Thursday, April 9, 2020

How Mogae handled the coronavirus of his time

At the time that Festus Mogae became president on April 1, 1998, Botswana had the world’s highest HIV/AIDS prevalence rate in the world. AIDS deaths were very high and as documentary evidence from banks can prove, the mortuary business was among the most lucrative.

Over decades, the government had spent hundreds of millions of pula educating its citizens and down the road, it became very clear that this investment was going to waste. Eight years earlier, a medical aid administrator called Associated Fund Administrators (AFA) had been established. In time, it would administer the Botswana Public Officers’ Medical Aid Scheme (BPOMAS) and Pula Medical Aid Fund.

It was through AFA that Mogae would be able to reverse the HIV/AIDS scourge. The result was that Botswana’s anti-HIV/AIDS model would serve as an example not just to the continent but the entire world. While it used a different set of words, the New York Times basically stated that Botswana’s model was undoubtedly the best in the world and way before “knowledge-based economy” was on anybody’s lips, Professor Sheila Tlou proposed that Botswana should sell its HIV/AIDS expertise to the rest of the world. It was little wonder then that AFA’s Managing Director, Kabelo Ebineng, would deputise for the Minister of Health in the Health Sector Forum of the High Level Consultative Council. The latter discusses national policy issues between the private and public sectors under the chairmanship of the state president.

As recounted by Ebineng to Sunday Standard in a 2008 interview, the overflow of HIV/AIDS patients from the public sector health system at this time necessitated partnership with the private sector. AFA itself had come into being at a time that the government was in the process of establishing a medical aid scheme.

Said Ebineng: “There was agreement that the scheme should not be run within government but that it should be run by an outside entity which would operate it along business lines.”

A tender was put out and AFA made a good enough impression to get the job. All that happened at a time when there was no systematic focus on a scourge that was wreaking havoc on a small nation. What passed for intervention then was limited to providing information provided by the government and the World Health Organisation. Around this time some sections of the treating population, notably private doctors, were disinclined to see HIV patients because the counselling and clinical attention took too long and was not cost-effective.

“We took the view that if the figures and information from the government and WHO were correct, in 20 to 25 years we would be looking at a situation where the country’s population would be decimated if nothing were done,” Ebineng recalled in 2008 of the early-1990’s thinking. “We then recommended to BPOMAS that HIV/AIDS must be provided for in the benefit structure. There were heated debates with some people looking at the issue from a moral point of view and suggesting that only those who were irresponsible were at risk. There were also others who felt that only the young would be affected.”

AFA’s case was that if in the past Batswana had got by on meagre resources, then the country’s improved economy could be immensely helpful in turning around the HIV/AIDS situation. By using mathematical and economic modeling, the company demonstrated that if Botswana could use revenues from its natural resources to fight HIV/AIDS it would succeed in creating a population that would take the country farther.

“Fortunately, our advice was taken by our clients,” said Ebineng, who is now the Permanent Secretary in the Ministry of Transport and Communications.

The breakthrough came in March 1993 at a crucial PULA special general meeting in a Gaborone Sun conference room. Ebineng remembers of this meeting: “This is where Debswana Diamond Company played a major part because at the time the company was just over 50 percent of Pula membership. They could make or break this thing.” 

Fortunately, representatives of Debswana employees made that thing by endorsing the reforms that were being proposed. That cleared the way for a scheme that now offers comprehensive HIV coverage. The reforms were later adopted by BPOMAS.

More than two decades later, Botswana has to deal with another public health emergency. At this point in time, novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) appears to be deadlier than HIV/AIDS. It is new, has no cure yet and could mutate and become more deadly like the flu was in western societies back in 1918. Wuhan, a large city of 11 million people in central China and its first four reported cases have all been linked to the Huanan (Southern China) Seafood Wholesale Market.

Whether the government should be using a cost-benefit analysis that it used with HIV/AIDS is an extremely complex issue but coronavirus is a challenge Botswana has never faced before.   At a press conference that she addressed last week, the Minister of International and Foreign Affairs, Unity Dow, said that Botswana can’t afford to evacuate Batswana students living in China because the cost is just too prohibitive. That Air Botswana planes are too small to be used for the evacuation means that Botswana would have to charter a bigger jet – whose costs would be astronomical. There would be need to mobilise and deploy health professionals. That said, she added that students who can afford to pay their passage to Botswana are free to so.

Naturally, China would want the world to believe that it is containing the spread of the disease but there is evidence to the contrary. Within China itself, the disease is spreading, the World Health Organization has declared the viral outbreak an international public health emergency and on Thursday, the United States elevated its travel advisory to the highest level. With particular regard to Batswana students, the government and the potential victims are not saying the same thing. While the government has been keen to stress that no Motswana student has, as yet, been affected by the virus, some students themselves are saying that the longer they stay in China, the greater the risk of contracting the virus. It is times like these that one wishes that Chinese media was more independent because the Botswana government is relying on official Chinese information – which the domestic media can’t contradict.

The business decision that Mogae with HIV/AIDS made had a bountiful and unintentional moral yield. The business decision that President Mokgweetsi Masisi’s government has evidently made would have none such if the coronavirus outbreak gets out of hand with Batswana students stuck in China.

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