US to deliver multi-billion Pula medical drug shipment to Botswana

Botswana is expected to receive a consignment of medical drugs worth US$100 million from the United States, with deliveries anticipated to begin any time and continue over the next three years.

Highly placed sources within the global health sector told Botswana Guardian that the US government maintains a strong affinity for Botswana, viewing it as a key strategic partner.

Botswana and the United States enjoy a longstanding strategic relationship, collaborating across sectors including trade, security, health, and investment.

The two countries also share membership in several major international institutions, such as the United Nations, the International Monetary Fund, and the World Bank.

Although details of the forthcoming consignment remain confidential, credit is being directed to President Advocate Duma Boko for persuading Washington to soften its stance after the administration of President Donald Trump announced sweeping aid cuts and increased tariffs on US trading partners.

Earlier this year, President Boko undertook a working visit to the US for the launch of Botswana’s first satellite, BOTSAT-1. His trip concluded with a meeting in Washington, DC, with US Secretary of State Marco Rubio, during which Boko raised the issue of Botswana’s critical shortage of essential medicines.

Secretary Rubio reportedly reaffirmed the importance of the US–Botswana strategic partnership, particularly in the realms of trade and regional security emphasising that national security cannot thrive where populations lack access to healthcare.

Upon his return, President Boko announced that he had successfully negotiated for the United States to maintain its support for both the President’s Emergency Plan for AIDS Relief (PEPFAR) and the African Growth and Opportunity Act (AGOA), despite earlier threats of reduction or withdrawal.

Botswana’s longstanding health diplomacy built over decades has played a pivotal role in enabling the country to overcome past public health crises, including the HIV epidemic. Besides the US regards Botswana as a partner of choice, focusing on key areas in the national interests of the United States.

For some years, one of the goals for US Department of State was aligning with the 2021 Interim National Security Strategy’s (NSS) focus on the US leadership role in global health and health security, including reducing the risk of communicable diseases and lowering the threat of pandemics.

It also adopts the NSS emphasis on promoting democracy, good governance, and human rights, both to improve the lives of Batswana and to blunt the influence of authoritarian actors.

The goal is aligned with the PEPFAR Botswana Country Operational Plan 2021, and is designed to achieve global health goals, including UNAIDS 95-95-95 by 2030.

This goal supports the Government of Botswana’s stated goals to reduce Trafficking in Persons (TIP), to combat Gender Based Violence (GBV), and to improve the participation of women in the political process.

The US decision to continue its foreign assistance to Botswana could have not come at a better time than now when the country is in dire need. In February this year the UN issued a statement headlined “Impacts of U.S. pause of foreign assistance on global AIDS programmes in Botswana.”

The statement showeed that prior to the US pause of foreign assistance, the Government of Botswana funded two thirds of its HIV response (approximately US$ 90 - 95 M).

The remaining costs were covered by the U.S Government (US$ 55 M via the U.S. President’s Emergency Plan for AIDS Relief, PEPFAR, and US$ 12M via the Global Fund to Fight AIDS, Tuberculosis and Malaria).

The pause and stop order will undermine Botswana’s ability to fully achieve UNAIDS’ 95-95-95 targets and the efforts to finding the missing 5-2-2 in Botswana. That means reaching an additional five percent of all people living with HIV with testing so they are aware of their HIV status; ensuring that an additional two percent of all people who are living with HIV and are aware on treatment and ensuring an additional two percent of all those aware of their status and on treatment have their viral load suppressed.

The pause in assistance would also take away safe spaces for key populations (KPs) and adolescent girls and young women (AGYW) and increase their vulnerability to HIV-related sigma and discrimination, gender-based violence, mental health problems and other related social ills and reduce access to early diagnosis and treatment for HIV which leads to health complications and higher default rates for treatment adherence which correlates to a lack of viral suppression.

UNAIDS consulted with a significant number of CSOs to establish the impact of the pause and stopped orders on the provision of services. Additionally, a task force set up by NAHPA and the Ministry of Health and co-chaired by UNAIDS met to establish a complete picture of disruptions not just for CSOs but also within MOH and NAHPA where a total of about 207 positions are funded by PEPFAR.

Most of the affected CSOs are those providing some services for key and vulnerable populations (AGYW, MSM, SW, PLWHIV). The government continues to provide services and encourages the affected CSOs to refer and link clients to government facilities.

While CSOs have been funded to provide demand creation activities, only three of those consulted have clinics or drop-in centres that were considered safe by the aforementioned population groups.

They offer HIV counselling and testing Services, ART dispensing, PrEP dispensing, adherence and psychosocial support, condom distribution and referral and linkages to other services. The stop order has led to the closure of these CSO clinics and drop-in centres and disrupted service delivery.

While Botswana’s government health facilities continue to operate and provide services, the Ministry of Health issued a press release on 29 January assuring Batswana living with HIV that the pause of US assistance will not affect the availability of ARVs as they are directly procured by the Government of Botswana.

This was followed by another press release on 6 February further assuring continuity of services. Through the Joint Oversight Committee, a task team will be established to monitor developments and ensure that HIV services are not disrupted, clients are referred and linked to care at government facilities and that CSO’s providing services will receive domestic funding.