Dear Dr. Dikoloti (Hereinafter referred to as Dr. D). I hope this letter finds you in good spirits. This week I have decided to write outside my comfort zone of economics and I find myself landing in your area of expertise, the health sector. It does not matter whether some people have in the past referred to you as a dog’s doctor or not. What matters most is that you are our health minister. The presidency and indeed the nation have bestowed you with the power and responsibility of ensuring that our health is in good condition. A healthy nation is indeed a productive nation.
Dr. D, as I write this to you, many nations have finished reflecting on lessons learned from the COVID-19 pandemic. Many nations have made choices in terms of practices to adopt from the pandemic response to create more resilient health systems. The COVID-19 pandemic, as you may agree with me Dr. D, offered many nations across the world a chance to RESET their respective health system priorities. In other countries, it has provided a leapfrogging moment for health systems transformation through innovation and other means. In others, it exposed the vulnerabilities of their health systems. The question is, where is the nation of Botswana in these categories? You are the expert in this area Dr. D, so I will leave you to answer that on our behalf. (As I do, let me also offer you a space, in this newspaper, to update the nation on how far we are as a nation. Are we progressing or regressing, in your view?).
While you are still making a consideration on whether to write back or not, let me remind you, Dr. D, and of course the noble nation of Botswana that despite being a wealthy nation, inequity continues to be a significant issue in our country. This is reflected by amongst other things the number of people who are currently on the database of the country’s medical aid funds amongst them Botsogo, BOMAID, BOMPAS, Pula, and Doctors Medical Aid. In case you or any of our people have forgotten Dr. D, at the last count there were only 336, 943 people covered by the five medical aid companies some of which are repatriating 100 percent of their profits back to their countries of origin.
Of these 145, 711 are principals. In the language of health insurance, which you know and understand better than I do, it means that only 145 711 of our people can afford to pay for their health insurance through monthly premiums. In a country of 2.4 million, and a workforce of close to a million (of which 394, 446 are formally employed) this is problematic. These numbers tell a story and that story is that private health insurance is beyond the reach of most Batswana. The #Bottomline of that story is that many are now left with no option but to rely on Marina, Nyangabwe, Letsholathebe, and 15 other hospitals across the country. Dr. D, the story from these numbers also says over 2 million of our people rely on only 906 doctors and 7679 nursing staff that were part of the headcount in the last count made across the country. Our nation is not only facing a serious shortage of personnel and medication but the physical state of major hospitals like Nyangabwe and Marina is bad.
An audit inspection of the hospital by the Auditor General has raised red flags about the state of some of the machines used by the hospital. While some of our leaders have means and can travel across borders to seek medical care the majority of our people have to make do with what is available here. I hope you have read through some of these reports and are working on a well-informed blueprint strategy that can be implemented and end chronic problems in our public health system. I know doctors to be professionals who do not just continuously research but usually also have good hearts to save lives – doesn’t matter if it is a life of an animal or a human being. But then again, Dr. D, we cannot save lives when several machines in our hospitals are dysfunctional to the detriment of service delivery. We cannot save lives when unemployment is making some of our people commit suicide. We cannot save lives when a large majority of those who are formally employed (394, 446 as per the last count by Statistics Botswana) are earning a paltry P5, 320 per month. Given all these, one can safely say we cannot save lives without National Health Insurance (NHI). The NHI can come handy in terms of building new public health institutions and maintaining old ones, workers remuneration and timely procurement of medication.
Dr. D, our public health service is falling apart. Partly because of history and largely due to failure. Some of the referral hospitals were conceived at a time when the country’s population was a lot smaller than today, life expectancy was shorter and medical treatment and equipment less sophisticated and cheaper. But now we are in desperate need of reforms and not just tinkering, a wholesale rethink. Yet it appears in recent years nobody dared to take us there. Our nation has been and is still in need of a health minister who can confront his cabinet colleagues to face a problem that is staring everyone in the face.
A minister who is prepared to make that first step which will ensure that all Batswana have universal health coverage. Universal health coverage means that all Batswana, regardless of how much they’re able to pay, get the health services they need. This type of coverage, Dr. D, is part of the United Nations’ sustainable development goals, which 193 countries, including Botswana, have agreed to achieve by 2030. Unfortunately, while we are signatories to some of these international agreements we tend to more leaned toward talking than doing. Public Relations (PR) stunts have been our modus operandi lately.
There have a lot of talking but very little doing including about possible reforms in the health sector. Of course in your other area of expertise, politics, the perception of doing something about a given problem is, after all, a means to win votes. But we are talking about precious lives here Dr. D. So let me challenge you or your assistant Sethomo Lelatisitswe to do two things before Christmas break. First, write us back and let the nation know what you think of the current status of the public health system including how you plan to solve the problems is facing. Secondly, consider starting debates within your sub-sector relating to how we can tailor-make a National Health Insurance that could save the lives of our people. The #Bottomline is that we have a chronic problem in the public health sector and we need to address it in a far more considerate way. You have been chosen to lead us in that regard so please do just that.
