The following organisations feature prominently in Botswana:

African Comprehensive HIV/AIDS Partnerships (ACHAP)

This is a joint initiative between the Government of Botswana, the Bill & Melinda Gates Foundation, and the Merck Company Foundation/Merck & Co., Inc. to prevent and treat HIV/AIDS in Botswana. It is unique in that it is a public/private partnership in development. ACHAP’s focus is to support the goals of the government to decrease HIV incidence and significantly increase the rate of diagnosis and treatment of HIV/AIDS in Botswana by rapidly advancing prevention programmes, healthcare access, patient management and treatment of HIV. The partnership was formally announced on July 10 th 2000. Both donor foundations are dedicating $50 million over 5 years towards the project. Merck also donates two antiretroviral medicines for the treatment programmes.⁶

Bristol Myers Foundation

This organisation funds the KITSO⁷ programme which operates the first paediatric AIDS clinic in Africa. The clinic is based at Princess Marina Hospital and opened in June 2003.

 The World Health Organisation (WHO)

 The WHO is currently involved in a community health approach to palliative care for HIV/AIDS and cancer patients in Africa. This joint project - involving the five countries of Botswana, Ethiopia, Tanzania, Uganda and Zimbabwe - seeks to improve the quality of life of HIV/AIDS and cancer patients in sub-Saharan Africa by developing comprehensive palliative care programmes through a community health approach. The project contains four major elements: team building, situation analysis, needs assessment and action plans.

In its project report 2004, WHO noted that Botswana’s strengths lay in factors such as: the community home-based care programme; policies already in place (for care and support, for ARVs); and the commitment of government. Weakness included: the lack of trained human resources; lack of understanding of palliative care among health providers; inadequate capacity to train for palliative care; shortage of health professionals and social workers; increased burden of care/ burnout among caregivers; and an inadequate number of hospices, halfway houses and day care centres. Crucially, the report states;

Botswana has relatively more resources and better health infrastructure than the other countries involved in this project, but has not reached a health status in accordance with its level of resources.⁸

Botswana Network of AIDS Service Organisations (BONASO)

Non-governmental and community based organisations are invited to submit proposals to BONASO for review. BONASO assists in identifying innovative grass roots level ideas that may be scaled up or adopted in other communities.

There is no national hospice/palliative care body in Botswana and there are no known twinning arrangements.

President’s Emergency Plan for AIDS Relief (PEPFAR)

 During his state of the Union address in 2003, President Bush announced his PEPFAR initiative; this groundbreaking intervention encompasses HIV/AIDS activities in more than 75 countries and focuses on 15 countries worldwide – of which Botswana is one of 12 in Africa – to develop integrated care and treatment programmes (Table 3). Over the next 5 years, PEPFAR is donating a total of US $15 billion, of which 15% is earmarked for palliative care. This has dramatically changed the palliative care landscape in Africa, as bids for new initiatives are attracting the funding for implementation. Four main areas are targeted:

• prevention of HIV transmission
• treatment of AIDS and associated conditions
• palliative care for HIV infected individuals
• care for AIDS orphans and other vulnerable children

 Table 3
Countries of Africa involved in PEPFAR, the Diana, Princess of Wales memorial Fund (Diana Fund) and WHO projects

In 2004, Botswana was allocated $17.9 million to support a HIV/AIDS comprehensive treatment, care and prevention programme.⁹