Healthcare in Botswana

Abstract

Botswana is one of the countries situated in Sub-Saharan Africa. Sub-Saharan Africa is a group of African countries located to the south of the Sahara Desert; it is also called "Black" or "Dark Africa." Botswana is a country that is largely prone to different diseases and epidemics, especially HIV/AIDS, tuberculosis, and malaria, which have been delaying economic growth, reducing the life expectancy and affecting education in Africa for decades. HIV/AIDS reduces GDP growth by one percent a year. The reason is the permanent loss of skilled workers. In South Africa, HIV/AIDS can reduce GDP by as much as 17% over the next decade. In addition, HIV/AIDS decreased the production of agricultural products by 20% (Ledikwe et al., 2014).

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Every year HIV/AIDS strikes people of different social levels: from poor workers to teachers and professors. As the teachers in developing countries have comparatively high salaries, they travel more often and have sexual relations with students or local women, who may be infected with HIV. As a result, HIV/AIDS affects teachers to a great extent. The epidemic not only affects numerous professors, but also has an influence on the quality of education at local, regional, and national levels. HIV/AIDS is not the only problem of its kind. In South Africa, there is recorded the world's largest index of deaths per capita due to tuberculosis. The increasing number of multi-disease tuberculosis, which is resistant to many drugs, is also of great concern. Diarrhea and respiratory infections, measles, malaria, and malnutrition are the biggest threats to the health of children in this region (De Blij, 2010).

Malaria is also one of the main causes of death among African children under five years. It is estimated that African women are about 175 times more likely to die during pregnancy or childbirth than women in industrialized countries (Ledikwe et al., 2014). The purpose of the current essay is to investigate the status of human health in Botswana and to analyze the most common diseases, the reasons for the emergence of the epidemics, and the standards of healthcare in Botswana. In the current paper, possible measures and ways to fight these diseases are also highlighted. It is also indicated how foreign aid works to save the lives of African people.

Of course, it could be possible to cope with many diseases that affect both children and adults using minimal resources, if these resources were used rationally and strategically. It is necessary to be able to provide first aid, especially in rural areas, promote healthy lifestyles, ensure disease prevention, and improve the level of education among all age groups in Africa.

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The Reasons for Three Main Health Problems in Botswana

Health problems in Botswana are deplorable due to the lack of hospitals and skilled healthcare workers, and due to the outflow of doctors and nurses to the developed countries. Corruption is another problem that absorbs the already lacking resources required for making improvements in such spheres as healthcare and education. Unfortunately, even in the 21st century, a lot of African people, including Botswana citizens, use traditional African medicine instead of visiting doctors. The reason for that is the lack of hospitals, poverty, and religious beliefs of the Africans. Traditional African medicine is a set of conventional methods, technologies, and beliefs that Africans use for medical purposes.

This includes herbal remedies, spells, and rituals. In the 21st century, a significant part of the African population does not have access to quality health care and medicines due to their high cost (De Blij, 2010). In Botswana, the risk of infectious and tropical diseases is high. The lack of clean water (approximately 70% of the population has access to it) leads to outbreaks of enteric infectious diseases. In 2000, healthcare expenditures amounted to 6% of GDP.

The most serious health problem is AIDS. In terms of its prevalence, Botswana occupies the second place in the world after Swaziland. According to the country's Ministry of Healthcare, there were 13% of AIDS carriers in 1996 (about one hundred eighty thousand people). In 2001, 38.8% of adults (fifteen-forty-nine years old) were AIDS carriers. In 2003, there were three hundred fifty thousand AIDS patients and HIV-positive people in Botswana, thirty-three thousand of whom died. According to the 2007 estimate, 23.9% of adults (15-49 years of age) were infected with HIV/AIDS. Twenty-six thousand of the whole Botswana population annually dies from AIDS. 69% of HIV-infected people live in Africa.

Botswana occupies second place in the world after Malawi by the number of HIV-infected individuals. A quarter of the adult population is HIV-infected. In addition to AIDS, there are some other diseases prevalent in the country. Malaria and tuberculosis are among the major ones. In 1999, there were seven hundred cases of tuberculosis per one hundred thousand people. In 2000, 17% of children at the age of five suffered from malaria (Nkomazana et al., 2014).

AIDS in Africa Is a Threat to Demographic Development

In the last decade of the 20th century, acquired immune deficiency syndrome (AIDS) became the critical issue of the socio-economic and demographic development of third world countries. Nowadays, this deadly disease, the treatment measures for which have not been developed yet, is one of the most important issues. According to the UN, at the end of 2000, there were 36.1 million HIV-infected people or those who had AIDS. The vast majority of those people equaling to 25.3 million people (or 70%) are from Africa. Meanwhile, only 12.5% of the population lives in Africa. Three-quarters of the 22 million deaths from AIDS in the world are recorded in Africa (Thigpen et al., 2012).

The ways and causes of the human immunodeficiency virus (HIV) are still fairly unknown. There are different versions regarding this issue. They are all somehow connected to Africa, where the epidemic began around the late 70's - the early ’80s. According to one version, some African monkeys are carriers of the virus. According to another version, this virus was received by Western laboratories and tested in Africa. Anyway, the virus went ahead and took a strong position among the majority of the population. In Africa, in contrast to other countries, HIV is transmitted mainly through sexual contact. Drug abuse in the region is less important than the behavior associated with the frequent change of partners (De Blij, 2010).

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Two-thirds of infants are infected with the virus from their mothers at the moment of birth. Theoretically, it is possible to prevent this infection, but it is expensive (about $ 3,000 per case) and is practiced only in rich countries or among wealthy patients in Africa. But due to lack of funds, this way of combating the transmission of AIDS is practically inapplicable. Babies are born healthy but they are infected during lactation. Unfortunately, only a few women, being aware that they or their partner are carriers of the virus, refuse to continue their reproductive function, and the birth of children obviously continues. HIV-infected individuals always develop AIDS within about one to several years and die from various diseases. But even if treated under normal circumstances, the disease becomes deadly because the human body cannot fight it due to low immunity.

By the end of 2000, Botswana had occupied the first place in the world in terms of HIV prevalence. The proportion of infected individuals in the country exceeded 35%. In Botswana, at least 2/3 of those who are now 15 years old can die prematurely from AIDS. According to the UN Population Division, AIDS “steals” from 10 to 20 years of people’s life (Thigpen et al., 2012).

The suffering that this pandemic disease cause seems endless and its impact on the economy is undeniable. In Botswana, where the economic rate is high thanks to the production of diamonds, diamond sorters become victims of AIDS, and the replacement of workers reduces profits. The cost of medical services, increased insurance benefits in case of death, funeral expenses, and the cost of labor recruitment and training reduce the corporate profits. Therefore, AIDS significantly affects the economic statistics of Botswana and the whole continent as well.

Unfortunately, the statistics are deplorable as the prevalence of HIV/AIDS in Botswana is growing.

HIV-associated Tuberculosis: Detection and Treatment of Tuberculosis

Botswana has one of the highest tuberculosis incidence rates (327 per 100 000 people) in Africa. Tuberculosis is the most frequent cause of death. In South Africa, tuberculosis killed 8.8% of people in 2013 (Nkomazana et al., 2014). The delay of diagnosis results in death in most cases. The reasons for the delay of diagnosis can be different: the use of unconventional medicine and visiting of the religious healers before undergoing treatment of tuberculosis, as well as living in an area where there is no hospital, and others.

HIV-infection leads to the spread of tuberculosis. Therefore, in areas with a high incidence of HIV-infection, it is important to strengthen the common measures to detect and treat tuberculosis; it is necessary to develop additional measures and deal with other common infections that are connected with HIV-infection and tuberculosis. These measures should be complementary to ongoing attempts to improve the means of treatment and diagnosis of tuberculosis, including the development of more effective vaccines, diagnostic tests, as well as methods of prevention and treatment. A unified approach to HIV-associated tuberculosis is essential.

The main measures for tuberculosis control include identification of the disease, its treatment, and monitoring of the effectiveness of the treatment. In terms of epidemiology, the number of patients should be reduced in order to decrease the spread of infection. To counter the influence of HIV-infection on the spread of tuberculosis, the detection of tuberculosis must be more active and treatment should be undertaken at an earlier stage of disease development for it to be more effective.

 

There are recommendations for the detection of tuberculosis among the individuals seeking medical help with certain symptoms, such as chronic cough. However, enhancing detection makes sense only in case there is a reasonable probability of getting cured. Otherwise, excessive identification without successful treatment will only increase the number of symptoms of tuberculosis and cause drug resistance.

The most effective measure for the detection and shortening of the period of infectivity is the detection of tuberculosis in groups with high rates of HIV infection: patients with respiratory symptoms, people who undergo voluntary testing for HIV-infection, prisoners, people who work in the medical field, and those who have had close contacts with the HIV-associated tuberculosis patients. Tuberculosis programs should maintain general health services that provide conditions for adequate treatment of tuberculosis and the prevention of drug resistance.

The success rate of disease treatment (% of registered cases) in Botswana was 73% in 2013, which is 3.00 percentage points less than in 2012 (76%). During the period from 2002 to 2013, the success rate of disease treatment (% of registered cases) increased by 2.00% in Botswana (approximately 71%). The average annual variation in the success rate of tuberculosis treatment in Botswana during this period amounted to 0.167%. The maximum increase in the success rate of tuberculosis treatment was observed in 2009 - 18.0%; the biggest decrease was seen in 2004 - 12.0%. The maximum success rate of tuberculosis treatment in Botswana was reached in 2010 - 78%, the minimal one was observed in 2008 - 58% (Nkomazana et al., 2014).

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Malaria as Another Reason for Deaths

There are no boundaries for mosquitoes. Botswana joined seven other countries in the fight against malaria to strengthen the cross-border program. One of the basic elements of malaria elimination as a threat to public health is the elimination of the transmission of mosquito-borne malaria in a certain geographical area. In order to enhance the efforts to combat this disease, Global Fund has provided southern African countries - Botswana, Namibia, South Africa, Swaziland, Angola, Mozambique, Zambia, and Zimbabwe – with a new grant entitled "Malaria elimination in eight countries." Four most affected by the disease countries - Botswana, Namibia, South Africa, and Swaziland - are close to the stage of malaria eradication, reaching the 75% reduction rate of disease from 2000 to 2012 (Ledikwe et al., 2014).

Global Fund grant of $ 17.8 million called "Malaria elimination in eight countries" aims at strengthening regional efforts to counter existing threats, and progress in the eradication of malaria, especially in border areas. The grant is used to support the regional malaria surveillance system, establishing a database and regional laboratories to monitor the transmission of malaria vectors and determine the most effective methods of combating the epidemic. The grant complements the existing Global Fund grants amounting to the US $ 275 million that was provided to those eight countries in order to accelerate the progress in malaria eradication (Ledikwe et al., 2014).

Botswana is one of the four countries that are currently at the final stage of malaria elimination. Botswana was the last country that signed a grant agreement in order to enhance national efforts for disease eradication. In October 2015, Global Fund transferred the first tranche of funding in the framework of the signed grant for malaria eradication in the amount of $ 5.1 million. The new grant is to supplement the government's efforts to eliminate the disease by 2018. The country is working tirelessly to eradicate malaria, and Botswana received this grant at a critical moment in its history (Ledikwe et al., 2014).

The Global Fund Supports Healthcare Financing in Botswana

The new grants signed not long ago between the Global Fund and Botswana, mark a new stage in the partnership, the main purpose of which is to support prevention, treatment, and care for people affected by HIV and tuberculosis. Financial resources provided through the Global Fund come from various partners. The amount of grants is $ 27 million. The main purposes of grants include complete exclusion of local transmission of malaria or malaria eradication, prevention of HIV transmission, reduction of morbidity and mortality, as well as mitigating the psychological and economic consequences associated with tuberculosis. Private institutions work together with local NGOs to promote national interests in the field of HIV prevention, and provision of care and support to the citizens.

In Botswana, there is a high prevalence of HIV and tuberculosis. HIV prevalence equals to 18.5%. Due to this indicator, the country is ranked as having one of the highest prevalence rates of these diseases in the world. Botswana has one of the world's highest rates of tuberculosis prevalence. These two diseases are closely linked as 60% of people with tuberculosis in Botswana are infected with HIV (Thigpen et al., 2012). Significant healthcare financing has allowed Botswana to become the world’s leader in the scale and complexity of HIV and tuberculosis programs. However, the intensification of the struggle against the HIV-tuberculosis co-infection is still essential. The strengthening of community systems to step up the fight against HIV and tuberculosis is of great importance.

Grants management signed in 2015 is implemented by the Ministry of Health of Botswana and the African Partnership for the Prevention of HIV/AIDS, which is a civil society organization. The funds are used to support the prevention and treatment of HIV and tuberculosis with programs being implemented to expand services for HIV testing among tuberculosis patients. Funding is also used for the treatment of HIV patients with HIV-tuberculosis co-infection.

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Funds focus on the strengthening of the management capacity of procurement and logistics at the national and sub-national levels, as well as the enhancement of national health information systems. Development partners in Botswana welcomed the new grants, noting that they will play a crucial role in the fight against epidemics. In order to achieve zero incidences of malaria at the local level and to intensify the fight against HIV and tuberculosis, it is important for Botswana to take full advantage of the grants provided by the Global Fund.

The strategy of the International Development Association (IDA) is to fight against the three most spread diseases in Botswana. For the effective prevention, care, and treatment of HIV/AIDS, malaria, and tuberculosis in Botswana and other African countries, effective measures must be taken. It is necessary to fight against malaria using strong insecticide-treated nets, expand the availability of effective drugs against the disease, improve living conditions, and carry out checks of HIV-infected people for tuberculosis. It is essential to create a more effective national healthcare system to ensure the inclusion of measures to prevent disease in maternal and child health programs.

Thanks to the assistance of the International Development Association and the World Bank fund in terms of helping the poorest countries, the two millions of HIV-infected children and adults have been integrated into antiretroviral therapy, and it was purchased and distributed through more than fifty-seven millions of anti-malaria nets throughout South Africa.

Now in Botswana, there are a number of public and private hospitals. Public hospitals are divided into three levels depending on the severity of the disease. Three of the largest hospitals are located in Gaborone, Francistown, and Lobatse. In 2006, there were 526 doctors (1 for 3346 citizens) in the country, and 3911 beds in hospitals (1 for 450 people). Total healthcare expenditure amounted to 7.2% of GDP. In 2002, Botswana became the first African country that implemented a program of access to medicines. It is also interrelated with AIDS volunteer work aimed at preventing the transmission of disease and raising public awareness (Nkomazana et al., 2014).

Conclusion

The health standards are low across entire Africa, and Botswana is not an exception. There are three most spread diseases in Botswana: HIV/AIDS, tuberculosis, and malaria. These diseases often become the cause of poverty, which must be prevented. Almost all of those who die from AIDS, malaria, and tuberculosis are the residents of developing countries. Although the number of new HIV infections is reduced and the number of individuals undergoing antiretroviral therapy is growing, thirty-four million people are still living with HIV/AIDS. These diseases kill more and more people each year, which places a heavy burden on the economy and households in Africa.

According to economists, the rate of economic growth in some African countries is slowed down due to the malaria prevalence, which significantly affects the growth of the regional economy. Today, the Botswana government focuses on healthcare, mainly on disease prevention and healthy living. The economy of African countries suffers from high rates of treatment of certain diseases as well as the significant loss of labor due to the epidemics. The success in raising awareness among the citizens about the disease is still low, despite the many educational programs and the work of NGOs.

Unfortunately, the success of such educational programs is minimal, as in rural areas there is not enough qualified personnel in medical institutions. First of all, health services officials have to deal with AIDS, which has struck most African countries. In order to ensure efficient work of health services, it is important to redirect resources from treatment centers with good modern facilities in urban areas to the health facilities that provide first aid.

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