A report by the World Health organisation (WHO) is painting Botswana’s health industry as a sector in crisis. In its Botswana Country Office Biennial Report 2022-2023, WHO reveals that some of the issues arising from a training that it conducted in collaboration with the Ministry of Health included “challenges with data completeness and quality, that hampered causality assessment; biased reporting of AEFIs (Adverse Events Following Immunization) towards COVID-19 vaccinations; lack of a mechanism for feedback to ensure that there is continuous improvement of data and management of cases by healthcare workers.”
Some of the identified issues also include “medical professionals indicating vaccines as cause of serious adverse events (including deaths) in hospital records and death certificates without adequate validation; and lack of a communication strategy to inform healthcare workers, medical professionals, communities, families, and media of classified cases.”
The report says with support from WHO, MoH, and BoMRA (Botswana Medicine Regulatory Authority), the national and district AEFI committees drafted recommendations to address the challenges identified.
The report also reveals that “The country is handling several medico-legal cases seeking compensation for harm patients suffered during health service delivery.”
WHO notes that “Given this, and as the country did not have a defined patient safety guideline, a situational analysis through purposive and convenient sampling was done.”
In total, WHO says, 344 staff members, 328 patients, and 16 key informants from the Ministry of Health (MoH) and partners were interviewed.
“The outcome of this survey was a recommendation that policies and strategies be reviewed to ensure better patient management and safety,” says WHO adding that “Based on the findings of situational analysis, the MoH, with WHO technical support, conducted a workshop from 20 to 24 November 2023 to develop a patient safety strategic plan and the operational plan. This has now been finalised and is waiting for endorsement in 2024.”
The reports states that the “need to protect healthcare workers has become even more important with the recent emergence of diseases like COVID-19.”
It says “a resolution that encourages countries to safeguard and invest in healthcare worker protection, the MoH, with WHO support, conducted a workshop to finalise the Botswana National Policy Guidelines for Occupational Health and Safety of Workers in the Health System, which started in 2016 and then stalled.”
Following the WHO report, the organisation says “work was done with Princess Marina Hospital to assist them in reducing maternal mortality through supportive supervision and mentoring of healthcare staff in their catchment area facilities.”
“ In 2022, a follow-up was undertaken at Princess Marina Hospital facilities. However, before the facilities were visited, Princess Marina Hospital identified three hospitals (Ghanzi Primary Hospital, and Molepolole and Lobatse District Hospitals) that they considered capable of strengthening without heavy resource injection,” the report says.
According to WHO; “Efforts were made to strengthen the Maternal, Perinatal, Deaths, Surveillance and Response (MPDSR).”
Despite implementation of the Integrated Management of Childhood Illnesses (IMCI) strategy, the under-five mortality rate remains high, the report says.
In a foreword that accompanies the report, WHO Country Representative Josephine Namboze notes that “Inequality in Botswana remains among the highest in the world, job creation lags, and unemployment is structurally high at 25.4% (end of 2022).”
She said: “The unemployment rate rose to 26% in 2021, with youth unemployment posing a critical challenge for the country. Poverty in Botswana is linked to geographical and gender disparities, with rural areas experiencing high poverty levels at 24.2% in 2015/16, with urban villages at 13.4%, and cities/towns at 9.4%.”
According to Namboze, “ Female headed households showed a 55% poverty incidence, which was, on average, 10% higher than male-headed households. Between 10% and 12% of children who ought to be in school are not. These are some of the indicators that have been used to advise on health investments in the country.”
The report also notes that Botswana is experiencing an epidemiological transition with Communicable Diseases (CDs), Non Communicable Diseases (NCDs) and violence being in the top 10 causes of burden of disease since 2010.
“ HIV/Acquired Immune Deficiency Syndrome (AIDS) still has the biggest impact on DALYs lost, despite the burden reducing by 29%. NCDs have become increasingly significant over the last ten years. The burden of ischemic heart disease increased by 31%, stroke increased by 19% and diabetes increased by 40%,” the report says.