Emerging infectious diseases are a growing threat to human health throughout the world, including in Botswana. The government of Botswana has over the years received mixed performance reviews on health, especially from citizens who experienced problems in obtaining care or went without needed medical care. Afrobarometer, a pan-African, nonpartisan survey research network that provides reliable data on African experiences and evaluations of democracy, governance, and quality of life conducted a survey in April 2020 which showed that Batswana citizens regard health as the second most important national problem they want the government to address.
Although Botswana is one of ten African countries which provide free and universal healthcare, there was growing evidence before the threat of coronavirus that the country was regressing from achieving health equity and eliminating health disparities.
Statistics show that global research and development (R&D) for diseases that unduly affect African countries appear to be insufficient, with governments struggling to prioritise investment in R&D. The African region comprises 15% of the world’s population, yet only accounted for 1.1% of global investments in R&D in 2016. Furthermore, there are substantial disparities within the continent, with Egypt, Nigeria and South Africa contributing 64% of the total R&D spending.
Botswana has not been clear cut and consistent with regards to channelling money towards health since the government’s health expenditure always fluctuates from one year to the other. The 2020 Gender Protocol Barometre urged Botswana to prioritise investment in health systems in national budgets in order to achieve the Abuja Declaration commitments. On 27 April 2001, African Union countries met and pledged to set a target of allocating at least 15% of their annual budget to improve the health sector. This vow became known as the Abuja Declaration. The Abuja Declaration was meant to strengthen Africa’s health systems and ensure their preparedness for disease outbreaks. The question on the lips of most Batswana is whether this has translated into any tangible results.
Over the years, Botswana has shown strong commitment in responding to its HIV epidemic and has become a standard within sub-Saharan Africa. It was the first country in the region to provide universal free antiretroviral treatment (ART) to people living with HIV. The impact of its treatment programme has been extensive. New infections have decreased significantly, from 18,000 in 2005, to 10,000 in 2010, and down to 8,500 in 2018. AIDS-related deaths have also dramatically decreased from a peak of 18,000 recorded in 2002 to 4,800 in 2018.
However, research in the field of HIV and AIDS published between 2014 and 2019 shows that Botswana is not building up a knowledge base in response to this disease. The importance of doing research in Botswana instead of relying on other researchers and institutions is because it helps understand the local social, economic and cultural factors where solutions cannot only be imitated from one country to the next.
A medical practitioner who spoke to this publication indicated that Botswana failed to extensively invest in research consortia for the HIV epidemic but instead spend a lot of money on treatment. “This trajectory has to be reversed. If we had invested enough in research, the investments would be bearing fruit now because some of the approved drugs being tested against Covid-19 are in use for other diseases, such as malaria,” says the public health official who spoke on condition of anonymity.
Investing in research should not be viewed as channelling money away from treatment and prevention, but simply as a way of levelling the playing field because research is just as important as prevention and treatment. Health financing is not just about spending more money on health but making sure that the money goes to the right programs.
Among other things, the official said Covid-19 should offer fresh impetus for Botswana to reassess the health delivery systems. “Part of the fight against infectious and emerging diseases entails funding research,” says the official, adding that “Botswana should take a leaf out of South Africa’s book. South Africa invested heavily in research and this helped them monitor, evaluate and respond to a wide range of public health issues. Good clinical research can position Botswana at the centre of research efforts into infectious diseases and reducing disease burden.”
This assessment seems to be corroborated by Dr Michael Makanga, the Chief Executive Officer of the European and Developing Countries Clinical Trials Partnership (EDCTP).
Dr Makanga says says the European Union backed global health partnership which supports the development of new or improved drugs against HIV, tuberculosis, malaria and other neglected diseases, has to some degree prepared the African continent to face Covid-19.
“When you have a programme that has been systematically developing research capacity across Africa, it can easily be translated into the fight against Covid-19. Research and clinical trials can build on platforms that have been developed for other diseases, such as HIV, tuberculosis and malaria,” says Makanga.
At the moment, the EDCTP has issued grants to medical researchers in 37 countries in sub-Saharan Africa. Now, the coronavirus highlights the value of the scheme, which has invested over €590 million since 2014.
While most Southern African Development Community (SADC) member states spend less than 10% of their GDP on health save for a few, the World Health Organisation (WHO) says prioritising health on the African continent has no direct relationship to a country’s wealth. The organisation also says numerous countries with high per capita income – such as Botswana, Seychelles, Mauritius, among others – do not systematically spend more of their budgets on health. On the other hand, lower income countries the likes of Gambia and Ethiopia spend more.
The challenge of healthcare financing in Botswana is that it seems to be the biggest challenge in achieving the United Nations Sustainable Development Goal (SDG) No. 3 of “good health and well-being for all.”
Experts use two measures to assess health financing: the level of health spending as a proportion of the total government spending and health spending as a proportion of a country’s Gross Domestic Product (GDP). The GDP represents the total value of everything produced in the country. It does not matter if citizens or foreigners produce it – if they operate within a country’s boundaries, research includes this production in GDP.
