The Government of Botswana is having sleepless nights in responding to calls by the World Health Organization (WHO) to incorporate safe and effective traditional medicine into the primary health-care system as well as bring traditional healers into a legal framework.
What makes it difficult is the pollution of the practice by bogus traditional practitioners who claim supernatural powers and often than not put people’s lives in danger. Traditional medicine is mostly issued by traditional doctors who have become notorious for claiming the know-how and powers to cure ailments.
Efforts to curb this group and discourage communities not to rely on them have proved futile as traditional doctors still remain central to the culture of many Africans. The World Health Organization (WHO) estimates that 80 per cent of people in Africa regularly seek their services.
The government in its efforts to curb these incidences decided to come up with a law that will look into these issues.
The proposed Bill seeks to address among other issues concerns that some healers claim to possess cures for various terminal ailments, among them HIV/AIDS. This will be addressed by a Council that will, among other things, authenticate the efficacy of herbal medicines.
Other concerns on the side of government are possible risks of cross infections through contaminated body piercing instruments and other means during traditional doctors’ treatment processes as well as the influx of foreign nationals claiming to be traditional doctors.
Traditional doctors through their Umbrella bodies have already made a promise to the government that they would refer infectious diseases such as diarrhoea, HIV/AIDS and Tuberculosis to medical doctors.
Weekendpost has established that the government is finding it difficult to address some of the issues including the definition of who is a traditional doctor. Some of the issues that make it difficult are rooted traditions that some traditional doctors claim to have inherited or have been taught the practice by their parents while some go for actual training and so forth.
The question of definition is expected to cause uproar once it is finalized. The bill also envisages referrals from one party to the other among many other issues.
Plans to involve and regulate traditional doctors emanated from a growing realization that it is possible for traditional and western practitioners to work together to improve patients’ well-being, especially when it comes to developing new medications, reporting new cases of contagious diseases and finding ways to ensure that patients stick to their prescribed treatments according to research.
Traditional doctors have in-depth knowledge of plant materials and their various curative powers. They use leaves, seeds, stems, bark or roots to treat symptoms. Most traditional healers are both herbalists and diviners, while some specialize in one aspect.
This healing system rose to popularity after the realization that Doctors trained in the Western sciences largely focus on the biomedical causes of disease, traditional beliefs take a more holistic approach.
Although traditional doctors are not officially recognized by government and still operate outside formal health structures, Batswana still consider them essential in their day to day lives. This has, in some instances, led to catastrophic incidences where some patients preferring traditional doctors disregard medical doctors’ advice and choose to take herbal medicines that have dangerous interactions with pharmaceuticals.
In 2002, WHO issued its first comprehensive guidelines to help countries such as Zimbabwe, develop policies to regulate traditional medicine. Zimbabwe is of the view that there is need for some standardization of operations and that people should be able to consult registered and licensed traditional healers at proper premises.
South Africa leads continental efforts to bring traditional healers into a legal framework. In early 2005, South African Parliament approved a law to recognize the country’s estimated 200,000 healers as health-service providers. It is understood that those registered would, for example, be allowed to prescribe sick leave and offer treatment for numerous conditions. Some hailed this as an important step in rooting out charlatans and protecting patients, but others saw it differently.
In a brief interview with Weekendpost, Medical Practitioners Group chairperson, Dr Gagoitsiwe Saleshando said they welcome the move by the Ministry. He added that the law will help in the exchange of ideas to move the health of the nation forward.
“However this must be done in a way that will not jeopardize the health of the nation by promoting anything that may be hazardous to people in the long run,” he warned.
Doctors for Life, which represents over a thousand health practitioners in South Africa, however is objected to the government’s plans to legitimize healers.
“Most of the medicines used by traditional practitioners have not been validated scientifically,” states Doctors for Life.
“Many people suffer because of the serious complications that arise due to the use of traditional medicines.” The group warned that such a law could open “a can of worms” of legal controversies and medical complications. They urged that remedies be thoroughly researched before approval.
Other medical practitioners point out that traditional healers, with or without the support of the law, are already providing services within communities. Bringing them within the primary-health fold would therefore help rather than hinder efforts to flush out harmful practices.
Research shows that in Tanzania, the Dar es Salaam-based Institute of Traditional Medicine has a pilot programme to test the efficacy of local herbs in helping reduce the severity of other illnesses often seen in HIV patients.
Herbalists, it is understood, are allowing the institute to evaluate the substances they use to treat patients. If scientists discover beneficial elements in the herbs, they purify them and determine what the proper dosage should be. This addresses a major concern that some people have with the way medicines have been prescribed by traditional healers. Some 25 herbalists are currently working with the institute.
The Minister of Health was unable to give this publication her comment saying she was still busy in a meeting.
Government is currently sitting on 4 400 vacant posts that remain unfilled in the civil service. This is notwithstanding the high unemployment rate in Botswana which has been exacerbated by the recent outbreak of the deadly COVID-19 pandemic.
Just before the burst of COVID-19, official data released by Statistics Botswana in January 2020, indicate that unemployment in Botswana has increased from 17.6 percent three years ago to 20.7 percent. “Unemployment rate went up by 3.1 percentage between the two periods, from 17.6 to 20.7 percent,” statistics point out.
Leading commercial bank, First National Bank Botswana (FNBB), expects the central bank to sharpen its monetary policy knife and cut the Bank Rate twice in the last quarter of 2020.
The bank expects a 25 basis point (bps) in the beginning of the last quarter, which is next month, and another shed by the same bps in December, making a total of 50 bps cut in the last quarter. According to the bank’s researchers, the central bank is now holding on to 4.25 percent for the time being pending for more informed data on the economic climate.
An audit of the accounts and records for the supply of food rations to the institutions in the Northern Region for the financial year-ended 31 March 2019 was carried out. According to Auditor General’s report and observations, there are weaknesses and shortcomings that were somehow addressed to the Accounting Officer for comments.
Auditor General, Pulane Letebele indicated on the report that, across all depots in the region that there had been instances where food items were short for periods ranging from 1 to 7 months in the institutions for a variety of reasons, including absence of regular contracts and supplier failures. The success of this programme is dependent on regular and reliable availability of the supplies to achieve its objective, the report said.
There would be instances where food items were returned from the feeding centers to the depots for reasons of spoilage or any other cause. In these cases, instances had been noted where these returns were not supported by any documentation, which could lead to these items being lost without trace.
The report further stressed that large quantities of various food items valued at over P772 thousand from different depots were damaged by rodents, and written off.Included in the write off were 13 538 (340ml) cartons of milk valued at P75 745. In this connection, the Auditor General says it is important that the warehouses be maintained to a standard where they would not be infested by rodents and other pests.
Still in the Northern region, the report noted that there is an outstanding matter relating to the supply of stewed steak (283×3.1kg cans) to the Maun depot which was allegedly defective. The steak had been supplied by Botswana Meat Commission to the depot in November 2016.
In March 2017 part of the consignment was reported to the supplier as defective, and was to be replaced. Even as there was no agreement reached between the parties regarding replacement, in 51 October 2018 the items in question were disposed of by destruction. This disposal represented a loss as the whole consignment had been paid for, according to the report.
“In my view, the loss resulted directly from failure by the depot managers to deal with the matter immediately upon receipt of the consignment and detection of the defects. Audit inspections during visits to Selibe Phikwe, Maun, Shakawe, Ghanzi and Francistown depots had raised a number of observations on points of detail related to the maintenance of records, reconciliations of stocks and related matters, which I drew to the attention of the Accounting Officer for comments,” Letebele said in her report.
In the Southern region, a scrutiny of the records for the control of stocks of food items in the Southern Region had indicated intermittent shortages of the various items, principally Tsabana, Malutu, Sunflower Oil and Milk which was mainly due to absence of subsisting contracts for the supply of these items.
“The contract for the supply of Tsabana to all depots expired in September 2018 and was not replaced by a substantive contract. The supplier contracts for these stocks should be so managed that the expiry of one contract is immediately followed by the commencement of the next.”
Suppliers who had been contracted to supply foodstuffs had failed to do so and no timely action had been taken to redress the situation to ensure continuity of supply of the food items, the report noted.
In one case, the report highlighted that the supplier was to manufacture and supply 1 136 metric tonnes of Malutu for a 4-months period from March 2019 to June 2019, but had been unable to honour the obligation. The situation was relieved by inter-depot transfers, at additional cost in transportation and subsistence expenses.
In another case, the contract was for the supply of Sunflower Oil to Mabutsane, where the supplier had also failed to deliver. Examination of the Molepolole depot Food Issues Register had indicated a number of instances where food items consigned to the various feeding centres had been returned for a variety of reasons, including food item available; no storage space; and in other cases the whole consignments were returned, and reasons not stated.
This is an indication of lack of proper management and monitoring of the affairs of the depot, which could result in losses from frequent movements of the food items concerned.The maintenance of accounting records in the region, typically in Letlhakeng, Tsabong, and Mabutsane was less than satisfactory, according to Auditor General’s report.
In these depots a number of instances had been noted where receipts and issues had not been recorded over long periods, resulting in incorrect balances reflected in the accounting records. This is a serious weakness which could lead to or result in losses without trace or detection, and is a contravention of Supplies Regulations and Procedures, Letebele said.
Similarly, consignments of a total of 892 bags of Malutu and 3 bags of beans from Tsabong depot to different feeding centres had not been received in those centres, and are considered lost. These are also not reflected in the Statement of Losses in the Annual Statements of Accounts for the same periods.