This discussion presents a retrospective interpretation of the evolving gestalt of the China Medical Teams (CMTs) initiative by addressing the intersection between practising medicine and knowledge sharing.
It focuses on the medical exchanges between Botswana and China, experiences and the benefits thereof. This policy analysis aims at generating in-depth insights about how the Chinese Medical Teams are influencing Botswana’s Health sector and their general impartation on the population of Botswana.
In tandem with observations made by Lin Anshan (2011), when he deliberates on Chinese medical cooperation with Africa, this discussion argues that Botswana has benefited immensely from the CMTs. They have uplifted the livelihoods of many Batswana.
This discussion paper on ‘Chinese Medical Cooperation in Botswana’ is the first in a series of research reports that Weekend Post will publish jointly with the Chinese Embassy in Botswana. The Chinese medical exchange initiative fits well into Botswana’s redistributive health policy.
According to Shinn (2006), medical cooperation between China and Africa started as early as 1963 when China sent its first medical team to Algeria. With the increase in China’s power and the implementation of the “going-out” strategy, China’s policy towards Africa became the international community’s focus. In contrast, for China, South-South cooperation became more significant.
While medical collaboration, in general, is one of the most active forms of assistance, the dispatch of CMTs by the government of China to undertake voluntary work in the countries concerned is the oldest and most effective form of Chinese medical cooperation in Africa (Li 2009).
Dr Monkgogi Goepamang, Princess Marina Hospital Superintendent in Gaborone, agrees, “the Chinese medical exchange initiative helps to plug the human resource gap in our health facilities, especially Marina in Gaborone. Nyangabwe Referral Hospital in Francistown.”
Significantly, Healthcare in Botswana is improving. According to the Lancet’s study, Botswana rose to the fourth decile in Healthcare Access and Quality Index (HAQ) between 1990 and 2000. Botswana now ranks 122 out of 195 countries, with a HAQ index of 52, rising from 39.7 in 2000.
Botswana’s total spending on health per capita (International $, 2014) was $871, and total spending on health as a percentage of GDP was 5.4%. These facts about healthcare in Botswana show that the country should increase spending on healthcare and improve education about communicable diseases.
Accomplishing these goals should improve general health (Journal of Public Health in Africa, 2018). While acknowledging the assistance from China, Dr Goepamang posits that Botswana must train more health professionals and be in a position to retain them. “The Chinese teams help close the human resource gap in our facilities, but we still experience brain drain because we are unable to retain the few we have trained,” he observed.
Chinese medical team in Botswana has become an excellent example of the longstanding friendship and tangible cooperation between our two countries, Dr Goepamang said.
The policy triangle framework for policy analysis (Walt and Gilson, 1994) was used to guide this study; hence it incorporates actors (medical personnel, diplomats, political leaders), process and content (medical teams exchange initiative and how it operates).
According to literature, the Chinese government takes charge of the training, payment and related fees of the doctors sent abroad. At the same time, the partner country provides the teams with medical facilities, medications, medical instruments, accommodation and related facilities. It should be responsible for the security of the life and property of the Chinese medical personnel.
Admittedly, Dr Goepamang shared that Chinese teams offer an array of medical specialities in addition to traditional medicine. His observations match what has been shared by Li Anshan (2011) that most groups include specialists in scanning, orthopaedics, epidemiology, gynaecology, surgery, ophthalmology, water chemistry, bacteriology, and virology.
Meanwhile, Dr Lin Jian, part of the Chinese Medical Team based at Princess Marina, stated that they have brought high-level medical treatment technology and expertise and trained a large number of local medical staff through clinical teaching and academic lectures. He said the contributions are evident during participation in the hospital’s organised training where they contribute.
He said that before the trip to Botswana or any other country in Africa, they conducted ten months of English and professional skills in the foreign aid medical training base. Intensified training and training on medical treatment and protection against new diseases, in this instance, the COVID-19 pandemic.
Shinn (2006) ‘s assertion that china’s medical exchange initiative has helped transfer skills to native medical practitioners agrees strongly with the views of Dr Goepamang when he states, “the Chinese medical team helps to train our local medical staff because they bring much experience with them.”
For illustration, Dr Lin Jian cites examples of contributions made by their team members. A Hematologist who is part of the CMT teaches trainee doctors from the University of Botswana on various medical aspects such as using a microscope and bone marrow puncture, among other elements.
He notes that Botswana does not have a lot of registered Hematologists. Additionally, Dr Lin, another member, a Pediatrician, helps train intern doctors. According to Dr Lin, the Chinese Medical Team contributes immensely by passing on knowledge to Batswana medical staff and students. He hailed the China-Botswana strong bilateral relations to usher in solid ties, ensuring that the people’s health was prioritised.
“With our vast medical experience and the support we get from Botswana medical staff, many lives have been saved,” he said. On a typical day at Marina Referral Hospital, Dr Lin sees an average of between 10 to 20 patients in a hospital ward.
The Chinese Medical Team at Marina Referral Hospital comprises 21 medical officers, with 14 doctors and seven nurses. The team arrived in September last year at the height of the COVID-19 pandemic in Botswana and had to quarantine for two weeks before starting work.
Data from verified sources indicate that China has dispatched a total of 16 medical teams with 507 medical and nursing staff and carried out good medical cooperation with Botswana for the past four decades. The 16th batch of the medical team with 46 members came to Botswana against the odds in September last year (2021) at Botswana’s most challenging time and was stationed at Princess Marina Hospital in Gaborone and Nyangabgwe Referral Hospital in Francistown.
Information gleaned from various sources suggests that the medical team has provided 58,656 medical services over the past year, including 26,971 outpatient consultations, 2,926 surgeries, and 1,578 rescues of critically ill patients. Information shared by Ambassador Zhao in 2017 depicted that Chinese Medical teams had helped treat and cure more than 2 million people in Botswana; this is almost equivalent to the country’s population.
Dr Wu Zhaohui emphasises the numbers shared above; he said they see many clients per day at the Nyangabwe Referral Hospital in Francistown. According to Dr Wu, his team in Francistown comprises 21 members, with 19 being medical professionals, one driver and one cook.
Among the medical professionals are three nurses (oncology, paediatrician, intense care unit) and 16 medical doctors. He said they contribute by practising medicine and training local medical practitioners on the job and during clinical training.
Dr Wu said their experience with Botswana had exposed them to the health environment of the country, “and we are enjoying sharing our knowledge,” he added. The medical team must carry out medical work and exchange experiences through close cooperation and medical practice with the Botswana medical personnel, observed Dr Wu.
Meanwhile, past and present, Botswana’s Health and Wellness Ministers have hailed the partnership between China and Botswana in the sector of health, saying it bridged the human resource gap in the country’s health sector. On the other hand, former Chinese Ambassador to Botswana Zhao Yanbo noted in 2017, medicine and healthcare have been one of the top priority areas in China’s assistance to Botswana.
He said cooperation in medical care and public health had brought huge benefits to African countries, making it a big plus to strengthen ties between China and Africa. The envoy said China’s fruitful contribution to the country’s medical services had helped Botswana achieve the goal of poverty eradication, as diseases contribute to poverty.
The Health system in Botswana is delivered through a decentralised model, with primary health care being the pillar of the delivery system. Botswana has an extensive network of health facilities (hospitals, clinics, health posts, mobile stops) in the 27 health districts (Journal of Public Health, 2018).
In addition, there is an extensive network of health facilities where there are 101 clinics that can cater for inpatients, 171 clinics without beds, a further 338 health posts and 844 mobile clinics (JPH, 2018). According to the JPR (2018), Public Sector healthcare services are almost free for citizens whilst foreigners pay a subsidised fee.
Primary Health Care Services in the country have been integrated within the general hospital and healthcare services and are provided in hospitals’ respective outpatients’ departments. Through these structures, a complement of preventive, promotive and rehabilitative health services and treatment and care are provided.
By implication, Dr Goepamang highlights that whilst the value addition from the Chinese medical team is there for all to see, there is still a need to spread specialists across the country. He notes that the Chinese Medical Team is based only at two hospitals, being Princess Marina and Nyangabwe Referral Hospital.
There is a strong correlation between the views of the patients who have passed through the hands of the Chinese Medical Team and express results shared by the team. Thato, a patient who was assisted by one Chinese medic at Princess Marina, praised his professionalism.
“While the English is not perfect, what is important is that they can communicate with clients. His service was top-notch,” she said. Her views are shared by Kenny Manama in Francistown, who was assisted by a Chinese medic. “I am happy with the way they deal with patients. They are very professional.” Manama believes that the Government of Botswana should negotiate for more Chinese medics to come to Botswana so that they can assist in rural areas where there is a clear gap and need.
Overall, Li Anshan (2006) ‘s findings show a clear sign that China and Botswana have been enjoying amicable relations and excellent cooperation since diplomatic ties were established in 1975. After the Beijing Summit of the Forum on China-Africa Cooperation in November 2006, the bilateral relationship has ushered in a new chapter, with cooperative fruits continuously achieved in many areas (Pei, 2007).
According to Pei (2007), China has kept the tradition of sending medical teams to support Africa’s health services since the 1960s. As a major responsible country always honouring its commitment, China will continue to provide support and needed help to African friends within its capability through sending medical teams and other forms of assistance (Pei, 2007).
From a Foreign Policy perspective, the China Medical Exchange initiative borrows from “liberal internationalism,” a theory of international relations based on the belief that the current global system is capable of engendering a peaceful world order (Miao, 2009).
In his narration, Miao (2009) observes that liberalism emphasises international cooperation as a means of furthering each nation’s respective interests. In today’s globalised society, using economic tactics—such as bilateral trade agreements and international diplomacy—can be more effective in advancing political interests than threatening force.
In conclusion, Botswana has benefited immensely from the Chinese Medical Teams (CMTs), and they have uplifted the livelihoods of many Batswana. As observed by Ambassador, a healthy population becomes economically available. Observations from Dr Goepamang and a chronological examination of the literature point to Botswana’s need to improve its health training regime and further expand its relations with countries such as China to lobby for more medical experts to benefit rural areas.
China is celebrating its 100 years of Independence, and Botswana is commemorating 55 years of Independence – an introspection could inform the next step of the medical exchanges and further inform Botswana’s strategy of training and retaining medical professionals. Botswana should demonstrate that it is learning something from the Chinese Medical Team Exchanges.
Findings suggest that their being here depicts a severe gap in the human resource capacity of the country. Finally, this article is informed by extensive literature review, documents reviews, and interviews with medical professionals, diplomats, and members of the public.
Chen, Zhu, 2008, Speech at the national meeting regarding international cooperation in medical heath, 10 January, Beijing.
Hsu, Elisabeth, 2008, “Medicine as business: Chinese medicine in Tanzania”, in Chris Alden, Daniel Large and Richardo Soares de Oliveira (eds),China Returns to Africa: A Rising Power and a Continent Embrace, pp. 221-235. London: Hurst and Company.
Li, Anshan, 2006, “China-African relations in the discourse on China’s Rise”, World Economics and Politics, Issue 11, 7-14.
Li, Anshan, 2007, “China and Africa: Policy and challenges”, China Security, 3 (3), 69-93. Li，Anshan, 2008, “China’s new policy towards Africa”, in Robert Rotberg (ed), China into Africa: Trade, Aid, and Influence, pp.21-49. Washington DC: Brookings Institution Press.
Li, Anshan, 2009, “Chinese medical teams abroad: A history of cooperation”, Foreign Affairs Review, 26 (1), 25-45. Liu, Jirui (ed.), 1998, Chinese Medical Teams in Tanzania. Health Department of Shandong Province.
Lu, Chunming, 2006, “Cotecxin—Tie of Sino-African Friendship”, Voice of Friendship. Available at http://qkzz.net/magazine/1003-5303B/2006/06/1849404.htm (accessed 30 June 2008).
Lu, Shuqun and Wu Qiong, 2003, Into Benin. Yinchuan: Ninxia People’s Press.
Miao, A. 2009. Confucianist capitulation. Pp 174-75. Google Scholar.
Pei, Guangjiang, 2007, “The white angel: Chinese medical teams in Africa”, People’s Daily, 5 and 7 November.
Mowana Copper Mine in Dukwi will finally pay its former employees a total amount of P23, 789, 984.00 end of this month. For over three years Mowana Copper Mine has been under judicial management. Updating members, Botswana Mine Workers Union (BMWU) Executive Secretary Kitso Phiri this week said the High Court issued an order for the implementation of the compromise scheme of December 9, 2021 and this was to be done within 30 days after court order.
“Therefore payment of benefits under the scheme including those owed to Messina Copper Botswana employees should be effected sometime in January latest end of January 2022,” Kitso said. Kitso also explained that cash settlement will be 30 percent of the total Messina Copper Botswana estate and negotiated estate is $3,233,000 (about P35, 563,000).
Messina Copper was placed under liquidation and was thereafter acquired by Leboam Holdings to operate Mowana Mine. Leboam Holdings struck a deal with the Messina Copper’s liquidator who became a shareholder of Leboam Holdings. Leboam Holdings could not service its debts and its creditors placed it under provisional judicial management on December 18, 2018 and in judicial management on February 28, 2019.
A new company Max Power expressed interest to acquire the mining operations. It offered to take over the Mowana Mine from Leboam Holdings, however, the company had to pay the debts of Leboam including monies owed to Messina Copper, being employees benefits and other debts owed to other creditors.
The monies, were agreed to be paid through a scheme of compromise proposed by Max Power, being a negotiated payment schedule, which was subject to the financial ability of the new owners. “On December 9, 2021, Messina Copper liquidator, called a meeting of creditors, which the BMWU on behalf of its members (former Messina Copper employees) attended, to seek mandate from creditors to proceed with a proposed settlement for Messina Copper on the scheme of compromise. It is important to note that employee benefits are regarded as preferential credit, meaning once a scheme is approved they are paid first.”
A savingram the Ministry of Local Government and Rural Development sent to Town Clerks and Council Secretaries explaining why councilors across the country should not have access to their terminal benefits before end of their term has been revealed.
The contents of the savingram came out in the wake of a war of words between counselors and the Ministry of Local Government and Rural Development. The councilors through the Botswana Association of Local Authorities (BALA) accuse the Ministry of refusing to allow them to have access to their terminal benefits before end of their term.
This has since been denied by the Ministry. In the savingram to town councils and council secretaries across the country, Permanent Secretary in the Ministry of Local Government and Rural Development Molefi Keaja states that, “Kindly be advised that the terminal benefits budget is made during the final year of term of office for Honorable Councilors.” Keaja reminded town clerks and council secretaries that, “The nominal budget Councils make each and every financial year is to cater for events where a Councilor’s term of office ends before the statutory time due to death, resignation or any other reason.”
The savingram also goes into detail about why the government had in the past allowed councilors to have access to their terminal benefits before the end of their term. “Regarding the special dispensation made in the 2014-2019, it should be noted that the advance was granted because at that time there was an approved budget for terminal benefits during the financial year,” explained Keaja. He added that, “Town Clerks/Council Secretaries made discretions depending on the liquidity position of Councils which attracted a lot of audit queries.”
Keaja also revealed that councils across the country were struggling financially and therefore if they were to grant councilors access to their terminal benefits, this could leave their in a dire financial situation. Given the fact that Local Authorities currently have cash flow problems and budgetary constraints, it is not advisable to grant terminal benefits advance as it would only serve to compound the liquidity problems of councils.
It is understood that the Ministry was inundated with calls from some Councils as they sought clarification regarding access to their terminal benefits. The Ministry fears that should councils pay out the terminal benefits this would affect their coffers as the government spends a lot on councilors salaries.
Reports show that apart from elected councilors, the government spends at least P6, 577, 746, 00 on nominated councilors across the country as their monthly salaries. Former Assistant Minister of Local Government and Rural Development, Botlogile Tshireletso once told Parliament that in total there are 113 nominated councilors and their salaries per a year add up to P78, 933,16.00. She added that their projected gratuity is P9, 866,646.00.
A surge in consumer spending is expected to be a key driver of Botswana’s economic recovery, according to recent projections by Fitch Solutions. Fitch Solutions said it forecasts household spending in Botswana to grow by a real rate of 5.9% in 2022.
The bullish Fitch Solutions noted that “This is a considerable deceleration from 9.4% growth estimated in 2021, it comes mainly from the base effects of the contraction of 2.5% recorded in 2020,” adding that, “We project total household spending (in real terms) to reach BWP59.9bn (USD8.8bn) in 2022, increasing from BWP56.5bn (USD8.3bn) in 2021.” According to Fitch Solutions, this is higher than the pre-Covid-19 total household spending (in real terms) of P53.0 billion (USD7.8bn) in 2019 and it indicates a full recovery in consumer spending.
“We forecast real household spending to grow by 5.9% in 2022, decelerating from the estimated growth of 9.4% in 2021. We note that the Covid-19 pandemic and the related restrictions on economic activity resulted in real household spending contracting by 2.5% in 2020, creating a lower base for spending to grow from in 2021 and 2022,” Fitch Solutions says.
Total household spending (in real terms), the agency says, will increase in 2022 when compared to 2021. In 2021 and 2022, total household spending (in real terms) will be above the pre-Covid-19 levels in 2019, indicating a full recovery in consumer spending, says Fitch Solutions. It says as of December 6 2021 (latest data available), 38.4% of people in Botswana have received at least one vaccine dose, while this is relatively low it is higher than Africa average of 11.3%.
“The emergence of new Covid-19 variants such as Omicron, which was first detected in the country in November 2021, poses a downside risk to our outlook for consumer spending, particularly as a large proportion of the country’s population is unvaccinated and this could result in stricter measures being implemented once again,” says Fitch Solutions.
Growth will ease in 2022, Fitch Solution says. “Our forecast for an improvement in consumer spending in Botswana in 2022 is in line with our Country Risk team’s forecast that the economy will grow by a real rate of 5.3% over 2022, from an estimated 12.5% growth in 2021 as the low base effects from 2020 dissipate,” it says.
Fitch Solutions notes that “Our Country Risk team expects private consumption to be the main driver of Botswana’s economic growth in 2022, as disposable incomes and the labour market continue to recover from the impacts of the Covid-19 pandemic.” It says Botswana’s tourism sector has been negatively impacted by the Covid-19 pandemic and the related travel restrictions.
According to Fitch Solutions, “The emergence of the Omicron variant, which was first detected in November 2021, has resulted in travel bans being implemented on Southern African countries such as South Africa, Botswana, Lesotho, Namibia, Zimbabwe and Eswatini. This will further delay the recovery of Botswana’s tourism sector in 2021 and early 2022.” Fitch Solutions, therefore, forecasts Botswana’s tourist arrivals to grow by 81.2% in 2022, from an estimated contraction of 40.3% in 2021.
It notes that the 72.4% contraction in 2020 has created a low base for tourist arrivals to grow from. “The rollout of vaccines in South Africa and its key source markets will aid the recovery of the tourism sector over the coming months and this bodes well for the employment and incomes of people employed in the hospitality industry, particularly restaurants and hotels as well as recreation and culture businesses,” the report says.
Fitch Solutions further notes that with economies reopening, consumers are demanding products that they had little access to over the previous year. However, manufacturers are facing several problems. It says supply chain issues and bottlenecks are resulting in consumer goods shortages, feeding through into supply-side inflation. Fitch Solutions believes the global semiconductor shortage will continue into 2022, putting the pressure on the supply of several consumer goods.
It says the spread of the Delta variant is upending factory production in Asia, disrupting shipping and posing more shocks to the world economy. Similarly, manufacturers are facing shortages of key components and higher raw materials costs, the report says adding that while this is somewhat restricted to consumer goods, there is a high risk that this feeds through into more consumer services over the 2022 year.
“Our global view for a notable recovery in consumer spending relies on the ability of authorities to vaccinate a large enough proportion of their populations and thereby experience a notable drop in Covid-19 infections and a decline in hospitalisation rates,” says Fitch Solutions. Both these factors, it says, will lead to governments gradually lifting restrictions, which will boost consumer confidence and retail sales.
“As of December 6 2021, 38.4% of people in Botswana have received at least one vaccine dose. While this is low, it is higher than the Africa average of 11.3%. The vaccines being administered in Botswana include Pfizer-BioNTech, Sinovac and Johnson & Johnson. We believe that a successful vaccine rollout will aid the country’s consumer spending recovery,” says Fitch Solutions. Therefore, the agency says, “Our forecasts account for risks that are highly likely to play out in 2022, including the easing of government support. However, if other risks start to play out, this may lead to forecast revisions.”