STATEMENT BY THE MINISTER OF HEALTH HON. DR EDWIN G. DIKOLOTI AT A MEDIA BRIEFING ON MEDICAL SUPPLIES SITUATION IN THE COUNTRY

1. Director of ceremonies, we are gathered here this morning for an update on the state of medications in our country following my last update to our parliament in November 2022. Kana motlapele a re “O mpotse tsa ko ke tswang, tsa ko ke yang gake di itse”.

The issue of medical supplies in our country has become so topical and critical for our people such that regular updates on the situation has become so necessary in order to keep our people well informed.

2. Director of ceremonies, my ministry is conscious of this fact and has therefore, taken a deliberate decision to regularly update the nation on the progress being made on this issue.

As an important stakeholder and a key vehicle with which the ministry disseminates information to its various publics, it is important that we engage the media as we are hereby now doing.

3. Director of ceremonies, in my last update on this issue, I did allude to some short term, medium and long term interventions that the ministry was doing to ensure that the country has sufficient supply of medications in all its facilities.

Given the dire situation we find ourselves in, it is indeed important that we have short term interventions that can be deployed while working on the medium and long term interventions which we believe will ultimately bring these current challenges to an end. Like I alluded to during my last address, I have no doubt that as per the UCCSA hymn number 276, that “Motlha Ono oa heta.” Surely it will pass.

4. Director of ceremonies, I did mention during my last address that we had engaged Baylor College of Medicine to assist us get some of our most required medications quicker. I am happy to report that since my last address November, this collaboration with Baylor College of Medicine is bearing fruits. The first consignment of four (4) list items comprising mainly cancer medications to the tune of BWP 1 660 740.00 has been received. The second batch of cancer medicines with 10 list items at a cost of ZAR 5, 403, 840.00 is in order.

The third (3rd ) consignment sourced through IDA foundation comprising 65 line items with most commonly used antibiotics, hypertension, diabetes medicines and other commodities to the tune of USD 1, 475, 447, 65 will be airfreighted from Netherlands this week and is expected before the end of January, 2023.

The fourth (4th) consignment still through Baylor College of Medicine is through a company based in Canada called Apotex comprising 13 line items of critical cardiovascular medicines and antibiotics to the tune of USD1, 048, 665.00 will also come by air in the next two (2) weeks. We will also be receiving more medicines from IDA foundation by sea valued at USD 1, 097, 655, 45 by April, 2023 which will be our fifth (5th) consignment from Baylor College of Medicine.

5. Director of ceremonies, we also have other partners who continue to support my Ministry and the people of Botswana in sourcing important medicines across the world. UNICEF through a long standing agreement continues to assist us with childhood vaccines and other medicines as need be. We are currently awaiting delivery of two (2) types of vaccines at a cost of USD 229 440.00 in the next two weeks. In addition, procurement of four (4) types of vaccines at USD 1, 605, 520.60 is ongoing.

The United Nations Office for Projects (UNOPS) supports the Ministry in sourcing TB medicines. Between September and November, a consignment worth USD 28 890.02 was received. Another consignment worth USD 38 849.76 is already at the airport under clearance.

6. Director of ceremonies, in realising the dire state of availability of medicines in the country and the challenges with sourcing, towards the end of last year, my Ministry made an appeal to our foreign missions through the Ministry of Foreign Affairs to assist with identifying and connecting us with manufacturing companies that could provide us with medicines.

It is through this initiative that one company from India called Medwise was identified and it managed to successfully register 18 products with Botswana Medicines Regulatory Authority (BoMRA). These products were ordered in October, 2022 to be manufactured for Botswana at a cost of USD 923, 610. 00.

A part of this consignment will be air-freighted this week and will be received by the end of January, 2023. The rest will come by sea in the next 6-8 weeks. This consignment comprises a variety of products including antibiotics, painkillers and diabetic medicines.

7. Ladies and gentlemen, considering that India is one of the largest producers of generic medicines, and hence a major exporter of pharmaceuticals and yet we had only one Indian company registering 18 items, I led a team of experts from the Ministry and BoMRA to further explore the Indian market.

It was through this visit that a number of companies were approved following inspection of their manufacturing plants. One such company is Hester Bioscience which managed to have over 90 products exempted.

My Ministry has just completed procurement of 79 line items comprising diverse products used in our facilities to the tune of USD 4, 532, 706.58. These medicines and other commodities are expected in April considering that they are going to be manufactured for Botswana.

Furthermore, as a result of MoH/BoMRA team in India, 90 products from Medwise were also approved by BoMRA and procurement of critical commodities from this list is at evaluation stage.

8. Director of ceremonies, our efforts on stabilising the medicine situation in the country are not only focusing internationally. Procurement of readily available medicines and medical supplies from our local suppliers is ongoing.

At a regional level, we have just completed procurement of medicines and other commodities from a South African based company called Nu World Industries with offices in several countries including India, China, Brazil and Australia.

This is a 56 line item procurement comprising a variety of medicines and commodities commonly used in inpatient care including infusions at a cost of BWP 119 421 955.80. You should note that delivery of these items is expected this week.

9. Director of Ceremonies, it is important to mention that the receiving, warehousing and distribution of these medicines and medical commodities is done by our contracted company- Botswana Post as you have seen during the tour. High priority is given to distribution of products to health facilities.

On average Botswana Post makes more than ten (10) deliveries per day. It is therefore not surprising that CMS availability is kept at minimal levels with the focus being on keeping healthy stock levels at the facilities.

10. Ladies and Gentlemen, one of the initiatives we have aggressively implemented during this difficult time of shortages of medicines was to increase the budget for micro-procurement of medicines for health facilities. This financial year, 2022/2023, to-date health facilities have been allocated a total of BWP103, 332,170.00 to procure medicines on a need basis. I will not talk about the impact of this budget as I have DHMT Coordinators here today who will share their experiences.

11. Director of Ceremonies, I would not want to end my address without mentioning huge challenges related to procurement of medicines and medical commodities lest it is misconstrued to be a normal or simple undertaking. The challenge of availability of medicines is a global phenomenon. It is not unique to Botswana.

There are however specific factors that make Botswana more vulnerable. The lack of pharmaceutical manufacturing locally means we import all our medical commodities. This brings in issues of logistics and supply chain which were compounded by Covid-19 pandemic affecting not only the transportation of commodities but the actual production of pharmaceuticals.

The global and individual country regulatory frameworks for exportation and importation of medical commodities are also barriers to be negotiated during procurement of medicines. The lead time between procurement and receipt of the medicines is also an issue in this regard. The challenge of being a small population is yet another factor affecting our ability to procure medicines.

It is very important to understand that medicines are manufactured on specific orders for specific countries and manufacturing companies work with quantities. So as Botswana with our small population we fail to make enough quantities to the interest manufacturers. Consequently we are exploring further the use of big companies which are not only manufacturers but also aggregators, meaning that they can pull orders from different countries to make the quantities needed for manufacturing as a long term risk mitigation strategy. I need also to mention the local procurement regulatory framework that does not support efficient procurement of medicines and medical commodities.

My Ministry is critically analysing this situation and recommendation will be made to the relevant authorities in due course. Ladies and gentlemen, the envisioned long term interventions include luring medications manufacturers to come and set up shop in Botswana. Currently, the main challenge is that there are no medications manufacturing companies in Botswana.

12. As I have already, demonstrated, the subject of pharmaceutical shortage, is not just about procurement of such. It is also about disease prevention, early diagnosis and hence timely management of illnesses, and the rationale use of pharmaceuticals where required.

To reduce the volume, of people needing medications and impact on pharmaceutical shortage, my Ministry has decided to concentrate on Primary Healthcare revitalisation; this should reduce disease prevalence and hence the volume/quantity of medication required to manage diseases. I have therefore decided to improve on clinical case management.

13. This should introduce lifestyle changes and modifications that would prevent and minimise diseases and conditions such as obesity, diabetes, hypertension and complications of such diseases among others. Ladies and gentlemen, the art of medicine and clinical excellence is a lifelong learning and ongoing, self-motivated pursuit of knowledge and the application of such knowledge.

For this reason, I have decided to solicit the knowledge and experience of clinical expertise available in the country to expand and improve on clinical case management. Therefore, a number of specialists will soon be working with the Ministry to reduce various backlogs, provide guidance and mentoring of clinicians in the Public Sector.

14. Director of ceremonies, ladies and gentlemen, in-spite of all, I want to assure all Batswana that the issue of medications supply will remain our top priority. The current stock level at facilities show that we are stabilizing hence we anticipate a normal situation in future.

15. As a long term strategy, CMS will be using local framework contracts to manage procurement of medical commodities. To date two (2) framework tenders have been awarded which contain critical medicines. The third (3rd) framework tender is at cooling period while some are in progress. My Ministry will closely monitor availability of medicines and if there are challenges these will be addressed in a timely manner including as alluded above the engagement of international aggregators. My ministry remains committed to ensure that the nation receive medications in our facilities as prescribed. Surely, motlha ono o a heta.

16. Director of ceremonies, research has shown that the best yardstick to assess the quality of health care service is not customer satisfaction but customer experience. Challenges with supply of commodities contributed negatively to our customer’s experience.

As a Ministry that endeavours to transform customer experience, I cannot overemphasize the need for a motivated and well-resourced workforce. Mentorship is key to realising this goal.

My Ministry will work on a quality mentorship program that will not only give our customers a great experience but will have positive implications on our workforce’s career prospects. This is key to sustainability of everything I have deliberated on today.

17. I thank you for your attention ladies and gentlemen.