Provide correct information on Botswana
DR EDWARD T MAGANU | Friday June 6, 2008 00:00
The information may not always project the country in a positive light, but the situation cannot be worse than it is now, certainly in the health field. Because of such initiatives as the Millenium Development Goals, countries are being continuously compared, and if a country does not collect and provide up to date information that can be validated, the International Agencies use various methods to generate figures; the commonest method nowadays being computer modelling.
I feel that the rather unfavourable figures (and many of them may not be true) on Botswana that appear in various international reports and publications may do the country a great deal of harm, whether in relation to attracting investment or in relation to tourism, or just image. What we need is that the figures used to project Botswana should be based on the best methods of data collection possible.
To make my point, I will give below a series of figures on Botswana that were presented recently at a conference organized by the global health partnership that monitors Maternal, Neonatal and Child Survival, and I will also give my opinion regarding the likely validity of these figures, which are contained in the report of the said partnership, called the Countdown to 2015.
These figures were presented for all countries which warrant being monitored because they risk not attaining the Millenium Development Goals that relate to child health and maternal health.
Population 1.858 Million: This is probably a projection from the last census (2001). My worry; in countries of southern Africa where mortality is so high because of HIV/AIDS, and fertility has dropped significantly, population growth has slowed down dramatically or even reversed. This has been shown in southern African countries that have undergone recent censuses. The, government has to wait for the next census to get a more accurate figure.
Infant Mortality Rate per 1000 live births (2006): 90. Was in the 30s at the close of the 1980s. Under-five mortality rate (2006): 124. Was 58 in 1990. Neonatal mortality rate 40 per 1000 live births in 2000- no previous figure.
The infant and under-five mortality figures are pretty bad, not so much because of their absolute levels as they remain among the better ones in Sub-Saharan Africa, but because of the deterioration since 1990. We attribute it almost entirely to HIV/AIDS.Much poorer countries have shown a drop in these rates (an improvement) of up to 40% since the beginning of the 2000s. Maternal mortality in Botswana, like child mortality, has also shown an increase in the 1990's, again attributable to HIV/AIDS.
Back to my theme; is the statistics agency in Botswana, and are the relevant sectors involved, happy with these figures? Why is Botswana not undertaking Demographic Health Surveys (DHS's) between censuses to generate this kind of information?
The countries Botswana is compared with have all had recent DHS's, they can stand by their figures. Can Botswana stand for these figures? Are our infant and child mortality rates still deteriorating? Has the high coverage of PMTCT and ART in general not resulted in a significant drop in all forms of mortality, including that of children?
I am aware that DHS's are expensive, that most of the low income countries have them done through donor support, but because the information they generate is so vital for comparative analysis, and for monitoring progress, I feel government should invest in periodic standardized DHS's, so that Botswana can be compared with its peers on a level playing field.
As far as I know, there has never been a survey of neonatal mortality in Botswana, and the figure of 40 does not make sense considering the more than 90% deliveries by skilled attendants in health facilities, which is among the highest on the continent.
The same report gives skilled attendance at delivery for Botswana as 94% in 2000, so the level of maternal mortality- estimated at 380 in 2005- also raises questions. Again, a DHS would resolve the issue of if this is indeed the case, and whether in fact the high coverage with ARV's has made an impact and reduced all these death rates, even if it is not to 1990 levels. Percentage of HIV+ pregnant women receiving ARVs for PMTCT is put at more than 95%. Surely it must have an impact on child mortality?
Let us now look at a couple of policy indicators in the same report. These are policies expected to move a country to the attainment of the MDG's that are discussed above on child and maternal mortality.
The following policies are regarded as not in place (or at least not documented!): Community treatment of pneumonia with antibiotics; IMCI (Integrated Management of Childhood Illness) adapted to cover newborns 0-1 week of age; Costed implementation plan(s) for maternal, newborn and child health available; Midwives be authorized to administer a core set of life saving interventions; and specific notification of maternal deaths.
All these are largely routine programmatic measures that UN Agencies continuously help countries to put in place, and one wonders if the lack of data on Botswana means the policies are not in place, or they are just not documented. In addition, in relation to treatment of diarrhoeal disease, only 7% of children <5 years with diarrhoea receive oral rehydration therapy or increased fluids with continued feeding, or in the case of pneumonia, 14% of children <5 years with suspected pneumonia are taken to appropriate health provider.
These figures are from 2000, what is the situation now, is it still that bad? I hope it is not too much to hope that by the next Countdown report, we will see figures whose origin is known and which we can all stand by.
I have given the figures in the two paragraphs above to show how it is easy for a country to be classified mediocre simply because it is not collecting proper data or documenting what it does, thereby not being compared with others on an equal footing.
Botswana's health performance has not been generating much interest in the international community in the last decade, mainly because by being classified middle income, it has lost donors.
Donors tend to demand and help collection of information where they are active because they have to provide these as justification to their tax payers at home for continuing the aid they give to a particular country.
However, we should also note that countries are like students during exams; they attract a lot of attention when they are doing either extremely well or extremely badly. It would appear that Botswana is not attracting much interest in its health sector because it is neither doing very well nor very badly; it is just getting along.
I believe the country should take an initiative to collect information, document it, and supply it to relevant Agencies to try to attract the attention of the world, and measure itself against countries in Africa and elsewhere which are at the same level of development.
In my recent letter to Mmegi I commented at length about fertility, mortality and population growth. I had been prompted by a news item in a BTV news bulletin, where some people, including a government expert, were unbelievably advising Government to encourage people to have more children!
I was pleasantly surprised this past weekend when an authoritative Government figure expressed in another BTV news bulletin, while addressing a gathering, that they were worried by international organizations publicising figures about Botswana whose origin is not known. Now, in these days of the internet we should realize that people pick up figures, sometimes figures they cant even interpret, and send them around the world.
Today for example, I read something from a website called Kenya Today, coming to me via Google Alerts on Botswana, that claims that food security in Botswana is worse than that of hunger-prone countries like Ethiopia and war-torn Burundi, Sierra Leone and super-inflation hit Zimbabwe etc.
They start by stating that according to a Botswana paper, the Sunday Standard, Botswana faces the highest level of malnutrition in the world. This according to them, the Sunday Standard has got from an FAO report. I know for a fact that although Botswana is a food-deficit country in terms of production, the nutrition status of Botswana children is much better than that of many countries in the region which are actually more food sufficient in terms of production, but which have worse food security and poorer social safety nets. (The Countdown report quotes underweight prevalence for children <5 years as 11%, but the figure is for 2000).I visited the site of the said Botswana weekly and saw the article that had attracted the Kenyan attention. The headline was 'Botswana Faces Starvation- FAO'. I then went to the FAO website and opened a page entitled 'Crop Prospects and Food Situation- No.2, April 2008'. In the section entitled 'Countries in Crisis Requiring External Assistance', there were 37 of them, no Botswana. They were classified into three categories: 1) Exceptional shortfall in aggregate food production/supplies (in Africa only Lesotho, Somalia, Swaziland and Zimbabwe in this category). 2) Widespread lack of access - Eritrea, Liberia, Mauritania and Sierra Leone; 3) Severe localized food insecurity - 13 African countries including Burundi, Ghana, Ethiopia, Kenya etc, again no Botswana. So, what prompted the Sunday Standard 'Botswana faces starvation' article?
I am giving this information as a wake-up call to our Government Ministries not only to monitor information coming via Agencies, but to also monitor the local press and correct them where they do not reflect the true situation on the ground.
Somebody reading this from outside Botswana would really think the population is on the verge of starvation with the 'highest level of malnutrition in the world' as claimed by the Kenyan website.So much for the information and knowledge age!
We are all flooded by information, much of it of doubtful integrity, and it is for us to separate the wheat from the chaff. Governments have the responsibility to at least give correct information about their countries that can be validated and compared to others.