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China Medical Exchange Initiative: Botswana’s window to a healthy population

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.

Reference

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.

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Opposition talks: Conveners ditched, experts engaged

13th October 2021

The much-anticipated opposition unity talks that will see Umbrella for Democratic Change (UDC) engage Botswana Patriotic Front (BPF), and Alliance for Progressives (AP) are expected to kick off any time from now.

According to informants, the talks, which were preceded by-elections negotiations, aim to be as inclusive as possible. As the talks start, the UDC, composed of Botswana National Front (BNF), Botswana Congress Party (BCP) and Botswana People’s Party (BPP), insist on retaining its preferred model of Umbrella; on the other hand, the BPF is proposing a PACT; and AP is in favour of an alliance model.

BPF is reportedly sceptical on the umbrella model and wants cooperation with the flexibility to allow other parties to join hands with UDC but without necessarily contesting elections using UDC symbols and colours.

BPF, which is currently the fastest-growing party, seems to be focused on self-actualization, self-preservation and securing institutional capacity in case of any political calamity. Although often profitable, cooperation politics can often leave individual political parties battered by political events and weakened beyond meaningful survival.

Discussions with some BPF members suggest that the party has big ambitions and harbour serious intentions of taking the BDP by its horns-all by itself-one day. “The position by some of our leaders is that the future of the UDC remains uncertain. The position and advice are that we should not put all our eggs in one basket. And the party elders think the pact model of cooperation is the safest under prevailing circumstances. Some, however, are worried that we should not overestimate our worth despite being the fastest-growing party in the country.

However, the matter is yet to be concluded once we receive the official invite,” revealed a BPF member of the NEC. Asked about the specifics of the pact idea, another high ranking party official revealed that the party Patron, Lt Gen Ian Khama and his brother Tshekedi Khama are among those who are for the election pact model.

BPF Spokesperson Lawrence Ookeditse has earlier this year told this publication that: “We have not settled on a model yet.” He also added that as a party, they are ready and willing to work with UDC, “but we will have our thoughts on how the cooperation or the talks should transpire, and they too will tell us their preference, and we will sit on the table to see how best to work together”.

AP heads into these negotiations with proposals of its own. On the model part, AP has expressed flexibility but want its partners to consider other models. AP believes that beyond the umbrella model, the coalition could also have a matrix to ensure that opposition parties select the best candidates for parliamentary and council seats.

AP, a splinter party of the beleaguered Botswana Movement for Democracy (BMD), asks for the constituencies allocated to BMD in the previous talks before it was kicked out on the eve of the 2019 elections.

AP, which garnered a popular vote of under 40 000 in the 2019 general elections, is confident that it brings tremendous value to the UDC, and state power could be within reach in 2024.
To reconcile the various interest of political parties, the leaders have agreed to engage political experts in a bid to arrive at the best decisions.

“There will be no conveners because parties in the past believed that they (conveners) took decisions on behalf of the constituent parties, though they are not representing any. So, the idea is to rope in political experts to direct UDC and the negotiating parties as to which path of cooperation model to follow,” a highly placed informant said this week.

UDC convener Lebang Mpotokwane has also defended the umbrella model in the past, noting that it creates fewer problems for the participants. The negotiations will be the fourth opposition cooperation talks since the 2009 elections. The opposition has held talks in 2011, 2012 and 2017. The 2012 talks resulted in Umbrella for Democratic Change (UDC), which has been anchoring negotiations since then.

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‘Dingake’ name spoils Botswana’s interest in ILO top post

13th October 2021

When the Chairperson of the International Labour Organization (ILO) Governing Body invited member states to submit candidates for the vacant Director-General post for consideration, Botswana developed a keen interest.

It swiftly mobilized to beat the deadline, but the unions, upon consultation, nominated Justice Key Dingake as their preferred candidate, much to the government’s disappointment, who then decided to dump the whole issue altogether.

In accordance with the Rules governing the appointment of the Director-General and the decisions made by the Governing Body at its 341st and 342nd Sessions, the Chairperson of the Governing Body calls for candidates for appointment to the office of Director-General of the ILO through communication to all Governing Body members and all ILO Member States and candidatures must be submitted by a Member State of the ILO or by a regular or deputy member of the Governing Body.

The deadline for submission was on Friday, 1 October 2021, and candidatures were to be sent by postal or electronic mail to the following address to the Chairperson of the Governing Body.
This publication had established that when Cabinet sat to discuss the issue, it was resolved that the unions as key stakeholders should be consulted and requested to submit a name for consideration. They did and offered Justice Oagile Key Dingake-a distinguished scholar and labour law expert whose contribution to the country’s labour fraternity is unparalleled.

When asked this week to share their side of the story, the unions said they were first invited to partake in the process by the government but never got a response after they nominated judge Dingake as an ideal candidate.

“We sent our correspondence to the Minister of Employment, Labour and productivity, Mpho Balopi, with our suggested name being Justice Oagile Key Dingake, but since then we never got a response,” said unionist, Tobokani Rari who further expressed disappointment at how the government has handled the matter.

Rari said that while he would not want to impute any improper motives to anyone, the developments rekindled memories of the government’s hostility towards Judge Dingake, who has been forced by circumstances to take his skills and wealth of experience to the benefit of other countries. Balopi did not respond to questions sent to him and did not pick this publication’s calls at the time of going to press.

Cabinet insiders say Dingake’s name spoilt the party and dampened the spirits. “In the list of nominated names, he was the leading candidate, but I guess the powers that be could not imagine themselves campaigning for him and doing all they did for the Executive Secretary of SADC Secretariat, Elias Magosi.”

Dingake’s sin, observers say, has always been his progressive, independent mind and family’s political background, all of which have always stood in his way to progress to the country’s judicial ladder’s ends.

It is understood that also in the mix and preferred by the state was former Attorney General, judge, and now Ambassador and Permanent Representative of Botswana to the United Nations and other international organizations, Dr Athaliah Molokomme, who also has a background in human rights advocacy.

But insiders say many believed that the country should export Dingake to represent the country given his decorated experience and background. As a lawyer, Dingake represented 90% of Trade Unions in Botswana, drafted numerous Collective Labour Agreements, later presided overall trade disputes, including Collective Labour Agreements, and made determinations as Judge of the Industrial Court of Botswana.

Dingake has also written and lectured widely on trade, labour and human rights and holds numerous citations and awards for his work regarding peace, human rights, and social development. Had he contested and won, he would have been the first African to lead the ILO.

The ILO is built on the constitutional principle that universal and lasting peace can be established only if based on social justice. The ILO has been the source of such hallmarks of industrial society as the 8-hour day, maternity protection, child labour laws and a whole range of policies promoting workplace safety and peaceful industrial relations. Unique among UN organizations, the ILO has a tripartite structure involving governments, employers and workers.

ILO Director-General elections events lineup…

At its 341st (March 2021) and 342nd (June 2021) Sessions, the ILO Governing Body approved the following timetable for the appointment of the Director-General because the current term of office of the Director-General will come to an end on 30 September 2022:

1 July 2021: The Chairperson of the Governing Body calls for candidatures
1 October 2021: Last date for the reception of candidatures
A week in January 2022: The Chairperson of the Governing Body conducts interviews with candidates for the position of Director-General based on the format and principles contained in document GB.342/INS/6 and the guidance provided by the Governing Body at its 342nd Session
14-15 March 2022 (344th Session of the Governing Body): The Governing Body conducts candidate(s) hearings
25 March 2022 (344th Session of the Governing Body): The Governing Body conducts the ballot for the election of the Director-General
1 October 2022: The term of office of the Director-General commences.

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Botswana, EU clash over human rights issues 

13th October 2021
human-rights

Botswana and the European Union (EU) appear to have been at each other’s throats behind the scenes since last year, with the EU saying it held several meetings with Botswana to convince her to address human rights issues. 

This is contained in a 2020 Human Rights Report that reveals broad divisions in contentious issues boiling behind the scenes between Gaborone and the Union. According to the report, which was released recently, the EU says it “continues to follow closely three main human rights issues in Botswana: the application of the death penalty; the rights of LGBTI persons; and gender equality.”

“Botswana remains part of a small group of countries – in Africa and globally – which continue to retain the death penalty both in law and in practice. Three executions were recorded in 2020,” the report says. According to the report, the Botswana Government indicated that a public debate on the application of the death penalty should be part of its ongoing work towards developing a Comprehensive Human Rights Strategy and the related National Action Plan.

The report says further progress on the rights of LGBTI persons’ seen in 2019, when Botswana’s High Court decriminalised same-sex consensual relations, is still pending, subject to a final court decision over a government appeal.

“Finally, gender-based violence and the need to advance gender equality and women’s rights in society remain another challenge for the country. In response to the high incidence of gender-based violence – which has intensified in many countries during the current COVID-19 pandemic – the President and the First Lady launched a public campaign to fight gender-based violence and to promote equality,” the report says.

The report says the EU did not fold its arms and watch from the sidelines the human rights issues in question are concerned but confronted Botswana to have the contentious issue addressed. “The EU continued to engage with the Botswana Government, multilateral organisations, non-governmental organisations and the broader society in Botswana in three main areas: the death penalty, gender-based violence and empowerment of women, and rights of LGBTI persons, as well as on the support of media and implementation of Universal Periodic Review recommendations,” the report says.

The report says that in addition to ad hoc consultations and human rights-oriented outreach efforts, the EU engaged with the Botswana Government on human rights formally in the context of the Article 8 Political Dialogue, which took place in February 2020.

“The dialogue offered an opportunity to exchange views on EU’s and Botswana’s experiences concerning the three EU priority areas in Botswana (capital punishment, gender-based violence and rights of LGBTI persons) as well as other human rights challenges, while also exploring opportunities for EU-Botswana cooperation on human rights issues in the context of the EU-Africa partnership and at the multilateral level,” the report says.

In parallel to engagement with the government, the EU said it continued to maintain dialogue with representatives of civil society focusing on human rights and with UN organisations and other partners of the country.

“The EU continues to be the driving force behind the Gender Dialogue (in principle co-chaired with UN Women and the Gender Affairs Department in the Ministry of Immigration, Nationality and Gender), which brings together various stakeholders to discuss gender issues to chart a way forward regarding partnerships. The EU has also used public diplomacy efforts to stimulate broader dialogue in the country on human rights issues,” the report says.

The EU said it continued to provide financial support to projects funded through the European Instrument for Democracy and Human Rights, with activities focused primarily on helping Botswana tackle gender-based violence, strengthen the notion of gender equality in the country, and promote participation in political processes.

“With six projects already underway, the EU signed two new programmes, in the wake of the COVID-19 pandemic, to support victims of gender-based and domestic violence and defend the rights of marginalised people, with a combined budget of EUR 430,000,” the report says. It says one of the projects is designed to offer care services to victims of gender-based violence and provide clinical services, counselling, shelter, and a referral system for legal and social assistance. Another project provides legal, medical and psychosocial support to refugees, undocumented migrants and indigenous people.

It says Botswana remains an important like-minded partner for the EU on the human rights agenda at a multilateral level. “The country’s positive role on human rights in the multilateral context would be further strengthened by initiating a domestic process of reflection about the signature and ratification of several pending core human rights conventions and/or optional protocols (e.g. the Convention for the Protection of all Persons from Enforced Disappearances, the International Covenant on Economic, Social and Cultural Rights, the Convention on the Rights of Persons with Disabilities, the Optional Protocol of the Convention against Torture, etc.)” the report says.

But the report acknowledged that Botswana is a stable and well-established democracy with a legal framework and institutions designed to guarantee respect for human rights in society. It says human rights complaints are addressed by the courts, with the government accepting decisions and implementing relevant rulings.

“Although the media scene in the country is relatively undeveloped, the World Press Freedom Index has noted a further positive trend concerning the role of the media in society (as was also the case in 2019) and has improved Botswana’s ranking from 44th to 39th place (out of 180 countries),” the report says.  Meanwhile, this week, President Dr Mokgweetsi Masisi met with the EU delegation led by the managing director for Africa of the European External Action Services, Ms Rita Laranjinha.

 

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