What Botswana can teach the world about solving a health crisis | Top countries

The Republic of Botswana recently made headlines for being the first nation in the world to detect the omicron variant of COVID-19 – a testament to the thoroughness of the country’s virus sequencing efforts. Although perhaps less visible, Botswana has recently made headlines as the first high-HIV-burden country to effectively eliminate mother-to-child transmission of HIV. Reaching this milestone means that this small nation with a high percentage of the population living with HIV (estimated at 20%) can now confidently look forward to raising an AIDS-free generation.

This is an extraordinary achievement, and we believe that understanding how it was accomplished provides insights that the developed world could take to heart as nations around the world – developed and developing – grapple with disparities. health issues that have been laid bare by the coronavirus pandemic.

In 1999, with the country ravaged by HIV and its future existence literally in doubt, Botswana embarked on an aggressive plan to reduce mother-to-child transmission of the virus. The Baylor College of Medicine International Pediatrics AIDS Initiative (BIPAI) and the Bristol Myers Squibb Foundation’s Secure the Future program were the first two partners in the country’s efforts to scale up its pediatric response to HIV. The BMS Foundation began its work in 2001 by providing funding and BIPAI providing scientific and medical expertise. In 2003, the Botswana-Baylor Children’s Clinical Center of Excellence was treating 1,200 children a year and training hundreds of medical professionals. This was at a time when there was skepticism about the possibility of effectively treating HIV-infected children in low- and middle-income countries, let alone doing so on a large scale.

It is important to note that this was a collaborative effort, a true public-private partnership and this partnership had several essential characteristics, without which we know success would not have been possible.

First, this initiative was not only tacitly supported by the highest levels of government, but actively driven by the highest ranks. In 2001, the then president of Botswana, former President Festus Gontebanye Mogae, told the United Nations General Assembly that the AIDS pandemic meant that his people were “Endangered,” and it was not hyperbole. When the country has acted, it has done so with 100% commitment at all levels of government, starting at the highest. What was at stake was life or death, for millions of individuals and for an entire nation.

Second, in developing and executing our plan, we ensured that everyone involved, especially the community, had a voice and a place at the table. We learned early on that having the science and delivery mechanism in place would not guarantee success unless there was a comprehensive community education program. As the first treatment launch to help break mother-to-child transmission, in addition to treating children infected with the virus, we needed trusted community partners to explain to mothers and grandmothers that there was of life at Baylor/BMS clinics. With stigma and mistrust being so high during this time, community support and education were as important as medical interventions.

Third, we had to develop an atmosphere of complete trust. We had to be transparent about what we were doing. There could be no hidden agendas anywhere. We needed to be able to have an uncomfortable discussion and continue to deliver quality results and progress at all levels of government and stakeholder partnership.

Fourth, every facet of our program had to be integrated with the existing health care infrastructure. We would not have succeeded, and we would not have achieved the sustainability of our programs, if we were seen as outsiders who showed up to replace what the country has already developed for its people.

All of these elements combined have created a rich, beautifully woven fabric that is large enough to touch the whole of society, strong enough to protect the most vulnerable, and dense enough to withstand over 20 years of constant use.

As a result, Botswana has achieved a public health victory that few would have believed possible when we first embarked on this mission. What began in 2001 in a two-room trailer on the grounds of Princess Marina Hospital in the city of Gaborone, Botswana – the continent’s first dedicated pediatric HIV/AIDS treatment program – is now a example for countries around the world of the possibilities of treating deadly diseases through determination, commitment and public-private partnerships based on these key principles that have guided us since our beginnings.

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