Civil society calls for efficiency in the health sector
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The Botswana Council of Non-Governmental Organizations (BOCONGO) in partnership with the South African Institute of International Affairs (SAIIA) says equitable access to social services and efficiency of delivery through a broad range of policies should be ensured in Botswana.
In a joint report released this week, the two entities say the Revised National Health Policy of 2010 ensures that all Batswana have equal access to health care at all times. Across Botswanas 27 health districts there are three national referral hospitals, 15 district hospitals, 17 primary hospitals, and 105 clinics with beds and 206 without beds, 351 health posts and 931 mobile stops. This extensive network of services means that most citizens live within a 5-10 km radius of a health facility.
However, a major constraint to Botswanas public health system is efficiency. In their report, BOCONGO and SAIIA indicated that challenges include poor quality of services, a shortage of human resources, problems associated with urbanization and inadequate planning. A study conducted in 2014 found that the ratio of doctors to people in Botswana was 4:10, 000, while the nurse to people ratio was 42:10, 000.
According to the World Health organization (WHO), countries with fewer than 10 doctors and 40 nurses for every 10, 000 people are considered to not have enough healthcare professionals. The ratios are even worse in rural districts, indicating that health care professionals are concentrated in urban areas.
Additionally, only 21% of the doctors registered with the Botswana Health Professionals Council were from Botswana, resulting in a reliance on migrant professionals. The report indicates that the effects of these shortcomings are most felt in the area of maternal health. Statistics Botswana estimates that out of every 100,000 live births, 156.6 women die due to excessive bleeding, obstructed labour, uterine rupture and hypertensive disorders.
Almost 98% of these deaths occur in health facilities, meaning they may have been prevented had the facilities been properly resourced with knowledgeable staff and emergency obstetric care procedures. A majority of pregnant women (73%) also attend the recommended four or more antenatal visits, further indicating that the problem lies at the point of delivery. If Botswana is to meet its 2030 SDGs, its maternal mortality ratio will need to be reduced to 70 per 100, 000.
Research conducted in 2014 revealed that the factors leading to the high number of maternal deaths include: failure to recognize the seriousness of a patients condition; lack of knowledge; failure to follow recommended practice; failure to implement policies; and poor organizational arrangements.
According to the family planning coordinator of the Health Ministry, further research is currently being conducted to identify gaps that lead to maternal deaths. Each maternity facility has also been fitted with an audit committee responsible for investigating maternal negligence and deaths.
Civil society says HIV/AIDS is another area that requires attention, further indicating that there has been a determined national response to this epidemic in Botswana. It says, in 2018, over 90% of those living with the virus knew their status. 83% of those living with HIV were on free antiretroviral treatment, and 81% of people living with HIV/AIDS were virally suppressed.
Various programmes and policies have contributed towards reaching these commendable figures. The New National Strategic Framework on HIV/AIDS III 2018-2023 has also been put in place and will guide governments response to improve health outcomes for the countrys population. The framework takes the view that the HIV/AIDS epidemic has evolved from being a generalized epidemic to a series of micro epidemic affecting different populations in different ways.
The framework therefore, the report highlights, proposes a review of strategies to address the increasingly varied burden of HIV/AIDS across different populations and settings. It further states that several challenges in addressing HIV/AIDS remain, chief among them the gender imbalance observed among those living with the disease. Geographical variations also presents a challenge. Understanding and managing co-infections should be a third priority.
Civil society says the capacity of health sector staff should be improved through effective training, monitoring and evaluation. It further stressed that there is need for greater commitment, better management and more accountability at the individual, health facility and district levels, as well as at the Ministry of Health and Wellness and the Ministry of Finance and Economic Development.
Accountability is also required from the Parliament committees responsible for health and coordination of the SDGs to improve the practice of emergency obstetric care. There should be ongoing training for hospital staff in new and modern technologies to reduce maternal deaths.
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DPP drops Kably threat to kill case
The Botswana Democratic Party (BDP) Chief Whip and Member of Parliament for Letlhakeng/Lephephe Liakat Kably has welcomed the Directorate of Public Prosecution (DPP)’s decision not to prosecute BDP councillor, Meshack Tshenyego who allegedly threatened to kill him. However, the legislator has warned that should anything happen to his life, the state and the courts will have to account.
In an interview with this publication, Kablay said he has heard that the DPP has declined to prosecute Tshenyego in a case in which he threatened to kill him adding that the reasons he received are that there was not enough evidence to prosecute. “I am fine and at peace with the decision not to prosecute over evidential deficits but I must warn that should anything happen to my life both the DPP and the Magistrate will have to account,” Kablay said.
Connectedly, Kably said he has made peace with Tshenyego, “we have made peace and he even called me where upon we agreed to work for the party and bury the hatchet”.
The DPP reportedly entered into a Nolle Prosequi in the matter, meaning that no action would be taken against the former Letlhakeng Sub-district council chairperson and currently councillor for Matshwabisi.
According to the charge sheet before the Court, councilor Tshenyego on July 8th, 2022 allegedly threatened MP Kably by indirectly uttering the following words to nominatedcouncilor Anderson Molebogi Mathibe, “Mosadi wa ga Liakat le ban aba gagwe ba tsile go lela, Mosadi wame le banake le bone ba tsile go lela. E tla re re mo meeting, ka re tsena meeting mmogo, ke tla mo tlolela a bo ke mmolaya.”
Loosely translated this means, Liakat’s wife and children are going to shed tears and my wife and kids will shed tears too. I will jump on him and kill him during a meeting.
Mathibe is said to have recorded the meeting and forwarded it to Kably who reported the matter to the police.
In a notice to the Magistrate Court to have the case against Tshenyego, acting director of Public Prosecutions, Wesson Manchwe cited the nolle prosequi by the director of public prosecution in terms of section 51 A (30) of the Constitution and section 10 of the criminal procedure and evidence act (CAP 08:02) laws of Botswana as reasons for dropping the charges.
A nolle prosequi is a formal notice of abandonment by a plaintiff or prosecutor of all or part of a suit or action.
“In pursuance of my powers under section 51 A (300 of the Constitution and section 10 of the criminal procedure and evidence act (CAP 08:02) laws of Botswana, I do hereby stop and discontinue criminal proceedings against the accused Meshack Tshenyego in the Kweneng Administrative District, CR.No.1077/07/2022 being the case of the State vs Tshenyego,” said Manchwe. The acting director had drafted the notice dropping the charges on 13th day of March 2023.
The case then resumed before the Molepolole Magistrate Solomon Setshedi on the 14th of March 2023. The Magistrate issued an order directing “that matters be withdrawn with prejudice to the State, accused is acquitted and discharged.”
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DPP seizes prosecution duties from Police
Directorate of Public Prosecution (DPP) has finally taken over prosecution from the Botswana Police Service (BPS). The police have been prosecuting for years, but the takeover means that they will now only focus on investigations and then hand over to the DPP for prosecution.
Talks of complete takeover began as far back as 2008, but for years it seemed implementation was sluggish. However, the Minister of Justice, Machana Shamukuni, revealed that the complete takeover is expected to be completed soon.
During a presentation to the Committee of Supply by Shamukuni this week, it was revealed that the project has been implemented in 22 police stations nationwide, including Maun, Selebi-Phikwe, Palapye, Francistown, and Kasane. He further stated that the project has been allocated P3,000,000 for the 2023/2024 financial year to facilitate the opening of more satellite offices for the DPP.
Shamukuni said the Lobatse station is scheduled for a complete takeover by the end of May 2023, while the Kasane DPP satellite office has been established and became operational as of February 1, 2023.
“As reported previously, preparations are at an advanced stage to open a satellite office in Tsabong to curtail expenses, as well as frequent long-distance trips to these areas, as it is currently serviced by the Lobatse DPP office,” Shamukuni said.
Shamukuni said that the takeover strategy is to enable a seamless and gradual takeover of prosecution from the BPS without overwhelming and overstretching the thin resources at its disposal.
According to Shamukuni, the implementation of the prosecution takeover project has increased the workload of the 211 prosecutors in the DPP establishment.
Furthermore, the Justice Minister said DPP statistics show that the DPP has a total of 11,903 cases and dockets as of January 2023. He indicated that this is a significant increase in the number of cases being handled by the DPP, considering that in November 2021, the DPP had just over 8,471 files.
“Out of the total case load, 8 382 are cases pending before various courts while 3521 are dockets received from law enforcement agencies of which 1 325 are awaiting service of summons while the rest are being assessed for suitability of prosecution or otherwise” said Shamukuni.
He further stated that The DPP has consistently maintained an 80% success rate in matters completed at court.
“As at the end of January 2023, the success rate stood at 82.3% against a target of 90% whilst the average performance in respect of turnaround time for conclusion of cases at court stood at 17.5 months against a target of 18 months,” he said.
BACKLOG OF CASES – LAND TRIBUNAL
Meanwhile, Minister Shamukuni has revealed that Gaborone land Tribunal is experiencing a backlog of cases. Before parliament this week, Shamukuni revealed that a total 230 appeals were completed for the period of April 2022- December 2022 and only 76.5% of them were completed within set time frame.
The minister said that the Gaborone division has experiencing a backlog of cases due to manpower constraints and he further indicated that presiding officers from other divisions have been brought in to expedite case disposal.
He further indicated that the land tribunal is a specialized court that has been empowered to resolve appeals arising from land boards. “It has been mandated to determine appeals from the decisions of Physical planning committees of Districts Councils” said Shamukuni.
Land Tribunal relocated to the Ministry of Justice from Ministry of Land and Water Affairs in November 2022.
“An amount of P37, 842,670 is requested to cover salaries, allowance and other operational expenses for the Department of the land Tribunal,” alluded Shamukuni
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BCP, AP stalemate in 7 constituencies
When the Botswana Congress Party (BCP), Alliance for Progressives, Botswana Labour Party (BLP), and conveners reconvene next week, the controversial issue of allocation of the seven constituencies will be the main topic of discussion, WeekendPost can reveal.
Not only that, but the additional four constituencies will also dominate the talks. The idea is to finally close the “constituency allocation phase,” which has proven to be the most difficult part of the ongoing negotiations.
Earlier this year, the two parties announced that the marathon talks would be concluded by February. Even at a media briefing last month, BCP Secretary General Goretetse Kekgonegile and Publicity Secretary Dr. Mpho Pheko were optimistic that the negotiations would be concluded before the end of February.
However, it is now mid-March and the talks have yet to be concluded. What could be the reasons for the delay? This is a question that both Kekgonegile and Pheko have not responded to, as they have ignored the reporters’ inquiries. However, a senior figure within the party has confided to this publication as to what is delaying the highly anticipated negotiations.
“We are reconvening next week to finalize constituency allocations, taking into account the additional four new ones plus the outstanding seven,” he explained. It later surfaced that Gaborone Central, Gaborone North, Mogoditshane, Tswapong North, Francistown West, Tati West, and Nata Gweta are all contested by both BCP and AP. This is because the other 50 constituencies were allocated by December of last year.
The three parties have failed to find common ground for the Bosele Ward by-elections. Are these constituencies not a deal breaker for the talks? “None of the constituencies is a deal breaker,” responded a very calm BCP official.
In Bosele Ward, AP has yielded to BCP, despite most of its members disapproving the decision. On the other hand, BLP has refused, and it will face off with BCP together with Botswana Democratic Party (BDP) and Umbrella for Democratic Change (UDC).
The decision by BLP to face off with BCP has been labelled as a false start for the talks by political observers.