World Health Organisation (WHO) Regional Director Dr. Matshidiso Moeti has stated that the biggest problem facing the Botswana health sector is shortage of personnel.
She said she realised this during her official visit to Botswana this week where she met Acting President Mokgweetsi Masisi and high powered delegation from Ministry of Health and Wellness comprising Minister Dorcas Makgato, her assistant Phillip Makgalemele and Permanent Secretary Shenaaz El-Halabi. According to the first female WHO Regional Director who is also a first native Motswana to occupy the lucrative and influential international position, Botswana hospitals and clinics are capacitated by few personnel.
“I think the biggest challenge that I have identified is that of a few capacity or lack of enough personnel in the health sector,” she told Weekend Post on the sideline, shortly after press conference in Gaborone this week. She highlighted that this notwithstanding that Botswana is still a country that imports a significant number of health care workers. “We have gaps in the number of doctors and number of nurses because we are a country with small population with a highest numbers of people who need health services,” she told this publication.
She admitted that there are also many other doctors and nurses flying out of the country for greener pastures particularly to the United Kingdom (UK). In light of those going out for greener pastures she pointed out: “Yes I am aware of that” while adding that it is a serious challenge although “it should be looked into a context of a country’s economic situation.” She said brain drain as it is called is also a challenge and she thinks government is working towards different ways to addressing the issue particularly with regard to the departure of some local specialists that have been trained locally and abroad.
“So these things like remuneration constantly needs to be considered, in terms of how you can retain your people, how can you motivate them, and things like the pay rise. They need to come up with ways to retain the health workers and improve their conditions of service,” the WHO representative highlighted. On his part, the Botswana Nurses Union (BONU) President Obonolo Rahube echoed the WHO Regional Director’s sentiments that the biggest problem in the country’s health sector remains lack of adequate staff in clinics and hospitals.
He said there is burden of patients as nurses’ patient ratio is very high. “Yes I can confirm that we have a serious issue of lack of personnel in our health facilities. Our main issue is that we have approximately 1000 vacancy positions and also that we have only 300 graduates who are now roaming the streets but could be filling the positions but it’s not happening,” Rahube said. He stressed to this publication that “we believe that these nurses should be absorbed into the market because of the already burden of nurses patient ration.” He also pointed out that nurses are no longer progressing to higher scales.
To justify this he said “nurses start the profession on C4 or C3 salary bands and then they move to C1 as per parallel progression. But then from there, they become stagnant and rarely move to the next notch. This notwithstanding that there are posts in the ministry and are not filled as we pointed out.” However when commenting on the matter on behalf of government, the Permanent Secretary in the Ministry of health and Wellness, Shenaaz El-Halabi confirmed the shortage of personnel in the health facilities although downplaying the magnitude of the issue.
“Absolutely, we have a shortage of Human Resource. But sometimes it is not so much of shortage sometimes it is a misconception. But don’t get me wrong, there are genuine cases where we have shortage but sometimes it is how we utilise staff that is there,” the PS told Weekend Post past the same press briefing. So, she added that they have been working on workload assessment in terms of ideally how many people they should be having in a certain area (health facility). In terms of the personnel, she insisted that Shortage of staff is a challenge throughout the world (and Botswana is not an exception).
“So we continue to train, our medical school is there to train, our Institute of Health Sciences there as well and others on specialization. We also work on our strategies to make sure that they are able to attract and retain staff that is there.” The Ministry of Health and Permanent Secretary also revealed that they are working on strategies to improve nurses’ salaries and conditions of service to attract and retain them in the profession which will also address the issue of limited staff in which some depart for good paying countries.
“The good news is that we are also working on attraction and retention strategy. We are working on a new strategy that we have submitted to Directorate on Public Service Management (DPSM) as we have identified areas that we believe we can actually strengthen to be able to address this issue of retention of staff.” El-Halabi explained that there are number of issues that they will be looking at such as remuneration of health workers so that they don’t go out for greener pastures, and issues of pay structure. “Minister also mentioned this before at a parliamentary committee on supplies that there is need to look at our remuneration package for our health workers.”
On facilities she said she is aware they are congested and that there is need to work towards de-congesting them. “That’s why we have an amazing project that just started on de congesting Princess Marina Hospital. We have started decongesting the maternity wing at the hospital. Not everybody that is delivered in Marina needs to be delivered there. We have maternity clinics across the country. Now they are asked to deliver in other clinics where there is maternity ward other than Marina. Mid wives deliver them. In the event of emergency they can be refereed to Marina. So since this initiative we have seen congestion decreasing.”
She also said as a ministry they also need the nurses to multi task (multi skilling) so that they are able to consult, prescribe and dispense medication (treatment) including on HIV/AIDS. This is essential particularly as we have limited number of nurses and doctors, she highlighted. Some patients have had to die and others continue to die at the hands of doctors and nurses at health facilities across the country because of congestion and lack of adequate staffing.
Despite the government of Botswana’s ambition to have one of its own to lead Southern Africa Development Community (SADC) since its establishment in 1980, the Presidency says there is no budget specifically dedicated to the campaign.
The Government has released the name of Permanent Secretary to the President, Elias Mpedi Magosi, as the candidate for the SADC Executive Secretary position. Magosi is expected to face off with Democratic Republic of Congo (DRC) candidate, Faustin Mukela. The position will become vacant in August this year.
However, despite the optimism the Botswana Government has not yet set aside a budget to assist Magosi to win against the seemingly DRC giant. “We all know that the COVID-19 pandemic has negatively affected the country’s ability to effectively fund any new project. This campaign is not an exception. As such, we do not have any budget for the campaign. However, we have so far managed to take advantage of His Excellency the President’s working visits to the neighbouring countries to also carry out the campaigns,” Press Secretary to the President, Batlhalefi Leagajang, explained.
Botswana has housed SADC since the establishment of the then SADCC in 1980, but has never occupied top most leadership positions at the SADC Secretariat. “We therefore, strongly believe that we should also have an opportunity to contribute to the management of our regional body as it continues to drive the important issues of regional integration industrialization and socio-economic development.
This will also profile Botswana as a strong advocate of regional integration,” he responded to this publication’s questionnaire as to why the Government wants to occupy the plum post. SADC is a Member State driven organization. As such, Leagajang said, needs a well-grounded Executive Secretary with a blend of management and leadership acumen; a transformational leader with political awareness and integrity; private and public sector experience; a deep culture of corporate governance; as well as strategic agility and result-oriented consummate diplomat.
“These are the unique attributes of our candidate,” he said. So far President Mokgweetsi Masisi has visited nine out of 16 SADC member states on a working visit and also taking an opportunity to present to them his candidate.
“The countries have appreciated this effort and we remain hopeful. However, it is important to note that this is a democratic and competitive process which must be respected,” he responded when asked about the reception and assurances from various countries to cast a vote for Magosi.
In 2018, when Pelonomi Venson-Moitoi challenged for the Africa Union (AU) Chairperson, the government appointed former President Festus Mogae to be the campaign leader. Does the Government have anyone apart from Masisi to help with the campaign?
“The campaigns for the candidate are strictly led by the Government of Botswana. Since this is a candidate for Botswana, not just the Government, it will be appreciated if all Batswana, including the media, could also shoulder the responsibility to campaign for the candidate in their own spheres of influence,” Leagajang responded.
While there are sceptics on Magosi winning against the DRC man, the Government is confident and believes that with the unique traits that he possess, Magosi stands a chance. He is said to be a strong advocate of justice and fairness as he has played this role in his current role as PSP and in his previous roles as PS and in the private sector. He has helped individuals and companies to find justice and fairness in most of their dealings with Government.
Magosi is also said to be a proponent of corporate governance and which he has relentlessly pursued in most of his career including in Government and other sectors. A strong believer in following laid down procedures and laws. “He carries a variety of skills as an HR expert with experience in different sectors, a strategist and an Organization development specialist.
His experience and exposure spans government, parastatal, private sector and at regional level as well, thus making him a suitable candidate for the regional role. He has worked with governments, businesses, development partners and politicians and is comfortable navigating through all of them,” Leagajang concluded.
The Minister of Land Management, Water and Sanitation Services, Kefentse Mzwinila looked a politician set to shoot the moon as he laid bare his billions of pula development agenda recently in Parliament.
His Ministry’s combined Recurrent and Development Budget Proposals for the 2021/ 2022 Financial Year is pegged at Four Billion, Three Hundred and Sixty – Five Million, two Hundred and Nineteen Thousand, Five Hundred and Sixty Pula (P4, 365, 219, 560). This is a budget 38.3% more than the allocation for the 2020/2021 Financial Year.
Mzwinila preluded his request to parliament with a demonstration that his Ministry has no champagne taste on a beer budget – indicating that his ministry’s expenditure at the end of February 2021P2.111 Billion or 96% of development budget; and P910 million or 90% of the recurrent budget.
Notwithstanding the budget dust, the Minister justified this year’s increase in the Ministry’s total budget. He attributed the escalation to the commencement of major projects under the water sector. These include the implementation of the North South Carrier (NSC) 22.2 covering various sub projects. Mzwinila noted that these are all public value projects which are aimed at improving the lives of Batswana.
Mzwinila’s Ministry has projected that the sum of Nine Hundred and Sixty –Three Million, Nine Hundred and Forty – Seven Thousand, Five Hundred and Sixty Pula (P963, 947, 560) be permitted for the Recurrent Budget and stand part of the 2021 / 2022 Appropriation Bill ( No. 1 of 2021).
“55% of the Recurrent Budget is geared towards the Revenue Support Grant for 12 Land Boards and their subordinate authorities while the sum of P5 Million is allocated to the Real Estate Advisory Council (REAC). The remaining 44% is proposed for the Ministry Departments.”
The sum of Three Billion, Four Hundred and One Million, Two hundred and Seventy –Two Thousand Pula (P3, 401, 272, 000), for the Development Budget was approved and stand part of the same schedule of the appropriation (2021/2022).
When breaking down the Development Budget, Minister Mzwinila noted that Water Supply and Sanitation projects will account for P1.098 Billion to finance the Maun Water and Sanitation project, Molepolole Sanitation projects and the Shakawe Water Treatment Plant Rehabilitation.
With all the implementation bottlenecks troubling several projects in the country, Mzwinila had to satisfy the question of whether his Ministry demonstrated a dire need for the budget with reference to its execution of the budget for the financial year 2020/2021 and its delivery of strategic initiatives and projects?
Mzwinila’s pitch found favour with parliament and his ministry will get an aggregate budget of P3.198 Billion for the 2020/ 2021 Financial Year. Within this allocation, P2.188 Billion is for the Development Budget and P1.010 Billion will cover the Recurrent Budget.
The Minister revealed his strategic interventions for land management, water and sanitation services. Highlighting that efforts by Government to provide serviced residential land to citizens on the waiting list are being hampered by limited resources. He shared that his ministry needs P94 Billion to cover such costs which will directly link to water, sewage, roads, electricity, telecommunications and storm water drainage leading to the allocation of 4 587 plots on un-serviced land.
The minister projected that 22 952 un-serviced residential plots are planned to be allocated in the next financial year. However, there is a trend where allocated land remains fallow and undeveloped which raises misgivings that the requests could have been made on speculative plans.
Mzwinila noted that in the spirit of forging stronger International connections, the Ministry will in June 2021 sign a Memorandum of Understanding on Land matters between Namibia and Botswana with the aim of opening doors to the creation of Dry Ports in the country, facilitate international trade through Walvis Bay Sea Port.
Botswana is already challenged by scarcity of naturally occurring water resources due to the aridity of the country creating persistent water shortages. The type of infrastructure required to improve national water security is a true reflection of intensive investment needed in the water sector The Minister stressed.
“An emerging issue such as the COVID -19 pandemic poses serious challenges as the control of the virus requires reliable water supply. In an effort to mitigate the challenge, the Ministry has undertaken extensive bowsing throughout the country which included the provision of additional capacity for supplementary bowsing to areas with pervasive water shortages, plus an additional forty one (41) un-gazetted settlements.
Operational costs due to bowsing were at an average of P6 Million per month before the COVID-19 pandemic and increased to an unsustainable amount of the order of P13 Million per month, since the beginning of the State of Emergency in April 2020,” the minister shared.
Through the support of a World Bank Loan, the Ministry is implementing several initiatives under the Botswana Emergency Water Security and Efficiency (BEWSE) project. Through BEWSE the Raw Water Pricing and Abstraction Strategy will assess the pricing of water in a manner that enables the provision of water to support new economic development, the strategy is planned to be completed in June 2021.
The Ministry has commenced the development of a long term National Water Security Strategy to improve resilience to climate change impacts. The strategy development entails prioritization of the proposed future mega water transfers such as the Chobe – Zambezi water transfer, the Atlantic Ocean water transfer to Botswana through Namibia and Lesotho – Botswana water transfer.
Following the signing of the tripartite Memorandum of Agreement (MoA) between Botswana, Lesotho and South Africa in November 2017 for the Lesotho –Botswana Water Transfer project, a 24 months contract for a combined prefeasibility and feasibility study for the development of a bankable Lesotho – Botswana Water Transfer project feasibility study was signed and is to be completed in 2022.
One of the Ministry’s famous major water supply projects such as the North South Carrier (NSC) 2.2 has experienced hiccups; having tenders for contract 1 (Masama to Mmamashia Pipeline) and Contract 2 (Mahalapye to Masama Pipeline) cancelled due to budgetary constraints.
The Botswana Climate Change policy draft of 2021 was tabled in Parliament by the Minister of Environment, Natural Resources Conservation and Tourism, Philda Kereng for consideration and adoption.
The policy attempts to indicate the country’s environmentally conscious development agenda as Substantial resources are being dedicated to research and policy efforts to mitigate climate change and support adaptation to the current and future impacts of greenhouse gas emissions.
Kereng indicated that Botswana is not immune to the impacts of climate change and it continues to delay the country’s national development efforts and that the key economic development sectors dependent on the climate system have recorded declines over the years due to the variability of the rainfall and other climatic conditions. Experts elsewhere have pointed out that lack of consideration of population dynamics hampers the development of stronger, more effective solutions to the challenges climate change poses – hopefully this policy if effectively implemented could partly answer this question.
Kereng underscored that sectors such as agriculture, water, bio diversity, health and tourism have suffered the most and the consequences of these have contributed significantly to the decline of livelihoods in Botswana especially in rural areas.
To respond to the changing climate, Botswana has embarked on sectoral reform such as climate smart agriculture, poverty alleviation initiatives, building resilience on the economic productive sectors, diversification of tourism for the improvement of livelihoods and income generation, local economic development and sustainable environment.
The efforts require a coordinated mechanism that will provide an enabling environment for an integrated approach to the formulation and implantation of development plans and socio economic related policies in Botswana that are responsive to the changing climatic conditions.
Minister Kereng explained the draft policy is characterized by an inclusive and integrated approach to social, economic development and governance modalities that would enable the country to achieve a sustainable development pathway. It provides opportunities for improved livelihoods through creation of green jobs, development and transfer of relevant technologies as well as creation and ease of access to both local and international markets. It also commits the government, private sector and non-state actors to adopt adaptation and mitigation measures that would facilitate sustainability and building of resilience of all sectors.
While Members of Parliament were trying to comprehend the policy, this publication got in touch with Green Botswana to solicit their views on the policy draft. Ms. Sela Motshwane, the Founder of the Trust highlighted that “the Climate Change policy was meant to be read in August 2019. It is long overdue, and we all need to see it and understand it in full.
I understand the current budget does not allow for a full implementation- but I could be wrong. More funds could have been allocated since. I think generally, Batswana need to understand fully what this means to our daily lives. I believe the true understanding is by policy drafters and the Ministry of Environment only.”
In the same vein, Green Botswana Trust took to the streets to provide a community solution to climate change on World Health Day (Wednesday). Green Botswana held a “Free Trees for Babies” at Extension 2 Clinic where fruit trees were gifted to parents, expectant mothers, 25 health workers, police officers and the prison officers who had accompanied prisoners to the clinic.
Motshwane said: “The decision to do the “Free Trees for Babies” by gifting fruit trees was to raise awareness to our imminent food security issue as stated by the Deputy Permanent Secretary of the Ministry of Agricultural Development and Food Security, Mr. Thabang Botshoma and encourage the general public to plant a tree so that we can reach our SGD Goal 13 : Climate Action. The trees gifted are to be named after the baby recipient”.
Green Botswana is calling for the urgent action from government and members of the public to create a culture of community accountability and collegiality in moving Botswana towards climate action and sustainability. To achieve the 2030 Paris Agreement Pledge, it will take all citizens and not just the government to reach goals.
Parliament resolved to adopt the Botswana Climate Change Policy, 2021.