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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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News

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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Opinions

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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Opinions

Internal party-democracy under pressure

21st June 2022

British novelist, W. Somerset Maugham once opined: If a nation values anything more than freedom, it will lose its freedom; and the irony of it is that if it is comfort or money that it values more, it will lose that too.

The truism in these words cannot be underestimated, especially when contextualizing against the political developments in Botswana. We have become a nation that does not value democracy, yet nothing represent freedom more than democracy. In fact, we desire, and value winning power or clinging to power more than anything else, even if it harms the democratic credentials of our political institutions. This is happening across political parties ruling and opposition.

As far as democracy is concerned, we are regressing. We are becoming worse-off than we were in the past. If not arrested, Botswana will lose its status as among few democratic nations in the Africa. Ironically, Botswana was the first country in Africa to embrace democracy, and has held elections every five years without fail since independence.

We were once viewed as the shining example of Africa. Those accolades are not worth it any more. Young democracies such as South Africa, with strong institutions, deserves to be exalted. Botswana has lost faith in democracy, and we will pay a price for it. It is a slippery slope to dictatorship, which will bring among other excess, assault on civil liberties and human rights violations.

Former President, Festus Mogae once stated that Botswanas democracy will only become authentic, when a different party, other than the Botswana Democratic Party (BDP) wins elections, and when the President of such party is not from Serowe.

Although many may not publicly care to admit, Mogaes assertion is true. BDP has over the years projected itself as a dyed-in-the-wool proponent of democracy, but the moment its stay in power became threatened and uncertain, it started behaving in a manner that is at variance with democratic values.This has been happening over the years now, and the situation is getting worse by the day.

Recently, the BDP party leadership has been preaching compromise and consensus candidates for 2024 general elections. Essentially, the leadership has lost faith in theBulela Ditswedispensation, which has been used to selected party candidates for council and parliament since 2003. The leadership is discouraging democracy because they believe primary elections threaten party unity. It is a strange assertion indeed.

Bulela Ditswewas an enrichment of internal party democracy in the sense that it replaced the previous method of selection of candidates known as Committee of 18, in which a branch committee made of 18 people endorsed the representatives. While it is true that political contest can divide, the ruling party should be investing in political education and strengthening in its primary elections processes. Democracy does not come cheap or easy, but it is valuable.

Any unity that we desire so much at the expense of democracy is not true unity. Like W. Somerset Maugham said, democracy would be lost in the process, and ultimately, even the unity that was desired would eventually be lost too. Any solution that sacrifice democracy would not bring any results in the long run, except misery.

We have seen that also in opposition ranks. The Umbrella for Democratic Change (UDC) recently indicated that its incumbent Members of Parliament (MPs) should not be challenged for their seats. While BDP is sacrificing democracy to stay in power, UDC is sacrificing democracy to win power. It is a scary reality given the fact that both parties ruling and opposition have embraced this position and believe democracy is the hindrance to their political ambitions.

These current reality points to one thing; our political parties have lost faith in democracy. They desire power more than, the purpose of power itself. It is also a crisis of leadership across the political divide, where we have seen dissenting views being met with persecution. We have seen perverting of political process endorsed by those in echelons of power to manipulate political outcomes in their favour.

Democracy should not be optional, it should be mandatory. Any leader proposing curtailing of democracy should be viewed with suspicion, and his adventures should be rejected before it is too late. Members of political parties, as subscribers of democracy, should collectively rise to the occasion to save their democracy from self-interest that is becoming prevalent among Botswana political parties.

The so-called compromise candidates, only benefits the leadership because it creates comforts for them. But for members, and for the nation, it is causing damage by reversing the gains that have been made over the years. We should reject leaders who only preach democracy in word, but are hesitant to practice it.

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