Although Botswana has to some extent reacted by pragmatic measures, there still seems to be inaction with regards to fully enforcing decisions such as promoting healthy diets, improving primary health care for screening and early detection of chronic diseases, controlling alcohol abusers and encouraging physical activity.
While morbidity and mortality of NCDs in Botswana is not well documented, the World Bank collection of development indicators, compiled from officially recognised sources states that the cause of death by non-communicable diseases in Botswana was reported at 45.7 % in 2016. Furthermore, the rising burden of NCDs in Botswana poses a threat to the achievements of the Sustainable Development Goals (SDGs).
“Although there is a strong impetus to the economic reform agenda and aid the country’s efforts to graduate from upper middle to high-income status, NCDs have the power to devour the benefits of economic gains if left unchecked,” says Public Health Researcher, Judith Tshegofatso.
She also says NCDs continue to increase in Botswana and they are now altering demographics, stunting development and impacting on economic growth. “Despite the fact that they are preventable, NCDs pose a major challenge for Botswana’s socioeconomic development,” she says.
The 2030 Agenda for Sustainable Development adopted at the United Nations Summit on Sustainable Development in September 2015, recognises NCDs as a major challenge for sustainable development.
The Botswana Multi-Sectoral Strategy for the Prevention and Control of Non-Communicable Diseases 2018-2023 says “a population based Non-Communicable Diseases and their risk factors survey (STEPS) conducted in Botswana in 2014 revealed adult prevalence of 29% for hypertension, 5% for diabetes, 30% for obesity, 18% for tobacco use, and 95% for unhealthy diet.” While prominent causes for heart disease, diabetes and cancer can be prevented, public health experts and researchers say Botswana needs preventive actions and efficient strategies to address risk factors such as tobacco, alcohol, obesity, blood pressure diet and physical inactivity.
Tshegofatso says tobacco and alcohol jeopardises Botswana’s progress on a range of sustainable development goals, including a crippling economic loss.
“COVID-19 has plunged the world economy into a recession with the potential of profound socio-economic consequences. Whilst Botswana faces an economic threat, policy makers can help salvage this economic crisis by preventing unnecessary health catastrophe caused by tobacco, alcohol, obesity and physical inactivity,” she says.
She also says unless the country moves to immediately address the burden of NCDs, there is likelihood that NCDs and conditions such as cancer, diabetes, cardio vascular diseases and diabetes will move closer to being one of the greatest threats to human lives in Botswana, just like HIV and AIDS.
A 2017 study conducted across Botswana shows that 5 percent of Batswana meet the basic qualifications for a ‘healthy lifestyle’. According to the study, a person qualifies for a healthy lifestyle only when they do not smoke or excessively drink, engage in exercise for at least 2 hours 30 minutes a week, and have a body fat percentage under 20 percent for males and 30 percent for females.
“If the present trend is maintained, the health systems in Botswana will be unable to support the burden of the disease and will be incapable of providing people with standard health care,” says Tshegofatso.
At the moment, 95 percent of health budgets in Botswana have been directed towards HIV/AIDS and the National AIDS Coordinating Agency (NACA) estimates that the cost for Botswana’s HIV response (prevention and treatment of the disease) will rise from approximately P2, 74 billion in 2014 to P3, 39 billion in 2030.
Since NCDs increase burden of the healthcare system, Tshegofatso says the government must at least have health facilities to ensure effective diagnosis and treatment of NCDs rather than continue on this trajectory where patients are always referred to South Africa.
“If there is no change in the current trends, well before 2050, NCDs will be responsible for over 50 percent of deaths in the country,” says Tshegofatso.
Currently the world has nine NCD targets to be achieved by the year 2025, some of which include decreasing tobacco use by a third, reducing physical inactivity by ten percent as well as reduction of alcohol use and salt intake.
Studies which have been conducted in Botswana have shown an increasing trend of NCDs mainly from people involved in risky behaviours such as physical inactivity, smoking, excessive alcohol consumption and unhealthy diets. The studies also show that NCDs weigh heavily on incomes of families and this has huge developmental costs.
Botswana is slowly going through a transition from infectious to non-communicable diseases which is mainly caused by changes in smoking and drinking habits, physical activity as well as diet.
