session of the World Health Assembly in November 2021, to launch negotiations for a pandemic treaty under the auspices of the WHO.”
Parallel to this work are allegedly the urgent need for amendments to International Health Regulations (2005) which all aim to strengthen global health security. Another important process that is aligned with these two, is the High-Level Political Declaration on Pandemic Prevention, Preparedness and Response, which is expected to be endorsed by the United Nations General Assembly this year.
“We are indeed aware that all these global agendas have tremendous potential to set the tone for international legal obligations for preparedness and response to future health emergencies and pandemics. For these reasons, I wish to emphasize the need for the processes to be guided by the principles of equity, inclusivity of all Member States as well as international collaboration and solidarity,” said Masisi.
The inequities in access to vaccines, PPE and medicines during the COVID-19 pandemic will probably remain one of the major failures of the international community in the 21st Century.
Officials argue that in a globalised and highly interconnected world, the health concerns of developing countries should be a concern of the developed countries as well. Diseases have no borders, pandemics are global and therefore, the risks to one country invariably affect another.
“Therefore, from the lessons learnt from the COVID-19 pandemic, the international community must work hard to ensure that a multilateral governance mechanism is in place that will result in equitable access to vaccines, medicines, diagnostics and other medical products and tools,” said Masisi.
Botswana supports the need to maintain adequate regional stockpiles of pandemic health products such as vaccines, diagnostics and other necessary medical products while avoiding hoarding of such products by wealthier countries.
There is also allegedly a need for this Instrument to have governance and accountability mechanisms, including respecting the WHO guidelines and the International Health Regulations in terms of travel and trade. Botswana officials argued this issue because when in November 2021, Botswana and South Africa first identified and reported a new variant of SARS-CoV-2, some Member States immediately imposed travel and flight restrictions on several Southern African countries which hindered their ability to manage the pandemic collectively.
With respect to Health Financing, the World Health Organization has reported that in order to achieve SGD 3 – healthy lives and well-being for all ages – the sub-Saharan African countries will need to spend, on average, 7.5% of the region’s Gross Domestic Product, or US $271 per capita per year on health. Currently on average Sub Saharan countries spend US $189.00 per capita per year on health.
Many countries in the Africa Region are on average, still far from meeting key health financing goals such as the Abuja Declaration target of allocating 15% of the Government budget to health.
Masisi, said “We note with concern that out-of-pocket expenditure is still higher than 40% of the total health expenditure in many countries according to the report by the High-Level Task Force on Innovative International Financing for Health Systems (HLTF).”
He said, “We however, acknowledge the reforms in the WHO Africa Region that have increased access to health services and financial risk protection, moving countries closer to advancement of universal health coverage.”
Officials urged developed countries and development partners to align their funding with regional and national priorities including reducing conditionalities on voluntary contributions.
It is believed that removing conditionalities and allowing more flexibilities in spending has the potential to unlock the much-needed financial resources that will enable WHO to cross fund other broad priorities, hence provide adequate leadership and technical support to countries.
Dr Tedros Adhanom Ghebreyesus, World Health Organization(WHO)Director-General, said “It is a great pleasure for me to be here to officially designate the Botswana National HIV Reference Laboratory at the National Health Laboratory, Gaborone, has been designated as a WHO Collaborating Centre for HIV Drug Resistance and other diagnostic testing.”
He said, “In addition to HIV, the centre’s mandate will include diseases such as viral hepatitis, sexual transmitted infections, tuberculosis, cancer, and emerging and re-emerging diseases. This new WHO collaborating centre joins a network of over 50 collaborating centres globally supporting WHO’s HIV programme, and many others working on drug resistance more broadly.”
This lab was also the first, globally, to detect the Omnicron variant of SARS-CoV-2 virus. The idea of using national institutions for international purposes started with the League of Nations, when laboratories were first designated as reference centres for the standardization of biological products.
“The Second World Health Assembly in 1949 established the policy that has prevailed ever since: that WHO should not establish its own research institutions, but utilize the expertise and capacity of top research institutions all over the world, like this one,” said Ghebreyesus.
Over the decades, the number of collaborating centers has grown with more than 800 collaborating centres in more than 80 Member States.
However, the number of collaborating centres in African countries remains small: as of 2023, there are only 25 of them. Increasing this number and, with it, ensuring a more balanced geographical distribution, is allegedly a priority.
