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.”
Here is how one Permanent Secretary encapsulates the clear tension between democracy and bureaucracy in Botswana: “President Mokgweetsi Masisi’s Government is behaving like a state surrounded with armed forces in order to capture it or force its surrender. The situation has turned so volatile, for tomorrow is not guaranteed for us top civil servants.
These are the painful results of a personalized civil service in our view as permanent secretaries”. Although his deduction of the situation may be summed as sour grapes because he is one of the ‘victims’ of the reshuffle, he is convinced this is a perfect description of the rationale behind frequent changes and transfers characterising the current civil service.
The result of it all, he said, is that “there is too much instability at managerial and strategic levels of the civil service leading to a noticeable directionless civil service.” He continued: “Changes and transfers are inevitable in the civil service, but to a permissible scale and frequency. Think of soccer team coach who changes and transfers his entire squad every month; you know the consequences?”
The Tsunami has hit hard at critical departments and Ministries leaving a strong wave of uncertainty, many demoralised and some jobless. In traditional approaches to public administration, democracy gives the goals; and bureaucracy delivers the technical efficiency required for implementation. But the recent moves in the civil service are indicative of conflicting imperatives – the notion of separation between politicians and administrators is becoming blurred by the day.
“Look at what happened to Prisons and BDF where second in command were overlooked for outsiders, and these are the people who had sacrificially served for donkey’s years hoping for a seat at the ladder’s end. The frequency of the changes, at times affecting the same Ministry or individual also demonstrates some level of ineptitude, clumsiness and lack of foresight from those in charge,” remarked the PS who added that their view is that the transfers are not related to anything but “settling scores, creating corruption opportunities and pushing out perceived dissident and former president, Ian Khama’s alleged loyalists and most of these transfers are said to be products of intelligence detection.”
Partly blaming Khama for the mess and his unwillingness to let go, the PS dismissed Masisi for falling to the trap and failing to outgrow the destructive tiff. “Khama is here to stay and the sooner Masisi comes to terms with the fact that he (Masisi) is the state President, the better. For a President to still be making these changes and transfers signals signs of a confused man who has not yet started rolling his roadmap, if at all it was ever there. I am saying this because any roadmap comes with key players and policies,” he concluded.
The Ministry of Health and Wellness seems to be the most hard-hit by the transfers, having experienced three Permanent Secretaries changes within a year and a half. Insiders say the changes have everything to do with the Ministry being the centre of COVID-19 tenders and economic opportunities. “The buck stops with the PS and no right-thinking PS can just allow glaring corruption under his watch as an accounting officer. Technocrats are generally law abiding, the pressure comes with politically appointed leaders racing against political terms to loot,” revealed a director in the Ministry preferring anonymity.
The latest transfer of Kabelo Ebineng she says was also motivated by his firm attitude against the President’s blue-eyed Task Team boys. “The Task Team wants to own the COVID-19 pandemic and government interventions and always cry foul when the Ministry reasserts itself as mandated by law,” said the director who added that Masisi who was always caught between the crossfire decided on sacrificing Ebineng to the joy of his team as they (Task Team) were in the habit of threatening to resign citing Ebineng as the problem.
Ebineng joins the Office of the President as a deputy Coordinator (government implementation and coordination office).The incoming PS is the soft-spoken Grace Muzila, known and described by her close associates as a conformist albeit knowledgeable.
One of the losers in the grand scheme is Thato Raphaka who many had seen as the next PSP because of his experience and calm demeanour following a declaration of interest in the Southern African Development Community (SADC) Secretary post by the current PSP, Elias Magosi.
But hardly ten months into his post, Raphaka has been transferred out to the National Strategy Office in what many see as a demotion of some sort. Other notable changes coming into OP are Pearl Ramokoka formerly with the Employment, Labour and Productivity Ministry coming in as a Permanent Secretary and Kgomotso Abi as director of Public Service Reforms.
One of the ousted senior officers in the Office of the President warned that there are no signs that the changes and transfers will stop anytime soon: “If you are observant you would have long noticed that the changes don’t only affect senior officers but government decisions as well. A decision is made today and the government backtracks on it within a week. Not only that, the President says this today, and his deputy denies it the following day in Parliament,” he warned.
Some observers have blamed the turmoil in the civil service partly to lack of accountable presidential advisers or kitchen cabinet properly schooled on matters of statecraft. They point out that politicians or those peripheral to them should refrain from hampering the technical and organizational activities of public managers – or else the party (reshuffling) won’t stop.
In the view expressed by some Permanent Secretaries, Elias Magosi, has not really been himself since joining the civil service; and has cut a picture of indifference in most critical engagements; the most notable been a permanent secretaries platform which he chairs. As things stand there is need to reconcile the imperatives of democracy and democracy in Botswana. Peace will rein only when public value should stand astride the fault that runs between politicians and public managers.
Former Permanent Secretary to the President, Carter Morupisi, is fighting for survival in a matter in which the State has charged him and his wife, Pinnie Morupisi, with corruption and money laundering.
Morupisi has joined a list of prominent figures that served in the previous administration and who have been accused of corruption during their tenure in office. While others have been emerging victorious, Morupisi is yet to find that luck. The High Court recently dismissed his no case to answer application.
United States President, Joe Biden, is faced with a decision to make relating to the Covid-19 vaccine intellectual property after 175 former world leaders and Nobel laurates joined the campaign urging the US to take “urgent action” to suspend intellectual property rights for Covid-19 vaccines to help boost global inoculation rates.
According to the world leaders, doing so would allow developing countries to make their own copies of the vaccines that have been developed by pharmaceutical companies without fear of being sued for intellectual property infringements.
“A WTO waiver is a vital and necessary step to bringing an end to this pandemic. It must be combined with ensuring vaccine know-how and technology is shared openly,” the signatories, comprising more than 100 Nobel prize-winners and over 70 former world leaders, wrote in a letter to US President Joe Biden, according to Financial Times.
A measure to allow countries to temporarily override patent rights for Covid related medical products was proposed at the World Trade Organization by India and South Africa in October, and has since been backed by nearly 60 countries.
Former leaders who signed the letter included Gordon Brown, former UK Prime Minister; François Hollande, former French President; Mikhail Gorbachev, former President of the USSR; and Yves Leterme, former Belgian Prime Minister.
In their official communication, South Africa and India said: “As new diagnostics, therapeutics and vaccines for Covid-19 are developed, there are significant concerns [about] how these will be made available promptly, in sufficient quantities and at affordable prices to meet global demand.”
While developed countries have been able to secure enough vaccine to inoculate their citizens, developing countries such as Botswana are struggling to source enough to swiftly vaccine their citizens, something which world leaders believe it would work against global recovery therefore proving counter-productive.
Since the availability of vaccines, Botswana has been able to secure only 60 000 doses of vaccines, 30 000 as donation as from the Indian government, while the other 30 000 was sourced through COVAX facility. Canada, has pre-ordered vaccines in surplus and it will be able to vaccinate each of its citizens six times over. In the UK and US, it is four vaccines per person; and two each in the EU and Australia.
For vaccines produced in Europe, developing countries are forced to pay double what European countries are paying, making it more expensive for already financially struggling economies. European countries however justify the price of vaccines and that they deserve to buy them cheap since they contributed in their development.
It is evident that vaccines cannot be made available immediately to all countries worldwide with wealthy economies being the only success story in that regard, something that has been referred to as a “catastrophic moral failure”, head of the World Health Organisation (WHO), Tedros Adhanom Ghebreyesus.
The challenge facing developing countries is not only the price, but also the capacity of vaccine manufactures to be able to do so to meet global demand within a short time. The proposal for a patent waiver by India and South Africa has been rejected by developed countries, known for hosting the world leading pharmaceutical companies such US, European Union, the United Kingdom, and Switzerland.
According to the Financial Times, US business groups including pharmaceutical industry representatives, have urged Biden to resist supporting a waiver to IP rules at the WTO, arguing that the proposal led by India and South Africa was too “vague” and “broad”.
The individuals who signed the letter, including Nobel laureates in economics as well as from across the arts and sciences, warned that inequitable vaccine access would impact the global economy and prevent it from recovering.
“The world saw unprecedented development of safe and effective vaccines, in major part thanks to US public investment,” the group wrote. “We all welcome that vaccination rollout in the US and many wealthier countries is bringing hope to their citizens.”
“Yet for the majority of the world that same hope is yet to be seen. New waves of suffering are now rising across the globe. Our global economy cannot rebuild if it remains vulnerable to this virus.” The group warned that fully enforcing IP was “self-defeating for the US” as it hindered global vaccination efforts. “Given artificial global supply shortages, the US economy already risks losing $1.3tn in gross domestic product this year.”