Incoming Minister of Health and Wellness, Dr Lemogang Kwape, has vowed to transform the ministry by digitalisation of health care, strengthening primary health care , improving availability of drugs to over 90 percent and ensuring that facilities are maintained. In this exclusive interview with The Patriot on Sunday Dr Kwape lays down the roadmap, which will ensure that no one is left behind.
UNAIDS has developed a strategy known as ‘Fast track’ whose aim is to end AIDS epidemic by 2030, with the first target by 2020 known as 90-90-90 intended to have 500 000 or fewer infections. The 2030 target known as 95-95-95 is to have 200 000 or few infections. “Fast-Track drives the 90–90–90 targets: that by 2020, 90% of people living with HIV know their HIV status, 90% of people who know their status are receiving treatment and 90% of people on HIV treatment have a suppressed viral load so their immune system remains strong and the likelihood of their infection being passed on is greatly reduced,” reads a statement from UNAIDS.
“We want to maintain momentum in the measurement of HIV/AIDS target 95-95-95 from 90-90-90,” says Dr Kwape.
One of Dr Kwape’s priorities is to ensure that Non-Communicable Diseases (NCDs), which are some of the major public health issues in Botswana that place a burden on the health sector, are managed.
How is the uptake of PrEP, why is government seemingly reluctant to market it and hold public campaigns about it when it appears to be a high impact HIV Strategy?
Dr Kwape: The uptake of PrEP has been slow. The country started implementing it among key populations namely Female Sex Workers (FSW) and Men who have sex with Men (MSM). It has also been started in Youth Friendly Clinic in five youth friendly facilities covering 4 distrcits, (Bontleng, Tlokweng Main clinic, Thamaga, Scottish YFS, Mahalapye YFS and Francistown YFS) mainly for adolescent girls and young women (AGYW) who are 18 years and above.
The government has planned on a phased rollout that will end up including members of the general population who perceive themselves to be a high risk of acquiring HIV throughout the country.
It is indeed a high impact intervention but there has to be effective planning to ensure that when the public is informed, the service is availed without fail hence the delay, Health workers throughout the country still have to be included and trained on PrEP Implementation.
What is government doing about the rate of new infections and the rate of prevalence which does not seem to have gone down in the past 10 years?
Dr Kwape: in terms of new infections, the government has employed a multisectoral approach to reducing new infections starting with the individual going up to the highest office in the land.
Individuals are educated in HIV prevention. The aim is to get all those that are negative to remain negative and those that are positive to be diagnosed and put on treatment, adhere to their treatment so that they are virally suppressed. We now know that treatment is prevention as well.
HIV positive individuals who are virally suppressed have low chances of transmitting the virus. The country is employing both biomedical and behavioral interventions to cut down new infections.
The ‘Treat All’ and ‘Option B plus’ strategies have been adopted to reduce HIV transmission. PrEP wprks towards cutting down new infections. The circumcision program is being employed to reduce new infections.
Realizing that Ke Populations have been a very high HIV prevalence (FSW-over 40% and MSM over 13%, with very high HIV incidence above that of the general population , government took a deliberate decision to treat all HIV positive FSW in 2015, with the aim of getting them virally suppressed so as to reduce transmission.
Government working with its development partners, civil society organisations and everybody else you can think of in the country is spreading the message of HIV prevention though condom usage, HIV testing, reduction of multiple concurrent partnerships and abstinence among others to ensure there is reduction of HIV spread. STI treatment is also being provided for everyone.
HIV prevalence
Dr Kwape: The HIV prevalence has not been going down as shown by our previous surveys because as people on ARVs, they leave longer and hence keep the prevalence up. However the incidence has been going down from 1.45% to 1.35% in 2013. This has translated to a reduction of new infections from about 13,000 in 2010 to about 8,500 in 2018.
ARV case- has the case been settled and has government drawn any lessons from the litigation?
Dr Kwape : The ARV case is still on-going. However, so far lessons have been drawn from the case. The biggest lesson is that Government has to ensure everything is done to ensure that all those on ARV don’t run out of their life saving medications under whatever circumstances. In other words Batswana have to be granted security with their treatment.
Will government improve the distribution system of drugs given that people are continually returned for lack of medicines in dispensaries?
Dr Kwape: Yes. The ministry is working on a strategy to improve availability of all medicines for critical conditions. However, the Prescribers are always advised to use alternative drugs where the prescribed ones are not available.
It is a policy of the ministry that hospitals and clinics should always communicate amongst themselves to find out where the prescribed medicines could possibly be available. Similarly DHMTs and hospitals are given funds for micro-procurement while CMS is awaiting delivery of large consignments from suppliers.
The ministry is also working on installing a system with an end to end visibility which will provide real time on line visibility of commodities within connected facilities.
Can you clarify why CMS procurement continues to be a challenge and when is government going to legislate for WHO, UNICEF and SADC to assist you with global procurement as per President Masisi’s SONA?
Dr Kwape: there are various reasons for the challenges faced by CMS some which are not unique to Botswana such as, global shortage of Active Pharmaceutical Ingredients (API) or key starting materials for production of medicines. Other challenges such as small order quantities are expected to be overcome through the strategy announced by His Excellency in his State of the Nation Address. The ministry is working on ensuring that the relevant steps are in place to implement the strategic interventions to improve availability of critical commodities.
When will the global procurement start and has local suppliers been informed about the new arrangement, if so, what are their views?
Dr Kwape: procurement of medicines has been sourced from the global market and it shall continue to be the case. Even the local manufacturers buy finished commodities for repackaging. The method of procurement remains the prerogative of the procuring entity as per the PPADB Act and regulations. Therefore, the ministry shall continue to follow the PPADB Act and its Regulations as a public entity.
They have been allegations that President Masisi’s sister is involved in supplies of ARVs, how true is that?
Dr Kwape: the ministry through CMS follows the standardized bidding package (SBP) as prescribed by PPADB Board. Any procurement is hence done in compliance to the SBP> as one of the requirements, bidders are required to provide the owners/shareholders and directors without requirement for stating relations to extended family members. Therefore, all CMS tenders are evaluated according to the set out evaluation criteria in the Invitation to Tender document regardless of the medicines required.