A rich state with mostly poor citizens, Botswana has historically been ham-handed in its handling of public healthcare.
Sometime during the administration of President Ian Khama, life-saving medication worth tens of millions of pula would pile up at the Central Medical Stores while shelves at dispensaries government’s healthcare facilities remained empty for months on end. Upon expiry, the medication would be tossed into a bonfire specially built for that purpose. New consignments would arrive and the cycle would repeat itself. The problem appears to have been arrested but the ham-handedness has not gone away.
In January this year, Sunday Standard learnt about acute shortage of asthma inhalers across the country. Shortage of inhalers is double jeopardy at a time that a severe acute respiratory syndrome is still running rampant across the globe. Asthma itself is a respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty in breathing. To control this condition, asthma patients need inhalers, which are hand-held, portable devices that deliver medication to the lungs through the mouth. In that regard, asthma is a risk factor for COVID-19.
The Ministry of Health did acknowledge that there was such shortage and its spokesperson, Shirley Mukamambo, attributed to supply chains having been overwhelmed by the Covid-19 pandemic.
“Manufacturing and transportation of the products were delayed; the global demand continues to soar while the supply is shrinking causing scarcity in the markets,” she said, adding that some kind of respiratory solution was being used “as a rescue for management of acute episodes of asthma is available in stock.”
The other mitigation measure that Mukamambo revealed was providing funds to District Health Management Teams and hospitals to make what she called “local micro procurements.” The latter were meant to serve “as a safety net for healthcare facilities to procure stocks during such shortages from the local market.”
For more stable supply, orders that, at the time, had yet to be delivered to CMS Central were to be expedited and the Ministry hoped to replenish its stocks soon.
“The next phase of tender process is expected to be approved soon by the Public Procurement and Asset Disposal Board and framework contracts will be in place with sufficient risk mitigation plans for the next two to three years. The above measures will collectively assist to address and prevent any potential shortages,” Mukamambo said.
In response to a general question about the government’s policy on the availability of essential drugs and medical supplies (like asthma inhalers), she said that the Ministry “strives to achieve an availability target of 97 percent for all the essential medicines.”
That was in January and as the year ends, the situation has gone from bad to worse and there is no indication that it is about to improve. When the asthma patient who had alerted Sunday Standard to the shortage of asthma inhalers went to the Letsholathebe Primary Hospital shows on October 27, 2022, Paracetamol pills was all an asthma patient could get. The inhaler he had been prescribed was not in stock. The situation hadn’t changed this past Friday.
Responding to President Mokgweetsi Masisi’s state-of-the-nation address last month, the Leader of the Opposition, Dithapelo Keorapetse, made a startling allegation that could possibly be true.
“People are dying,” he said in reference to the acute and historic shortage of prescription drugs and other critical medical supplies in government hospitals and clinics. “People are dying of stroke and diabetic coma – which occurs when a patient doesn’t take medication. This amounts to a death sentence and violation of human rights.”
While there has been no official announcement that the non-adherence to prescription drugs has indeed caused any deaths, there has been official confirmation of such phenomenon by the Ministry itself. On the basis of solid science, health workers at government health facilities routinely tell chronic-disease patients on such drugs that non-adherence to drugs causes a medical condition to worsen and that death could be the result.
As Jwaneng-Mabutsane MP Mephato Reatile argued, the problem extends way beyond the shortage because in some cases, even when drugs are available, health professionals who should dispense them are not. He said that he was recently contacted by some constituents of his who complained that they had been waiting for hours on end at a local to fill their ARV prescription. While the drugs were available, the health worker dispensing them was not.
Keorapetse also poked holes in the explanation that the Ministry of Health has consistently given with regard to these shortages: that Covid-19 has crippled the international drug supply chain that serves it.
“The shortage is not a result of Covid,” Keorapetse countered. “Do you want to tell me that we are the only country in the [SADC] region that has been so affected? Why is this not a problem in Mauritius, in Seychelles, in South Africa, in Namibia, in Zambia? Why is there no acute drugs shortage in those countries? Are we the only ones [whose supply chain has been] affected by Covid among so many countries? I don’t think so.”
The Selebi Phikwe West MP added that what the Opposition Bench has been told and what it believes to be the case, is that “there is interference in the procurement system of the Ministry of Health.” He promised that the Bench will talk more expansively about the latter in the due course.
A month before the start of the 2022/3 parliamentary year, the Minister of Health, Dr. Edwin Dikoloti had officiated at the Walk for Life Campaign. The latter is an initiative to get members of the public walk for exercise by taking at least 10 000 steps a day. This is a very good exercise and the reason Cuba has one of the best national healthcare systems in the world is because it puts a lot of emphasis on preventative healthcare – which entails personal responsibility at one level. Such emphasis eases pressure on healthcare facilities and Botswana would do well to adopt similar strategy.
The irony though was that at that precise moment, the Minister of Health had himself taken 10 000 steps away from the sort of public healthcare that his party’s election manifesto articulated in 2019. The unacknowledged health emergency that gets worse by the day strongly suggests that he is now more than 10 000 steps away.
The worst affected from this emergency is a loyal voter constituency that braves the October heat each election cycle to cast their votes because, in part, they had been promised good healthcare. Away from the “interference” that he alleged, Keorapetse made a statement of fact regarding why the powers-that-be are never anxious to ensure proper management of the healthcare system. He said that he recently learned that a certain cabinet minister had been hospitalised and that he was absolutely certain that this minister hadn’t been hospitalised at a government hospital but a private hospital where there is no drugs shortage.
“I don’t think he has been hospitalised at Princess Marina or Selebi Phikwe Hospital or Ramotswa or Nyangabgwe,” the MP quipped.
