Primary health care in Botswana appears to be a major concern for the Ministry of Health due to various factors but poverty and drought seem to stand out the most.
Speaking before the Public Accounts Committee (PAC) on Thursday, the Permanent Secretary in the Ministry of Health and Wellness, Kabelo Ebineng said the country’s primary health care indicators are not where they are supposed to be.
“My ministry continues with its commitment to achieving the Global Strategy for women, children and adolescent health linked to Sustainable Development Goals (SDG’s) which aims at reduction of maternal mortality to 70/100 000 live births by 2030,” he noted.
As of 2018 the maternal mortality ratio was at 133.7 per 100 000 live births. It reduced from 156.6 per 100,000 live births in 2016 to 143 per 100 000 live births in 2017.
“The percentage of maternal mortality due to post-partum haemorrhage and septic abortions were 34% and 21% in 2017 and 2018. The other major cause is hypertensive disorders. The current figure of 133.7 deaths per 100, 000 population indicates that maternal mortality remains very high, viewed against the set global maternal mortality ratio target of less than 70 per 100, 000 live births by 2030.” He said.
He also noted that the infant mortality increased from 17 per 1000 live births to 38 per 1000 live births in the same period.
Both figures are more than the Sustainable Development Goals targets of 25 per 1000 live births for under 5 mortality and 12 per 1000 live births for infant mortality.
The PS noted that while the Ministry had come up with high impact interventions such as immunisation, Integrated Management of Childhood Illnesses (IMCI) and Early Child Development to reduce death of children born in the first month, the 2017 Botswana Demographic Survey showed that under 5 mortality increased from 28 per 1000 live births in 2011 census to 56 per 1000 live births in 2018.
He also indicated that the main challenges are inadequate capacity (skill and infrastructure) in health facilities to deal with neonates andHigh rates of malnutrition in areas such as Ghanzi, Kgalagadi, Bobirwa and Selibe Phikwe.
The Bobonong Member of Parliament, Taolo Lucas, asked if the prevalence in Selibe-Phikwe and Bobonong had anything to do with the closure of the Selibe-Phikwe mine.
The PS highlighted that that’s what the statistics show but it also boils down to poverty because when the economy goes down such are bound to happen.
He also noted that from January 2020 until May there has been 35 maternal mortalities, 17 occurred in Princess Marina and Nyangabgwe referral hospitals.
“The statistics indicate that these are people from the lower end and they don’t have access better health care facilities. Poor people demographically are the ones affected by malnutrition and infant mortality and mostly these are people in rural areas.” He said.
The PS indicated that intensive maternal healthcare strategies have been put in place with the support of relevant stakeholders to strive for the attainment of the global targets.
“The Ministry of Health in collaboration with the WHO, the European Union and the United Nations Population Fund (UNPFA) are implementing maternal mortality audits, Emergency Obstetric and New-Born Care (EmONC) as part of the interventions,” he noted.
He said the ministry has challenges it needs to strategically address. But some of them, he said, are beyond the Ministry’s capability such as shortage of healthcare professionals and attrition and that some are due to lack of due diligence in the utilisation of standard protocols in patient management by healthcare workers.
“The ministry continues to strengthen strategies that can reduce under 5 mortalities and these include continuation of key interventions like IMCI, New-born Care, zinc sulphate, vitamin A supplementation; aggressive training and upgrading of Health care facilities to address neonatal care;re-introduction of direct feeding in areas with high malnutrition and underweight; blanket coverage of supplementary feeding; and public education on breastfeeding and complementary feeding. The National measles Strategic Plan 2013-2020 called for strategic activities towards elimination of measles rubella.” He noted.
The PS told the PAC that to this end, a follow up measles rubella campaign targeting children aged nine (9) to fifty-nine (59) months will be conducted in financial year 2020/21 with a budget of 8,7 million Pula secured for that purpose.