With no end in sight to the Covid-19 crisis, the overall message remains clear cut as it was two years ago before the start of the pandemic: the returns from smart investments in preparedness and response are likely to be large multiples of their costs.
There is no doubt that the Covid-19 pandemic has exposed overlooked weaknesses in Botswana’s infectious-disease-surveillance and response capabilities. Scores of countries, including some believed to have strong response capabilities, failed to detect or respond assertively to the early signs of the coronavirus. This resulted in most countries fighting the virus after transmission was already intensifying.
Had Botswana been consistent in adequately investing in healthcare systems, then the arrival of coronavirus should have heralded sweeter days for the country. However, years of under-spending are now creating headaches and the coronavirus pandemic has laid bare the state of the country’s public health sector.
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.
Speaking to this publication, a former public health official who spoke on condition of anonymity indicated that addressing the current health weaknesses will not be easy since government is still trying to steady the economy which was battered by Covid-19.
“Although the government’s eyes are focused on steadying the economic ship and returning to the new normal, they can start making smart investments now in order to improve the current Covid-19 response as well as cement public-health systems in preparation for future pandemics,” he says.
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.”
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 and saw new infections and Aids related deaths decreasing drastically.
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.
While Botswana did extremely well in the treatment of HIV/Aids, the country failed to extensively invest in research consortia for the HIV epidemic. Some health officials say if Botswana had invested enough in HIV research, the investments would be bearing fruit now. They gave an example that some of the approved drugs being tested against Covid-19 are in use for other diseases, such as malaria.
“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,” says a commentator, Ronald Dintle.
This valuation was validated by the Chief Executive Officer of the European and Developing Countries Clinical Trials Partnership (EDCTP), Dr Michael Makanga. He 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.
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.
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.
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.
