‘Let-them-die’ policy meant to solve MoH budget problems

08 Oct 2017

Increasingly nowadays, patients at government health facilities are having to buy their own medication because it is not available at such facilities.

The Block 6 clinic for sugar diabetes, which is collocated with the Princess Marina Referral Hospital, has not had a cholesterol drug called Lipogen for some five months now. In communicating information about the shortage, the dispensary staff ask patients to buy the drug for themselves. For some that is not a problem but for others it is. Asthma is a critical medical condition and it is important that health facilities should never run of medication used to treat it.

However, in Maun, one clinic has run out of a drug called hydrocortisone sodium succinate which is administered in the form of an injection. Three weeks ago, a Maun woman was rushed to that clinic in the village after suffering an asthmatic attack. After more than an hour, the nurse informed the family that both the clinic didn’t have hydrocortisone.

The nurse suggested though that the family could buy the drug from private pharmacies in the village, explaining that such method of procurement was quite common. One family member was indeed dispatched to a nearby pharmacy to get the medication and only then was administered – some 90 minutes later.

A government doctor says that it is scandalous that a hospital would run out of vital life-saving drug such as hydrocortisone especially at this time of the year.

“Asthma attacks – indeed many more ailments, tend to be more frequent in spring when trees blossom. It would be very dangerous for health facilities to not stock up well enough for this season,” he says.

Maun is a very peculiar situation because the nearest place with reliable drug supply (Francistown) is almost 700 kilometres away. Letsholathebe Memorial Hospital in Maun serves as a referral hospital for the rest of North West, a region with a population of 176 000. Population size is an important factor in drug supply and Letsholathebe will be under serious strain.

The shortage in the Ministry of Health and Wellness also extends to personnel and equipment and according to good sources, explains the government’s plan to introduce a policy that discriminates against people who drink alcohol. In terms of this policy, which was packaged as a savingram by the ministry’s Permanent Secretary, Shenaz El-Halabi, “self-inflicted injuries” are removed from the government’s medical cover. Such injuries relate to drunk-driving, riding motorbikes without helmet, failure to use seat belts for self or children as passengers, participation in riots and mass gatherings involving violence leading to injury, lung cancer associated with tobacco and tobacco products, and attempted suicide related to alcohol or drug abuse. Outside officialdom, the policy has been shorthanded to “Let them die.” The inclusion of children on this list means that if a parent-motorist neglects to strap in a four-year child and the latter sustains injuries in a road accident, the government would not provide medical cover for that child.

According to sources both inside and outside government, “Let-them-die” is a direct response to the budgetary problems that the Ministry of Health and Wellness is facing. During a briefing session at the Office of the President, senior officials are said to have told President Ian Khama about acute financial problems that make it extremely difficult for the ministry to deliver services. In response, he directed that alcohol drinkers be excluded from government’s quite generous medical cover. As a matter of fact, in his 2016 state-of-the-nation address, Khama said the same things that would later come out in El-Halabi’s savingram. He said that “self-inflicted harm injuries will be paid for by patients who have been irresponsible with their lives.” Earlier this year, El-Halabi appeared before the Public Accounts Committee and one of her most uncomfortable moments would have been when an opposition MP, Dithapelo Keorapetse, got her to reveal the source of the policy. El-Halabi revealed that the directive she issued was initiated through another from “cabinet.”

“Let-them-die” as a budgetary control measure would raise questions that would be very uncomfortable for Khama. The first is that for more than a decade now, Members of Parliament as well as of the public, have complained about lavish spending on the Botswana Defence Force (BDF) at the expense of more deserving spending areas. At a time that this controversial policy was being put in place, the government was planning to buy fighter jets at a cost of P5 billion. Along the way, BCL copper mine in Selebi Phikwe closed down, virtually turning the latter into a ghost town. Still, government would not agree to calls and pleas that the fighter jets be struck off the shopping list. Earlier this year, Khama travelled to Sweden in service of plans to buy Gripen jets. Challenged by a Swedish journalist on whether the money that Botswana plans to spend to buy fighter jets from her country couldn’t be better spent used on more pressing social developmental needs as local “critics” have argued, Khama said that ultimately parliament has the final say on the matter.

“Those critics are in parliament and that is the opportunity that they have in a democracy to be able to raise their concerns and try to reverse any of our procurement plans,” Khama said at a press conference he addressed with the Swedish prime minister, Stefan Löfven.

What Khama didn’t say – which the Swedish journalists didn’t know – is that the government bench is controlled by cabinet which, in turn, is controlled by Khama himself. At a personal level, Khama has been associated with a company owned by his own brothers, Seleka Springs, which has been buying equipment for the army for decades. In this respect, the company benefits from the “Let-them-die” policy because money that would otherwise be used to cover medical costs of drinkers instead goes towards a multi-billion-pula transaction in which Seleka Springs – or any of its subsidiaries – acts as the procuring entity.

An MP who knows a lot about national security has also questioned the purchase of the jets. Speaking in parliament last year, the Gabane-Mankgodi MP, Major General Pius Mokgware, blew off the idea that BDF needs fighter jets which typically come at great cost. Mokgware, who is an opposition MP, proposed that instead of buying jets, the government should buy attack helicopters which can do a better job and, more importantly, are much cheaper.

As recently as a year ago, none other than the Minister of Health and Wellness, Dorcas Makgatho, used the promise of healthcare to woo voters. Addressing a Botswana Democratic Party political rally in Sekoma ahead of a hotly-contested bye-election, Makgato told residents that if they want a hospital in their area, then they should vote for her party. The money that could conceivably have built that hospital will now purchase fighter jets.

Even allowing for a situation where the purchase of the fighter jets is legitimate, there is still a huge question mark over the quality of decision-making in the executive branch of government. Khama seems determined to spend billions of pula to prepare for a speculative emergency in a future of an indeterminate timeframe than deal with an ongoing public health crisis on the ground that could be costing some citizens their lives.