Botswana

Botswana is a landlocked country in southern Africa, bounded by South Africa, Zambia, Zimbabwe, and Namibia. The former British protectorate of Bechuananland emerged as an independent nation in 1966 and quickly became one of the most progressive countries in Africa. With an economic growth rate averaging nine percent a year since 1966, Botswana climbed from poverty to a middle-income state by the 1990s. At the same time, the country has been virtually crippled by the AIDS epidemic, with one in three Batswana infected.

The population is 1,816,000 and growing at 1.5 percent annually. Growth is driven by a high birth rate at 23.17 per 1,000 population and an influx of migrants, mainly from nearby Zimbabwe. The death rate is also high at 13.63 per 1,000 population. Median age is 20.9. Life expectancy, which in the 1980s had reached an average of 64 years, has dropped to 51.55 years for males and 49.58 years for females, and is expected to decline even further in the coming years. Over half of all Batswana live in urban areas. Gross national income is U.S. $5,180, with 24 percent living on U.S. $1 a day or less. The unemployment rate is 24 percent.

Communicable diseases are responsible for upward of 77 percent of all deaths in Botswana. Malaria is endemic in the northern regions. While sanitation in the urban areas is fairly good, with 100 percent access to clean water and 57 percent to sanitary waste facilities, it is far from adequate in rural areas, where only 90 percent have safe water and 23 percent use sanitary facilities. Waterborne and foodborne illnesses are common. Severe flooding in 2006 set off an epidemic of diarrheal infections. Tuberculosis is also a growing problem, with 553 cases per 100,000 people.

[Page 286]Nothing has had as great an impact on health in Botswana as the AIDS epidemic. The adult prevalence rate is 24 percent, giving the country the sec-ond-highest prevalence in the world, next to Swaziland. There are an estimated 270,000 Batswana living with the virus today, including 140,000 women and 14,000 children. AIDS-related deaths exceed 18,000. AIDS cases fill 60 percent of the country's hospital beds. The country has worked hard to check the growth of the disease and deal with those afflicted. About 85 percent of patients in need receive anti-retroviral drug therapy. Educational programs also seem to be paying off: In a 2006 Joint United Nations Programme on HIV/AIDS survey, 88 percent of men and 75 percent of women said they had used a condom during their last sexual encounter.

AIDS has created 120,000 orphans, a population that will only grow in the coming years. Infant and child mortality has risen since 1990, with 87 deaths per 1,000 in infants younger than 1 and 120 deaths per 1,000 in children aged 1–5. Most children do receive routine immunization and the chance to go to school.

Botswana earmarks 6.4 percent of its Gross Domestic Product on healthcare, spending about U.S. $206 per capita. There are 22 hospital beds per 10,000 people, and a wide variety of health facilities spread across the country. The medical community is small, with 715 physicians and 4,753 nurses in 2004. The government recognizes the need to recruit more medical staff, but is somewhat hampered by the lack of a national medical college.

...