Botswana’s approach to health is an example to the African continent, with strong leadership, investment in research and development and universal health services available for a nominal charge, said Dr Jean Kaseya, head of the Africa Centres for Disease Control and Prevention (Africa CDC).

Kaseya was speaking on Monday at the opening of the World Health Organization (WHO) Africa regional committee meeting being held in Botswana’s capital, Gaborone.

“Botswana was the first African country to achieve 70% coverage of COVID-19 vaccines because of the strong leadership of the president and the allocation of adequate resources to procure vaccines,” said Kaseya.

“Its investment of 1-2% of its GDP to research and development is why Botswana is one of the leaders in the development of vaccines for animals. Knowing that the next pandemic will be a zoonotic one, it means that Botswana will play a key role in addressing this issue in Africa,” he added.

Kaseya added that he was surprised to learn that Botswana’s citizens were able to “access to all the healthcare that they need” by only paying a 15-cent contribution for every dollar charged.

Kaseya said that Africa needed to prepare for the next pandemic by pushing local manufacturing of vaccines and medicines and ensuring there was “enough funding for pandemic prevention, preparedness and response”.

The African region had failed to submit a regional application to the Pandemic Fund, unlike the Caribbean, Asia and Latin America and needed to ensure it made an application during the next call for proposals to fund a joint emergency action plan, he added.

The WHO Africa region excludes some of the countries in the far north of the continent that associate more closely with Arab states and are part of the Eastern Mediterranean Region (EMRO).

HIV laboratory declared WHO centre of excellence

Meanwhile, WHO Director-General Dr Tedros Adhanom Ghebreyusus told the meeting that Botswana’s National HIV Reference Laboratory has been designated as a WHO Collaborating Centre of Excellence “in recognition of the laboratory’s excellence in the field of HIV diagnosis and the potential of deeper collaboration with WHO in advancing the health and well-being of people living with HIV”.

“In 2021, WHO certified Botswana for reaching the silver tier on the path to eliminating mother-to-child transmission of HIV. And in 2022, Botswana reached the 95-95-95 targets for testing, treatment and viral suppression of HIV, one of only five countries to do so,” said Tedros, referring to the targets of 95% for testing all people, putting 95% of those with HIV on treatment, and achieving viral suppression in 95% of people living with HIV.

“Botswana is a model to show anything is possible, added Tedros. Peace is possible. Stability is possible. Democracy is possible. Growth is possible, even to an upper middle-income country or even even higher. Africa can grow. Africa can be stable, Africa can be peaceful. Africa can be a democratic continent,” added Tedros.

Botswana has a small population of 2.6 million people and has made its wealth from minerals.

Urgency of universal health coverage

WHO Africa Regional Director Dr Matshidiso Moeti, who hails from Botswana, also expressed pride in her country’s health milestones. 

“It is one of the countries where direct payments for healthcare is almost non-existent,” said Moeti. “With a minimal nominal contribution, people have access to everything that is available in the country and transferred outside of it [for other treatment]. It is an example of how to make sure that payments are not a burden to the customer. I’m very proud of this.

“We could take many examples and I’ll just cite a couple. For example, the mother-to-child transmission of HIV has been reduced to less than 5%, and Botswana has been the first high-burden country in the world to achieve this milestone.

“HIV transmission rates have fallen from 40% of the sexually active age group in 1999 to below 1% this year. What an achievement for a nation that once had the highest HIV prevalence rate in the world.”

In contrast to Botswana, Moeti pointed out that “public spending on health is low in the majority of our countries, and Africa is home to two of the three poorest people who pay directly out of pocket for their health care.” 

Meanwhile, Tedros said that every WHO member state needed to “radically reorient health systems towards primary health care as the foundation of universal health coverage”.

“Nowhere is more important than here in our continent. Across the region, hundreds of millions of people lack access to essential services or are pushed into poverty by catastrophe out-of-pocket spending. Closing these gaps must be top of the to-do list for every member state,” urged Tedros.

Climate change threat

Moeti and Tedros both urged African member states to take measures to mitigate the effects of climate change on their citizens’ health.

“We have seen Europe burn literally over the past few months. Here in our region, prolonged drought in the Sahel, and also in the greater Horn of Africa and cyclones in southern Africa have increased morbidity, mortality and human suffering,” said Moeti.

“These phenomena are taking a heavy toll on health services. We are working with partners to support our member states in their efforts to provide essential health and nutrition services to affected countries and communities.”

She said that an African regional initiative to combat the health consequences of climate change on the continent had been launched in May on the sidelines of the World Health Summit, while the Climate-Health Africa Network for Collaboration and Engagement (CHANCE) had been formed in 2021 to assist countries in southern and east Africa to address climate change.

Meanwhile, Tedros encouraged all African member states to participate actively at COP28 in the United Arab Emirates, which will feature a day dedicated to health for the first time.

“Health systems are increasingly dealing with the consequences of climate change in terms of communicable and non-communicable diseases, and the impacts of more frequent and more severe extreme weather events,” said Tedros.