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Botswana's healthcare system has been steadily improving and expanding its infrastructure to become more accessible. The country's position as an upper middle-income country has allowed them to make strides in univversal health access for all Batswana. The infant mortality and maternal mortality ratios have been on a steady decline as a result of the improvements that have been made. The majority of the country's 2.3 million inhabitants now live within five kilometers of a healthcare facility. The country's improving healthcare infrastructure has also been reflected in an increase of the average life expectancy from birth, with nearly all births occuring in healthcare facilities. Access to healthcare has not aleviated all of the country's healthcare concerns. Like many countries in Sub-Saharan Africa, Botswana is battling high rates of HIV/AIDS and infectious diseases.

Expenditure on health
Botswana's total expenditure on health is 5.4% of their GDP or $871 per person. Over the last five years, UNICEF estimates that the government has allocated 11% of their total budget on healthcare. In a 2016 health financing profile by the Health Policy Project, they found that Botswana's government funded 57% of the country's total healthcare expenditure. The vast majority of that funding came from mineral resource revenue which meant the government did not have to earmark any tax dollars for healthcare funding. 39% of the country's healthcare funding came from companies and individuals with donors only accounting for 7%. Historically, a lot of Botswana's healthcare funding came from donors as part of an international effort to combat the spread of HIV/AIDS in Africa. In recent years, these donations have decreased as the international effort to combat HIV/AIDS has slowed and Botswana has increased its internal revenue. The President's Emergency Plan For AIDS Relief (PEPFAP) has decreased its funding from $90 million in 2010 to $40 million in 2015. In 2016, funding was decreased again to $35 million with a set goal of continuing to decrease funding by $10 million per year.

Staffing
Botswana's physician density as of 2016 was 0.37 per 1,000 people.

Hospitals
Botswana has 26 hospitals spread across the country that are part of a three tiered system overseen by the Ministry of Health and Wellness. The first tier has 16 hospitals located in rural areas that each serve a maximum of 10,000 people. Each hospital has between 20 and 70 beds. The second tier is made up of seven district hospitals located in larger villages and cities. They have between 71 and 250 beds. The third tier has three referral based hospitals that are specialized. Botswana's hospital bed density as of 2010 is 1.8 beds per 1000 people.

Life expectancy
Life expectancy at birth in Botswana is 64 for men and 68 for women. The probability of dying under the age of five is 36.5 per 1,000 births and under the age of one it is 38 per 1,000 births. According to UNICEF, the high amount of hospital births, the high rate of death among young children points to a lack of quality of care for mothers and newborns. The probability of dying between 15 and 60 years is 294 per 1,000 people for men and 208 per 1,000 people for women.

Birth rate
Botswana's birth rate is 20.9 births per 1,000 people in 2020. Botswana has the 72nd highest birth rate in the world.

Maternal mortality ratio (MMR)
Botswana's maternal mortality ratio (MMR) in 2018 was 133.7 per 100,000 people. This was a decline from 143.2 per 100,000 people in 2017 and 156.6 per 100,000 people in 2016.

Infant mortality ratio (IMR)
Botswana's total infant mortality ratio (IMR) is 26.8 deaths per 1,000 live births. The gender break down has the male IMR at 29.2 deaths per 1,000 live births and the female IMR at 24.2 deaths per 1,000 live births. Botswana has the 66th highest IMR in the world.

Obesity
In 2016 18.9% of Batswana were obese. Botswana has the 114th highest rate of obesity in the world.

Malnutrition
In 2007, 11.2% of children under the age of 5 in Botswana were considered malnourished, up from 10.1% in 2000. As a result of malnourishment, 31.4% children under the age of 5 are stunted.

UNICEF estimates that only 1 in 5 babies are exclusively breastfed in their first 6 months and only 46% of children are given food as well as being breastfed at 6-9 months. These factors contribute to high rates of stunted growth and to Botswana's high rate of deaths for children under the age of 5.

HIV/AIDS
20.3% of Botswana’s adult population, ages 15 to 49, have HIV/AIDS.[3] This is down from 25% of the population in 2013.[22] This means Botswana has the fourth highest HIV prevalence in the world, after South Africa, Lesotho, and Eswatini.[3]

In 2018, Botswana had 8,500 new cases and 4,800 deaths from HIV/AIDS, down from the country’s peak of 18,000 deaths in 2002.[2][22]

Universal free antiretroviral treatment
The Botswana government was the first country in sub-Saharan Africa to provide universal free antiretroviral treatment to people that had tested positive for HIV/AIDS.[2] As a result, in 2018 85% of adults and 38% of children living with HIV/AIDS were on antiretroviral treatment.[3]

Women
Women have consistently been more impacted by HIV/AIDS. In 2016 the HIV/AIDS prevalence rate for adult women in Botswana was 26.3%. In contrast, the HIV/AIDS prevalence for men of the same age was 17.6%. Exposure to early sexual debuts, forced marriages and gender-based violence has made women in Botswana more vulnerable to HIV/AIDS. Botswana’s government has tried to address these inequities through increased social services for young women, investment in female economic empowerment and more effective HIV prevention programmes for girls. [3]

HIV and AIDS estimates in 2018 [23]
Adults and children living with HIV: 370,000 [330,000 - 400,000]

Adults aged 15 to 49 HIV prevalence rate: 20.3 [17.3 - 21.8]

Adults aged 15 and over living with HIV: 350,000 [320,000 - 380,000]

Women aged 15 and over living with HIV: 200,000 [180,000 - 220,000]

Men aged 15 and over living with HIV: 150,000 [140,000 - 170,000]

Children aged 0 to 14 living with HIV: 14,000 [10,000 - 17,000]

Deaths due to AIDS: 4,800 [4100 - 5,700]

Orphans due to AIDS aged 0 to 17: 65,000 [56,000 - 77,000]



Coronavirus disease 2019 (COVID-19)
Botswana had its first three confirmed cases of COVID-19 on 30 March, 2020 and one confirmed death from COVID-19 on 31 March, 2020. In response to the spread of COVID-19, Botswana closed their borders to everyone except Batswana and Botswana residents. Batswana and Botswana residents returning to Botswana from high risk countries were required to enter government mandated 14-day quarantine at government approved locations. All residents of Botswana are expected to remain at home unless they were performing government approved essential services. All people performing or transporting essential services were required to receive a COVID-19 travel permits from the Botswana government. The Botswana government declared a state of emergency starting April 3 until further notice.

Criticisms
Although Botswana has a relatively high healthcare worker density for the region, they are mostly concentrated in urban areas. The country is also grappling with a high rate of vacancies in health worker positions in multiple regions of the country. Botswana has been unable to retain internationally trained health workers which contributes to the high rate of vacancies. Associated with this problem is their dependence on migrant health workers and out-of-country training programs. A 2014 study on Botswana's human resources for health, found that the country must begin to attract and retain migrant health workers while also fostering domestic training programs. To avoid inequities in health services the government must also distribute the workforce in a way that will fill vacancies. A 2016 study found that there was a direct correlation between doctor and nurse density, and the mortality rate and loss-to-follow-up (LTFU) on individual patients. They found that increasing the doctor density from one to two doctors per 10,000 people decreased the predicted probability of death by 27%. Their proposed temporary solution is to redistribute healthcare workers equitably throughout the country.