researchafrica.rti.org: Sub-Saharan Africa

Botswana

HIV prevalence 15-49, 2007/2008 23.9%

Tuberculosis death rate 95/100,000 population

Malaria death rate (children under 5) 72/100,000 population

Botswana is a land-locked nation in south central Africa, located on South Africa's northern border. Botswana is about the size of Texas but has a population of only 1.6 million. The small population is a result of Botswana's aridity; two-thirds of the nation is taken up by the Kalahari Desert, and only 5 percent of Botswana's land is arable.

The presence of diamonds and other mineral resources has made Botswana wealthy relative to other African nations. The per capita GNI of more than $3,000 is deceptive, however, as wealth is unevenly distributed, and a quarter of the working age population is unemployed.

Botswana has been devastated by HIV/AIDS. Almost 39 percent of the adult population is HIV-positive. Reversing the trend of rapid population growth seen in most African nations, AIDS is expected to result in Botswana's population falling by a quarter by 2025. (Botswana's President Festus Mogai reported in a November 2003 speech that the incidence rate appears to have fallen to 35.4% in 2002, but much of the decrease is due to deaths.) Botswana's HIV prevalence rate is the second highest in the world, superceded only by that of Swaziland.

TB prevalence in Botswana is currently 231 per 100,000, with a death rate of about 43 per 100,000. One of the goals of the BOTUSA Project, a joint venture of the Botswana Ministry of health and the CDC, is to address the growing problem of TB in Botswana.

Malaria is endemic in the northern parts of Botswana, including Kasane and Francistown, but generally not in the south. WHO reports that in 2000 the malaria death rate for children ages 0-4 was 72 per 100,000.

Sources: Synergy, CDC, United Nations Statistical Division

According to a November 2003 Human Sciences Research Council report, Botswana spends approximately 10.4% of its government revenues on the health sector. This is below the 15% of resources pledged at the 2001 Abuja conference. In per capita dollar terms, Botswana is spending around $191 per capita per year in the health sector.

Botswana established a National AIDS Council in 1989. A National AIDS Co-ordinating Agency (NACA) was set up in 2000 and was given responsibility for mobilising and co-ordinating a multi-sectorial national response to HIV and AIDS. This organization is chaired by the President and is also the secretariat for the National AIDS Council.

Botswana has concluded its National Multisectoral Second Medium Term Plan for HIV/AIDS (MTP2: 1997-2002). The triad of objectives included in this strategic plan were:

Preventing sexual transmission of HIV.
Ensuring the safety of the blood supply.
Caring for people living with HIV/AIDS (PLWHA) and their families.

Awareness campaigns targeted to high-risk populations and the social marketing of condoms were activities undertaken to achieve the first objective. Since the beginning of 2004, HIV tests are given as a routine part of checkups in both public and private clinics in Botswana. The testing is compulsory but routine, however patients can opt out. This makes Botswana the first country in Africa to have a national policy of routinely offering HIV test, on a voluntary basis.

An estimated 110,000 Botswana are in need of ARV treatment, and approximately 17,500 were receiving treatment in the first quarter of 2004. Botswana hopes to double that by the end of 2005.

The government of Botswana has also established a pilot project for preventing mother-to-child-transmission (MTCT) of HIV by treating HIV-positive pregnant women with AZT. The MTCT program is implemented in collaboration with UNICEF, and the government has committed $3.6 million per year to support it. Many women who receive MTCT counseling have refused to be tested for HIV.

The need for doctors, pharmacists, and health care technicians to treat HIV/AIDS is rising, and Botswana has no medical school. Even though government has anti-AIDS programs in place, but it has a hard time keeping people on staff and loses many of its skilled health care professionals to corporations and partners including NGOs, all of whom pay better than the government, says President Mogai. Currently, Botswana is building a medical school and trying to train more of its own people.

A National Strategic Plan on HIV/AIDS (2003–2009) has been developed to achieve an expanded multisectoral response at to expand upon previous advances.

In its efforts against TB and malaria, Botswana has adopted a DOTS program, and about 71 percent of TB cases are treated under DOTS protocols. In 2000 the government of Botswana undertook a major campaign to eliminate mosquitoes as a measure to control malaria.

Sources: HSRC report, Synergy, UNICEF, Congressional Black Caucus Foundation (October 30, 2003), United Nations Statistics Division, AllAfrica.com: IRIN, March 11 2004, interview with Dr. Ndwapi Ndwapi, VOA news; UNAIDS; www.avert.org

Total population. mid-2009	2.0 (millions)
HIV prevalence 15-49, 2007/2008	23.9%
Tuberculosis death rate	95/100,000 population
Prevalence of tuberculosis per 100,000 population, 2000	490
Prevalence of tuberculosis per 100,000 population, 2004	553
% Tuberculosis detection rate under DOTS, 2001	69
% Tuberculosis detection rate under DOTS, 2004	67
% Tuberculosis treatment success rate under DOTS, 2000	77
% Tuberculosis treatment success rate under DOTS, 2003	77
Malaria death rate (children under 5)	72/100,000 population
GNI PPP Per Capita, 2008	13,100 (US$)
Life expectancy at birth	49 years
Infant mortality rate	48/1,000 live births
Total fertility rate	3.2 per woman
Crude birth rate	25/1,000 population
Crude death rate	12/1,000 population
Adult male literacy level	86% (pct. 15+ literate)
Adult female literacy level	93% (pct. 15+ literate)
Contraceptive prevalence rate, modern methods	42% of women in union
Estimated number of people living with HIV: Adults and Children, 2005	270,000
Estimated number of people living with HIV: Adults and children, end 2003	350,000
Estimated number of people living with HIV: Adults and children, end 2001	350,000
Estimated number of people living with HIV: Adults (15+), 2005	260,000
Estimated number of people living with HIV: Adults (15-49), end 2003	330,000
Estimated number of people living with HIV: Adults (15-49), end 2001	330,000
Estimated number of people living with HIV: Adults (15-49) rate (%), 2005	37.3%
Estimated number of people living with HIV: Adults (15-49) rate (%), 2003	38.0%
Estimated number of people living with HIV: Women (15+), 2005	140,000
Estimated number of people living with HIV: Women 15-49, end 2003	190,000
Estimated number of people living with HIV: Women 15-49, end 2001	190,000
Estimated number of people living with HIV: Children (0-14), 2005	14,000
Estimated number of people living with HIV: Children (0-14), end 2003	25,000
Estimated number of people living with HIV: Children (0-14), end 2001	22,000
Estimated number of AIDS deaths: Adults and children, 2005	18,000
AIDS deaths in adults and children, end 2003	33,000
AIDS deaths in adults and children, end 2001	28,000
Estimated number of orphans due to AIDS: Children (0-17), 2005	120,000
Orphans due to AIDS (0-17), living 2003	120,000
Orphans due to AIDS (0-17), living 2001	95,000

Demographic data contained in this section was obtained from the following sources: The Population Reference Bureau’s 2009 World Population Data Sheet was used for total population, life expectancy at birth, infant mortality, fertility, birth rate, death rate, % of married women 15-49 using modern methods of contraception, % of population 15-49 with HIV/AIDS in 2007/2008, and the GNI PPP per capita (2008). Literacy rates were found in the Population Reference Bureau’s publication 2005 Women of Our World. HIV prevalence data for 2001 and 2003 was obtained from the UNAIDS Barcelona 2002 report; HIV prevalence and orphan data for 2005 was obtained from the UNAIDS Report on the Global AIDS Epidemic 2006. Data on the % women who have discussed AIDS prevention with their husband or partner can be found in ORC Macro and USAID’s Women’s Lives and Experiences: Changes in the Past Ten Years (Research Findings from the Demographic and Health Surveys). Childhood malaria mortality data was accessed in 2003 from the United Nations Statistics Divisions’ Millennium Indicators. Tuberculosis data was obtained from the United Nations Statistics Division’s Millennium Indicators: MDGInfo 2006. In some cases information was unavailable.

Botswana’s public health system consists of 23 district health teams, 3 referral hospitals, 12 district hospitals, 17 primary hospitals, 222 clinics, 330 health posts and 740 mobile stops. The 237 bed Princess Marina Hospital in Gaborone is the largest private health care institution in the country. President Mogae reported in a November 2003 speech that 60% of acute care hospital beds in Botswana are occupied by AIDS patients.

The WHO estimates that Botswana had 23.8 physicians and 219.1 nurses per 100,000 population in 1994. In a November 2003 speech President Mogae spoke very frankly about the need to recruit health professionals away from other African countries.

Sources: Botswana Government Website, WHO

Although the University of Botswana has a faculty of science, Botswana's lack of a national medical school is a considerable impediment to pursuing research in the country, as well as a primary reason behind Botswana's chronic deficiency in trained medical personnel.

There are currently many initiatives aimed a combatting HIV/AIDS in Botswana. One of the most publicized of these initiatives is the African Comprehensive HIV/AIDS Partnerships (ACHAP). This partnership is a collaboration between Botswana's government, the Bill & Melinda Gates Foundation and the Merck Company Foundation. ACHAP was established in July 2000 to supporting the goals of the Botswana Government in decreasing HIV incidence and significantly increasing the rate of diagnosis and treatment of the disease.

Source: www.avert.org

Future goals of the BOTUSA Project (the local CDC Global AIDS Program) include:
- Strengthening HIV/AIDS education in the schools
- Increasing the coverage of Voluntary Counseling and Testing (VCT) programs
- Reducing Mother-to-Child transmission
- Increasing the availability of TB preventive treatments using isoniazid as a prophylactic, and anti-retroviral treatments for AIDS patients
- Improving
... additional information

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