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Test and treat; a very exciting and welcome move for Botswana

On the 12th of May this year, Ministry of Health through its Permanent Secretary released a memorandum informing all the DHMTs of its decision to adopt the new World Health Organization (WHO) recommendation of treating all HIV infected individuals regardless of their CD4 count or clinical staging. This was to be effective from the 1st of June 2016.

Botswana is one of the countries in the world to be hard hit by HIV for the past three decades with the current national HIV prevalence standing at 18. 5% and the incidence rate at 1. 35 %. However, Botswana continues to be the pioneer in the world of HIV and has managed to put up a good fight against this epidemic and surpass the set targets. Botswana was bound to follow suit in keeping with international standards and WHO recommendations as it has set high standards in the whole wide world. Botswana was the first country in sub-Saharan Africa to provide free antiretroviral treatment to people with HIV, in 2002 through the MASA Program.

A study recently published in The Lancet HIV by a Motswana doctor Dr Tendani Gaolathe and others, revealed that Botswana is already close to reaching the 90-90-90 target for testing, treatment and viral suppression, and is ahead of the United States and most European countries in its efforts to improve treatment coverage. Of note is that this study was carried out with the old guidelines where treatment was initiated at CD4 count of less than 350.Now with WHO recommendation of treatment for all, which undoubtedly has good scientific back-up, Botswana is expected to shine even more. However like they always say all great changes are preceded by chaos.

This article is meant to inspire the debate and look at both sides of the newly implemented “Test and Treat” Policy.

PROs

Good treatment outcomes – The primary aim of ART is the prevention of the mortality and morbidity associated with chronic HIV infection at low cost of drug toxicity. It is a known fact that the earlier the treatment is started, the more improvement in the physical and psychological wellbeing of people living with HIV infection. It has all along mainly been about balancing the benefit with the economic implications of starting HAART early; but research has showed overwhelming benefits of starting every HIV positive on treatment, both economical and medical.

Prevention – ART is usually started for the health benefit of the individual, but in certain circumstances it may be beneficial to start ART to primarily reduce the risk of onward sexual transmission of HIV. Test and treat will act as both a PMTCT strategy and reduce vertical transmission (from mother to child) as well as reduction in the sexual transmission of HIV. For some patients (discordant couples, most at risk populations like commercial sex workers etc.) this may be the primary aim. A study carried out in UK revealed the size of the effect of ART on reducing the risk of sexual transmission of HIV to be estimated at greater than 95%. At a population level, test and treat will definitely reduce the rate of new HIV infections.

Economical – I cannot emphasize the economic benefits of test and treat any further. It will reduce the burden of treating opportunistic infections like TB, meningitis, recurrent pneumonias and others that are rampant in ART-naïve HIV sufferers. Estimates of the cost effectiveness of antiretroviral therapy have been assessed in studies in North America and Europe. Their findings have been consistent with an estimated incremental cost effectiveness ratio of about US$20,000 per quality adjusted life year for combination antiretroviral therapy compared to no therapy based on drug costs and treatment patterns in the USA and Europe. In short, “test and treat” is cost effective!

CONs

Cost – With its high HIV prevalence rate (the second highest in the world), the question on everyone’s lips is will Botswana afford to have such a large number of people on ARVs? And will the ARV treatment be sustainable over the next years?

Pill fatigue – One may argue that the earlier patients are started on treatment the sooner they will get tired of taking daily medications. With the previous guidelines of monitoring one’s CD4 count until it reaches 350 or they develop an opportunistic infection before starting on treatment, it might have helped with buying time and prolonging years of one living with HIV without treatment.

High defaulter rate – due to pill fatigue (and having started medications when physically and mentally fit), we might find ourselves in a situation where we have a lot of patients that have been initiated on treatment but not necessarily maintained on it. Thorough education and counseling to our people will be needed to ensure patients are really ready when they start HAART, and they understand that they do not need to become unwell to start or resume it.

Overburdened health care system – We will surely see an influx of patients populating IDCCs and crowding our already overburdened (public) health facilities. This is something that the government should be prepared for and have a stern plan in place in regards to the facility spaces, staffing, drug supplies etc.

Increased drug reactions – There are some drugs that cannot be started at high CD4 count levels like Nevirapine as the chances of severe drug reactions are high. This would be an issue if that drug has to be used on someone who is newly diagnosed of HIV and still has a very high CD count. However, with Botswana’s guidelines that have changed overtime, such drugs are no longer used as first line therapy and chances of them being used at initiation are very slim.

Increased drug toxicities – Some of the ARVS that we have in the market have documented long-term or cumulative side effects. The longer one uses them the more the side effects start being prevalent. For instance, AZT overtime causes changes in the body fat distribution, affects peripheral nerves and causes constant burning or pricking sensation under feet and discoloration of the nails. This is something that can potentially worsen the longer someone stays on that same treatment.

However, this is not much of an issue as overtime Botswana has moved from using such drugs as first line and opted to adopt newer drugs with less side-effect or toxicity profile. In the same memorandum, it was announced that the first line drug of choice shall be Dolutegravir, a drug that I first got into contact with in 2014, during my visit to UK. UK had long started using Dolutegravir as their first line drug as it has been shown to have very minimal side effects.

Despite all the challenges that may ensue with implementation of “test and treat” at the beginning, this is a move that we should all welcome with both hands as it surely harbors enormous benefits in the long run. Myopic complications should not distract us from looking at the bigger picture but rather help in making the best use of this policy.

For comments or questions please email HYPERLINK "mailto:agboima@yahoo.com" agboima@yahoo.com
 

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Brands are important

27th March 2023

So, the conclusion is brands are important. I start by concluding because one hopes this is a foregone conclusion given the furore that erupts over a botched brand. If a fast food chef bungles a food order, there’d be possibly some isolated complaint thrown. However, if the same company’s marketing expert or agency cooks up a tasteless brand there is a country-wide outcry. Why?  Perhaps this is because brands affect us more deeply than we care to understand or admit. The fact that the uproar might be equal parts of schadenfreude, black twitter-esque criticism and, disappointment does not take away from the decibel of concern raised.

A good place to start our understanding of a brand is naturally by defining what a brand is. Marty Neumier, the genius who authored The Brand Gap, offers this instructive definition – “A brand is a person’s gut feel about a product or service”. In other words, a brand is not what the company says it is. It is what the people feel it is. It is the sum total of what it means to them. Brands are perceptions. So, brands are defined by individuals not companies. But brands are owned by companies not individuals. Brands are crafted in privacy but consumed publicly. Brands are communal. Granted, you say. But that doesn’t still explain why everybody and their pet dog feel entitled to jump in feet first into a brand slug-fest armed with a hot opinion. True. But consider the following truism.

 

Brands are living. They act as milestones in our past. They are signposts of our identity. Beacons of our triumphs. Indexes of our consumption. Most importantly, they have invaded our very words and world view. Try going for just 24 hours without mentioning a single brand name. Quite difficult, right? Because they live among us they have become one of us. And we have therefore built ‘brand bonds’ with them. For example, iPhone owners gather here. You love your iPhone. It goes everywhere. You turn to it in moments of joy and when we need a quick mood boost. Notice how that ‘relationship’ started with desire as you longingly gazed upon it in a glossy brochure. That quickly progressed to asking other people what they thought about it. Followed by the zero moment of truth were you committed and voted your approval through a purchase. Does that sound like a romantic relationship timeline. You bet it does. Because it is. When we conduct brand workshops we run the Brand Loyalty ™ exercise wherein we test people’s loyalty to their favourite brand(s). The results are always quite intriguing. Most people are willing to pay a 40% premium over the standard price for ‘their’ brand. They simply won’t easily ‘breakup’ with it. Doing so can cause brand ‘heart ache’. There is strong brand elasticity for loved brands.

 

Now that we know brands are communal and endeared, then companies armed with this knowledge, must exercise caution and practise reverence when approaching the subject of rebranding. It’s fragile. The question marketers ought to ask themselves before gleefully jumping into the hot rebranding cauldron is – Do we go for an Evolution (partial rebrand) or a Revolution(full rebrand)? An evolution is incremental. It introduces small but significant changes or additions to the existing visual brand. Here, think of the subtle changes you’ve seen in financial or FMCG brands over the decades. Evolution allows you to redirect the brand without alienating its horde of faithful followers. As humans we love the familiar and certain. Change scares us. Especially if we’ve not been privy to the important but probably blinkered ‘strategy sessions’ ongoing behind the scenes. Revolutions are often messy. They are often hard reset about-turns aiming for a total new look and ‘feel’.

 

 

Hard rebranding is risky business. History is littered with the agony of brands large and small who felt the heat of public disfavour. In January 2009, PepsiCo rebranded the Tropicana. When the newly designed package hit the shelves, consumers were not having it. The New York Times reports that ‘some of the commenting described the new packaging as ‘ugly’ ‘stupid’. They wanted their old one back that showed a ripe orange with a straw in it. Sales dipped 20%. PepsiCo reverted to the old logo and packaging within a month. In 2006 Mastercard had to backtrack away from it’s new logo after public criticism, as did Leeds United, and the clothing brand Gap. AdAge magazine reports that critics most common sentiment about the Gap logo was that it looked like something a child had created using a clip-art gallery. Botswana is no different. University of Botswana had to retreat into the comfort of the known and accepted heritage strong brand.  Sir Ketumile Masire Teaching Hospital was badgered with complaints till it ‘adjusted’ its logo.

 

 

So if the landscape of rebranding is so treacherous then whey take the risk? Companies need to soberly assess they need for a rebrand. According to the fellows at Ignyte Branding a rebrand is ignited by the following admissions :

Our brand name no longer reflects our company’s vision.
We’re embarrassed to hand out our business cards.

Our competitive advantage is vague or poorly articulated.
Our brand has lost focus and become too complex to understand. Our business model or strategy has changed.
Our business has outgrown its current brand.
We’re undergoing or recently underwent a merger or acquisition. Our business has moved or expanded its geographic reach.
We need to disassociate our brand from a negative image.
We’re struggling to raise our prices and increase our profit margins. We want to expand our influence and connect to new audiences. We’re not attracting top talent for the positions we need to fill. All the above are good reasons to rebrand.

The downside to this debacle is that companies genuinely needing to rebrand might be hesitant or delay it altogether. The silver lining I guess is that marketing often mocked for its charlatans, is briefly transformed from being the Archilles heel into Thanos’ glove in an instant.

So what does a company need to do to safely navigate the rebranding terrain? Companies need to interrogate their brand purpose thoroughly. Not what they think they stand for but what they authentically represent when seen through the lens of their team members. In our Brand Workshop we use a number of tools to tease out the compelling brand truth. This section always draws amusing insights. Unfailingly, the top management (CEO & CFO)always has a vastly different picture of their brand to the rest of their ExCo and middle management, as do they to the customer-facing officer. We have only come across one company that had good internal alignment. Needless to say that brand is doing superbly well.

There is need a for brand strategies to guide the brand. One observes that most brands ‘make a plan’ as they go along. Little or no deliberate position on Brand audit, Customer research, Brand positioning and purpose, Architecture, Messaging, Naming, Tagline, Brand Training and may more. A brand strategy distils why your business exists beyond making money – its ‘why’. It defines what makes your brand what it is, what differentiates it from the competition and how you want your customers to perceive it. Lacking a brand strategy disadvantages the company in that it appears soul-less and lacking in personality. Naturally, people do not like to hang around humans with nothing to say. A brand strategy understands the value proposition. People don’t buy nails for the nails sake. They buy nails to hammer into the wall to hang pictures of their loved ones. People don’t buy make up because of its several hues and shades. Make up is self-expression. Understanding this arms a brand with an iron clad clad strategy on the brand battlefield.

But perhaps you’ve done the important research and strategy work. It’s still possible to bungle the final look and feel.  A few years ago one large brand had an extensive strategy done. Hopes were high for a top tier brand reveal. The eventual proposed brand was lack-lustre. I distinctly remember, being tasked as local agency to ‘land’ the brand and we outright refused. We could see this was a disaster of epic proportions begging to happen. The brand consultants were summoned to revise the logo. After a several tweaks and compromises the brand landed. It currently exists as one of the country’s largest brands. Getting the logo and visual look right is important. But how does one know if they are on the right path? Using the simile of a brand being a person – The answer is how do you know your outfit is right? It must serve a function, be the right fit and cut, it must be coordinated and lastly it must say something about you. So it is possible to bath in a luxurious bath gel, apply exotic lotion, be facebeat and still somehow wear a faux pas outfit. Avoid that.

Another suggestion is to do the obvious. Pre-test the logo and its look and feel on a cross section of your existing and prospective audience. There are tools to do this. Their feedback can save you money, time and pain. Additionally one must do another obvious check – use Google Image to verify the visual outcome and plain Google search to verify the name. These are so obvious they are hopefully for gone conclusions. But for the brands that have gone ahead without them, I hope you have not concluded your brand journeys as there is a world of opportunity waiting to be unlocked with the right brand strategy key.

Cliff Mada is Head of ArmourGetOn Brand Consultancy, based in Gaborone and Cape Town.

cliff@armourgeton.com

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The case for Botswana to ratify the ACDEG

6th March 2023

The Ibrahim Index of African Governance (IIAG) is the most comprehensive dataset measuring African governance performance through a wide range of 81 indicators under the categories of Security & Rule of law, Participation, Rights & Inclusion, Foundations of Economic Opportunity, and Human Development. It employs scores, expressed out of 100, which quantify a country’s performance for each governance measure and ranks, out of 54, in relation to the 54 African countries.

The 2022 IIAG Overall Governance score is 68.1 and ranks Botswana at number 5 in Africa. In 2019 Botswana was ranked 2nd with an overall score of 73.3. That is a sharp decline. The best-performing countries are Mauritius, Seychelles, Tunisia, and Cabo Verde, in that order. A glance at the categories shows that Botswana is in third place in Africa on the Security and Rule of law; ninth in the Participation, Rights & Inclusion Category – indicating a shrinking participatory environment; eighth for Foundations of Economic Opportunity category; and fifth in the Human Development category.

The 2022 IIAG comes to a sweeping conclusion: Governments are less accountable and transparent in 2021 than at any time over the last ten years; Higher GDP does not necessarily indicate better governance; rule of law has weakened in the last five years; Democratic backsliding in Africa has accelerated since 2018; Major restrictions on freedom of association and assembly since 2012. Botswana is no exception to these conclusions. In fact, a look at the 10-year trend shows a major challenge. While Botswana remains in the top 5 of the best-performing countries in Africa, there are signs of decline, especially in the categories of Human Development and Security & Rule of law.

I start with this picture to show that Botswana is no longer the poster child for democracy, good governance, and commitment to the rule of law that it once was. In fact, to use the term used in the IIAG, Botswana is experiencing a “democratic backsliding.”

The 2021 Transparency International Corruption Perception Index (CPI) had Botswana at 55/ 100, the lowest ever score recorded by Botswana dethroning Botswana as Africa’s least corrupt country to a distant third place, where it was in 2019 with a CPI of 61/100. (A score closer to zero denotes the worst corrupt and a score closer to 100 indicates the least corrupt country). The concern here is that while other African states are advancing in their transparency and accountability indexes, Botswana is backsliding.

The Transitional National Development Plan lists participatory democracy, the rule of law, transparency, and accountability, as key “deliverables,” if you may call those deliverables. If indeed Botswana is committed to these principles, she must ratify the African Charter on Democracy Elections and Governance (ACDEG).

The African Charter on Democracy Elections and Governance is the African Union’s principal policy document for advancing democratic governance in African Union member states. The ACDEG embodies the continent’s commitment to a democratic agenda and set the standards upon which countries agreed to be held accountable. The Charter was adopted in 2007 and came into force a decade ago, in 2012.

Article 2 of the Charter details its objectives among others as to a) Promote adherence, by each State Party, to the universal values and principles of democracy and respect for human rights; b) Promote and protect the independence of the judiciary; c) Promote the establishment of the necessary conditions to foster citizen participation, transparency, access to information, freedom of the press and accountability in the management of public affairs; d) Promote gender balance and equality in the governance and development processes.

The Charter emphasizes certain principles through which member states must uphold: Citizen Participation, Accountable Institutions, Respect for Human Rights, Adherence to the principles of the Rule of Law, Respect for the supremacy of the constitution and constitutional order, Entrenchment of democratic Principles, Separation of Powers, Respect for the Judiciary, Independence and impartiality of electoral bodies, best practice in the management of elections. These are among the top issues that Batswana have been calling for, that they be entrenched in the new Constitution.

The ACDEG is a revolutionary document. Article 3 of the ACDEG, sets guidance on the principles that must guide the implementation of the Charter among them: Effective participation of citizens in democratic and development processes and in the governance of public affairs; Promotion of a system of government that is representative; Holding of regular, transparent, free and fair elections; Separation of powers; Promotion of gender equality in public and private institutions and others.

Batswana have been calling for laws that make it mandatory for citizen participation in public affairs, more so, such calls have been amplified in the just-ended “consultative process” into the review of the Constitution of Botswana. Many scholars, academics, and Batswana, in general, have consistently made calls for a constitution that provides for clear separation of powers to prevent concentration of power in one branch, in Botswana’s case, the Executive, and provide for effective checks and balances. Other countries, like Kenya, have laws that promote gender equality in public and private institutions inscribed in their constitutions. The ACDEG could be a useful advocacy tool for the promotion of gender equality.

Perhaps more relevant to Botswana’s situation now is Article 10 of the Charter. Given how the constitutional review process unfolded, the numerous procedural mistakes and omissions, the lack of genuine consultations, the Charter principles could have provided a direction, if Botswana was party to the Charter. “State Parties shall ensure that the process of amendment or revision of their constitution reposes on national consensus, obtained, if need be, through referendum,” reads part of Article 10, giving clear clarity, that the Constitution belong to the people.

With the African Charter on Democracy Elections and Governance in hand, ratified, and also given the many shortfalls in the current constitution, Batswana can have a tool in hand, not only to hold the government accountable but also a tool for measuring aspirations and shortfalls of our governance institutional framework.

Botswana has not signed, nor has it acceded or ratified the ACDEG. The time to ratify the ACDEG is now. Our Movement, Motheo O Mosha Society, with support from the Democracy Works Foundation and The Charter Project Africa, will run a campaign to promote, popularise and advocate for the ratification of the Charter (#RatifytheCharter Campaign). The initiative is co-founded by the European Union. The Campaign is implemented with the support of our sister organizations: Global Shapers Community – Gaborone Hub, #FamilyMeetingBW, Botswana Center for Public Integrity, Black Roots Organization, Economic Development Forum, Molao-Matters, WoTech Foundation, University of Botswana Political Science Society, Young Minds Africa and Branding Akosua.

Ratifying the Charter would reaffirm Botswana’s commitment to upholding strong democratic values, and respect for constitutionalism, and promote the rule of law and political accountability. Join us in calling the Government of Botswana to #RatifyTheCharter.

*Morena MONGANJA is the Chairperson of Motheo O Mosha society; a grassroots movement advocating for a new Constitution for Botswana. Contact: socialcontractbw@gmail.com or WhatsApp 77 469 362.

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The Taiwan Question: China ramps up military exercises to rebuff US provocations

18th August 2022

US House Speaker Nancy Pelosis visit to Taiwan has violated the One-China policy, and caused the escalation of tensions across the Taiwan Strait. Experts and political observers across the spectra agree that Pelosis actions and subsequent pronouncements by US President Joe Biden gave impetus to an already simmering tension in the Taiwan Strait, provoking China to strengthen its legitimate hold on the Taiwan Strait waters, which the US and Taiwan deem as international waters.

Pelosis visit to Chinas Taiwan region has been heavily criticised across the globe, with China arguing that this is a serious violation of the one-China principle and the provisions of the three China-US Joint Communiqus. In response to this reckless move which seriously undermined China’s sovereignty, and interfered in China’s internal affairs, the expectation is for China to give a firm response. Pelosi visit violated the commitments made by the U.S. side, and seriously jeopardized peace and stability across the Taiwan Strait.

To give context to Chinas position over Taiwan region, the history behind gives us perspective. It is also important to note that the history between China and Taiwan is well documented and the US has always recognized it.

The Peoples Republic of China recognises Taiwan as its territory. It has always been the case even before the Nationalist Republic of China government fled to the previously Japanese-ruled Island after losing the civil war on the mainland in 1949. According to literature that threat was contained for decades first with a military alliance between the US and the ROC on Taiwan, and after Washington switched diplomatic recognition to the PRC in 1979 by the US One China policy, which acknowledges Beijings position that Taiwan is part of One China. Effectively, Taiwans administration was transferred to the Republic of China from Japan after the Second World War in 1945, along with the split between the Peoples Republic of China (PRC) and the Republic of China (ROC) as a consequence of the Chinese Civil War. Disregarding this history, as the US is attempting to do, will surely initiate some defence reaction on the side of China to affirm its sovereignty.

However, this history was undermined since Taiwan claimed to democratise in the 1990s and China has grown ever more belligerent. Furthermore, it is well documented that the Biden administration, following the Trump presidency, has made subtle changes in the way it deals with Taipei, such as loosening restrictions on US officials meeting Taiwanese officials this should make China uneasy. And while the White House continues to say it does not support Taiwanese independence, Bidens words and actions are parallel to this pledge because he has warned China that the US would intervene militarily if China attacked Taiwan another statement that has provoked China.

Pelosi, in her private space, would know that her actions amount to provocation of China. This act of aggression by the USA seriously undermines the virtues of sovereignty and territorial integrity which has a huge potential to destabilize not only the Taiwan Strait but the whole of the Asia- Pacific region. The Americans know very well that their provocative behavior is deliberately invoking the spirit of separatism masqueraded as Taiwan independence. The US is misled to think that by supporting separatism of Taiwan from China that would give them an edge over China in a geopolitics. This is what one Chinese diplomat said this week: The critical point is if every country put their One-China policy into practice with sincerity, with no compromise, is going to guarantee the peace and stability across the Taiwan Strait. Therefore, it was in the wake of US House speaker Nancy Pelosis visit to Taiwan, that China, in a natural response revealed plans for unprecedented military exercises near the island, prompting fears of a crisis in the Taiwan Strait and the entire Asia-Pacific region. The world community must promote and foster peace, this may be achieved when international laws are respected. It may also happen when nations respect the sovereignty of another. China may be in a better space because it is well capacitated to stake its territorial integrity, what about a small nation, if this happens to it?

As to why military exercises by Beijing; it is an expected response because China was provoked by the actions of Pelosi. To fortify this position, Chinese President, Xi signed a legal basis for Chinas Peoples Liberation Army to safeguard Chinas national sovereignty, security and development interests. The legal basis will also allow military missions around disaster relief, humanitarian aid and peacekeeping. In addition the legal changes would allow troops to prevent spillover effects of regional instabilities from affecting China, secure vital transport routes for strategic materials like oil, or safeguard Chinas overseas investments, projects and personnel. It then follows that President Xis administration cannot afford to look weak under a US provocation. President Xi must protector Chinas sovereignty and territorial integrity, of which Taiwan is a central part. Beijing is very clear on One-China Policy, and expects all world players to recognize and respect it.

The Peoples Liberation Army has made it clear that it has firepower that covers all of Taiwan, and it can strike wherever it wants. This sentiments have been attributed to Zhang Junshe, a researcher at the PLA Navy Research Institute. Zheng further said, We got really close to Taiwan. We encircled Taiwan. And we demonstrated that we can effectively stop intervention by foreign forces. This is a strong reaction from China to warn the US against provocation and violation of the One-China Policy.

Beijings military exercises will certainly shake Taiwans confidence in the sources of its economic and political survival. The potential for an effective blockade threatens the air and shipping routes that support Taiwans central role in global technology supply chains. Should a humanitarian situation arise in Taiwan, the blame would squarely be on the US.

As Chinas military exercises along the Taiwan Strait progress and grow, it remains that the decision by Nancy Pelosi to visit Chinas Taiwan region gravely undermined peace and stability across the Taiwan Strait, and sent a wrong signal to Taiwan independence separatist forces. This then speaks to international conventions, as the UN Secretary-General Antnio Guterres explicitly stressed that the UN remains committed to the UN General Assembly Resolution 2758. The centerpiece is the one-China principle, namely, there is but one China in the world, the government of the Peoples Republic of China is the sole legal government representing the whole of China, and Taiwan is a part of China. It must be noted that the US and the US-led NATO countries have selectively applied international law, this has been going on unabated. There is a plethora of actions that have collapsed several states after they were attacked under the pretext of the so-called possession of weapons of mass destruction illuminating them as threats – and sometimes even without any valid reason. to blatantly launch military strikes and even unleash wars on sovereign countrie

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