Botswana faces ‘ dire’ health crisis

Acute shortage of critical medications, especially for chronic conditions Cancer drugs currently at 44 percent availability Govt. enlists private health facilities, pays whooping P1 billion

The critical shortage of most of the pharmaceutical supplies in the country remains “dire and indeed unsatisfactory”, because there are still many Batswana who are unable to access all the medications prescribed for them.

The situation is likely to be corrected by the end of December 2022, Health Minister, Dr. Edwin Dikoloti told Parliament this week. Dikoloti admitted that pharmaceutical supply into the country is very low adding that intervention measures have not helped to address the issues completely.

The Minister said some progress was made in securing certain medications since his last winter address especially regarding procurement of most vaccines, including vaccines for children and other Extended Programme of Immunisation ( EPI) vaccines, Anti- Retroviral Vaccines ( ARVs), anti- diarrhoeal medications and Tuberculosis ( TB) medications; all of which are currently in good supply.

However, what continues to be of great concern is the current acute shortage of critical medications, especially for chronic conditions. Cancer drugs for example, are currently at 44 percent availability.

The implication of this is that when patients are inadequately managed, they may eventually require other more expensive and cumbersome ways of treatment. Dikoloti said as a result of the acute shortage of critical drugs, government has had no option but to refer patients to private health facilities leading to a sharp rise in cost from P300 million to about P1billion.

He explained that the protracted Russia/ Ukraine war has worsened the situation. The cost of a shipping container from China to South Africa used to be US$ 3000, but now is US$ 18 000 a matter that is significantly increasing the cost of importing medicines and having an impact on general supply chain of commodities.

Botswana is experiencing a serious challenge with pharmaceutical and related supplies and they are currently working with Baylor College of Medicine which has the largest oncology hospital in the world and Texas Children’s Hospital, which also has the largest children’s hospital, to temporarily assist supply with most medications.

“With their wealth of experience and their robust network base globally, we anticipate delivery of most, if not all by the end of December 2022,” he said.

Dikoloti said that the long term strategy of attracting pharmaceutical manufacturing has the advantages of enhancing consistent local pharmaceutical supply, citizen skills transfer, job creation and entrepreneurial skill development, particularly for the youth.

Dikoloti said low- and middle- income countries like Botswana face an epidemiological transition.

“As we strive to become wealthier, disease burdens are shifting from infectious to non- communicable diseases ( NCDs) such as cardiovascular disease, cancer, and diabetes,” he said, adding that “to meet our citizens’ evolving health needs, governments will need to purchase and make available a very different set of health products from those procured before”.

He said Botswana faces a transition in health system organisation as it moves away from soloed diseasespecific programmes spending toward universal health coverage. Dikoloti said that Government is working on introducing injectable anti- retroviral ( ARV) medications soon.

“Botswana has through the professional guidance of the Clinical Guidelines Committee adopted the use of injectable antiretroviral medicines given every two months for both prevention ( Pre- exposure Prophylaxis- PrEP) and treatment. The injectable ARVs for both prevention and treatment will no doubt improve adherence to HIV treatment in our country,” he said.

The injectable ARV medication formula will comprise cabotegravir and Rilpirvirine. Cabotegravir injection has already been registered by the Botswana Medicines Regulatory Authority ( BoMRA), while Rilpirvirine is still undergoing registration process. The ministry anticipates the nRV medication to be used after June 2023.