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.
Botswana has made improvements on preventing and ending arbitrary deprivation of liberty, but significant challenges remain in further developing and implementing a legal framework, the UN Working Group on Arbitrary Detention said at the end of a visit recently.
Head of the delegation, Elina Steinerte, appreciated the transparency of Botswana for opening her doors to them. Having had full and unimpeded access and visited 19 places of deprivation of liberty and confidentiality interviewing over 100 persons deprived of their liberty.
She mentioned “We commend Botswana for its openness in inviting the Working Group to conduct this visit which is the first visit of the Working Group to the Southern African region in over a decade. This is a further extension of the commitment to uphold international human rights obligations undertaken by Botswana through its ratification of international human rights treaties.”
Another good act Botswana has been praised for is the remission of sentences. Steinerte echoed that the Prisons Act grants remission of one third of the sentence to anyone who has been imprisoned for more than one month unless the person has been sentenced to life imprisonment or detained at the President’s Pleasure or if the remission would result in the discharge of any prisoner before serving a term of imprisonment of one month.
On the other side; The Group received testimonies about the police using excessive force, including beatings, electrocution, and suffocation of suspects to extract confessions. Of which when the suspects raised the matter with the magistrates, medical examinations would be ordered but often not carried out and the consideration of cases would proceed.
“The Group recall that any such treatment may amount to torture and ill-treatment absolutely prohibited in international law and also lead to arbitrary detention. Judicial authorities must ensure that the Government has met its obligation of demonstrating that confessions were given without coercion, including through any direct or indirect physical or undue psychological pressure. Judges should consider inadmissible any statement obtained through torture or ill-treatment and should order prompt and effective investigations into such allegations,” said Steinerte.
One of the group’s main concern was the DIS held suspects for over 48 hours for interviews. Established under the Intelligence and Security Service Act, the Directorate of Intelligence and Security (DIS) has powers to arrest with or without a warrant.
The group said the “DIS usually requests individuals to come in for an interview and has no powers to detain anyone beyond 48 hours; any overnight detention would take place in regular police stations.”
The Group was able to visit the DIS facilities in Sebele and received numerous testimonies from persons who have been taken there for interviewing, making it evident that individuals can be detained in the facility even if the detention does not last more than few hours.
Moreover, while arrest without a warrant is permissible only when there is a reasonable suspicion of a crime being committed, the evidence received indicates that arrests without a warrant are a rule rather than an exception, in contravention to article 9 of the Covenant.
Even short periods of detention constitute deprivation of liberty when a person is not free to leave at will and in all those instances when safeguards against arbitrary detention are violated, also such short periods may amount to arbitrary deprivation of liberty.
The group also learned of instances when persons were taken to DIS for interviewing without being given the possibility to notify their next of kin and that while individuals are allowed to consult their lawyers prior to being interviewed, lawyers are not allowed to be present during the interviews.
The UN Working Group on Arbitrary Detention mentioned they will continue engaging in the constructive dialogue with the Government of Botswana over the following months while they determine their final conclusions in relation to the country visit.
Standard Chartered Bank Botswana (SCBB) has informed the government that it will not be accepting new loan applications for the Government Employees Motor Vehicle and Residential Property Advance Scheme (GEMVAS and LAMVAS) facility.
This emerges in a correspondence between Acting Permanent Secretary in the Ministry of Finance Boniface Mphetlhe and some government departments. In a letter he wrote recently to government departments informing them of the decision, Mphetlhe indicated that the Ministry received a request from the Bank to consider reviewing GEMVAS and LAMVAS agreement.
He said: “In summary SCBB requested the following; Government should consider reviewing GEMVAS and LAMVAS interest rate from prime plus 0.5% to prime plus 2%.” The Bank indicated that the review should be both for existing GEMVAS and LAMVAS clients and potential customers going forward.
Mphetlhe said the Bank informed the Ministry that the current GEMVAS and LAMVAS interest rate structure results into them making losses, “as the cost of loa disbursements is higher that their end collections.”
He said it also requested that the loan tenure for the residential property loans to be increased from 20 to 25 years and the loan tenure for new motor vehicles loans to be increased from 60 months to 72 months.
Mphetlhe indicated that the Bank’s request has been duly forwarded to the Directorate of Public Service Management for consideration, since GEMVAS and LAMVAS is a Condition of Service Scheme. He saidthe Bank did also inform the Ministry that if the matter is not resolved by the 6th June, 2022, they would cease receipt of new GEMVAS and LAMVAS loan applications.
“A follow up virtual meeting was held to discuss their resolution and SCB did confirm that they will not be accepting any new loans from GEMVAS and LAMVAS. The decision includes top-up advances,” said Mphetlhe. He advised civil servants to consider applying for loans from other banks.
In a letter addressed to the Ministry, SCBB Chief Executive Officer Mpho Masupe informed theministry that, “Reference is made to your letter dated 18th March 2022 wherein the Ministry had indicated that feedback to our proposal on the above subject is being sought.”
In thesame letter dated 10 May 2022, Masupe stated that the Bank was requesting for an update on the Ministry’s engagements with the relevant stakeholder (Directorate of Public Service Management) and provide an indicative timeline for conclusion.
He said the “SCBB informs the Ministry of its intention to cease issuance of new loans to applicants from 6th June 2022 in absence of any feedback on the matter and closure of the discussions between the two parties.” Previously, Masupe had also had requested the Ministry to consider a review of clause 3 of the agreement which speaks to the interest rate charged on the facilities.
Masupe indicated in the letter dated 21 December 2021 that although all the Banks in the market had signed a similar agreement, subject to amendments that each may have requested. “We would like to suggest that our review be considered individually as opposed to being an industry position as we are cognisant of the requirements of section 25 of the Competition Act of 2018 which discourages fixing of pricing set for consumers,” he said.
He added that,“In this way,clients would still have the opportunity to shop around for more favourable pricing and the other Banks, may if they wish to, similarly, individually approach your office for a review of their pricing to the extent that they deem suitable for their respective organisations.”
Masupe also stated that: “On the issue of our request for the revision of the Interest Rate, we kindly request for an increase from the current rate of prime plus 0.5% to prime plus 2%, with no other increases during the loan period.” The Bank CEO said the rationale for the request to review pricing is due to the current construct of the GEMVAS scheme which is currently structured in a way that is resulting in the Bank making a loss.
“The greater part of the GEMVAS portfolio is the mortgage boo which constitutes 40% of the Bank’s total mortgage portfolio,” said Masupe. He saidthe losses that the Bank is incurring are as a result of the legacy pricing of prime plus 0% as the 1995 agreement which a slight increase in the August 2018 agreement to prime plus 0.5%.
“With this pricing, the GEMVAS portfolio has not been profitable to the Bank, causing distress and impeding its ability to continue to support government employees to buy houses and cars. The portfolio is currently priced at 5.25%,” he said. Masupe said the performance of both the GEMVAS home loan and auto loan portfolios in terms of profitability have become unsustainable for the Bank.
Healso said, when the agreement was signed in August 2018, the prime lending rate was 6.75% which made the pricing in effect at the time sufficient from a profitable perspective. “It has since dropped by a total 1.5%. The funds that are loaned to customers are sourced at a high rate, which now leaves the Bank with marginal profits on the portfolio before factoring in other operational expenses associated with administration of the scheme and after sales care of the portfolio,” said the CEO.