The United Nations Office in Botswana has raised questions about Botswana’s preparedness to fight COVID-19.
In a report titled, socio economic analysis of COVID-19 in Botswana dated 6 May 2020, the UN reveals that “there is currently limited information on the in-country availability and stock levels of critical health equipment and supplies including personal protective equipment (PPE), essential medicines, testing kits and reagents among others to assess the country’s state of readiness to respond to COVID-19.”
The report observes that “the total cost of establishing surge capacity for medical supplies including essential medicines, reagents, health sector response to (Gender Based Violence) GBV, test kits, hospital beds, acute and intensive care beds and equipment is yet unknown.”
According to the report, the Government of Botswana (GoB) spends at least US$86 per capita on health with about 4 percent of the total health expenditures generated through out-of-pocket payments. The report says this enables access to needed health services without significant financial hardships for a large proportion of the population and this is anticipated to remain so during the COVID-19 response.
“Nonetheless, while the financial requirements for the Ministry of Health and Wellness to ensure
COVID-19 Preparedness and Response are estimated at US$ 1,500,000, this may prove to be a conservative budget. Such unanticipated increases in health expenditure may prompt diversion of
funding from non-COVID 19 related budget lines, calling into question the sustainability of financing arrangements,” the report says.
It says that quantification and forecasting are erratic, coupled with a weak Logistics Management Information Systems (LMIS) leading to frequent stock outs of essential (Sexual Reproductive Health) SRH commodities.
“This challenge is expected to extend to essential medicines as the country scales up multi-month dispensing of chronic disease medications to minimize individuals’ contact with health facilities. It is also important to underscore the attention placed in Botswana to keep in focus the need to also address the double burden of HIV/AIDS and (Non Communicable Diseases) NCDs,” the reports notes.
It says the efforts intended to minimize the spread of the virus, such as containment measures, including social distancing and lockdown, closing of schools, the prohibition of public gatherings and closure of non-essential business and economic activities, will have far reaching social and economic consequences.
“COVID-19 exposed vulnerabilities and inequities prevalent in the current system. Existing
supportive programmes that prove successful in narrowing inequalities should be expanded.
At the same time, gaps and short-comings should be addressed. Vulnerable and marginalized
populations should remain a priority when devising response and recovery plans and strategies,” the report says.
The report warns that the capacity of Botswana’s healthcare system is limited and will quickly reach its limit, in the absence of quick and decisive containment measures, resulting in significant loss of life.
Therefore, it says, it is critical that adequate effort be put into identifying policies and measures that minimize the social and economic fallout, especially for the most vulnerable segments of the population
At an estimated 18 hospital beds per population of 10,000 and 120 intensive care beds across the country, the report says, Botswana has a lower inpatient care capacity compared to other middle-income countries in the region.
“Although the country is in the early phase of the outbreak, evidence from other countries further along the pandemic curve would indicate the need to establish surge capacity for hospital beds and inpatient care capabilities,” the report says.
It says Botswana has trained fewer than 30 laboratory personnel to process COVID-19 specimens currently yielding a capacity of up to 500 tests per day. “Despite the country having a network of medical laboratories (both public and private), the processing of specimens remains centralised to two laboratories (National Reference Laboratory and the Botswana Harvard Partnership HIV Reference Laboratory),” the report says.
This limited COVID-19 testing and diagnostic capacity, the report says, presents a significant risk to fully understanding the pandemic curve in Botswana and thus managing an effective response.
“The requirement for a travel permit to seek healthcare services may hinder access to essential health services and ultimately increase the pressure on emergency services or at worst, increase mortality. Access to maternal healthcare is a particular concern alongside the limited supply of sexual and reproductive health commodities in terms of the potential numbers of unintended pregnancies, including teenage pregnancies, and a rise in newly acquired HIV infections,” the report says.
It reveals that Botswana has a doctor to population ratio of 5.27 doctors per population of 10,000, representing half of the WHO recommended 10 doctors per 10,000.
“The density of nurses and midwives to the population is estimated at 54 per 10,000. Urban/rural disaggregates reveal significant disparities in availability of qualified healthcare professionals. The inevitable rationalization and equitable distribution of healthcare workers in response to COVID-19 in a country already facing shortage of skilled health workers will very likely impact the continuity of essential health services, including sexual and reproductive health (SRH), HIV and GBV services particularly in rural areas,” the report says.
The report observes that Botswana struggles with limited health informatics infrastructure and human capacities including monitoring and evaluation personnel, epidemiologists and biostatisticians, and data/ICT specialists. Information silos across the health system are institutionalized using two distinct patient management systems, with no interface capabilities across healthcare levels and from clinic-to-clinic.
“The combination of these factors represents a missed opportunity for harnessing integrated routine data for real-time disease surveillance which creates a significant blind spot for policy-makers who have to make timely critical decisions. Limited availability of timely disaggregated data will limit ability to identify and respond to hotspots with vulnerable populations and underserved locations,” the report says.
The report says the “UN system is well equipped to support during each phase of the epidemic—preparation, response, and recovery—through pooling resources and expertise.”