Public health system remains on sick bed
Critical medication at 44% Gov’t spends P1 billion on private hospitals
The shortage of drugs and medical supplies has besieged the country’s health facilities for some time now and is not close to coming to an end. Addressing Parliament on Friday, Minister of Health Dr Edwin Dikoloti said some progress was made in securing certain medications, but this has not fully addressed the situation as it remains dire and unsatisfactory. Dikoloti said many people are unable to access all the medications prescribed to them.
“What continues to be of great concern to us is the current acute shortage of critical medications, especially for chronic conditions. Cancer drugs, for example, are currently at 44% availability. The implication of this is that when patients are inadequately managed, they may eventually require other more expensive and cumbersome ways of treatment. Over the last two years, as a result of this acute shortage of critical drugs and specialists, government has had no option but to refer patients to private health facilities leading to a sharp rise in cost from P300,000,000 to about P1,000,000,000,” Dikoloti said. “Let me acknowledge that what we are going through has not been easy nor pleasant, and has caused a lot of misery for us all. However, there is hope as we are working around the clock to remedy the situation. Batswana should be rest assured that they will have most of the pharmaceutical supplies by end of December (this Christmas). My ministry remains committed to addressing this situation, regardless of what it may take for us to achieve that. It is a commitment we will keep until our people have all the medications they require.
Dikoloti said some of the interventions that they had adopted include short-term procurement of available medications from local distributors, working on expediting tendering processes, and also promoting the chronic medications dispensing programme “where we have partnered with the private sector for some of our patients to get medications from private pharmacies”.
He said while there are challenges, these interventions are bearing fruit as “we have reached some milestones”. He admitted that the intervention measures have not helped deal with these issues completely, as pharmaceutical supply to the country is still very low. “Botswana is experiencing a serious challenge with pharmaceutical and related supplies. There are multiple factors which have led us to this current situation, key amongst them, being sub-optimal procurement and unstable post-COVID-19 pandemic global supply chain challenges, inclusive of pharmaceutical manufacturing and supplies. “We will not rest in adopting new strategies to ease this situation. We are currently working with Baylor College of Medicine which has the largest oncology hospital in the world and the Texas Children’s Hospital which also has the largest children’s hospital, to assist with supplying us with most medications that we need for one year. 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. He added they are also engaging major pharmaceutical manufacturers for an immediate supply of most critical medications needed, including cancer drugs. Dikoloti said 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 also said it is worth pointing out that the crisis of pharmaceutical shortages is not unique to Botswana as most countries across the globe are experiencing similar challenges. He said most neighbouring countries to Botswana have similar problems of shortage of pharmaceutical supplies.
The minister said whereas production of medications went down as a result of restrictions imposed during COVID-19, demand for pharmaceuticals doubled and, in some cases, tripled. He said there has been a significant increase in people requiring chronic medications on account of the increased burden of non-communicable diseases (NCD) locally and globally, due to the long COVID syndrome. “Low- and middle-income countries like Botswana face an epidemiological transition. As we strive to become wealthier, disease burdens are shifting from infectious to NCDs such as cardiovascular disease, cancer, and diabetes. 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. Dikoloti also said the protracted Russia-Ukraine war has worsened the situation significantly increasing the cost of importing medicines and having an impact on the general supply chain of commodities.
“As a result, prices for most medications including Hydrochlorothiazide 25mg (HCT) for Hypertension and Metformin for Diabetes, increased exponentially, as they recorded more than 50% increases. This has had a ripple effect and is no doubt being felt by our people,” he said. Dikoloti added in the medium term they are reviewing, strengthening, and streamlining drug procurement processes. “I would also like to reiterate that our long-term solution to this problem relies on setting up Health Cluster under Health Special Economic Zone to promote pharmaceutical manufacturing plants in Botswana and develop a Health Financing Strategy,” he said.