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Civil society calls for efficiency in the health sector

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 Botswana’s 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 Botswana’s 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 patient’s 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 government’s response to improve health outcomes for the country’s 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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