24/07/2025
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BY Ketlhalefile F. C. Motshegwa
Minister of Local Government & Traditional Affairs
1.0 INTRODUCTION
Mr. Speaker, I rise to inform this Honourable House on the relocation of Primary Health Care (PHC) services from the Ministry of Health to the Ministry of Local Government and Traditional Affairs (MLGTA), pursuant to Government Gazette Extra Ordinary GN. NO 742 of 2024, dated 12th November 2024.
The decision forms part of Governments broader commitment to decentralisation of service delivery and realignment of sectoral functions to strengthen community level governance and bring services closer to the people.
2.0 BACKGROUND AND POLICY JUSTIFICATION
Mr. Speaker, the Ministry of Health structure provides for delivery of Primary Health Care services through both Primary hospitals and clinics. Under the new arrangement, clinics, along with public health and community-based programmes, have been transferred to Ministry of Local Government and Traditional Affairs, while Primary Hospitals remain under Ministry of Health.
3.0 This repositioning is consistent with the 1978 Declaration of Alma Alta which identifies Primary Health Care as a comprehensive, People-centered approach to health. Primary Health Care encompasses promotive, preventative, curative, rehabilitative and palliative services delivered as close as possible to peoples everyday environment.
4.0 Mr. Speaker, the 76th World Health Assembly held in May 2023, resolved to re-orient national health systems towards PHC as a foundation for Universal Health Coverage (UHC) health security and cost efficiency. In alignment with these global priorities, the Government of Botswana has adopted Primary Health Care as the cornerstone of its health strategy, affirming its relevance to community empowerment, equity and sustainability.
5.0 HISTORICAL INSTITUTIONAL ARRANGEMENTS
Mr. Speaker, Botswana adopted the PHC Strategy in 1978, operationalised jointly through the Ministry of Health and the Ministry of Local Government. Before April 2010, the Ministry of Health was solely responsible for national health policy formation and oversight while Ministry of Local Government and Traditional Affairs through District and Town Councils, provided community level health services, employed health workers and developed necessary infrastructure.
6.0 Mr. Speaker, all clinics, health posts and mobile stops were under Ministry of Local Government and Traditional Affairs, which also housed the Department of Primary Health Care Services for coordination of services in line with national policies. Thus, the current relocation is re-establishing and streamlining institutional roles in line with Botswanas decentralisation.
7.0 PRINCIPLES AND CONSENSUS GOVERNING THE TRANSFER
Mr. Speaker, to ensure a seamless transition, the Ministry of Health and Ministry of Local Government and Traditional Affairs agreed on key principles including:
Equitable distribution of resources (financial, human and infrastructural);
Protection of staff accommodation and office accommodation during the transition period;
Alignment of budget lines to operational needs;
Designation of PHC heads as Deputy Council Secretaries or Deputy Town Clerks;
A Phased approach to transfer staff from April 2025 to March 2026;
Cross Ministry career development, promotions and joint recruitment;
Centralised procurement of medicines through Central Medical Stores (CMS) complemented by local-level micro-procurement;
Outstanding grievances and dispute resolution are to be concluded by 31st March 2026.
8.0 PROGRESS TO DATE
8.1 Human Resources
Mr. Speaker, of the 17,838 employees at the Ministry of Heath, 8, 070 were identified for transfer. As of now 6,225 have received transfer letters. Shared resources such as, doctors, and pharmacy personnel will transition in Phase Two, which is re-scheduled to commence in July 2025.
Temporary personnel is currently used to maintain services, especially in critical areas. Plans are underway to absorb them into the permanent establishment, subject to resource availability.
To address staff concerns, a Joint Consultative Team has been set up to oversee the closure of outstanding cases which include 19 disciplinary cases, 57 disputes, 329 C band arrear cases and 3 court cases by Ministry of Health.
8.2 Infrastructure
Mr. Speaker, a total of 615 health facilities (98 clinics with maternity, 167 clinics without maternity and 350 health posts) 2,116 staff houses and 12 DHMT offices have been transferred. An additional 102 undeveloped plots across the country, 74 ongoing projects and 40 leased premises have also been handed over. A condition assessment needs is being undertaken and it includes, addressing widespread bat infestations.
8.3 Fleet
Mr. Speaker, the Ministry of Local Government and Traditional Affairs has received 584 vehicles and 3 boat ambulances from the Ministry of Health. More than 50% of these vehicles are in need of repair.
8.4 Budget
Mr. Speaker, an amount of Four Hundred and Ninety-Two Million, Seven Hundred and Sixty-Two Thousand, Two Hundred and Eighty P**a (P492, 762,280.00) has been transferred to Ministry of Local Government and Traditional Affairs for operations, and One Hundred and Fifty-Five Million P**a (P155 Million) for development projects. However, personnel emoluments for transferred staff are still being paid by Ministry of Health pending finalization of their transfer.
Mr. Speaker, discussions are ongoing regarding equitable sharing of the fuel budget, given that the Ministry of Local Government and Traditional Affairs now manages a significant portion of the fleet and incurs more transport related costs at the local level.
8.5 Medicine and Supplies
Medicines and Medical Commodities continue to be supplied by Central Medical Stores. However, stock-outs and underfunding of the drug vote remain a challenge. Ministry of Local Government and Traditional Affairs has been allocated P2.1 million for emergency procurement, for 2025/2026 financial year, an amount which remains inadequate.
8.6 Stakeholder Engagement
Consultation with staff and Trade Unions took place from 19th to 28th February 2025, followed by engagements with Council Secretaries, Ntlo ya Dikgosi, District Commissioners and Full Councils during the month of March 2025.
9.0 OUTSTANDING MATTERS
Mr. Speaker, outstanding matters include:
a) Full transfer of PHC programmes and donor funded Memorandum of Understanding;
b) Budget allocations associated with programmes and donor funded agreements;
c) Budget allocations associated with program
transfers;
d) Staff deployment of the above programmes, which is yet to be finalized.
10. CHALLENGES
Mr Speaker, the transition has not been without its difficulties and the following are challenges experienced:
a) Shortage of medicines;
b) Lack of pharmaceutical warehouse in some Districts;
c) Staffing gaps and delays in temporary employees remuneration;
d) Building facilities requiring urgent maintenance.
11. MITIGATIONS
Mr Speaker, to address these challenges, the following measures are being implemented:
a) E-pulse rollout, to improve management and
logistics of drugs;
b) Engagement with DPSM to fill critical positions and regularise temporary employment;
c) Facility condition assessment to inform infrastructure refurbishment costs and plans.
12. CONCLUSION
In conclusion, Mr Speaker, the relocation of Primary Health Care functions to the Ministry of Local Government and Traditional Affairs marks a significant milestone in Botswanas health sector reform and decentralisation agenda. Notable progress has been made in human resource deployment, facility handover, fleet management and budgeting.
However, the success of the transition hinges on addressing remaining bottlenecks, especially the transfer of the remaining personnel, resolution of grievances and adequate funding of essential services. Government remains committed to completing this transition by 31st March 2026, without compromising the quality of service delivery and the welfare of staff.
I thank you Mr. Speaker.