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Botswana Health system: A cry for change

DR KARL BRIGHT
HEALTH PRACTITIONER


Botswana has over the years delighted itself in being ranked higher than most regional/sub Saharan countries in areas like peace, economy and freedom among others but not the least. At some point we were ranked number 1 for being the “most globalized nation” in Africa. A country dubbed as a middle-income country, with a population of 2 million and a life expectancy of just 54. Sadly enough, all these accolades do not reflect any good about our health care services in this nation and for that we are really concerned.


The health care system in Botswana is in big trouble and this does not reflect the pride we “always” have for our country, nor does it reflect the “good” praises we seldom get from other countries for our “good” governance. If this was a joke at some point, it is not now. Botswana needs to wake up to its dwindling health care services/system. What we see on paper should reflect what is on the ground. Sadly currently it is not.


To better understand this problem one needs to have seen better health care systems to be in a better platform to reflect on our own. All of our Drs have trained outside the country (except for the recent small group that graduated from UB School of Medicine) including the Australian health care system, European countries, Americas, Asia and other African countries. We have seen major differences but most of them are really basic that we as nation should put in place.


We are losing young lives in hospitals in Botswana comparatively, not because we don’t know what to do but because of the scarce simple basic medical supplies that a standard referral hospital should have at all times and the lack of medical Doctors. I know this is a hard pill to swallow, and most of those who claim to be concerned about this don’t talk about it, at least to a level where change would be certain.


We love our country and we will engage in all good manner of discussions with our government to see inevitable change. I recently visited home on a holiday during which my nephew aged 2, accidentally sustained a laceration on the forehead that needed suturing. To my shock or surprise, on arrival to Princess Marina, there was only 1 doctor and 2 nurses working in the emergency department of the biggest public referral hospital in Botswana.

I was told that there was no suturing material and no dressing materials and that it had been like that for weeks and that there was no one to help me as the DR was “busy” with the patients who came hours before we did. To make matters worse, there were many patients and no one to help me as the DR was “busy” with the patients who came hours before we did. To make matters worse, there were many patients in cubicles not attended to, some waiting in mattresses so sick on the waiting area, in wheel chairs, both old and young, some sleeping on benches not attended to. What a sad picture.


In addition, this was on a morning shift were on a normal basis you would expect many doctors to be on the shift. This made me sad and wondered why Botswana; a country with only a population of 2 million people would not have a very good health care system or at least a standard at par with other regional countries. Where is our health care system going? Things are getting worse rather than better.


Workers are frustrated and we are losing more doctors. The sad thig is we “always talk” about this and nothing improves. This is a time where we need to reflect on our own health care system and ask ourselves why we can’t compete with neighbouring countries like south Africa, Namibia, Zambia, Zimbabwe and other first world countries where our own Drs seem to be running to. What is causing our hospitals to be in a terrible situation like this? I recently asked some Drs in Marina and others who are in clinics around Gaborone where they themselves go for medical help when they are unwell or have an emergency.

The answer was surprising and just made me feel we are really far from getting it right. One of them said” we go to private hospitals”. I further asked… “Does that mean then you do not value your own services you provide and the hospitals you work in to help yourselves?? “What about the many who cannot afford private health care…?” …They answered, “Go thata monna….”. This is really sad and even the country’s top officials would agree that we are in trouble and need to fix our health system ASAP. We need to retain Drs in Botswana. Not only our own local citizen Drs but we need to have international well-accredited good doctors who will stay in Botswana and help this system to flourish.


Most of our problems I realize are not on the ground per se like most people think but a mixture of both management in our hospitals and ministry level flaws and lack of accountability in hospitals and local clinics. Botswana should retain majority of their Local Drs in major referral centres and reserve rural or district placements to outsiders as many of the first world countries do. But I do agree this is a complex task that would need proper execution to balance out things.


Perhaps those Drs sent to rural areas could receive more incentives to service these areas. You cannot run major hospitals with outsiders and send/transfer your own Drs who could be making a huge impact or difference in these Dr shortage places to rural areas. We need to wake up Batswana.

I want to go to a hospital and have the highest confidence that I would get the help I need and better off, take my children and relatives to our hospitals and know that they will come back well and alive. Unfortunately at the moment things are not encouraging. I am saying this with a sad heart because Botswana health care system is terrible comparatively but could be better.
I urge our leaders to take this seriously and work quicker lest we find ourselves with a “non-existent” health care system.

The time for talking is over and we need to seriously act now and put in place new policies that will see our health care system improve. There is no Motswana Dr who likes working oversees or wants to live overseas forever. They all want to work and live in Botswana-for home is where the heart is-and they want to help improve the health of Batswana.


Unfortunately many factors including political, financial and working conditions have forced them to be where they are today. Not because they are disloyal but because our own Botswana cannot provide a great platform for these Drs to practice their good quality medicine they have patiently studied for many years outside the country.

All of us Drs who received grants/loans for medical education are eternally grateful to the government and the public of Botswana for their monetary funds. To see Drs resigning and leaving the country is sad and a waste of millions of Pula’s and this should stop.“ This is like buying a Rolls Royce and not servicing it or not get concerned when someone steals it” one Dr Macheng at Princess Marina said.


And let us all be honest, most of these factors are the comparative low salaries, lack of specialists in Botswana or the enticement of and retaining these specialists from partner medical schools or other countries, the lack of medications and or the turn over time to stock other important supplies in our major hospitals. It’s a really saddening scenario. We have over the years been talking about these issues but its like talking to deaf ears.


Batswana need and demand to see a good health care system that would afford to treat even our president, ministers, ambassadors and other high officials etc. Not to fly them out of the country when trouble kicks in for “better health care”. That I do not take pride in and I call on our government to scrutinize this and for them to put new and life changing measures they have never engrossed before to change this saddening scenario. Better health should be for all i.e. for both the man and woman working or not, rich or poor, medical aid or no medical aid and it should all together be affordable.


I believe in Botswana and I believe we can improve things. I pray that my cry for the health care system of this country to improve would be heard. I call on the government and all Drs of this country, currently working in the public sector, private sector, retired, resigned, working in neighbouring countries or working overseas to go back to the drawing boards and work together to pen down new policies that would take this nation on a different yet better direction regarding our health care system.


I also call on the medical body of this country BMA-Botswana medical association (if existent at all) to wake up and represent the interests of Drs in this country and to seriously advocate, represent and fight the battles of Drs with utmost zeal and zest and with respect. They need to fervently liaise with the governing body to discuss issues and matters regarding health care in Botswana and to make sure that matters are resolved and changed within a timely manner for sole purpose of improving our people’s health.

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Opinions

Can we cure ourselves from the cancer of corruption?

28th October 2020
DCEC DIRECTOR: Tymon Katholo

Bokani Lisa Motsu

“One of the saddest lessons of history is this: If we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken. Once you give a charlatan power over you, you almost never get it back.” Carl Sagan

Corruption is a heavy price to pay. The clean ones pay and suffer at the mercy of people who cannot have enough. They always want to eat and eat so selfishly like a bunch of ugly masked shrews. I hope God forgives me for ridiculing his creatures, but that mammal is so greedy. But corruption is not the new kid on the block, because it has always been everywhere.

This of course begs the question, why that is so? The common answer was and still is – abuse and misuse of power by those in power and weak institutions, disempowered to control the leaders. In 1996, the then President of The World Bank, James D. Wolfensohn named the ‘C-Word’ for the first time during an annual meeting of the Bretton Woods Institutions. A global fight against corruption started. Transparency International began its work. Internal and external audits mushroomed; commissions of inquiry followed and ever convoluted public tender procedures have become a bureaucratic nightmare to the private sector, trying to fight red tape.

The result is sobering corruption today is worse than it was 25 years ago. There is no denying that strong institutions help, but how does it come that in the annual Transparency International Ranking the same group of countries tend to be on the top while another group of countries, many African among them, tend to be on the bottom? Before one jumps to simple and seductive conclusions let us step back a moment.

Wolfensohn called corruption a cancer that destroys economies like a cancer destroys a body. A cancer is, simplified, good cells in a body gone bad, taking control of more and more good cells until the entire body is contaminated and eventually dies. So, let us look at the good cells of society first: they are family ties, clan and tribe affiliation, group cohesion, loyalty, empathy, reciprocity.

Most ordinary people like the reader of these lines or myself would claim to share such values. Once we ordinary people must make decisions, these good cells kick in: why should I hire a Mrs. Unknown, if I can hire my niece whose strengths and weaknesses I know? If I hire the niece, she will owe me and support my objectives.

Why should I purchase office furniture from that unknown company if I know that my friend’s business has good quality stuff? If I buy from him, he will make an extra effort to deliver his best and provide quality after sales service? So, why go through a convoluted tender process with uncertain outcome? In the unlikely case my friend does not perform as expected, I have many informal means to make him deliver, rather than going through a lengthy legal proceeding?

This sounds like common sense and natural and our private lives do work mostly that way and mostly quite well.

The problem is scale. Scale of power, scale of potential gains, scale of temptations, scale of risk. And who among us could throw the first stone were we in positions of power and claim not to succumb to the temptations of scale? Like in a body, cancer cells start growing out of proportion.

So, before we call out for new leaders – experience shows they are rarely better than the old ones – we need to look at ourselves first. But how easy is that? If I were the niece who gets the job through nepotism, why should I be overly critical? If I got a big furniture contract from a friend, why should I spill the beans? What right do I have to assume that, if I were a president or a minister or a corporate chief procurement officer I would not be tempted?

This is where we need to learn. What is useful, quick, efficient, and effective within a family or within a clan or a small community can become counterproductive and costly and destructive at larger corporate or national scale. Our empathy with small scale reciprocity easily permeates into complacency and complicity with large scale corruption and into an acquiescence with weak institutions to control it.

Our institutions can only be as strong as we wish them to be.

I was probably around ten years old and have always been that keen enthusiastic child that also liked to sing the favourite line of, ‘the world will become a better place.’  I would literally stand in front of a mirror and use my mom’s torch as a mic and sing along Michael Jackson’s hit song, ‘We are the world.’

Despite my horrible voice, I still believed in the message.  Few years later, my annoyance towards the world’s corrupt system wonders whether I was just too naïve. Few years later and I am still in doubt so as to whether I should go on blabbing that same old boring line. ‘The world is going to be a better place.’ The question is, when?

The answer is – as always: now.

This is pessimistic if not fatalistic – I challenge Sagan’s outlook with a paraphrased adage of unknown origin: Some people can be bamboozled all of the time, all people can be bamboozled some of the time, but never will all people be bamboozled all of the time.

We, the people are the only ones who can heal society from the cancer of corruption. We need to understand the temptation of scale and address it. We need to stop seeing ourselves just a victim of a disease that sleeps in all of us. We need to give power to the institutions that we have put in place to control corruption: parliaments, separation of power, the press, the ballot box. And sometimes we need to say as a niece – no, I do not want that job as a favour, I want it because I have proven to be better than other contenders.

It is going to be a struggle, because it will mean sacrifices, but sacrifices that we have chosen, not those imposed on us.

Let us start today.

*Bokani Lisa Motsu is a student at University of Botswana

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Opinions

Accounting Officers are out of touch with reality

19th October 2020

Parliament, the second arm of State through its parliamentary committees are one of Botswana’s most powerful mechanisms to ensure that government is held accountable at all times. The Accounting Officers are mostly Permanent Secretaries across government Ministries and Chief Executive Officers, Director Generals, Managing Directors of parastatals, state owned enterprises and Civil Society.

So parliament plays its oversight authority via the legislators sitting on a parliamentary committee and Accounting Officers sitting in the hot chair.  When left with no proper checks and balances, the Executive is prone to abuse the arrangement and so systematic oversight of the executive is usually carried out by parliamentary committees.  They track the work of various government departments and ministries, and conduct scrutiny into important aspects of their policy, direction and administration.

It is not rocket science that effective oversight requires that committees be totally independent and able to set their own agendas and have the power to summon ministers and top civil servants to appear and answer questions. Naturally, Accounting Officers are the highest ranking officials in the government hierarchy apart from cabinet Ministers and as such wield much power and influence in the performance of government.  To illustrate further, government performance is largely owed to the strategic and policy direction of top technocrats in various Ministries.

It is disheartening to point out that the recent parliament committees — as has been the case all over the years — has laid bare the incompetency, inadequacy and ineptitude of people bestowed with great responsibilities in public offices. To say that they are ineffective and inefficient sounds as an understatement. Some appear useless and hopeless when it comes to running the government despite the huge responsibility they possess.

If we were uncertain about the degree at which the Accounting Officers are incompetent, the ongoing parliament committees provide a glaring answer.  It is not an exaggeration to say that ordinary people on the streets have been held ransom by these technocrats who enjoy their air conditioned offices and relish being chauffeured around in luxurious BX SUV’s while the rest of the citizenry continue to suffer. Because of such high life the Accounting Officers seem to have, with time, they have gotten out of touch with the people they are supposed to serve.

An example; when appearing before the recent Public Accounts Committee (PAC), Office of the President Permanent Secretary, Thuso Ramodimoosi, looked reluctant to admit misuse of public funds. Although it is clear funds were misused, he looked unbothered when committee members grilled him over the P80 million Orapa House building that has since morphed into a white elephant for close to 10 successive years. To him, it seems it did not matter much and PAC members were worried for nothing.

On a separate day, another Accounting officer, Director of Public Service Management (DPSM), Naledi Mosalakatane, was not shy to reveal to PAC upon cross-examination that there exist more than 6 000 vacancies in government. Whatever reasons she gave as an excuse, they were not convincing and the committee looked sceptical too. She was faltering and seemed not to have a sense of urgency over the matter no matter how critical it is to the populace.

Botswana’s unemployment rate hoovers around 18 percent in a country where majority of the population is the youth, and the most affected by unemployment. It is still unclear why DPSM could underplay such a critical matter that may threaten the peace and stability of the country.
Accounting Officers clearly appear out of touch with the reality out there – if the PAC examinations are anything to go by.

Ideally the DPSM Director could be dropping the vacancy post digits while sourcing funds and setting timelines for the spaces to be filled as a matter of urgency so that the citizens get employed to feed their families and get out of unemployment and poverty ravaging the country.
The country should thank parliamentary committees such as PAC to expose these abnormalities and the behaviour of our leaders when in public office. How can a full Accounting Officer downplay the magnitude of the landless problem in Botswana and fail to come with direct solutions tailor made to provide Batswana with the land they desperately need?

Land is a life and death matter for some citizens, as we would know.

When Bonolo Khumotaka, the Accounting Officer in the Ministry of Land Management, Water and Sanitation Services, whom as a top official probably with a lucrative pay too appears to be lacking sense of urgency as she is failing on her key mandate of working around the clock to award the citizens with land especially those who need it most like the marginalised.  If government purports they need P94 billion to service land to address the land crisis what is plan B for government? Are we going to accept it the way it is?

Government should wake up from its slumber and intervene to avoid the 30 years unnecessary waiting period in State land and 13 years in Tribal land.  Accounting Officers are custodians of government policy, they should ensure it is effective and serve its purpose. What we have been doing over the years, has proved that it is not effective, and clearly there is a need for change of direction.

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Opinions

Is it possible to make people part of your business resilience planning after the State of Public Emergency?

12th October 2020

THABO MAJOLA

His Excellency Dr Mokgweetsi EK Masisi, the President of the Republic of Botswana found it appropriate to invoke Section 17 (1) of the Constitution of the Republic of Botswana, using the powers vested in him to declare a State of Public Emergency starting from the 2nd April 2020 at midnight.

The constitutional provision under Section 17 (2b) only provided that such a declaration could be up to a maximum of 21 days. His Excellency further invoked Section 93 (1) to convene an extra- ordinary meeting of Parliament to have the opportunity to consult members of parliament on measures that have been put in place to address the spread and transmission of the virus. At this meeting Members of Parliament passed a resolution on the legal instruments and regulations governing the period of the state of emergency, and extended its duration by six (6) months.

The passing of the State of Emergency is considered as a very crucial step in fighting the near apocalyptic potential of the Novel COVID-19 virus. One of the interesting initiatives that was developed and extended to the business community was a 3-month wage subsidy that came with a condition that no businesses would retrench for the duration of the State of Public Emergency. This has potentially saved many people’s jobs as most companies would have been extremely quick to reduce expenses by downsizing. Self-preservation as some would call it.

Most organisations would have tried to reduce costs by letting go of people, retreated and tried their best to live long enough to fight another day. In my view there is silver lining that we need to look at and consider. The fact that organisations are not allowed to retrench has forced certain companies to look at the people with a long-term view.

Most leaders have probably had to wonder how they are going to ensure that their people are resilient. Do they have team members who innovate and add value to the organisation during these testing times? Do they even have resilient people or are they just waiting for the inevitable end? Can they really train people and make them resilient? How can your team members be part of your recovery plan? What can they do to avoid losing the capabilities they need to operate meaningfully for the duration of the State of Public Emergency and beyond?

The above questions have forced companies to reimagine the future of work. The truth is that no organisation can operate to its full potential without resilient people. In the normal business cycle, new teams come on board; new business streams open, operations or production sites launch or close; new markets develop, and technology is introduced. All of this provides fresh opportunities – and risks.

The best analogy I have seen of people-focused resilience planning reframes employees as your organisation’s immune system, ready and prepared to anticipate risks and ensure they can tackle challenges, fend off illness and bounce back more quickly.  So, how do you supercharge your organizational immune system to become resilient?

COVID-19 has helped many organisations realize they were not as prepared as they believed themselves to be. Now is the time to take stock and reset for the future. All the strategies and plans prior to COVID-19 arriving in Botswana need to be thrown out of the window and you need to develop a new plan today. There is no room for tweaking or reframing. Botswana has been disrupted and we need to accept and embrace the change. What we initially anticipated as a disease that would take a short term is turning out to be something we are going to have to live with for a much longer time. It is going to be a marathon and therefore businesses need to have a plan to complete this marathon.

Start planning. Planning for change can help reduce employee stress, anxiety, and overall fear, boosting the confidence of staff and stakeholders. Think about conducting and then regularly refreshing a strategic business impact analysis, look at your employee engagement scores, dig into your customer metrics and explore the way people work alongside your behaviours and culture. This research will help to identify what you really want to protect, the risks that you need to plan for and what you need to survive during disruption. Don’t forget to ask your team members for their input. In many cases they are closest to critical business areas and already have ideas to make processes and systems more robust.

Revisit your organisational purpose. Purpose, values and principles are powerful tools. By putting your organisation’s purpose and values front and center, you provide clear decision-making guidelines for yourself and your organisation. There are very tough and interesting decisions to make which have to be made fast; so having guiding principles on which the business believes in will help and assist all decision makers with sanity checking the choices that are in front of them. One noticeable characteristic of companies that adapt well during change is that they have a strong sense of identity. Leaders and employees have a shared sense of purpose and a common performance culture; they know what the company stands for beyond shareholder value and how to get things done right.

Revisit your purpose and values. Understand if they have been internalised and are proving useful. If so, find ways to increase their use. If not, adapt them as necessities, to help inspire and guide people while immunizing yourself against future disruption. Design your employee experience. The most resilient, adaptive and high performing companies are made up of people who know each other, like each other, and support each other.

Adaptability requires us to teach other, speak up and discuss problems, and have a collective sense of belonging. Listening to your team members is a powerful and disruptive thing to do. It has the potential to transform the way you manage your organisation. Enlisting employees to help shape employee experience, motivates better performance, increases employee retention and helps you spot issues and risks sooner. More importantly, it gives employees a voice so you can get active and constructive suggestions to make your business more robust by adopting an inclusive approach.

Leaders need to show they care. If you want to build resilience, you must build on a basis of trust. And this means leaders should listen, care, and respond. It’s time to build the entire business model around trust and empathy. Many of the employees will be working under extreme pressure due to the looming question around what will happen when companies have to retrench. As a leader of a company transparency and open communication are the most critical aspects that need to be illustrated.

Take your team member into confidence because if you do have to go through the dreaded excise of retrenchment you have to remember that those people the company retains will judge you based on the process you follow. If you illustrate that the business or organization has no regard for loyalty and commitment, they will never commit to the long-term plans of the organisation which will leave you worse off in the end. Its an absolutely delicate balance but it must all be done in good faith. Hopefully, your organization will avoid this!

This is the best time to revisit your identify and train your people to encourage qualities that build strong, empathetic leadership; self-awareness and control, communication, kindness and psychological safety.  Resilience is the glue that binds functional silos and integrates partners, improves communications, helps you prepare, listen and understand. Most importantly, people-focused resilience helps individuals and teams to think collectively and with empathy – helping you respond and recover faster.

Article written by Thabo Majola, a brand communications expert with a wealth of experience in the field and is Managing Director of Incepta Communications.

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