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Centralisation crippled health care system

Publishing Date : 01 June, 2015

Author : ALFRED MASOKOLA

Member of Parliament for Tati East, Samson Guma Moyo

Member of Parliament for Tati East, Samson Guma Moyo has urged the Ministry of Health to concede that the country’s health system is on crisis mode, owing to unsolved issues piling up over the years.


Moyo said this at the opening of the sitting of the Public Accounts Committee (PAC) to examine Government accounts for Financial Year that ended 31st March 2014, earlier this week.


The committee which is chaired by MP for Kanye South, Abraham Kesupile is also made up of Ndaba Gaolathe, Kosta Markus, Biggie Butale, Dithapelo Keorapetse, Shaun Ntlhaile, Guma Moyo, Paulson Majaga and Ignatious Moswaane.  


Moyo said the fact that year after year the ministry is unable to resolve crucial issues confirm that there is indeed a crisis in Botswana’s health care system.


Moyo stated that issues like shortage of drugs including for critical illnesses like high blood pressure is a call for help. “What are the implications of this shortage?”He asked, further adding, “Some patients are dying as a result of this shortage.”


The Ministry of Health Acting Permanent Secretary, Tebogo Banamile acknowledged that the ministry is faced with challenges but denied that there was a crisis, as Moyo implied.


Banamile said that some of the challenges were brought on by the transition from decentralisation to centralisation after the 2009 general elections. Government has said that due to the economic situation of that time, health services were better managed at central government under the health ministry.  


According to Banamile centralisation resulted in the ministry taking over the responsibilities which were initially tasked to local authorities. She alleged that, when nurses were moved to central government, some resources they used like accommodation facilities and vehicles could not be transferred since they already belonged to the Ministry of Local Government, thus contributing to the web of problems the ministry is faced with.


The PAC was also not impressed that there over 50 doctors who do not have accommodation, it submitted that it is one of the factors that have resulted in Botswana not being able to attract and retain doctors.  


MP for Maun East, Kosta Markus expressed concern over the remuneration of Cuban doctors in Botswana. There is an understanding that they are unhappy with Botswana’s working conditions. The PAC heard this week that Cuban doctors are entitled to meagre allowances ranging from $600-$800 (P5878.00- P7838.00) depending on their area of speciality.


The Cuban doctors are also only transported to and from work, and government does not provide them with personal vehicles.


Botswana’s low wages have also been pointed out as the problem in the health care system as the country is unable to attract specialists to work in Botswana. Botswana is also unable to retain its medical professionals due to limited incentives in allowances. Failing to rectify the current situation means Botswana will continue losing doctors to greener pastures as they remain the most sought after professionals in the world.


MP for Gaborone Bonnington South Ndaba Gaolathe advised the Ministry of Health to develop a method which they will use to measure preventative care to see if the ministry is achieving its objectives.  


Gaolathe advised that the ministry should also have an effective supply chain management which is critical in management of the drugs to ensure that the supply is adequate and reaches the destinations where they are needed. While Botswana has never short of drugs, it is common for some health posts, especially those in rural areas to go experience a shortage of drugs.


Botswana infant mortality rate remains one of highest in the world for an upper middle income country, with an average of 36 deaths per 1000 live births. While the mortality rate for children under 5 years is at 28%.
Banamile announced that the Ministry of Health is reverting to decentralisation and the District Health Management Teams (DHMT) will be given more authority in order to improve efficiency. The Acting PS contended that a lot of issues were overlooked a few years ago when other health services were centralised.  


The Ministry of Health will also seek an arrangement where health professionals will be de-linked from public service so that there are certain benefits which health professionals are able to access that are in line with international practices.


Parliament has previously rejected a motion by Dithapelo Keorapetse to consider delinking health workers from civil service and setting up an independent Health Commission to be in charge of the health sector.

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