30 May 2017

Botswana: Govt Backtracks On 'Self-Injury' Directive

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(File photo).

Government has beat a hasty retreat hardly a month after the Ministry of Health and Wellness (MoHW) shocked many with an order that from April 01, state health facilities will no longer provide medical assistance to members of the public with "self-inflicted conditions".

A savingram dated 29th March 2017 titled: REMOVAL OF MEDICAL COVER FOR SELF INFLICTED HARM signed by the Permanent Secretary in the MOHW Shenaz El-Halabi announced the exclusion of "self-inflicted conditions" from free medical attention.

The tariff for self-inflicted harm as classified in the savingram include patients associated with drunken driving, riding motor bikes without a helmet, failure to use seat belts for self or children as passengers, participating in riots and other mass gathering involving violence leading to injury, lung cancer associated with tobacco and tobacco products use, attempted suicide related to alcohol or drug abuse. Under pressure from health practitioners, nurses, doctors and the general public the MoH quietly suspended the directive through a confidential savingram dated 12th May 2017 on the same issue.

Botswana Nurses Union (BONU), a trade union representing professional nurses, has lashed out at Government for the controversial decision. Nurses point out that as professionals they have vowed to assist clients without discrimination as encompassed in their Nurses' Pledge of Service. The pledge states that: "Nurses promise to care for the sick with all the skill and understanding they possess without regard to race, creed, colour, politics and social status sparing no effort to conserve life, alleviate suffering to promote health. And refraining from any action which might endanger life and health... "

Rejecting the directive, Secretary General of BONU Keoopetse Paphane, said in a statement; "we totally disagree with this proposal and we argue for it to be withdrawn not suspended as communicated".

Expressing concern on the decision by the Government, BONU contended that non-provision of needed medical attention or services to such category of people is nothing less than subjecting them to torture, inhuman and degrading treatment. "Further, we are of the view that the implementation of such proposal will be contravening Section 7 of the Constitution of Botswana, which provides inter alia that, No person shall be subjected to torture or inhuman or degrading treatment or punishment," said Paphane.

Further, Paphane said as a health professional-based union, they at all times promote and advocate for healthy living and lifestyle modification to reduce the scourge of non-communicable diseases. With the foregoing, nurses vow to at all times assist Government in her initiatives to fight alcohol and drug abuse, and in the same vein promote all other interventions put in place to reduce diseases.

However, the point of departure according to nurses is that "when people are denied services through a law or directives that would deny them access to health services in a discriminatory manner we are concerned and obviously do not support that". "We believe that every person is entitled to the same standard of health services without discrimination of any kind.

We also believe that contrary to the suggestion, people do not engage in social life to intentionally render themselves sick or unhealthy. People do not drink alcohol to intentionally have a Road Traffic Accident, in the same breath that people do not have unprotected sex to get HIV/AIDS, or eat unhealthy meat/ fatty-salty junk foods to intentionally suffer from hypertension or gout, obesity etc," said Paphane.

BCP sues MoHW

Hot on the heels of rejection from nurses and doctors, the opposition Botswana Congress Party (BCP) has through their lawyer Dutch Leburu dragged MoHW to court over the controversial Directive. They want court to dismiss the directive because it is unconstitutional, in breach of the Public Health Act and to declare it unlawful, null and void.

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