The Ministry of Health is responsible for Health Policy formulation and leadership in health on behalf of the Botswana Government as guided by National Health Policy (1995). On the other hand, the Ministry of Local Government facilitates in implementation of health programmes including the primary health services through the District Health Teams (DHTs). Health is an integral and indispensable component of Vision 2016. The country needs a healthy community and public service to attain the goals of the national vision. Provision of health service in the district goes a long way in building a compassionate, just and caring nation, one of the pillars of Vision 2016.
10.1.1The Institutional Framework
Health system in Kgatleng District is organized through the following sections-
The DHT Management plays the role of enabler through coordination of overall administrative and resource support services (finance, transport, material and facilities) within the district. It also coordinates primary health care. The primary health care is responsible for integration of preventive, promotion, rehabilitative, and appropriate curative health care through the participation and involvement of community groups at all levels of the health delivery system. It discharges these responsibilities through clinics, health posts and mobile stops throughout the district.
Hospital services mainly cater for inpatients. However, it also covers broad areas such as diagnostic service, support to primary health care, treatment services and takes care of referred patients from the health clinics. It does this through the District Hospital (Deborah Retief Memorial Hospital).
The ministry is responsible for the health policy formulation and facilitating implementation of the policy. It also has a duty to provide comprehensive, preventative, promotive, curative and rehabilitative health care services. The goals of the Ministry of Health (MoH) are as follows:
To improve efficiency and cost effectiveness of health care delivery.
To ensure equitable distribution of health services.
To improve quality of health care.
To train appropriate skilled personnel.
To strengthen primary health care programmes.
The district aims at improving the communities’ access to health services, improvement of the quality of the health services, development of the health sector by providing adequate manpower and transport, which is in line with Vision 2016. The district also wants to reduce the spread and impacts of HIV/AIDS through health education and support of the infected and affected.
The ministry’s core business is to provide basic physical and social facilities to communities. Through the Local Government Service Management and the Sanitation and Waste Management Department the ministry is responsible for the provision of primary health care services. Through the health institutions, the district has a duty to ensure customer satisfaction through timely delivery of quality service. The district will also ensure sufficient provision of health facilities to make health services accessible to the communities.
National AIDS Coordinating Agency (NACA)
NACA is responsible for ensuring a multi-sectoral action amongst all ministries, sectors, districts, NGOs, CBOs, People Living With HIV/AIDS and Private sector. It also mobilises resources for a long term and sustainable response to the epidemic. The district will continue to implement programmes such as community home based care and the prevention of mother to child transmission, which are in line with the national vision pillar of Caring and Compassionate Nation.
In this sector, private medical practitioners and private companies for waste collection and disposal will be considered. NGOs and CBOs that are engaged in the fight against HIV/AIDS will also be considered.
The private medical practitioners help ease the workload of health services in the district. They normally offer curative and counselling services. There are three private practitioners in the district all based in the main village of Mochudi.
During the plan period the Department of Public Health in the district intends to privatize waste collection and disposal as well as the landfill operation in line with the government’s privatization policy. The intention is to be done in 2 phases. The first phase being the privatization of solid waste collection and disposal followed by privatization of landfills. However, Landfill privatization would be subject to the “Department of Sanitation and Waste Management approval.
The private sector will be expected to have the capacity to provide the above services and the Department of Sanitation and Waste Management is expected to provide the policy guidelines for privatization of the services. The policy guideline will be expected to help local authorities to select competent companies to run the services on behalf of the local authorities.
The Department of Public Health will during the plan period endeavour to reduce waste going into the landfills. This will be done through waste minimisation. The department will work hand in hand with waste recycling companies and those salvaging metal, plastic and paper waste. The Department of Sanitation and Waste Management will be expected to help in identifying recycling companies while local authorities will be expected to work directly with the recycling companies. It is hoped that by the end of the plan period at least 25% of recyclable material will be reduced from the waste stream.
Another service that will be considered for privatisation will be vector control (pest control). Currently local authorities are providing this service at a highly subsidized cost. Since the Department of Public Health has already started reviewing the fees for solid waste collection, it is the intention of the department to review the pest control fees. The rationale is to make the service sustainable hence enticing the private sector to take over the service.
10.1.3.3NGOs and CBOS engaged in the Fight against HIV/AIDS
There are a number of NGOs and CBOs in the district that are engaged in the fight against HIV/AIDS in collaboration with the government. These include among others, the Tebelopele Voluntary Testing and Counselling Centre, Botswana Family Welfare Association and Bakgatla Bolokang Matshelo.
10.1.4Health Consultation Priorities
Communities are concerned about shortage of nurses in some health facilities, which leads to inadequate coverage of mobile stops in some catchment areas. Despite this issue they proposed that their health posts and clinics should be upgraded to include maternity wards. Although the district doesn’t have a problem of waste management, there is need for a special vehicle for clinical waste. They advocated for Community Home Based Care Givers to be given allowances that are attractive.
There is only one district referral hospital in Kgatleng where all clinics refer their patients to. This results in overcrowding/congestion at the hospital. Therefore there is a need for a primary hospital in the district.