In interviews and field visits in the last two weeks, Mmegi has established that many local health facilities that do not have pharmacists on duty, are not dispensing Antiretroviral medication, popularly known as ARVs, and that there is also a shortage of HIV test kits.
The investigation was sparked by complaints from some People Living with HIV (PLHIV) that they were experiencing troubles getting their ARVs from their regular clinics as pharmacists have disappeared due to an ongoing industrial action.
Early this month, the Botswana Nurses Union (BONU) directed its members to stop dispensing pills and medicines, a decision that has taken nurses’ and midwives’ out of pharmacies and thrown patients, such as PLHIVs, into the wind. As if their troubles are not enough, PLHIVs also claim there is a dire shortage of HIV test kits. Mmegi is informed that in some of the affected health facilities, test kits are reserved for women who are six months pregnant, which goes against the general advice that women should register their pregnancies at early stages.
It is also said that CD4 count test reagents are not available in numerous government facilities.
The facilities most affected by the troubles include Metsimotlhabe and Mmopane clinics which refer their patients to Nkoyaphiri while in Broadhurst BH1 refers patients to BH3. But the problem seems to be affecting even more health facilities across the country, from Mochudi to as far as afoot as Sehithwa.
In other areas, the Ministry of Health (MoH) has apparently found alternatives to address the dispensing of medicines. Union ambassador, Bonosi Segadimo, said as HIV activists they were aware of what is happening on the ground and were also aware of what longer distances for healthcare mean in terms of default. She explained that their efforts to raise grievances to relevant authorities in the health system have been futile.
“If a person is a habitual defaulter and they are told to get their medication from as far as Nkoyaphiri Clinic coming from Metsimotlhabe or Mmopane clinic, do you think they will care to go around borrowing money to go there?
“If we say we want to have won against HIV in 2030, we will not achieve that because we are the ones who push people to default by telling them to go collect their medication at health facilities far away.
“This shows that we do not know what we want,” she said. She confirmed that some people were turned away from some clinics and told that because of a shortage of HIV test kits, those available were kept for pregnant women only. Even amongst the pregnant women, only those who are six months along and older qualify for the test kits.
“This is delaying pregnant women from going through antenatal care and it also threatens unborn babies’ lives, more especially if their mothers are HIV positive.
“It’s a drawback for the country,” she said.
Segadimo also said lack of CD4 count testing and viral load reagents was going to make it hard for PLHIV to keep track of their health as they would not know their viral load and CD4 count. She added that they were disappointed that MoH promised to give PLHIV injectable ARVs this year in June but has since gone mum on the issue.
For his part, an HIV activist from Lobatse, Keddy Jacques, said the Health Ministry had reacted swiftly in the town when there was a shortage of medication at some facilities.
He however said reagents had been a problem and they now had chemistry and viral load reagents only.
“CD4 count testing is not being run.
“The town did receive test kits last week even though they’re not enough,” Jacques said.
Other HIV activists in areas such as Maun and Sehithwa told Mmegi that they were also facing similar challenges and some patients were defaulting.
Centre for Youth of Hope (CEYOHO) programme officer, Kennedy Mupeli, told Mmegi that sustaining the achievements of the global 95-95-95 targets, required continued availability of resources and access to health services for PLHIV. Last year, Botswana became the second country in the world after Eswatini to achieve the landmark UN goal towards eradicating AIDS. The UN target states that by 2025, 95% of HIV-positive people in a country should know their status, 95% of those diagnosed should be on medication and 95% of those under treatment should show signs that the virus is being suppressed.
“These achievements are not cast in stone and they can be reversed if we relent in this struggle,” Mupeli said. “Disruption of HIV and other non-communicable diseases services put us at risk of reversing these gains. “Tests kits and labs should be available all the time.” Despite the accounts of PLHIV and others, the Health Ministry’s chief public relations officer, Christopher Nyanga told Mmegi the ministry had not closed any clinics that have been dispensing ARVs.
He added that although it was true that not all clinics have pharmacists and pharmacy technicians, arrangements had been made in each District Health Management Team to facilitate for people with medications, including ARVs, in areas where nurses have stopped dispensing drugs.
“It is true that there are some people who have been defaulting on their medications including ARVs. However, this is not a new development.
“It is an issue that the ministry has been dealing with through the involvement of community leadership and family members to encourage all patients taking medications, especially for critical conditions, not to default,” he said.
Nyanga said defaulting on medications, including ARVs, has always been an issue in the country, became more prevalent during the COVID-19 pandemic, due to issues such as movement restrictions. He flatly denied that the Ministry is facing a shortage of HIV test kits.
“The ministry does not have any shortage of HIV test kits.
“The country’s biggest medical warehouse, Central Medical Stores has stocks of HIV and pregnancy test kits, ready to be dispatched to facilities on request,” he said.
Nyanga, however, acknowledged that there was sometimes a gap in supplies availability at clinics or facilities when the request to the Central Medical Stores was sent late or made when the facility requesting has already started running short of supplies.
