Inefficiency weakens Botswana health system
Civil society calls for greater commitment, better management and accountability
A major constraint to Botswana’s public health system is inefficiency, the recent Civil Society Submission to the African Peer Review Mechanism (APRM) has pointed out.
The report by Botswana civil society (BOCONGO) in partnership with the South African Institute of International Affairs (SAIIA) sees the need for greater commitment, better management and more accountability at the individual, health facility and district levels, as well as at the Ministry of Health and Wellness and the Ministry of Finance and Economic Development.
It also calls for accountability from Parliament committees responsible for health and coordination of the SDGs to improve the practice of emergency obstetric care. Challenges include poor quality of services, a shortage of human resources, problems associated with urbanisation and inadequate planning. For example, a study conducted in 2014 found that the ratio of doctors to people in Botswana was 4:10 000, while the nurse to people ratio was 42:10 000. According to the World Health Organisation, countries with fewer than 10 doctors and 40 nurses for every 10 000 people are considered to not have enough healthcare professionals.
The ratios are even worse in rural districts, indicating that health care professionals are concentrated in urban areas. Additionally, only 21 percent of the doctors registered with the Botswana Health Professionals Council were from Botswana, resulting in a reliance on migrant professionals.
According to the report, the effects of these shortcomings are mostly felt in maternal health.
Statistics Botswana estimates that out of every 100 000 live births, 156.6 women die due to excessive bleeding, obstructed labour, uterine rupture and hypertensive disorders. Almost 98 percent of these deaths occur in health facilities, meaning they may have been prevented had the facilities properly resourced with knowledgeable staff and emergency obstetric care procedures. A majority of pregnant women, about 73 percent also attend the recommended four or more antenatal visits, further indicating that the problem lies at the point of delivery. If Botswana is to meet its 2030 SDGs, its maternal mortality ratio will need to be reduced to 70 per 100 000. Research conducted in 2014 revealed that the factors leading to the high number of maternal deaths include: failure to recognise the seriousness of a patient’s condition; lack of knowledge; failure to follow recommended practice; lack of or failure to implement policies; and poor organisational arrangements.
According to the office coordinating family planning in the Ministry of Health and Wellness, further research is currently being conducted to identify gaps that lead to maternal deaths.
Each maternity facility has also been fitted with an audit committee responsible for investigating maternal negligence and deaths.
Another area of health that requires attention is HIV/AIDS and there has been a determined national response to this epidemic in Botswana.
In 2018, over 90 percent of those with HIV/AIDS knew their status, over 83 percent of those living with HIV/AIDS were on free antiretroviral treatment, and 81 percent of people living with HIV/ AIDS were virally suppressed. The New National Strategic Framework on HIV/AIDS III 2018–2023 has also been put in place and will guide government’s response to improve health outcomes for the country’s population. Several challenges in addressing HIV/AIDS remain, however, chief among them the gender imbalance observed among those living with the disease.
The prevalence rate for women (24.6 percent in 2018) is much higher than for men (16.2 percent in 2018), showing that young women are particularly at risk. Geographical variations also present a challenge.Prevalence rates range from 33 percent of adults in urban towns like Mahalapye, to 13 percent in villages like Hukuntsi. The report sees the need for ongoing training for hospital staff in new and modern technologies to reduce maternal deaths.
It also recommends that the capacity of health sector staff should be improved through effective training, monitoring and evaluation.
Currently, there are 27 health districts and three national referral hospitals, 15 district hospitals, 17 primary hospitals, 105 clinics with beds and 206 without, 351 health posts and 931 mobile stops.