The health care system of Botswana is based on the principles of primary health care. The government, when planning its activities, puts health promotion and care and disease prevention among its priorities. The basic objectives of which shall be access by all citizens of Botswana to essential health care, whatever their financial resources or place of domicile, and the assurance of equitable distribution of health resources and utilisation of health services. Health services is structured and operated in such a way that they will be linked with each other as well as with other social services.
The policy has a mandate to support the development of the private sector and in particular the cooperation of such sector with the public sector. The district’s provision of primary health care facilities to the local communities is based on the policy regulation of providing clinics with maternity to a 30km radius and those without maternity to 15km radius and health post 8km radius. It also integrates all social and public health acts and gives the framework for their interpretation and implementation.
10.2.2National Policy on HIV/AIDS
This policy outlines the national response to the epidemic in Botswana. It describes the role of national leaders, various government ministries, the private sector, NGOs and CBOs, persons living with HIV/AIDS and individual community members in the national response. It forms the basis on which a national strategic plan will be developed. Within the National Strategic plan, different ministries and organisations, even at district level, will formulate their sectoral plans and projects for implementation.
10.2.3Waste Management Act
This is a piece of legislation that will govern waste management in the district throughout the plan period. The act requires that a waste management plan be prepared for each plan period. Kgatleng District Waste Management Plan is being prepared currently. Such a plan will spell out how the district will manage its waste throughout the plan period.
The main aim of the department is to provide a healthy environment in which strong health families, capable of contributing positively to the development of our economy can be promoted. The section is responsible for the control of some of the factors that may have negative effect on the environment and human health. It ensures that households and business premises have safe sanitary facilities and water supply. It also monitors food hygiene in restaurants and shops. Kgatleng District has tried its best to provide refuse collection services to all areas in the district. To further improve refuse collection services, the district is planning to privatise in some areas. In conjunction with the water supply authorities, water quality is regularly monitored. The department has a problem of proper meat inspection because of proper slaughtering facilities.
Kgatleng District is serviced by one hospital – Deborah Retief Memorial Hospital. The government has taken over the running of the hospital following the disagreement between the Dutch Reformed Church and the Bakgatla Community.
The hospital is a district hospital that receives referrals from the Kgatleng catchment areas.
10.3.3Primary Health Care
The District Health Team (DHT) in consultation with the Ministry of Health is responsible for planning, evaluating and providing basic health services for persons resident in Kgatleng District in accordance with Government Policy and any guidelines from time to time issued by the ministry. Such services include the following :
Health Promotion and Avoidance of Ill-health encompassing:
The achievements for the department are encouraging save for the HIV/AIDS pandemic. More than 80% of the population live within 15 Km distance from a health facility. Other factors considered in the distribution of facilities are population accessibility and increased demand and need of health services.
In DDP 5 provision of maternity facilities was given a priority in the district and thus the Morwa and Boseja maternity wings were funded and constructed. Artesia and Bokaa Clinics were renovated and extended to cope with the increased demand of services.
Also, during DDP 5 it was observed that a number of structures of health facilities had run down and the design of others did not meet the needs of the services being provided in them. The formation of the Project Implementation Team (PIT) will help identify these facilities and suggest ways of improving them.
Each health facility in the district has been provided with a form of communication either a telephone or radio. To facilitate prompt referrals, all clinics and health posts have vehicles most of which are relatively new. These vehicles are also used for implementing programmes such as school health, follow up of patients and other outreach services. Each clinic with maternity in the district has been provided with small incinerators and are all working. A big incinerator was launched in the DRM Hospital in February 2002. This incinerator has capacity to handle all the clinical waste generated in the district.
10.3.4District Health System
The District Health Team is accommodated in a building situated next to the Rural Administration Centre (RAC). The building has limited number of offices and there is no room for expansion. District Health Team is experiencing shortage of transport for supervision of activities, implementation and monitoring of programmes. Shortages of staff particularly in the field of nurses with midwifery has been a critical issue in the provision of health care. Lack of equipment in some clinics is also a problem.
The DHT is well functional with the following facilities:-
HIV/AIDS has remained unabated, hence the upward trend observed. The Information, Education and Communication (IEC) is the cornerstone of the fight and all the sectors are involved in the fight (multi-sectoral approach). MTP III is being developed to guide us through the coming years of DDP6.
During DDP5 Community Home Based Care was one of the very important community responses to the impact of HIV/AIDS pandemic that is support to the infected and the affected. Such responses are being encouraged and supported. Programmes such as PMTCT were scaled down to the district as a measure of reducing mother to child transmission and eventually controlling the spread of HIV/AIDS. Iso Preventative Therapy (IPT) and Anti Retroviral drugs are expected to be introduced in the district during this plan period. These programmes are fully supported by the district in terms of transport and manpower.
Tuberculosis notification has increased by 10 – 15% per annum since 1997 when the lowest notification rate of 200 cases per 100 000 population was recorded country-wide. Kgatleng District notification rate is now 272 per 100 000 against 100 per 100 000 the WHO target. This increase is largely due to the advent of HIV/AIDS in Botswana. By way of recommendation:
The Ministry of Health should institutionalise a mechanism for regular updating for doctors and in-service training for other clinical and health service providers on TB diagnosis and treatment.
Contact tracing should be improved and efforts must be made to extend preventive therapy to contacts below five years of age, where active Tuberculosis has been excluded.
National Tuberculosis Programme (NTP) training programmes should include senior management staff and Family Welfare Educators (FWEs) in order to familiarise them with the NTP policy guidelines.
Nurses in rural clinics should start treatment for smear positive patients without waiting for Public Health Specialist (PHS) to review them.
The Botswana National Tuberculosis Programme (BNTP) must explore alternative ways of implementing the directly absolved therapy outside the health facilities such as the workplace and different community settings.
Kgatleng District is not malaria area at present. However, the malaria belt is spreading southward with time. The district has been warned to put preventative programmes in place according to Roll Back Malaria initiative. In this initiative countries are called to act together, strengthen existing activities aimed at controlling malaria epidemics and draw in new posters at various levels. Workshops and seminars on the prevention of malaria to the community and schools, sensitising the community on the importance of using Insecticide Treated Nets (ITN), community mobilisation using the politicians - through Kgotla meetings, train the health workers on the management of severe malaria.