Bullets or Hospital beds?

A healthcare system on ICU

  • Shortage of resources, medication and manpower still a challenge
  • P15 billion proposed for BDF
  • No war or threats
  • Similar pending trends


In the past few years the Botswana government devoted astronomical sums of money purchasing machines of war that take away lives in detriment of the paltry sums spent on improving people’s health. The leading cause of death in Botswana is health related issues, HIV/AIDS, Cancer, Malaria and road accidents as opposed to civil unrest and armed conflict.
Research data from Stockholm International Peace Research Institute -SIPRI on military expenditure and Trading Economics on health expenditure indicates that Botswana spends on the army similar to what it spends on health, with a growing trend while health budget shows a decrease. The defence ministry was allocated P4.95 billion in the 2016 financial year while health got P5.75 billion. Both of these figures were a close increase of defence’s 464 million and 451 million for health.
In 2015 government spent P5.04 billion to health’s P5.67 billion,  in 2012 defence accounted for 3.45 billion; health P4.2 billion, in 2011 defence P3.71 billion to P3.5 billion- the trend is such that the figures do not differ much and the defence budget has always been in the top five in Kenneth Matambo’s budgets.
In 2003 when Botswana topped many countries in HIV/AIDS related cases SIPRi had ranked it among the top five biggest defence spenders in Africa. SIPRI ranked Botswana at number 86 out of the 154 countries in a 2014 study on the value of military equipment purchases, with most of this directed at aircraft, vehicles and other equipment, as compared to maintenance.
The distorted priorities have meant that the health sector remains starved of opportunities to increase or double its budget in efforts to meet the health demands. A year ago Princess Marina hospital reported shortage of beds, expert doctors and medicine.  A few months ago, this publication carried a story of a confidential report done by the ministry which revealed that over 300 babies died in PMH and Nyangabgwe hospital (NRH) in 2014.
Some of the challenges stated in the report included unmonitored medical equipment. This month The Botswana Gazette ran a series of reports on the exaggerated budgetary requests by the Minister of defence, Shaw Kgathi to purchase fighter jets, tanks and spy gadgets at P15 billion and that Botswana faces no eminent security threat by its neighbours to prioritize the purchase of arms of wars as opposed to medicine that saves lives.
The Problems at Health
While the bulk of the government budget goes to Ministry of Health (MoH) after Education, closely followed by defense, Botswana’s health care system seems to be failing in many aspects.
Poor management, which has resulted in lack of resources due to mismanagement of funds and resources, has crippled the health care system possibly causing preventable deaths and diseases for adults and infants alike.
Recently, reports of dire shortage of medication as well as resources and manpower in hospitals and clinics emerged, an issue that the ministry admits is a challenge. While this is not a new challenge, the situation seems to be degenerating.  In 2014 member of Public Accounts Committee (PAC), Samson Guma Moyo urged the ministry to admit that the country’s health system was in crisis mode due to long standing unsolved issues that had piled up over the years.
He said the crisis in Botswana’s healthcare system was all too apparent because critical issues had not be solved after many years. “Issues like shortage of drugs including for critical illnesses like high blood pressure is a call for help. Some patients are dying as a result of this shortage,” he said. Though he acknowledged that they had challenges, the then Acting Permanent Secretary, Tebogo Banamile denied that there was a crisis.
A few months ago, following an investigation, The Botswana Gazette learnt from industry sources that most equipment and instruments used in Botswana hospitals and clinics were not calibrated or tested as often as they should; something leaving most Batswana at risk of being wrongly diagnosed, with some said to have died unnecessarily and other others in peril following misdiagnosis. The ministry later refuted these claims.
While it slightly declined from 189 per 100,000 population in 2009, Maternal Mortality Ration remains high at 152 per 100,000 as recorded in 2014, failing the Millennium Development Goal (MDG) target of 81 per 100,000. This remains one of the ministry’s biggest stumbling blocks.
According to the audit report, the Audit Committee assessed the two hospitals, where gross inadequacy in both manpower and equipment was revealed as one of the impediments to health in the baby units. One other challenge revealed was that there was no Paediatric ICU in NRH. It was also noted that sharing children with adults in the ICU impaired quality of health care.
Incompetency and mismanagement of funds is also rife at the ministry. Last year (2015) the Permanent Secretary of MoH; Shenaaz El-Halabi told the  Public Accounts Committee (PAC) that they had not recovered over P1.5 million  in traveling  imprest from ministry employees  and  that the money owed accounts for  60 per cent of  entire  government budget.
“Are we dealing with a crisis of imprest retirement in the Ministry of Health, because if the money owed is 60 per cent of government budget, then there is  a problem,” PAC member Dithapelo Keorapetse asked  MoH Accounting Officer and Permanent Secretary  Shanaz El Halabi .  “Why are you not collecting imprest?  The   impression one gets from you  is of negligence or carelessness in your ministry,” he added.
In response to PAC member Dithapelo Keorapetse who accused the ministry of gross negligence and carelessness, El Halabi said they were also concerned by the issue and that they have come up with remedial interventions to address it. She explained that while they have challenges of capacity, in the interim they are sensitizing employees on issues around retiring the  imprest and the importance of doing so.
The ministry was also interrogated on a contract for construction of units at Gaborone clinics which did not reflect the amount, yet signed.  The amount of the contract, the PAC found out, was instead reflected on the document of Public Procurement and Asset Disposal Board (PPADB) award recommendations.  It was revealed that while the three-year contract was valued at P1 572 million, in payment, the ministry had multiplied the amount by three, parting with   around P4.7 million to the construction company.
Last month, Francistown South MP, Wynter Mmolotsi, told this publication that shortage of doctors at Nyangabgwe Referral hospital was so bad that patients went days without being attended. He said he discovered in a recent visit to the hospital that doctors and nurses were not able to help all patients who needed help.
Asked if he was aware of the situation in parliament, MoH Assistant Minister, Phillip Makgalemele, said he was not aware of the issue. He however concurred that there was a shortage of doctors and specialists throughout their facilities. He said due to shortage of specialists, the average waiting period for specialists is about seven months.
Botswana’s low wages have also been pointed out as the problem in the health care system as the country is unable to attract specialists to work in Botswana. The country is also unable to retain its medical professionals due to limited incentives in allowances. Failing to rectify the current situation means Botswana will continue losing doctors to greener pastures as they remain the most sought after professionals in the world.
In May this year, doctors threatened to work normal hours as per the Public Service Act because they felt their grievances were not being listened to. They said they were not allowed to take off days despite sometimes working 36 hour shifts because of shortage of staff, yet the employer refuses to compensate them for their time.
During NDP 11 presentation in parliament last month, Minister of MoH, Dorcas Makgato mentioned as their success the accreditation of five health facilities (Mahalapye and Scottish Livingstone Hospitals, Phuthadikobo, Xhosa and Airstrip clinics) by the Council of Health Services Accreditation for Southern Africa (COHSASA) the only such accrediting body in Africa. This is despite her ministry dismissing COHSASA accreditation as “unnecessary earlier this year” when The Botswana Gazette questioned why so many of local hospitals had not been accredited.