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When former President Lt Gen Ian Khama counts his achievements, he begins with poverty eradication.
A World Health Organisation (WHO) analysis report has however damned immediate past president for neglecting the poor and projects President Mokgweetsi Masisi as the savior of Botswana’s poor.
The analysis report released during this week's African Union meeting in Addis Ababa, Ethiopia, revealed that despite its riches, Botswana under former Khama lagged behind poorer African countries in the fight against diseases of poverty known as neglected tropical diseases (NTDs).
The London Declaration on Neglected Tropical Diseases is a collaborative disease eradication programme launched on 30 January 2012 in London. It was inspired by the World Health Organization 2020 roadmap to eradicate or prevent transmission for neglected tropical diseases.
A review of 49 African countries’ progress in fighting neglected tropical diseases (NTDs) shows that some of the continent’s poorest countries, such as eSwatini (formerly known as Swaziland), Malawi and Mali outperformed some richer countries such as Botswana under former President Khama and South Africa under former President Jacob Zuma.
The analysis, by the organisation United to Combat NTDs, looked at the five most common NTDs in Africa: blinding trachoma, the leading cause of infectious blindness; intestinal worms that can stunt the growth of children; mosquito-borne elephantiasis; snail-borne bilharzia and river blindness.
The tiny country of eSwatini comes top of the chart with 92 per cent of the population at risk on treatment. Malawi is second with 91 per cent of the population on treatment and Mali is third with 90 per cent.
Richer middle-income countries such as South Africa, Equatorial Guinea, Gabon and Botswana were all ranked in the bottom third of the league table. In both South Africa - where nearly 20 million people are at risk of contracting at least one NTD - and Botswana just two per cent of the population in need are receiving treatment or preventive measures, according to the analysis. The report states that the “variation illustrates the widely differing priorities of governments, and highlights their uneven levels of commitment — notably to poorer rural remote areas with inadequate sanitation and clean water, where the ailments are most common. Without a greater focus on the disadvantaged, many people are suffering unnecessarily and the economic potential of their countries is being undermined.”
The African Union, The World Health Organisation (WHO) and a number of international media houses are however optimistic that Botswana’s situation will improve under President Masisi. A press statement issued by the African Union on Friday states: “However, Botswana looks set to change this with its late 2018 pledge to use its own domestic resources to eliminate all neglected tropical diseases found within its borders, starting in 2019.” The sentiment was echoed by international media outlets among them the Financial Times, The British Telegraph, The Nigerian Voice, The Hippocratic Post, and Business Ghana.
This was after President Masisi, hardly a month after taking over from former President Khama told A Commonwealth Heads of Government Meeting (CHOGM) in London on April 17th that he will use Botswana’s resources to eliminate all neglected tropical diseases in the country. Masisi repeated the pledge a day later in South London at an event hosted by Global Citizens on the night of April 17. Masisi promised to encourage fellow Commonwealth leaders at the Commonwealth Heads of Government Meeting to help eliminate Neglected Tropical Diseases (NTDs) and achieve clear vision for everyone everywhere.
The ink had hardly dried on news reports about Masisi’s pledge when he rolled back his sleeves to start the fight against NTDs. The World Health Organisation (WHO) is optimistic that President Masisi would have eliminated NDTs in Botswana in 2023, before the end of his first term in office.
WHO has also lauded President Masisi’s administration for his commitment to fighting NTDs. “The Government of Botswana has demonstrated commitment to accelerate malaria and other vector borne disease (VBD) elimination”, stated a press release from the international body. WHO last month helped the Ministry of Health and Wellness (MoHW) to develop a draft Integrated Vector Management (IVM) strategic plan 2019-2023. The strategic document is intended to facilitate better planning and implementation of vector control aiming at malaria and other VBDs elimination in the country.
Since IVM is a new concept to Botswana and is heavily reliant on inter-sectoral collaboration, The Ministry of Health and Wellness (MoHW) convened a wide range of stakeholder consultation to finalise and create buy-in for implementation of this key strategic document. This meeting was held on 23rd - 24th January 2019 in Gaborone, Botswana. WHO also facilitated this meeting that brought together different ministries, parastatals, non-governmental organisations and private sector entities that have a direct or indirect impact in disease vector proliferation and control in Botswana. Participants included veterinarians, medical doctors, agriculture, veterinary and medical entomologists, wildlife biologists, environmentalists, engineers, academia and researchers, advocacy and communication expects, among others.
The meeting endorsed the IVM strategy and the embedded inter-sectoral coordination mechanism for sound implementation. The meeting also identified overlaps between Malaria and Neglected Tropical Diseases (NTD) Programmes in MoHW and thus proposed integration for efficiency and effective implementation.
Botswana has been targeted for malaria elimination by the year 2020. The country has also been targeted for elimination of NTDs by the year 2023. NTDs found and suspected in Botswana, except for leprosy, are vector-borne. Schistosomiasis and trachoma are priority NTDs targeted for elimination. Surveys conducted by the NTD Unit in MoHW from 2015 have detected Schistosomiasis cases in 6 of the 27 districts in the country and six percent of blindness cases in Botswana are due to trachoma. There is lack of reliable data on lymphatic filariasis, plaque and leishmaniasis. Vectors to these NTDs thrive under local environmental conditions. There is risk of arboviral diseases, like yellow fever, due to the presence of vector mosquitoes and vicinity to endemic countries.
Earlier reports had indicated that under President Khama Batswana were living longer than they did a decade earlier. This is a major achievement following a major drop in life expectancy in the 1990s and early 2000 as multitudes succumbed to the HIV/AIDS pandemic. The bad news however is that although Batswana live longer, their health is poor in those extra years.
According to the latest WHO data published in 2018 life expectancy in Botswana is: Male 63.6, female 68.4 and total life expectancy is 66.1 which give Botswana a World Life Expectancy ranking of 138.
The South African Medical Research Council came up with an index to measure Healthy life expectancy. This refers to the average number of years that a person at a given age can expect to live in good health, taking into account mortality and loss of functional health and Botswana recorded one of the worst healthy life expectancy figures in the world.
Director of The South African Medical Research Council Charles Shey Wiysonge, used information from the Global Burden of Disease study to calculate healthy life expectancy and it revealed that although Botswana has a life expectancy of 66.1 more than 10 of the years are lived in poor health. The proportion of years of life spent in poor health in Sub Sahara Africa varied between countries, ranging from 11.9% in Djibouti to 14.8% in Botswana.
‘This point to the fact that much more effort is needed to increase healthy life expectancy in the region’ states the report by the health council.
“We found that the increase in healthy life expectancy in sub-Saharan Africa was smaller than the increase in overall life expectancy. This indicates that many years are lived in poor health in the region. In 2017, life expectancy at birth in sub-Saharan Africa was 63.9 years, but healthy life expectancy was only 55.2 years. This means that 13.6% of years of life in the region are spent in poor health.
Life expectancy in 2017 varied by sub region, ranging from 62.4 years in Central Africa to 65 years in Southern Africa. However, in Central Africa 14.4% and in Southern Africa 13.8% of these years are estimated to be spent in poor health, respectively”, states the report. With 14, 8% of Batswana’s lives spent in poor health, the figure are higher than the average of Central Africa with stands at 14, 4% and much higher than the Southern African average which is 13.8%.
While women live longer than men, many of these extra years are lived in poor health. The life expectancy at birth for women in sub-Saharan Africa in 2017 was 66.2 years, but healthy life expectancy was only 56.8 years. Thus, women spend 14.2% of their years in poor health. For men, life expectancy was 61.7 years and healthy life expectancy was 53.7 years. Thus, men in sub-Saharan African spend 13% of their lives in poor health. The figures however are still much lower than those of Botswana.
The average healthy life expectancy at birth in sub-Saharan Africa increased by 9.1 years, from 46.1 years in 1990 to 55.2 years in 2017. The increase in health life expectancy at birth varied from 0.9 years in Southern Africa to 12.4 years in Eastern Africa.