Botswana is a country with an approximate area of 582 thousand sq. km. (UNO, 2001). Its population is 1.795 million, and the sex ratio (men per hundred women) is 97 (UNO, 2004). The proportion of population under the age of 15 years is 39% (UNO, 2004), and the proportion of population above the age of 60 years is 4% (WHO, 2004). The literacy rate is 76.1% for men and 81.5% for women (UNESCO/MoH, 2004).
The country is a higher middle income group country (based on World Bank 2004 criteria). The proportion of health budget to GDP is 6.6%. The per capita total expenditure on health is 381 international $, and the per capita government expenditure on health is 252 international $ (WHO, 2004). The main language(s) used in the country is (are) English and Setswana (official). The largest ethnic group(s) is (are) Setswana speaking tribes. The largest religious group(s) is (are) Christian. The life expectancy at birth is 40.2 years for males and 40.6 years for females (WHO, 2004). The healthy life expectancy at birth is 36 years for males and 35 years for females (WHO, 2004).
Ben-Tovim and Cushnie (1986) ascertained the one-year prevalence of schizophrenia among individuals aged 15 years or older living in six villages in a remote area of Botswana. All cases were diagnosed independently by two experienced psychiatrists, following ICD-9 rubrics. DSM-III criteria were also applied, separately. Accurate contemporary population estimates of the villages were available.
The age-adjusted prevalence of schizophrenia was 5.3 per 1000 in terms of ICD-9, or 4.3 per 1000 by DSM-III, which has an upper age limit for onset of 45 years. Ben-Tovim (1983, 1985) encountered substantial psychiatric morbidity in primary level psychiatric care facilities in Botswana, but he found that acute psychoses and culture-bound syndromes were rare. Lobatse Mental Hospital reports indicate that acute psychotic conditions are a common cause of admissions. Almost 18% of admissions at the main national referral hospital were HIV positive (Sidandi et al, 2004). Ben-Tovim and Boyce (1988) compared patient profiles in psychiatric hospitals of Botswana and South Australia. The patients in Botswana in comparison to Australia had shorter duration of illness, were likely to suffer from psychotic illnesses rather than personality and neurotic illnesses and were more likely to suffer from violence against property or others rather than self. A few articles on sexual behaviour and HIV and wife abuse were also accessible (Herring, 2001; Mmidi & Delmonico, 2001; Maundeni, 2002).
MENTAL HEALTH RESOURCES
Mental Health Policy A mental health policy is present. Details about the year of formulation are not available.
Substance Abuse Policy A substance abuse policy is present. Details about the year of formulation are not available. The plan to develop a substance abuse policy is in the advanced stage.
National Mental Health Programme A national mental health programme is present. The programme was formulated in 1992. Plans are under way to have the programme evaluated.
National Therapeutic Drug Policy/Essential List of Drugs A national therapeutic drug policy/essential list of drugs is present. It was formulated in 1992. Revision of the policy is under way.
Mental Health Legislation The mental disorders act is under revision and will be soon replaced by the Mental Health Act of Botswana. The latest legislation was enacted in 1971.
Mental Health Financing There are budget allocations for mental health. The country spends 1% of the total health budget on mental health. The primary source of mental health financing is tax based. The country does not have disability benefits for persons with mental disorders.
Mental Health Facilities Mental health is a part of primary health care system. Actual treatment of severe mental disorders is available at the primary level. Regular training of primary care professionals is carried out in the field of mental health. In the last two years, about 343 personnel were provided training. Facilities for training community mental health nurses is present. It is an 18 months post-basic course which teaches nurses to function effectively in the community, district and tertiary psychiatric hospitals. The training is comprehensive. There are community care facilities for patients with mental disorders. Community care is mainly provided by family welfare educators based in primary care facilities. A community mental health nurse can provide all aspects of mental health and psychiatric nursing as well as render promotional, preventive, therapeutic and rehabilitative mental health services. They also provide consultative services due to the lack of trained psychiatrists and also train other non-specialized colleagues in the field of mental health.
Psychiatric Beds and Professionals
Total psychiatric beds per 10 000 population
Psychiatric beds in mental hospitals per 10 000 population
Psychiatric beds in general hospitals per 10 000 population
Psychiatric beds in other settings per 10 000 population
Number of psychiatrists per 100 000 population
Number of neurosurgeons per 100 000 population
Number of psychiatric nurses per 100 000 population
Number of neurologists per 100 000 population
Number of psychologists per 100 000 population
Number of social workers per 100 000 population
One neurologist visits from South Africa. There are 821 family welfare educators, 9 occupational therapists and 6 occupational therapy assistants.
Non-Governmental Organizations NGOs are involved with mental health in the country. They are mainly involved in advocacy, promotion, prevention and rehabilitation. Research is also an activity of NGOs.
Information Gathering System There is mental health reporting system in the country. The country has data collection system or epidemiological study on mental health.
Programmes for Special Population There are no services for special population groups.
Therapeutic Drugs The following therapeutic drugs are generally available at the primary health care level of the country: carbamazepine, phenobarbital, phenytoin sodium, sodium valproate, amitriptyline, chlorpromazine, diazepam, fluphenazine, haloperidol, lithium, biperiden, carbidopa, levodopa.