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BHPC rejects Batswana doctors trained in China

A semi-autonomous health regulatory body which was established by parliament, Botswana Health Professions Council (BHPC) is currently under heavy scrutiny for applying double standards in registering doctors.


It is understood that, in registering doctors, the organisation favours Chinese expatriates as opposed to local specialists although both having trained in China. This, notwithstanding, the government on one hand continues to send Batswana to China for training as doctors.
The reasons advanced by the BHPC for rejecting Batswana doctors trained in China is said to be that government sends the doctors to “fly by night” institutions in China who are not competent enough to practice as specialists upon their return.


However, the BHPC board is said to be infested with doctors in private practice who protect their monopoly interests. It is understood that they suppress the influx of equally competitive Batswana doctors as they fear competition from their honey pot in the likes of Bokamoso and Gaborone Private Hospitals.


BHPC is composed of members appointed by the Minister of Health and Wellness, Dorcus Makgatho. The council’s composition includes the Director of Health Services; the Dean of the Faculty of Medicine at the University of Botswana; three medical practitioners, one of whom is a specialist; two dentists; two pharmacists; six Allied Health Professionals; one Associated Health Professional; one person form the Public not associated with Health Professionals; and a representative from the Attorney-General Chambers (legal Advisor). The China/Botswana medical training partnership has been in existence for the past 40 years.

What PS Al-Halabi “knows” about BPHC


Meanwhile when appearing before the Public Accounts Committee (PAC) recently, the Accounting Officer at the Ministry of Health and Wellness, Permanent Secretary Shenaaz El-Halabi tried to distance herself from BHPC. She stressed that the Council is semi-autonomous and independent from government but was reminded that it’s directly under her ministry.


Starting to pit the PS against the wall was Selibe Phikwe West maverick legislator who highlighted to Halabi that there is a cartel of self-appointed BHPC council members who are mainly Doctors in the private space, and that this council has decided to not register Batswana specialist Doctors trained in China (and some countries) where the government sends students for training as doctors.


The Accounting officer then responded to Keorapetse by confirming that she “is aware” that the BHPC is mainly made up of private doctors or practitioners in the sector and that there is none from government except the Director of Health Services and the Attorney General representative.

According to Keorapetse, the reasons advanced by the council are that Batswana doctors do not write licensing exams to practice in China or other countries. “It is common knowledge that all Doctors /specialists trained outside our country do not necessarily have to write licensing exams of their country of training as a licensing exam is only required where the candidate intents to practice..in which case only Botswana’s licensing exam is necessary for Batswana…” he informed  Al-Halabi who was on the edge of her chair at the time.


Keorapetse emphasised that it is worth noting that if private practice doctors were to allow an influx of Batswana specialists from any country in large numbers they would risk competition in the private space adding that these people were making millions from Gaborone Private Hospital and Bokamoso hospital and that “they are avoiding competition by denying other Batswana specialists registration.” He asked the accounting officer whether she was aware that Batswana students are sent to China to specialize while on the other hand the BHPC refuses to register them upon their return to practice.


Al-Halabi stated: “yes I am aware of that.” When he asked further why then still they continue to send the student doctors there despite the development, Al-Halabi said “yes we do continue sending them to China to study but with due diligence being followed.” She added that, as a ministry when students doctors are sent to China they make sure that the schools which they attend are accredited.


The local doctors, Keorapetse narrated, have had one of them taking the BPHC to court and the Council lost, but they will not use the precedent to register everyone because they want to keep people out of registration for a while enjoying monopoly in the private space.
“They are fully aware that court cases take a while, they are also aware that in any case every time BHPC loses cases they do not have to personally pay anything, in the end it's the ministry of Health that pays,” he added.


The Selibe Phikwe West law maker also emphasized that this is corruption of the highest order by the elite who are holding the country’s health care at ransom through denying Batswana trained specialists only to protect their private interests. He added that it is sad that their Chinese counterparts are recruited here and registered by the same BHPC but Batswana who trained in the same system are denied that registration out of selfish interests.


The sentiment was also shared by Al-Halabi: “the local doctors’ concern is that Chinese doctors who studied at China come here in our country and they get easily registered and are accredited to practice as specialists while Batswana who likewise studied at China are not when they return back home.” When justifying the move she said, in China they have certain courses for developing countries and so the education system is very different.


On another related matter, Keorapetse said there are some senior doctors who have practiced for a long time as specialists whilst they only hold Member of the Royal Colleges of Physicians of the UK (MRCP or FRCP(Canada)/ Fellowship of the Colleges of Physicians of SA(FCP-SA).


“How many of these doctors have practiced and for how long? Were they hired and paid as specialists? Were they registered by the Health Professional Council? Why? Are some of them now in schools trying to specialize?” he wondered. Al-Halabi pleaded with the committee that she will look into the matter and make sure that the calamity is addressed.


In addition the Ministry of Health and Wellness PS Al-Halabi also told the PAC that she had a meeting with China ambassador and Health professionals to discuss all issues with regard to the professionals’ trainings and will map a way forward. Health Council board chair contradicts PS Al-Halabi


However when speaking to Weekend Post on the matter this week, BHPC Board Chairman Boago Modiitsane dismissed any misdeeds on the part of the Health Council board. In fact, he contradicted her superior, PS Al-Halabi saying that the organ is placed under the Ministry of Health and Wellness. He also said the partnership between government of Botswana through Ministry Of Health and Wellness and The People’s Republic of China also has no bearing on the registration of any applicant.


He broke ranks with the PS while defending BHPC saying they “are not aware” of where the Ministry Of Health and Wellness sends its employees for training when quizzed if this isn’t likely to strain relations between the doctors originating from the two countries. He was quick to clarify that BHPC does indeed recognize any trained specialists who meet registration requirements and that the country of training is never a requirement (in this case China).  


“BHPC does register Batswana trained specialists. We have about 105 Batswana specialists in the register as of February 2017 trained from various parts of the world and we continue to register Batswana specialists. Therefore, the statement that BHPC does not register Batswana specialists is misleading,” Modiitsane said.


He went on to stress that specialists are clinicians who have refined skills in patient care beyond that of a generalist, and therefore on assessing an application for specialist registration BHPC looks for, among other things, whether a training programme has delivered the appropriate clinical competencies to deliver specialized patient care to Batswana in a safe manner.


He also stated that: “training of health professionals follows two different pathways that lead to varied outcomes. Health professionals who intend to sharpen their skills in patient care will follow the clinical pathway that will enhance their clinical competency while those that are interested in research will follow an academic pathway.”  “Consistent with this mandate, BHPC is more concerned with clinical rather than academic programmes. This applies to every applicant regardless of the country of training.”


The BHPC Board Chairman also explained that assessment of applications for registration is an objective exercise that is based on the minimum requirement set by BHPC.  One must meet these minimum standards for them to be registered, he said. According to Modiitsane the BHPC boards are composed of members who are drawn from both the public and private sector, therefore the statement that Batswana Health Professionals are refused registration because of fear of competition is unfounded. Furthermore, he said both Batswana and Foreigners are eligible for private Practice if they meet the required standards. “The alleged fear for competition (real or imagined), therefore, should apply in case of where foreigners are registered.”  

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DIS blasted for cruelty – UN report

26th July 2022
DIS BOSS: Magosi

Botswana has made improvements on preventing and ending arbitrary deprivation of liberty, but significant challenges remain in further developing and implementing a legal framework, the UN Working Group on Arbitrary Detention said at the end of a visit recently.

Head of the delegation, Elina Steinerte, appreciated the transparency of Botswana for opening her doors to them. Having had full and unimpeded access and visited 19 places of deprivation of liberty and confidentiality interviewing over 100 persons deprived of their liberty.

She mentioned “We commend Botswana for its openness in inviting the Working Group to conduct this visit which is the first visit of the Working Group to the Southern African region in over a decade. This is a further extension of the commitment to uphold international human rights obligations undertaken by Botswana through its ratification of international human rights treaties.”

Another good act Botswana has been praised for is the remission of sentences. Steinerte echoed that the Prisons Act grants remission of one third of the sentence to anyone who has been imprisoned for more than one month unless the person has been sentenced to life imprisonment or detained at the President’s Pleasure or if the remission would result in the discharge of any prisoner before serving a term of imprisonment of one month.

On the other side; The Group received testimonies about the police using excessive force, including beatings, electrocution, and suffocation of suspects to extract confessions. Of which when the suspects raised the matter with the magistrates, medical examinations would be ordered but often not carried out and the consideration of cases would proceed.

“The Group recall that any such treatment may amount to torture and ill-treatment absolutely prohibited in international law and also lead to arbitrary detention. Judicial authorities must ensure that the Government has met its obligation of demonstrating that confessions were given without coercion, including through any direct or indirect physical or undue psychological pressure. Judges should consider inadmissible any statement obtained through torture or ill-treatment and should order prompt and effective investigations into such allegations,” said Steinerte.

One of the group’s main concern was the DIS held suspects for over 48 hours for interviews. Established under the Intelligence and Security Service Act, the Directorate of Intelligence and Security (DIS) has powers to arrest with or without a warrant.

The group said the “DIS usually requests individuals to come in for an interview and has no powers to detain anyone beyond 48 hours; any overnight detention would take place in regular police stations.”

The Group was able to visit the DIS facilities in Sebele and received numerous testimonies from persons who have been taken there for interviewing, making it evident that individuals can be detained in the facility even if the detention does not last more than few hours.

Moreover, while arrest without a warrant is permissible only when there is a reasonable suspicion of a crime being committed, the evidence received indicates that arrests without a warrant are a rule rather than an exception, in contravention to article 9 of the Covenant.

Even short periods of detention constitute deprivation of liberty when a person is not free to leave at will and in all those instances when safeguards against arbitrary detention are violated, also such short periods may amount to arbitrary deprivation of liberty.

The group also learned of instances when persons were taken to DIS for interviewing without being given the possibility to notify their next of kin and that while individuals are allowed to consult their lawyers prior to being interviewed, lawyers are not allowed to be present during the interviews.

The UN Working Group on Arbitrary Detention mentioned they will continue engaging in the constructive dialogue with the Government of Botswana over the following months while they determine their final conclusions in relation to the country visit.

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Stan Chart halts civil servants property loan facility

26th July 2022
Stan-Chart

Standard Chartered Bank Botswana (SCBB) has informed the government that it will not be accepting new loan applications for the Government Employees Motor Vehicle and Residential Property Advance Scheme (GEMVAS and LAMVAS) facility.

This emerges in a correspondence between Acting Permanent Secretary in the Ministry of Finance Boniface Mphetlhe and some government departments. In a letter he wrote recently to government departments informing them of the decision, Mphetlhe indicated that the Ministry received a request from the Bank to consider reviewing GEMVAS and LAMVAS agreement.

He said: “In summary SCBB requested the following; Government should consider reviewing GEMVAS and LAMVAS interest rate from prime plus 0.5% to prime plus 2%.” The Bank indicated that the review should be both for existing GEMVAS and LAMVAS clients and potential customers going forward.

Mphetlhe said the Bank informed the Ministry that the current GEMVAS and LAMVAS interest rate structure results into them making losses, “as the cost of loa disbursements is higher that their end collections.”

He said it also requested that the loan tenure for the residential property loans to be increased from 20 to 25 years and the loan tenure for new motor vehicles loans to be increased from 60 months to 72 months.

Mphetlhe indicated that the Bank’s request has been duly forwarded to the Directorate of Public Service Management for consideration, since GEMVAS and LAMVAS is a Condition of Service Scheme. He saidthe Bank did also inform the Ministry that if the matter is not resolved by the 6th June, 2022, they would cease receipt of new GEMVAS and LAMVAS loan applications.

“A follow up virtual meeting was held to discuss their resolution and SCB did confirm that they will not be accepting any new loans from GEMVAS and LAMVAS. The decision includes top-up advances,” said Mphetlhe. He advised civil servants to consider applying for loans from other banks.

In a letter addressed to the Ministry, SCBB Chief Executive Officer Mpho Masupe informed theministry that, “Reference is made to your letter dated 18th March 2022 wherein the Ministry had indicated that feedback to our proposal on the above subject is being sought.”

In thesame letter dated 10 May 2022, Masupe stated that the Bank was requesting for an update on the Ministry’s engagements with the relevant stakeholder (Directorate of Public Service Management) and provide an indicative timeline for conclusion.

He said the “SCBB informs the Ministry of its intention to cease issuance of new loans to applicants from 6th June 2022 in absence of any feedback on the matter and closure of the discussions between the two parties.”  Previously, Masupe had also had requested the Ministry to consider a review of clause 3 of the agreement which speaks to the interest rate charged on the facilities.

Masupe indicated in the letter dated 21 December 2021 that although all the Banks in the market had signed a similar agreement, subject to amendments that each may have requested. “We would like to suggest that our review be considered individually as opposed to being an industry position as we are cognisant of the requirements of section 25 of the Competition Act of 2018 which discourages fixing of pricing set for consumers,” he said.

He added that,“In this way,clients would still have the opportunity to shop around for more favourable pricing and the other Banks, may if they wish to, similarly, individually approach your office for a review of their pricing to the extent that they deem suitable for their respective organisations.”

Masupe also stated that: “On the issue of our request for the revision of the Interest Rate, we kindly request for an increase from the current rate of prime plus 0.5% to prime plus 2%, with no other increases during the loan period.” The Bank CEO said the rationale for the request to review pricing is due to the current construct of the GEMVAS scheme which is currently structured in a way that is resulting in the Bank making a loss.

“The greater part of the GEMVAS portfolio is the mortgage boo which constitutes 40% of the Bank’s total mortgage portfolio,” said Masupe. He saidthe losses that the Bank is incurring are as a result of the legacy pricing of prime plus 0% as the 1995 agreement which a slight increase in the August 2018 agreement to prime plus 0.5%.

“With this pricing, the GEMVAS portfolio has not been profitable to the Bank, causing distress and impeding its ability to continue to support government employees to buy houses and cars. The portfolio is currently priced at 5.25%,” he said.  Masupe said the performance of both the GEMVAS home loan and auto loan portfolios in terms of profitability have become unsustainable for the Bank.

Healso said, when the agreement was signed in August 2018, the prime lending rate was 6.75% which made the pricing in effect at the time sufficient from a profitable perspective. “It has since dropped by a total 1.5%. The funds that are loaned to customers are sourced at a high rate, which now leaves the Bank with marginal profits on the portfolio before factoring in other operational expenses associated with administration of the scheme and after sales care of the portfolio,” said the CEO.

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Botswana ranked 129 in female MPs representation

26th July 2022
Minister of Finance & Economic Development Peggy Serame

The Global Gender Gap Index, a report published by the World Economic Forum annually, has indicated that Botswana is among countries that fare badly when it comes to representation of women in legislative bodies.

The latest Global Gender Gap Index, published last week, benchmarks the current state and evolution of gender parity across four key dimensions (Economic Participation and Opportunity, Educational Attainment, Health and Survival, and Political Empowerment). It is the longest-standing index which tracks progress towards closing these gaps over time since its inception in 2006.

This year, the Global Gender Gap Index benchmarked 146 countries. Of these, a subset of 102 countries have been represented in every edition of the index since 2006, further providing a large constant sample for time series analysis.

Botswana ranks number 66 overall (out of 146 countries), with good rankings in most of the pillars. Botswana ranks 1st in Health and Survival, 7th in the Economic Participation and Opportunity, 22nd in Educational Attainment, and 129th in Political Empowerment.

The Global Gender Gap Index measures scores on a 0 to 100 scale and scores can be interpreted as the distance covered towards parity (i.e. the percentage of the gender gap that has been closed). The cross-country comparisons aim to support the identification of the most effective policies to close gender gaps.

The Economic Participation and Opportunity sub-index contains three concepts: the participation gap, the remuneration gap and the advancement gap. The participation gap is captured using the difference between women and men in labour-force participation rates. The remuneration gap is captured through a hard data indicator (ratio of estimated female-to-male earned income) and a qualitative indicator gathered through the World Economic Forum’s annual Executive Opinion Survey (wage equality for similar work).

Finally, the gap between the advancement of women and men is captured through two hard data statistics (the ratio of women to men among legislators, senior officials and managers, and the ratio of women to men among technical and professional workers).

The Educational Attainment sub-index captures the gap between women’s and men’s current access to education through the enrolment ratios of women to men in primary-, secondary- and tertiary-level education. A longer-term view of the country’s ability to educate women and men in equal numbers is captured through the ratio of women’s literacy rate to men’s literacy rate.

Health and Survival sub-index provides an overview of the differences between women’s and men’s health using two indicators. The first is the sex ratio at birth, which aims specifically to capture the phenomenon of “missing women”, prevalent in countries with a strong son preference. Second, the index uses the gap between women’s and men’s healthy life expectancy.

This measure provides an estimate of the number of years that women and men can expect to live in good health by accounting for the years lost to violence, disease, malnutrition and other factors.
Political Empowerment sub-index measures the gap between men and women at the highest level of political decision-making through the ratio of women to men in ministerial positions and the ratio of women to men in parliamentary positions. In addition, the reported included the ratio of women to men in terms of years in executive office (prime minister or president) for the last 50 years.

In the last general elections, only three women won elections, compared to 54 males. The three women are; Nnaniki Makwinja (Lentsweletau-Mmopane), Talita Monnakgotla (Kgalagadi North), and Anna Mokgethi (Gaborone Bonnington North). Four women were elected through Specially Elected dispensation; Peggy Serame, Dr Unity Dow, Phildah Kereng and Beauty Manake. All female MPs — save Dow, who resigned — are members of the executive.

Overall, Botswana has 63 seats, all 57 elected by the electorates, and six elected by parliament. Early this year, Botswana Democratic Party (BDP) secretary general and Gaborone North MP, Mpho Balopi, successfully moved a motion in parliament calling for increment of elective seats from 57 to 61. Balopi contented that population growth demands the country respond by increasing the number of MPs.

In Africa, Botswana play second fiddle to countries like Rwanda, Namibia, South Africa, Burundi, and Zimbabwe who have better representation of women, with Rwanda being the only country with more than 50 percent of women in parliament.

The low number of women in parliament is attributed to Botswana’s current, electoral system, First-Past-the-Post. During the 9th parliament, then MP for Mahalapye East tabled a motion in parliament in which she sort to increase the number of Specially Elected MPs in parliament to augment female representation in the National Assembly.

The motion was opposed famously, by then Specially Elected MP, Botsalo Ntuane, who said the citizens were not in favour of such a move since it dilute democracy, instead suggesting the Botswana should switch to Proportional-Representation-System. Botswana is currently undergoing Constitutional Review process, with the commission, appointed in December, expected to deliver the report to President Mokgweetsi Masisi by September this year.

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