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. 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. Although Botswana is anticipated to see a reduction in death rates caused by NCDs, the African Development Bank (AfDB) says Botswana will see the incidence of NCDs increase and dominate the overall disease burden between 2020 and 2030. Furthermore, the human toll of NCDs in Botswana is already quite heavy. Statistics show that NCDs account for 46% of all deaths in Botswana and this is likely to increase unless Botswana tunes up her health services and infrastructure to adapt accordingly.
A non-communicable disease, or NCD, is a medical condition or disease which by definition is non-infectious and cannot be passed from person to person. They include cardiovascular diseases, cancers, diabetes and lung diseases. While over 80% of these diseases can be prevented or delayed into old age, Botswana has not been zealous to fight NCDs as much as it did HIV/AIDS. Undoubtedly, there is a strong and urgent imperative for investment in NCDs in Botswana.
NCDs have also taken a toll on lives and livelihoods and have had an unimaginable impact on human capital and productivity in Botswana. On 16 July, 2021, the investment case, under the Task Force’s WHO-UNDP flagship programme, noted that “NCDs not only contribute to health care costs, but are a significant socio-economic drain to individuals, families and communities.”
The preliminary findings presented at the event noted that government expenditure on health care for NCDs of US$226 million (2.5 billion BWP) is just the tip of the iceberg. “The indirect (hidden) costs from, premature mortality and lost productivity (absenteeism, presenteeism) are almost five times higher. In Botswana, the cost of presenteeism alone, US$ 226 million (BWP 2.6 billion) is 4% more than the total health expenditures on NCDs. Altogether, the economic cost of NCDs to the Botswana economy is US$ 1.2 billion (BWP 13.2 billion) per year, which is equivalent to 5.92% of the country’s annual gross domestic product,” reads part of the findings.
Reports also show that 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. While prominent causes for heart disease, diabetes and cancer can be prevented, 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. According to health institutions, 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. Public health officials also say Batswana should be mindful of the fact that it is difficult to offset sugary beverage consumption with physical activity. For example, in order to offset consumption of a 330ml can of soft drink a person requires almost 18 minutes of running. The time increases if the person consumes more soft drinks per day.
Some countries have made progress on NCDs in recent decades by scaling up evidence-based therapies, such as drugs for secondary prevention of cardiovascular disease, and targeting risk factors, such as smoking and raised blood pressure. As Botswana transitions from infectious to non-communicable diseases, there is hope that legislative and regulatory actions such as Sugar Tax introduced by the then minister of Finance and Economic Development, Dr Thapelo Matsheka will curtail the rising trend in NCDs.
In a report titled “Saving lives, spending less: a strategic response to NCDs,” prepared by the World Health Organisation (WHO), for every $1 invested in scaling up actions to address non-communicable diseases (NCDs) in middle income countries such as Botswana, there will be a return to society of at least $7 in increased employment, productivity and longer life. The WHO guidelines also state in clear cut terms that added sugars should constitute no more than 10% of an individual’s total calorie intake and preferably less than 5%.
