source: Republic of Botswana (6/12/08): TAUTONA TIMES no 40 of 2008
The Weekly Electronic Press Circular of the Office of the President “Democracy, Development, Dignity and Discipline”
B3) 1/12/08: SPEECH BY H.E. THE FORMER PRESIDENT OF THE REPUBLIC OF BOTSWANA, MR. FESTUS G. MOGAE, AT A “BUSINESS COMBATING HIV AND AIDS” CONFERENCE ON WORLD AIDS DAY, Stockholm, Sweden
Director of Ceremonies, Distinguished Guests, Ladies and Gentlemen
1. It is an honour and privilege for me to be here with you today on World AIDS Day, a day when people around the world come together to renew their commitment to fight HIV and AIDS. First of December every year is a day when we wear our red ribbons to remind ourselves that AIDS has not gone away, but there is need to re-double our efforts.
2. I am grateful to my hosts - the International Council of Swedish Industry and the Swedish Industrial Metalworkers’ Union - for inviting me to this conference held under their Swedish Workplace HIV/AIDS Programme. I must state from the outset that I am delighted that your programme aims at contributing to the establishment and support of HIV and AIDS programmes at the workplace by engaging Swedish companies and their partners in Sub-Saharan Africa.
3. I also note with great satisfaction that you currently cooperate with 50 workplaces in Botswana, Kenya, South Africa, Tanzania, Uganda, Zambia and Zimbabwe to encourage the management and employees to work together to prevent the spread of HIV and AIDS, and assist those needing care, treatment and support.
4. It is befitting that the theme of this year’s World AIDS Day is LEADERSHIP and the sub-theme is Behaviour Change is my key responsibility to stop HIV and AIDS. There is no better time than now to encourage leaders at all levels to take action and lead from the front in the fight against the spread of HIV and AIDS.
5. You might be aware of the devastating effects the AIDS epidemic is having on the Sub-Saharan region. Sub-Saharan Africa is the most affected and infected in the world and its region of Southern African or the Southern African Development Community is the epicentre of the epidemic. Therefore, to us, World AIDS Day is something that is taken to heart and is on our minds every single day of the year.
6. Southern Africa remains disproportionately affected by the epidemic. In our nations are two thirds of the people living with HIV worldwide, and 90% of all infected children.
Although in some countries HIV prevalence rates have stabilised and started to decline, the levels are still too high. For example, 24% of adults in Botswana, 23% in Lesotho, 26% in Swaziland and 18% in South Africa are living with the virus.
7. However, we should acknowledge that in the 20 years since the commemoration of the first World AIDS Day in 1988, some achievement in the fight against HIV and AIDS have been made. Today, hope exists. Out of the 3 million people now on antiretroviral therapy worldwide, one million started therapy for the first time last year, and they did so in Africa. Today, in my country, Botswana, over 100,000 people are receiving antiretroviral therapy representing almost 95% of those in need.
8. Only 15 years ago no one in any country knew how to protect a baby from being infected with HIV if the mother was positive. Today in Botswana transmission of HIV to babies has reduced from 40% to 4% - a level comparable to that in developed countries, with much lower HIV prevalence.
9. I am proud to say that my country has recorded such significant gains. However, a lot remains to be done as new infections continue to occur. While we recognise the progress made in distribution of AIDS treatment, we must also acknowledge that HIV prevention remains a challenge. Despite significant efforts by African countries and growing financial flows from development partners, the response to the epidemic has failed to stop the occurrence of new infections and risky behaviour.
10. There were 1.9 million new HIV infections in sub-Saharan Africa in 2007. One may ask why have prevention efforts lagged behind? This has been attributed to several social factors such as number of multiple concurrent sexual partnerships, intergenerational sex, high mobility, limited prevalence of male circumcision and inconsistent condom use. Perhaps more than anything, insufficient ownership of the response has delayed meaningful results.
Greatest leadership challenge
11. AIDS represents the greatest leadership challenge of our time. The United Nations General Assembly, in its June 2006 Declaration on HIV/AIDS, emphasised that legal, regulatory and political barriers in member countries continue to block peoples’ access to effective prevention, care and treatment programmes.
12. This brings me to the crux of my presentation today and the theme of this year’s World AIDS Day – LEADERSHIP. Our presidents, parliamentarians, health ministers, religious, social and traditional leaders have great influence on public opinion about HIV and AIDS.
13. As decision-makers, they can encourage informed debate on issues related to HIV and AIDS. As lawmakers, they can design, adopt and oversee the implementation of legislation that protects human rights and advance effective HIV prevention. As guardians, they can ensure that appropriate funding is steered towards evidence-based interventions, and that government commitments on HIV and AIDS are respected.
14. During the International AIDS Conference in Mexico City early this year, a new initiative aimed at influencing the involvement of the top leadership in African countries was launched. I have the honour to be leading this initiative. Our aim is to advocate for new and innovative approaches to prevention in Sub-Saharan Africa. The initiative is called the Champions for an AIDS-Free Generation.
15. The Champions are an impressive group of former African presidents and some eminent personalities that include former presidents Joaquim Chissano of Mozambique, Benjamin Mkapa of Tanzania and Dr. Kenneth Kaunda of Zambia. Others are Archbishop emeritus and Nobel Laureate Desmond Tutu, South African Supreme Court of Appeals Justice Edwin Cameron and Professor Miriam Were, chair of the Kenyan National AIDS Control Council and Ethiopian supermodel and WHO goodwill ambassador Liya Tafese Kebede.
16. During the launch in Mexico, Justice Cameron made a profound statement to the media that: “Stronger, more visionary and outspoken leadership must come from the continent most affected by this epidemic.” His statement summed up what the Champions are all about.
17. Through collective experience, integrity and broad-based knowledge, the Champions hope to inspire African leaders to intensify evidence-informed responses to the epidemic to tackle HIV/AIDS in their communities and countries.
18. With a focus on proven HIV prevention practices, the Champions will speak freely and independently about the issues that need to be discussed, both publicly and behind the scenes. We will advocate for better policies, laws and practices that facilitate, rather than hinder effective responses to the HIV/AIDS epidemic. We will reinforce best practices in the region and highlight progress being made in countries visited.
19. The Champions will primarily target high-level leadership within and among the countries of Sub-Sahara Africa, including business leaders and the workers. Business is an essential partner in the response to HIV and AIDS. Involvement of the private sector is crucial to the success of any country's efforts against the epidemic. Employers have the responsibility to protect their most valuable input, the workers, from HIV infection.
20. One of the most effective ways of doing this is through the implementation of policies and programmes that seek to eliminate unfair discrimination in the workplace, promote prevention and innovative ways of managing HIV in the workplace. Eliminating stigma will encourage workers to voluntarily test to know their status and make prevention easier to deal with.
21. Let me cite an example of exemplary business leadership in the response to HIV and AIDS in Botswana. Botswana’s main diamond mining company, Debswana, which is also one of the largest employers in Botswana, has taken a deliberate decision to assist its employees. The company administers antiretroviral therapy to its employees free of charge.
22. They have expanded the programme and now employees’ spouses and children under 21years also have access to free testing and treatment. The company has been able to demonstrate a drop in AIDS-related deaths among its employees since beginning of the programme.
23. I must say I am also impressed and encouraged by the cooperation that exists between the International Council of Swedish Industry and the Swedish Industrial Metalworkers’ Union.
24. This is a demonstration of business leadership working with the workers for the benefit of both the company and the workers. Such best practices should be highlighted and extended to more companies in Botswana and other countries. Leadership means taking a socially-responsible stand in protecting your community and communities where you are conducting business.
25. Leadership against HIV and AIDS must continue and grow from strength to strength. We must, individually and collectively, continue to speak up openly about HIV and AIDS. We must tackle both the direct risk behaviours, and the indirect causes that lie deep-rooted in societies. We must not blame or judge, but support and encourage each other, so that together we can achieve our goal of an AIDS-Free Generation.
26. When I received my Mo Ibrahim award in Egypt last month, I pledged to continue to contribute to the fight against HIV and AIDS. I repeat that pledge before you today. I thank you.
Saturday, December 6, 2008
Remarks by His Honour the Vice President of the Republic of Botswana, Lt. General Mompati S. Merafhe, MP, at the launch of the Organ Donor Trust Fund
source: Republic of Botswana (6/12/08): TAUTONA TIMES no 40 of 2008
The Weekly Electronic Press Circular of the Office of the President “Democracy, Development, Dignity and Discipline”
B4) 3/12/08: REMARKS BY HIS HONOUR THE VICE PRESIDENT OF THE REPUBLIC OF BOTSWANA, LT. GENERAL MOMPATI S. MERAFHE, MP, AT THE LAUNCH OF THE ORGAN DONOR TRUST FUND:
[Salutations]…Ladies and Gentlemen;
1. I am very delighted and proud to be here this evening to launch the Organ Donor Trust Fund.
2. It has become increasingly clear that as a Government, we are faced with a difficult challenge of dealing with requests to cover medical expenses for citizens in need of organ transplants. While the dignity of life of our people forms one of the cornerstones of our vision, recognising and acting to pursue this vision and balancing that against the ever increasing national health budget is a mammoth challenge facing Government. As a matter of fact, the current financial resource constraints and high cost of specialised health care services have made it difficult for Government to sustain expenditure on referrals for major organ transplants, such as for the liver, heart and kidney.
3. To assist the Government in addressing this critical challenge an Organ Donor Trust Fund Committee was recently constituted by the Minister of Health. This Committee will assist the Government through the Ministry of Health to raise funds for the exclusive coverage of medical costs for patients in need of organ transplants. I am pleased to present to you the members of this Committee and they are:
• Mr. Satara Dada, Chairperson
• Mr. Kagiso Mmusi, Member
• Mr. Igbal Chand, Member
• Mr. Peter Stevenson, Member
• Dr. Kolaatamo Malefho, Member.
In their various capacities these gentlemen are men of courage who have distinguished themselves in service to this nation.
4. I would like to take this opportunity to express my profound gratitude to them for having answered the call to serve the nation in this very important assignment. Among other core functions the Committee will perform the following:
• To raise community awareness about issues related to Organ Transplant, with special emphasis on cost implications. • To scale-up fund-raising to assist Government and patients in need of Organ Transplant. • To develop strategic partnerships with potential donors locally and internationally and carry out any other duties to advance the cause for Organ Transplant
5. Directors of Ceremonies, major organs that are commonly covered by transplant programmes include kidneys, heart, liver, lungs, bone marrow, pancreases and intestines; while minor ones are the cornea, bone marrow and skin. Of these, the kidney transplant is the most common worldwide.
6. Research results about transplants undertaken in western countries and in the region indicate that the rate of chronic kidney failure is approximately 80 people in (1) one million per annum in societies such as ours. This suggests that 100 to 120 patients in Botswana may come for medical attention each year with chronic renal failure.
7. Not all these cases though will be candidates for organ transplant. Old age, major medical conditions such as diabetes, hypertension and the presence of HIV and AIDS infection may not be candidates for transplants although they remain challenges in health care delivery.
8. One may ask the question “where are we going to get the organs?” In developed countries, where the concept of “organ donation” is widely accepted and services well established, cadaver organs are a major source of transplanted kidneys.
9. Cadaver donation occurs when a patient at the penultimate moment of his/her life graciously pledges an organ which becomes available at short notice and needs to be used at once. Donors of these are usually young adults.
10. Ladies and Gentlemen, there are of course medical and ethical issues to be addressed; for example, how are we going to convince people to accept these new life saving programmes. Usually, organ donation is requested on non-conditional basis. This means that neither the donor nor their family can have any influence over who receives the organ. Donors are also not expected to specify the recipient on the basis of sex, age, religion, race or nationality.
11. Consent is another issue to be addressed. In many countries, people who wish their organs to be used after their death to save lives will carry a purpose-designed “organ donor card” in their purse or wallet together with their driver’s licence. In other countries the consent is reflected in the national identity card. As Batswana we are still to make up our minds about the options to adopt for use in our country.
12. Directors of Ceremonies, it is important to appreciate that the costs of Organ Transplant vary with the clinical diagnosis and condition of the patient; the pre-operative complications and the complexity of the surgery; the organ and the post-operative treatment regime. For example, bone marrow transplant can cost R12000.00 (twelve thousand Rands), while a liver transplant will require between R200,000 (two hundred thousand) and 500,000.00 (five hundred thousand Rands) at South African medical centres. These are conservative figures based on the assumption that there will be no complications in the operation.
13. A series of post-operative complications can result in a lengthy stay in the Intensive Care Unit (ICU) with major cost implications.
14. Some conditions such as heart transplants are even more expensive. Indeed, there are many other secondary charges I have not highlighted such as the costs of haemodialysis which can be as high as P250, 000.00 (two hundred and fifty thousand Rands) in one year for a single patient.
15. Directors of Ceremonies, it is important to note that the provision of services for transplant surgery involving kidneys, livers, lungs and hearts are highly specialised endeavours. The critical mass of expertise needed includes the full range of services provided by highly trained physicians in renal medicine, hepatology, pulmonary medicine and cardiology.
16. At present we do not have any of these specialist units in our facilities. Therefore, for Batswana to access organ transplants there are two possible ways to achieve this for now:
• Either to refer patients to already existing and functioning organ transplant programmes in other countries, especially South Africa; or
• To initiate a programme of providing these services in our country.
17. The latter is a medium to long-term strategy and requires development of specific legislative instruments as well as availability of specialized equipment and human resources. I must however, indicate that some simple transplant procedures such as skin and corneal transplants can be suitably performed in Botswana. The choice to continue doing donor kidney transplants in South Africa may be the feasible option because we are getting good results. This option would require the following interventions, among others:
• The commitment of Government to fund or establish haemodialysis in Botswana;
• Government-to-government agreement to allow South African organs to be implanted into Batswana;
• Government of Botswana’s commitment to fund supply of organs to selected South African transplant centres; • Arranging air ambulance flights to carry organs at short notice;
18. Government is in the process of developing legislation to address issues around organ transplants. The real issue here is the escalating costs and sustainability of such a programme. The Ministry of Health continues to look at various ways of financing health care programmes in this country, and the range of services that can be provided in Government, Missions and Mine hospitals.
19. Directors of Ceremony, before I conclude, I must thank Mme Mma Motsumi for appointing the Organ Donor Trust Fund Committee. Minister, our expectation is that your office will give this Committee the necessary support to facilitate the smooth running of the Trust.
20. I have no doubt that the Committee members we are parading at this launch will be equal to the task in discharging the onerous responsibility bestowed on them.
21. In conclusion allow me to officially launch the Organ Donor Trust Fund. I thank you all for the courtesy of your attention. PULA!
The Weekly Electronic Press Circular of the Office of the President “Democracy, Development, Dignity and Discipline”
B4) 3/12/08: REMARKS BY HIS HONOUR THE VICE PRESIDENT OF THE REPUBLIC OF BOTSWANA, LT. GENERAL MOMPATI S. MERAFHE, MP, AT THE LAUNCH OF THE ORGAN DONOR TRUST FUND:
[Salutations]…Ladies and Gentlemen;
1. I am very delighted and proud to be here this evening to launch the Organ Donor Trust Fund.
2. It has become increasingly clear that as a Government, we are faced with a difficult challenge of dealing with requests to cover medical expenses for citizens in need of organ transplants. While the dignity of life of our people forms one of the cornerstones of our vision, recognising and acting to pursue this vision and balancing that against the ever increasing national health budget is a mammoth challenge facing Government. As a matter of fact, the current financial resource constraints and high cost of specialised health care services have made it difficult for Government to sustain expenditure on referrals for major organ transplants, such as for the liver, heart and kidney.
3. To assist the Government in addressing this critical challenge an Organ Donor Trust Fund Committee was recently constituted by the Minister of Health. This Committee will assist the Government through the Ministry of Health to raise funds for the exclusive coverage of medical costs for patients in need of organ transplants. I am pleased to present to you the members of this Committee and they are:
• Mr. Satara Dada, Chairperson
• Mr. Kagiso Mmusi, Member
• Mr. Igbal Chand, Member
• Mr. Peter Stevenson, Member
• Dr. Kolaatamo Malefho, Member.
In their various capacities these gentlemen are men of courage who have distinguished themselves in service to this nation.
4. I would like to take this opportunity to express my profound gratitude to them for having answered the call to serve the nation in this very important assignment. Among other core functions the Committee will perform the following:
• To raise community awareness about issues related to Organ Transplant, with special emphasis on cost implications. • To scale-up fund-raising to assist Government and patients in need of Organ Transplant. • To develop strategic partnerships with potential donors locally and internationally and carry out any other duties to advance the cause for Organ Transplant
5. Directors of Ceremonies, major organs that are commonly covered by transplant programmes include kidneys, heart, liver, lungs, bone marrow, pancreases and intestines; while minor ones are the cornea, bone marrow and skin. Of these, the kidney transplant is the most common worldwide.
6. Research results about transplants undertaken in western countries and in the region indicate that the rate of chronic kidney failure is approximately 80 people in (1) one million per annum in societies such as ours. This suggests that 100 to 120 patients in Botswana may come for medical attention each year with chronic renal failure.
7. Not all these cases though will be candidates for organ transplant. Old age, major medical conditions such as diabetes, hypertension and the presence of HIV and AIDS infection may not be candidates for transplants although they remain challenges in health care delivery.
8. One may ask the question “where are we going to get the organs?” In developed countries, where the concept of “organ donation” is widely accepted and services well established, cadaver organs are a major source of transplanted kidneys.
9. Cadaver donation occurs when a patient at the penultimate moment of his/her life graciously pledges an organ which becomes available at short notice and needs to be used at once. Donors of these are usually young adults.
10. Ladies and Gentlemen, there are of course medical and ethical issues to be addressed; for example, how are we going to convince people to accept these new life saving programmes. Usually, organ donation is requested on non-conditional basis. This means that neither the donor nor their family can have any influence over who receives the organ. Donors are also not expected to specify the recipient on the basis of sex, age, religion, race or nationality.
11. Consent is another issue to be addressed. In many countries, people who wish their organs to be used after their death to save lives will carry a purpose-designed “organ donor card” in their purse or wallet together with their driver’s licence. In other countries the consent is reflected in the national identity card. As Batswana we are still to make up our minds about the options to adopt for use in our country.
12. Directors of Ceremonies, it is important to appreciate that the costs of Organ Transplant vary with the clinical diagnosis and condition of the patient; the pre-operative complications and the complexity of the surgery; the organ and the post-operative treatment regime. For example, bone marrow transplant can cost R12000.00 (twelve thousand Rands), while a liver transplant will require between R200,000 (two hundred thousand) and 500,000.00 (five hundred thousand Rands) at South African medical centres. These are conservative figures based on the assumption that there will be no complications in the operation.
13. A series of post-operative complications can result in a lengthy stay in the Intensive Care Unit (ICU) with major cost implications.
14. Some conditions such as heart transplants are even more expensive. Indeed, there are many other secondary charges I have not highlighted such as the costs of haemodialysis which can be as high as P250, 000.00 (two hundred and fifty thousand Rands) in one year for a single patient.
15. Directors of Ceremonies, it is important to note that the provision of services for transplant surgery involving kidneys, livers, lungs and hearts are highly specialised endeavours. The critical mass of expertise needed includes the full range of services provided by highly trained physicians in renal medicine, hepatology, pulmonary medicine and cardiology.
16. At present we do not have any of these specialist units in our facilities. Therefore, for Batswana to access organ transplants there are two possible ways to achieve this for now:
• Either to refer patients to already existing and functioning organ transplant programmes in other countries, especially South Africa; or
• To initiate a programme of providing these services in our country.
17. The latter is a medium to long-term strategy and requires development of specific legislative instruments as well as availability of specialized equipment and human resources. I must however, indicate that some simple transplant procedures such as skin and corneal transplants can be suitably performed in Botswana. The choice to continue doing donor kidney transplants in South Africa may be the feasible option because we are getting good results. This option would require the following interventions, among others:
• The commitment of Government to fund or establish haemodialysis in Botswana;
• Government-to-government agreement to allow South African organs to be implanted into Batswana;
• Government of Botswana’s commitment to fund supply of organs to selected South African transplant centres; • Arranging air ambulance flights to carry organs at short notice;
18. Government is in the process of developing legislation to address issues around organ transplants. The real issue here is the escalating costs and sustainability of such a programme. The Ministry of Health continues to look at various ways of financing health care programmes in this country, and the range of services that can be provided in Government, Missions and Mine hospitals.
19. Directors of Ceremony, before I conclude, I must thank Mme Mma Motsumi for appointing the Organ Donor Trust Fund Committee. Minister, our expectation is that your office will give this Committee the necessary support to facilitate the smooth running of the Trust.
20. I have no doubt that the Committee members we are parading at this launch will be equal to the task in discharging the onerous responsibility bestowed on them.
21. In conclusion allow me to officially launch the Organ Donor Trust Fund. I thank you all for the courtesy of your attention. PULA!
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