Posts

Mental Health in BotswanaBotswana’s 1969 Mental Disorders Act, Chapter 63:02, describes a person with mental illness as a “mentally disordered or defective person” who cannot handle their own affairs and is a danger to themselves or others due to an existing mental condition; and in the case of a child, one who cannot benefit from ordinary education. The Act does not permit the detaining in an institution of persons with mental illness except where cases fall under the Criminal Procedure and Evidence Act.

A patient’s next of kin who is an adult or any other person at least 21 years of age who has seen the patient within the last 14 days may apply for a reception order to the District Commissioner, who in turn liaises with a medical practitioner on referral and treatment protocols. If the patient does not comply, the District Commissioner is allowed to use law enforcement and can choose to carry out the processes of the reception order either privately or publicly. The District Commissioner also has the responsibility to safeguard the patient’s personal belongings and to allow a willing person to provide caregiving in the case of a Class III patient (one who does not require skilled medical care, failure to which is punishable by law).

Currently, mental health in Botswana is guided by the mental health policy drawn in 2003 that is now fully implemented and in line with human rights agreements.

Botswana’s Mental Health Services

Botswana is an upper-middle-income country with a population of 2.3 million and a physician-patient ratio of 0.5 to 1,000. As of 2014, Botswana had a total of 361 inpatient mental health professionals and a ratio of 17.7 mental health workers to 100,000 people. Nurses made up the highest proportion of these professionals at 12.17, and psychiatrists were fewest at 0.29 to a population of 100,000 with one mental hospital and five psychiatric units across different general hospitals. In 2014, there were 46 mental hospital inpatients, 6% of whom were involuntarily admitted. Of all inpatients, 93% stayed less than one year.

The University of Botswana and the U.N. partnered to promote mental health in Botswana. In a 2019 forum, the university vice-chancellor reported that the most prevalent mental and neurological disorders were schizophrenia, schizoaffective disorders and depression, with the majority of patients being males. In 2010, 14,481 Batswana youth aged 15-34 had a mental disorder. The Ministry of Health and Wellness representative pointed to risks of alcohol abuse among the youth dealing with mental health challenges and the U.N. Regional Representative encouraged students to build stress resilience and coping. The university offers mental health services to students through a psychiatric nurse, who can also make advanced care referrals where necessary.

The country also has mental health promotion programs for children as well as an alcohol abuse prevention program for all age groups across the country. The Botswana Network for Mental Health, a subsidiary of the global Mental Health Network (MHN), aims to promote mental health in Botswana through advocacy and community empowerment activities. The organization further addresses the stigma associated with mental illness and helps people access mental health care.

Traditional Systems

Botswana’s constitution makes provision for the House of Chiefs, or Ntlo ya Dikgotsi, a 15-member non-partisan system, of which seven of the members are Dikgotsi (chiefs) representing the different tribes. Eight are elected by their jurisdictions, four of whom are Dikgotsana (sub-chiefs). At the grassroots is the Kgotla, which serves as a local court system and informs parliament on community affairs, a go-between on local and tribal matters including property and customary law.

This Kgotla further encourages free expression in the community by providing a platform for open dialogue for conflict resolution. The Kgotla also handles minor criminal offenses and can take disciplinary action on wayward behavior. The Kgotla thereby promotes community cohesion and psychosocial health for overall mental health in Botswana.

Reforms in Mental Health in Botswana

Despite some human rights inadequacies in the 1969 Mental Health Act, mental health in Botswana has improved over the years, becoming increasingly compliant with WHO’s directives as stipulated in the 2003 mental health policy. The traditional systems of government have also boosted social cohesion, thereby promoting mental health in Botswana.

– Beth Warūgūrū Hinga
Photo: Flickr

HIV/AIDS in Botswana

Botswana is a landlocked country in Southern Africa that is bordered by South Africa, Zimbabwe and Namibia. It has a relatively stable economy, boasting the fifth highest GDP per capita in Africa. However, in 2019, Botswana had the third-highest rate of HIV/AIDS in the world with 21.9 percent of the population living HIV positive. This article will discuss the efforts that the government of Botswana and other global companies and organizations have made to help bring this epidemic to a halt.

“Masa” Program

HIV/AIDS rates have been steadily declining every year in Botswana since 2000, when the HIV/AIDS epidemic reached its peak in the country with 26.3 percent of people testing positive. In 2001, Festus Mogae, the President of Botswana at the time, pledged to devote significant resources towards stopping the spread of the virus. In 2002, through a partnership with the Botswana government, the American pharmaceutical company Merck & Co offered to donate antiretroviral therapy drugs (ART) free of charge to individuals in communities throughout the country. By 2013, the program, called “Masa,” had reached more than 220,000 individuals.The Masa program also helped fund infrastructure development and health care professional training. In addition, new treatment centers and resource centers were constructed to help treat patients and contributed to the decline in HIV/AIDS rates.

UNDP Efforts

In 2010, the United Nations Development Programme (UNDP) entered into a cost-sharing agreement with the government of Botswana. The agreement called for increased funding to help improve the capacity and effectiveness of HIV/AIDS treatment in the country. So far, the agreement has helped to improve Botswana’s institutional capacity to fight HIV/AIDS. In addition to these efforts, in 2010, the UNDP, in conjunction with the Unified Budget Results and Accountability Framework (UBRAF) helped fund additional HIV/AIDS prevention efforts. These efforts included a commitment to reduce the stigma of using HIV/AIDS-related services. This program has been successfully implemented in various communities across the country.

“90-90-90” Targets

In 2011, UNAIDS set what they dubbed “90-90-90” targets for the year 2020. The goal is to diagnose 90 percent of individuals with AIDS, have 90 percent of diagnosed individuals on antiretroviral therapy (ART) and ensure that 90 percent of individuals with AIDS achieve viral suppression. Botswana has already achieved these targets, as have other countries including Cambodia and Denmark. This is a testament to the commitment made by the Botswana government to fight HIV/AIDS.

New Health Strategies

In 2017, of the estimated 380,000 people diagnosed with HIV/AIDS in Botswana, almost 320,000 had access to treatment. However, in June 2019, President Mokgweetsi Masisi announced a renewed commitment to fighting HIV/AIDS in Botswana. This renewed focus includes two new five-year health strategies — the Third National Strategic Framework for HIV/AIDS and the Multi-Sectoral Strategy for the Prevention of Non-Communicable Diseases — to help further tackle the problem of HIV/AIDS in Botswana. These health strategies are set to be reevaluated in 2023.

– Hayley Jellison
Photo: Flickr