TDA Botswana HIV and AIDS
Okavango River Basin Transboundary
Diagnostic Assessment (TDA): Botswana
Component
A Socio-Economic Profile of River
Resources and HIV and Aids in the
Okavango Basin, Botswana
B. N. Ngwenya
Harry Oppenheimer Okavango Research Centre
May 2009
1
TDA Botswana HIV and AIDS
OKAVANGO RIVER BASIN TRANSBOUNDARY
DIAGNOSTIC ASSESSMENT (TDA): BOTSWANA
COMPONENT
Final Report
A SOCIO-ECONOMIC PROFILE OF RIVER RESOURCES AND
HIV AND AIDS IN THE OKAVANGO BASIN, BOTSWANA
Report prepared by B. N. Ngwenya
Harry Oppenheimer Okavango Research Center, University of
Botswana
Coordinated by L. Magole
July 2009
2
TDA Botswana HIV and AIDS
Executive summary
Livelihood/income diversification multi-local residences and migration characterize
human adaptation to flood/climate variability in the Okavango basin. Arable and
livestock farming, formal employment, government social safety nets, remittances
and fishing, constitute key sources of livelihood for a significant proportion of the
Delta population. Although arable agriculture is primarily dryland or rain-fed and less
dependent on drawing water from the Okavango River, it still remains the key food
system. There is limited, if any, commercial irrigation based arable farming. Molapo
farming (flood recession) along the Okavango River seasonal flood plains, although
hailed by most farmers as the most productive food system, faces tenure rights and
other legislative challenges. There is ample evidence that variability of livelihood and
or food systems of Okavango basin residents' speaks to local adaptations to
variability in flood regimes/cycles. Key transboundary issues therefore are that, in
order for the pristine status quo of water resources in the Okavango basin under
high/low flood scenarios, much will depend very much on how, communities/
households on the one hand, adapt contemporaneously or will adapt over time. On
the other hand, the effectiveness of local adaptation is determined by national
policies/programs. Government interventions can either capacitate or incapacitate
strategies depending on whether there is flexibility to address evolving impacts of
flood variability on dynamic interconnectedness between water and non water
livelihoods. The integrity of Okavango Delta water as natural resources cannot be
treated in isolation from other symbiotic natural resources based livelihoods/food
systems.
Gender, water resources and poverty dynamics in the Okavango basin indicate that
men and women are constrained in different and often unequal ways as potential
participants or beneficiaries' water resources. One direct water related resource that
cuts across age and gender is fishing. Whereas generally some natural resourced
based livelihood activities in the are gender specific, others cut across age and
gender. Under conditions of stress however, `resource use often redefines traditional
gender roles to include `gendered switching' and commercialization.' The majority of
households in gazetted settlements draw potable water from communal standpipes,
those in ungazetted settlement abstract untreated water from river flows and hand-
dug wells when the river is not flowing. Unreliability of water-supply and distance
from homesteads has resulted in men with donkey carts dominating collecting water
in ungazetted settlements in the Delta. Gender interacts with other dynamics that
include, household structure and asset profile (wealth and poverty levels).
Unfortunately, headcount poverty rate in Ngamiland is very severe (40% and 50%) in
Ngamiland east and Ngamiland west respectively. Furthermore, Ngamiland west has
high proportion of women headed households with low levels of human capital
development. Studies from elsewhere indicated that women tend to benefits different
from men in the fishing industry (marketing and processing). Building on work
already done by the BIOKAVANGO Project, the feasibility of transboundary
aquaculture projects in the three riparian countries should be considered. This
should be done in tandem with gender analysis that critically examines dimensions
of poverty with the view of formulating pro-poor, pro-growth small/medium program.
The key issues being that assuming that gender roles at trans-boundary level cannot
be assumed to be fixed. This assumption can result in intervention that would miss
the dynamics of water and other interactive natural resource utilization, such as,
consequently lead to inappropriate policies or programs in the Okavango Basin.
Although as a country, Botswana has comprehensive HIV and AIDS policies and
reasonably resourced national programs intervention aimed at disease prevention,
3
TDA Botswana HIV and AIDS
support and mitigation HIV Prevalence, incidence, trends and access is sues still
remain a challenge. New challenges include the number of HIV positive individuals
is expected rise and there will be a gradual spread of the HIV virus across districts. In
Ngamiland the surging rates of new infections is around 4.76%. Delivery of AIDS
services faces some challenges regarding access. Approximately 36% of the districts
populations are > 60km from an ARV clinic. Whereas planned infrastructural and
institutional developments in the Delta would enhance access to HIV related
services, the down side of these is that these changes are also likely to lead to
increased cross boundary migration which inadvertently increased risk of exposure to
HIV transmission.
The link between HIV and AIDS and natural resource based livelihood has been
neglected. Whereas the revised National Policy on HIV and AIDS (2006) has put
some sectors in the fore-front, the role of natural resource based sectors such as
agriculture; fisheries, water and CBNRM were not clearly defined in the National
Policy on HIV/AIDS. Case studies from four key water related sectors suggest that
the impact of AIDS on these sectors is verifiable, but in general, natural resource
institutions (NRM) or managers approach to HIV and AIDS have been inward looking
with regard to addressing the problem, their program interventions have shifted away
from hard realities of AIDS to soft targets around "wellness" in the workplace. A case
study of a viable government/safari HIV outreach partnerships is discussed in the
context of policy and program partnerships in the basin. HIV is a human crisis. It is
not easy therefore to link funding HIV interventions with natural resource
management projects/programs. However, government/private partnerships
transboundary project akin to the one spear headed by Kalahari Conservation
Society (with Safari Operators) between Botswana, Angola and Namibia.
Evidence from several Sentinel Surveillance Reports, the Botswana AIDS Impact
Survey II (BAIS 2004) and III (BAIS 2009) indicate that Francistown Kasane; or the
Francistown - Selebe - Pikwe trade routes, seems to be HIV transmission pathway.
Opening up the Maun-Shakawe Mohembo trade route could mean manufacturing
another HIV transmission conveyer belt The health needs of those people involved in
cross-border trade, as well as those people who offer services to these people, such
as sex workers.
Although there are numerous HIV and AIDS Program interventions, there are key
ones whose challenges have transboundary implication. Focus has been given to
three key intervention AIDS programs in Botswana. These are antiretroviral therapy
(ART) roll-out, prevention of transmission from mother to child (PMTCT), Sexually
Transmitted infections. With regard to ART, there are concerns over primary and
secondary resistance to ARVs, mothers and access to Dry Blood Spot (DBS) of HIV
children born HIV positive, changes in normative behaviors of long term survivors of
ARVs and long term monitoring of virologic failures. With regard to PMTCT, it is poor
male involvement in PMTCT. Pregnancy predisposes a woman to increased risk of
exposure to infection. Another challenge has to do with pressure on women to bear
children. More than 80% of HIV positive women and over 90% of women on HAART
reported having more than one pregnancy. STIs facilitate HIV transmission by
increasing both infectious and HIV susceptibility. The expansion of STI surveillance
system in border crossings and high transit sites is urgent. AIDS interventions are
dynamic in relation to human behavior. These dynamics include mortality, default,
extended survival, demographic shifts, prevalence and incidence. All these factors
have transboundary implications vulnerability to flood/climate variability for some
social groups
4
TDA Botswana HIV and AIDS
5
TDA Botswana HIV and AIDS
Contents
Executive summary ...................................................................................................................................... 3
Chapter 1: A socioeconomic profile of River Resources and HIV and AIDS in the Okavango
Delta ............................................................................................................................................................. 9
1.0 Introduction: ....................................................................................................................................... 9
1. 01. Methodology ................................................................................................................................ 11
1.1 Livelihood diversification and adaptation to variability .................................................................. 12
1.1.1 Migration and adaptation to shocks ............................................................................................. 12
Figure 1.1 Livelihood activities in five villages (Source: Kgathi et al, 2004)Error! Bookmark not defined.
Chapter 2 Gender and poverty context of access natural resources in the Okavango Basin .................. 16
2. 0 Introduction: gender relations in NRM in Botswana ....................................................................... 16
2.1 Intersections of gendered and other dimensions of social difference ............................................ 16
2.2. Dynamics of water use and redefining gender roles ....................................................................... 17
2.3 Patterns of water use at household level. ........................................................................................ 19
2. 4 Household `headship' and resource access. .................................................................................... 20
2. 4.1 Female household headship: `feminization of poverty? Or feminized poverty? ........................ 23
Chapter 3: HIV Prevalence, incidence, trends and challenges ................................................................. 25
3. 1 AIDS service delivery, settlement patterns and access ................................................................... 31
3.2 Access to Antiretroviral Therapy (ART) ............................................................................................ 36
Chapter 4: HIV and AIDS and natural resource based livelihood ............................................................... 39
4. 1 Introduction: .................................................................................................................................... 39
4.2 Access to Portable water and HIV and AIDS ..................................................................................... 40
4. 3 Agriculture in the context of HIV and AIDS ..................................................................................... 41
4.3.1 Gender, agriculture, HIV and AIDS ................................................................................................ 42
4.4 CBNRM and HIV and AIDS................................................................................................................ 43
4.4.1 Impact of HIV/AIDS on access to and utilization of natural resources .......................................... 45
4.4.2. NRM institution and HIV and AIDS ............................................................................................... 47
4.4.3 GovernmentcumDelta Safari HIV outreach: private partnerships .............................................. 49
4. 5 Okavango Delta fishery and HIV and AIDS ...................................................................................... 52
Chapter 5: HIV and AIDS Program interventions and Demographic Impacts Introduction:
National Program Interventions ................................................................................................................. 55
5.1.1 Key issues in ARV ........................................................................................................................... 55
5.1.2 Key issues: Prevention of Transmission from Mother to Child (PMTCT) ...................................... 56
5.1.3 Key issues: Sexually Transmitted infections ................................................................................. 57
5.1.4 Demographic Impacts ................................................................................................................... 58
6
TDA Botswana HIV and AIDS
5.1.6 Modeled Scenarios of AIDS impacts and (non) interventions ...................................................... 60
Summary and Conclusions ......................................................................................................................... 64
Cited references ......................................................................................................................................... 67
Transboundary Diagnostic Analysis of the Botswana Portion of the Okavango River Basin:
Land Use Planning ...................................................................................... Error! Bookmark not defined.
Table of Table
TABLE 1: DESCRIPTIONS OF NGAMILAND/OKAVANGO DELTA REGION ...................................................................... 10
TABLE 2:FREQUENCIES OF HOUSEHOLDS WHO EMIGRATED ...................................................................................... 13
TABLE 3: WATER DEMAND, STANDPIPES AND PRIVATE CONNECTIONS IN THE STUDY AREAS. ................................. 19
TABLE 3. 1: HEALTH SERVICE DELIVERY HIERARCHY ................................................................................................... 33
TABLE 3. 2: NGAMI/HEALTH DISTRICT 14 CLINICS AND THEIR CATCHMENT AREAS ................................................. 34
TABLE 3. 3: OKAVANGO/HEALTH DISTRICT 1 CLINICS AND THEIR CATCHMENT AREAS ............................................. 34
TABLE 3. 4: HEALTH POSTS EARMARKED TO BE UPGRADED IN THE ORDER IN WHICH THEY APPEAR. ..................... 35
TABLE 4. 1: THE ETHNIC COMPOSITION OF THE OCT VILLAGES AND SOCIAL SERVICES ............................................. 45
TABLE 4. 2: POPULATION, ETHNICITY AND SOCIAL/HEALTH INFRASTRUCTURE IN MABABE VILLAGE ....................... 45
TABLE 4. 3: ACCESS TO AND DOMESTIC UTILIZATION OF VELDT PRODUCTS .............................................................. 46
TABLE 4. 4: VELDT PRODUCT UTILIZATION DURING NORMAL AND STRESSFUL EPISODES ......................................... 47
TABLE 4. 5: HIV SAFARI OUTREACH ............................................................................................................................. 51
TABLE 5. 1: CASES OF OTHER STIS IN NGAMI 2006/2007 ............................................................................................ 58
7
TDA Botswana HIV and AIDS
Table of Figures
FIGURE 1. 1: LIVELIHOOD ACTIVITIES IN FIVE VILLAGES (SOURCE: KGATHI ET AL, 2004) ...................... 14
FIGURE 1. 2: LIVELIHOOD ACTIVITIES IN CBNRM VILLAGES (SOURCE NGWENYA AND THAKADU, 2007)
...................................................................................................................................................... 14
FIGURE 1. 3: ADAPTIVE STRATEGIES IN GUDIGWA, SEHITWA AND SHOROBE (SOURCE: KGATHI ET AL
2004) ............................................................................................................................................. 15
FIGURE 2. 1: FIGURE STRATEGIES FOR COPING WITH UNRELIABILITY OF WATER SUPPLY (SOURCE
NGWENYA AND KGATHI, (2006). .................................................................................................. 18
FIGURE 2. 2: RANKINGS REMITTANCES .................................................................................................. 21
FIGURE 2. 3: RANKING LIVESTOCK FARMING ......................................................................................... 22
FIGURE 2. 4: RANKING CBNRM ............................................................................................................... 22
FIGURE 2. 5: BOTSWANA POVERTY MAP (SOURCE, CSO, 2008)............................................................. 24
FIGURE 3. 1: POPULATION CENSUS BY SUBDISTRICT BY 2020 (SOURCE: DORRINGTON, MOULTRIE,
AND DANIEL (2006, PP:48) ........................................................................................................... 28
FIGURE 3. 2: ESTIMATED NEW INFECTIONS EACH YEAR (SOURCE: DORRINGTON, MOULTRIE, AND
DANIEL, 2006, PP48) ..................................................................................................................... 29
FIGURE 3. 3: NUMBERS INFECTED BY CENSUS SUBDISTRICTS AND YEAR (SOURCE: DORRINGTON,
MOULTRIE, AND DANIEL (2006, PP:50) ........................................................................................ 29
FIGURE 3. 4: ESTIMATED PREVALENCE BY AGE TO ALL ADULTS: SOURCE, NACA, 2008 HIV/AIDS IN
BOTSWANA: ESTIMATED TRENDS AND IMPLICATIONS BASED ON MODELING, PP9). ................. 30
FIGURE 3. 5: GRADUAL SPREAD OF THE HIV VIRUS ACROSS DISTRICTS .(SOURCE: DORRINGTON,
MOULTRIE, AND DANIEL (2006, PP:49) ........................................................................................ 30
FIGURE 3. 6: MOBILE CLINIC SOURCE: NGAMI 2008/9 PROGRESS REPORT ........................................... 35
FIGURE 3. 7: ARV UPTAKE IN GOVERNMENT MASA SITES,(APRIL 2006SEPTEMBER 2008) .................. 36
FIGURE 3. 8: CLINICS PROVIDING ART SERVICES IN BOTSWANA (SOURCE: MINISTRY OF HEALTH,
DEPARTMENT OF HIV/AIDS PREVENTION AND CARE, MONITORING AND EVALUATION UNIT .... 37
FIGURE 3. 9: CLINICS PROVIDING ART SERVICES IN BOTSWANA (SOURCE: MINISTRY OF HEALTH,
DEPARTMENT OF HIV/AIDS PREVENTION AND CARE, MONITORING AND EVALUATION UNIT. ... 38
FIGURE 3. 10: CLINICS PROVIDING ART SERVICES IN NGAMILAND (SOURCE: MINISTRY OF HEALTH,
DEPARTMENT OF HIV/AIDS PREVENTION AND CARE, MONITORING AND EVALUATION UNIT. ... 38
FIGURE 4. 1: CBNRMCBOS IN NGAMILAND (SOURCE HOORC GIS LAB) ................................................ 44
FIGURE 4. 2: UTILIZATION OF MEDICINAL PLANTS ................................................................................. 46
FIGURE 5. 1: NUMBERS INFECTED, WITH AIDS AND NOT ON TREATMENT, AND ON TREATMENT ....... 56
FIGURE 5. 2: AGE SEXDISTRIBUTION OF BOTSWANA POPULATION 1981 2021 ASSUMING NO HIV
AND AIDS ( DORRINGTON ET AL 2006 PP 54): .............................................................................. 58
FIGURE 5. 3: AC POPULATION PYRAMIDS ............................................................................................. 59
FIGURE 5. 4: ESTIMATED NUMBER OF AIDS RELATED DEATHS, 1981 2021, VARIOUS SCENARIOS
(SOURCE, DORRINGTON ET AL 2006, PP 62). ................................................................................ 61
FIGURE 5. 5: AGESEX DISTRIBUTION OF THE BOTSWANA POPULATION IN 2021, VARIOUS SCENARIOS
(SOURCE DORRINGTON ET AL PP55) ............................................................................................. 62
8
TDA Botswana HIV and AIDS
Chapter 1: A socio-economic profile of River Resources and
HIV and AIDS in the Okavango Delta
1.0 Introduction:
The Okavango Delta is located in Ngamiland district in northwestern Botswana. The
district is the third largest in the country. In official documents, the district is
described in various ways by different government departments and this can be
confusing. Table 1 below summarizes the various descriptions. The Okavango river
runs through the district, with the upper panhandle in what has been describe
invariably as Ngamiland north/west, Okavango or health District 1. The lower delta
roughly falls within Ngamiland south/east or Ngami /health district 14. For purposes
of this Report, I will use Ngamiland (Figure 1b) to refer both the upper and lower
delta and, where appropriate, differentiation will be made with specific reference to
either to Okavango or Ngami sub districts. Villages in the districts (figure 1b) will be
used as case studies to illustrate cross cutting transboundary issues in the Okavango
basin.
This report gives a critical appraisal of existing literature to assess the status quo of
river resources in the Botswana portion of the of the Okavango river basin. The
Report uses case studies from villages in the upper and lower part of the Okavango
river in Ngamiland to suggest the interface between national and transboundary
issues. However, key transboundary issues with implications for policy and program
interventions will be highlighted in the form of a summary discussion.
The objective of this report is to:
· Review existing literature in relation to river resources and HIV/AIDS for each
of the representative social areas.
· Assess gender dynamics in the use of water as well as other river ecosystem
resources for the Botswana portion of the basin in general and for selected
sites in detail
In order to meet these objectives, and for easy flow of issues, the Report is divided
into five sections (chapters). Chapter one examines existing literature with regard to
access and utilization of river resources in the context of the dynamics of livelihoods
diversifications with particular emphasis on local adaptation strategies to variability
and what is referred to as multilocal livelihoods. Context specific short-term coping
and long-term adaptive strategies were used respond to drying of the river channels.
The key transboundary issue from these case studies is that government
policy/program interventions aimed at reducing climatic variability must proactively
enhance, rather than constrain the locality driven adaptive capacities. Not only are
sources of livelihood and household coping or adaptive strategies in the Okavango
basin varied, but these activities are multi-local in a transnational Diaspora. Chapter
2 focuses on gender dynamics in the utilization of river resources with particular
emphasis on poverty context in the Okavango river basin. In Botswana generally,
and in the Okavango basin specifically, men and women are constrained in different
and often unequal ways as potential participants or beneficiaries' natural resources.
Structural poverty is a major factor in the Okavango basin that needs to be
addressed. Chapter 3 HIV Prevalence, incidence, trends and access challenges.
Compared to other African countries, Botswana has comprehensive HIV and AIDS
policies and reasonably resourced national programs intervention aimed at disease
prevention, support and mitigation. But there are new challenges particularly with
regard to HIV prevalence and incidence. Rates of new infections in the district are
relatively high (4.76%).
9
TDA Botswana HIV and AIDS
Delivery of AIDS services faces some challenges regarding access. Access to
treatment is also critical. Approximately 36% of the districts population is > 60km
from an ARV clinic. Some districts face more challenges than others due to a number
of factors, some of which are policy related, others as a result of uneven regional
development interventions especially those related to social development. Chapter 4
focuses on HIV and AIDS and natural resource based livelihood. The chapter
focuses on the impact of HIV and AIDS on three key natural sectors resources which
are dependent on services of the Okavango Delta, namely, agriculture, fish and
community based natural resource management (CBNRM) projects. The chapter
also examines impact of HIV and AIDS on, natural resource institutions (NRM) and
gives a case study of government/safari HIV outreach partnerships.
The last chapter focuses on three key intervention AIDS programs in Botswana with
specific reference to Ngamiland district. These are antiretroviral therapy (ART) roll-
out, prevention of transmission from mother to child (PMTCT), Sexually Transmitted
infections. These programs have key transboundary implication. With regard to ART,
there are concerns over primary and secondary resistance to ARVs, mothers and
access to Dry Blood Spot (DBS) of HIV children born HIV positive, changes in
normative behaviors of long term survivors of ARVs and long term monitoring of
virologic failures. With regard to PMTCT, it is poor male involvement in PMTCT, due
to pressure on women to bear children, more than 80% of HIV positive women and
over 90% of women on HAART reported having more than one pregnancy. STIs
facilitate HIV transmission by increasing both infectious and HIV susceptibility. The
need to expand STI surveillance system in border crossings and high transit sites to
prevention of new infections is highlighted.
Table 1: descriptions of Ngamiland/Okavango delta region
Ngamiland/Okavango delta
Upper Delta
Lower delta
Government Department
Ngamiland North
Ngamiland South
Central Statistics Office (CSO)
Household Income and
Ngamiland West
Ngamiland East
expenditure Survey
Administrative District
Okavango sub-district Ngami sub-district
Ministry of Health
Health district 1
Health District 14
10
TDA Botswana HIV and AIDS
Figure a 1: Okavango Delta (Source, HOORC GIS)
Figure a 2: Ngamiland District (Source: HOORC GIS Lab)
1. 01. Methodology
Data for the report was derived from extensive literature review of secondary and
grey literature. Data was also collected from semi-structured interviews with key
informants in various NRI and other government departments.
11
TDA Botswana HIV and AIDS
1.1 Livelihood diversification and adaptation to variability
Numerous socio-economic surveys have documented different ways in which
communities in the Okavango basin are risk averse, and how they diversify livelihood
activities to cushion themselves against short and long term income fluctuations
(Applied Development Research Consultants, 2001; Kgathi et al, 2004, Kgathi et al
2006; Kgathi, Ngwenya and Wilk, 2007;). Studies in other similar fresh water
wetlands system and lakes in Africa also suggest that communities in those areas
diversify sources of income as a strategy to cushion themselves against shocks, for
instance Bene et al (2003 ) with specific reference to the Yaere Flood plains in Lake
Chad Basin; Geheb and Binns (1997) with particular reference to fishing cum farmers
communities in Lake Victoria in Kenya; Sarch and Allison (2000) with regard to
African inland fisheries in general. Similar observations have been made in other
parts of the world such as Brazil (Cordel and McKean, 1992), Canada (Berkes, 1977)
and Spain (Freire and Garia-Allut, 2000).
From the scenarios describe above, whether in Africa, North America or Latin
America, people switch between farming and fishing in response to seasonal and
inter-annual variations in fish availability, or spatial variation in fish stock
(offshore/inshore, part fisher/fulltime fishers), location of fishing grounds and gears
used. Flexible mixing of livelihood activities in the Okavango basin, however, is not
haphazard. Household across and within villages prioritize and rank livelihood
activities differently depending on a number of factors. The community seasonal
calendar fluctuates between resource abundance and scarcity. Some of activities are
year round and have peaks during certain times of the year. For instance, beer
brewing often reaches a peak during the agricultural off-season. This implies that
households have to cushion themselves against likely adverse effects during
income/food transitional periods. Mixing of activities depends on household asset
qualification, access rights to river resources, formal and informal employment
opportunities, household structure/labour availability and level of resource
contribution to household income and or food security (Kgathi et al 2004).
1.1.1 Migration and adaptation to shocks
According to Ellis (2000), migration is of growing significance as rural people seek to
diversify livelihoods. Gwebu (2003) define migration, in the context of Botswana, as
the permanent relocation from one administrative unit to another. In Ngamiland, a
range of shocks and stresses are co-factors for social migration. Internal migration
processes in Botswana include rural-town; rural-rural; town-town and town-rural and
patterns of migration tend to reflect regional developments linked to the country's
ecological conditions (with the south east and the eastern being the main sender
regions and the north and west the least sources of origin for inter-regional
migrations) (Gwebu, 2003). This is more so especially in Ngamiland during long-
lasting droughts or disease outbreaks when the crop and livestock sector were
simultaneously affected (such as in 1995/96 droughts and outbreak of the cattle lung
disease) where many individuals or households relocated from the rural villages to
urban villages such Maun, Shakawe and Gumare in search of employment
opportunities.
The Okavango Delta has experienced a relatively high level of migration in recent
years, for instance, an analysis of the 2001 Census data reveals that the Census
District of Ngami Delta had a temporary migration rate of 13.2 in 2000/2001, which
was the highest in Botswana, and this is attributed to the rapid development of
12
TDA Botswana HIV and AIDS
tourism (Gwebu, 2003). Other Census Districts of Ngami South and Ngami East had
lower net migration rates of 3.5 each, as the tourism activities there are lower. Kgathi
and et al (2004) study of five villages (Gudigwa, Seronga, Etsha 6, Sehitwa,
Shorobe) in the Okavango Delta, found that the drying of the river channels in these
study areas has acted as a push factor for migration and local mobility (intra-district
mobility). Migration is therefore one important strategy for individuals to cope (short
term or adapt (long term) to shocks or stresses in the Delta.
Informal interviews revealed that those who remained in the above localities when
others out-migrated to Shorobe were mainly the poor households, as they could not
afford the costs of relocation. On the other hand, those who out-migrated to Maun
from Shorobe were mainly the economically active. This is confirmed by the fact that
the village of Shorobe has a very high proportion of the population of those who are
over the age of 65 years. In Sehitwa, 54% of the households reported that some
people out-migrated to a number of areas such as Tsau, Maun, Setlatla, Maila,
Naune, and Dobe as a result of the drying of Nhabe River and Lake Ngami (Table
1.2). In these areas, groundwater or surface water could easily be obtained. It was
also reported that others moved their livestock to other areas, including those near
the buffalo fence such as Kgomotshwaana and Habu, where there was plenty of
groundwater. However, most of the respondents complained that in these areas,
predators were a problem for their livestock (Kgathi et al, 2004).
Table 2:Frequencies of households who emigrated
Village
Frequencies Number of
%
households
Frequencies
(N)
Gudigwa
2
18
11.1
Sehitwa
15
28
53.6
Shorobe
10
17
58.8
Etsha 6
8
36
22.2
Ngwenya and Thakadu (2007) also found that many villagers maintain multiple
residences. Sankuyo residents for instance, were owners of residential plot/s in
Maun Some migrate seasonally or intermittently between two or more localities to do
`piece jobs.' In both scenarios, access to kinship support networks facilitates
migration flows and or investment opportunities across localities. Elmhirst (2008)
conceptualizes multi-local livelihoods in two ways. Firstly in the temporal sense,
multi-locality is seen in terms of movement of people through different spaces.
Secondly, multi-locality is viewed spatially in terms of networks that link different
household members across localities/borders as they seek and or derive livelihoods
in different places. Ermhirst (2008) differentiates between migration as a response to
crisis and livelihood failure, and migration as an accumulation strategy, in which
social and economic remittances' may play an important transformative role in
people-environment relationships. Multi-local livelihood pose national and
transboundary challenges regarding policy/program interventions that assume
geographical boundedness basin communities
Diversity of livelihood activities notwithstanding, the majority of Okavango basin
residents tend to rank agriculture (arable or livestock) first, formal employment
second and government assistance third most important. In general, traditional
arable farming is an extensive system with minimal input and occasionally fair, but
more often low returns. Other livelihood activities include basket-making, fishing,
community based tourism or community based natural resources management
13
TDA Botswana HIV and AIDS
(CBNRM) projects. The case studies by Kgathi et al. (2004) and Ngwenya and
Thakadu (2007) reflect variations in incomes based on natural and non-natural
resource exploitation within and across villages in upper and lower Delta (Figure 1
and Figure 2). The figures indicate that for a significant proportion of households
depend on formal safety nets provided by government (in the form of drought
relief/labour intensive public works, social welfare packages for under-fives, orphans,
indigent persons, community home based care, school feeding, old age pension and
war veterans) and informal safety nets such as remittances.
90
80
70
60
ds
GUDIGWA
50
ETSHA
househol
SEHITWA
40
SERONGA
SHOROBE
30
number of
%20
10
0
arable
livestock
formal
basket
remittances government drought relief beer brewing
CBNRM
other
agriculture
farming
employment
making
assistance
projects
Livelihood activities
Figure 1. 1: Livelihood activities in five villages (Source: Kgathi et al, 2004)
120%
100%
80%
60%
Basket weaving
40%
Cash_CBNRM
20%
Cash Other emp.
0%
Farming
Figure 1. 2: Livelihood activities in CBNRM villages (Source Ngwenya and Thakadu,
2007)
According to Stringer et al (2009:2), adaptation is a process of deliberate change in
anticipation of, or reaction to, external stimuli and stress. Kgathi et al (2004) revealed
that the main strategies adopted by Sehitwa households to the drying of Nhabe River
and Lake Ngami for instance, were digging of wells, switching from molapo to
dryland farming and dependence on government for water supply. For some of the
households, the drilling of wells was a short-term coping strategy before adaptive or
more permanent strategies were adopted. Figure 3 shows actual adaptive strategies
to drying of the river in three villages.
14
TDA Botswana HIV and AIDS
60
50
40
)
%
Gudigwa
30
Sehitwa
Shorobe
Frequencies( 20
10
0
driiled boreholes
depend on others for
depend on
switched to dry land purchased natural
looked for jobs
other
boreholes
government for
farming
resources
supply of water
Adaptive strategies
Figure 1. 3: Adaptive strategies in Gudigwa, Sehitwa and Shorobe (Source: Kgathi et al
2004)
Kgathi and et al. (2004) found that the drying of the river channels in these study
areas has acted as a push factor for migration and local mobility (intra-district
mobility). Migration is therefore one important strategy for individuals to cope (short
term or adapt (long term) to shocks or stresses in the Delta. Informal interviews
revealed that those who remained in the above localities when others out-migrated
were mainly the poor households as they could not afford the costs of relocation.
Those who out-migrated to Maun from Shorobe were mainly the economically active.
In Sehitwa, 54% of the households reported that some people out-migrated to a
number of areas such as Tsau, Maun, Setlatla, Maila, Naune, and Dobe as a result
of the drying of Nhabe River and Lake Ngami. In these areas, groundwater or
surface water could easily be obtained. Others moved their livestock to other areas
where there was plenty of groundwater. Dube and Sekhwela (2008) argue, in the
context of communities in the Limpopo River basin, considered local communities'
adaptive capacity to climate variability including differential nature of vulnerability to
risks of specific social groups. Studies in Botswana (Prah, 1978; Hitchcock, 1978 and
Cooke, 1978) have also documented different ways in which local communities
historically coped with and or adapted to climate variability (in particular drought
condition)s. The adaptive capacity of local communities to environmental as well as
resource variability has been of interest to other scholars. Wehbe et al. 2006
(www.aiaccproject.org) analyzed adaptation to climate variability of local
communities in Argentina and Mexico, Dabi et al. (2008) in Nigeria, Stringer et al
(2009) in southern Africa.
In summary, variability of livelihoods in the Okavango basisn represents an
unprecedented human adaptability to climate variability. Local communities in the
Okavango basin, are likely to experience what has been referred to as `double
exposure", that is, the interaction of global political and economic changes with
climatic risks and their effects on households and development opportunities (Eakin,
2005). How communities adapt contemporaneously or will adapt in the foreseeable
future is in part determined by households, communities, and governments.
However, the effectiveness of local adaptation measures is determined by national
policies. Government interventions can either capacitate or incapacitate strategies
depending on whether there is flexibility to address evolving impacts of shocks on
livelihoods.
15
TDA Botswana HIV and AIDS
Chapter 2 - Gender and poverty context of access natural
resources in the Okavango Basin
2. 0 Introduction: gender relations in NRM in Botswana
It has been noted that despite the importance of gender now being widely
acknowledged, in practice it often remains a marginal concern and frequently simply
added on to mainstream development policy and program and practice (Magnus,
2003). Men and women are constrained in different and often unequal ways as
potential participants or beneficiaries' natural resources. In the Okavango basin, as is
in the Botswana as a whole, gender relations are deeply embedded in and through
policies and programs associated with natural resource management. Cassidy `s
(2001) analysis of CBNRM projects for instance, noted gendered imbalances both in
terms of participation and benefits distribution. Neglect of gender analysis can lead to
misinterpretation of the specific characteristics of women and the constraints under
which they are assumed to operate. However, men's and women's interests are
neither the same nor completely unconnected to each other. Also men and women
resource users are not a homogenous group sharing the same interest's interests in
natural resources access and utilization.
This chapter will also use case studies to illustrate the different ways in which access
to natural resources in the Okavango basin is inflected by 1) gendered relations and,
Household `headship' in the context of poverty. Gender relations are often structured
through norms and institutions (Elmhirst & Resurreccion, 2008:9) and determine
different ways in which men and women derive and maintain the integrity of natural
resources in the Okavango basin.
2.1 Intersections of gendered and other dimensions of social difference
Kgathi et al. (2004) established that participation in specific natural resource based
and non-natural resourced based livelihood activities in the Okavango basin is
determined by gender. Livelihood activities such as beer brewing and basket making
are associated with women rather than men, and these activities give much lower
incomes. The District Drought Committee progress reports of Ngamiland also reveal
that women have tended to dominate men in drought relief/labour intensive public
works activities. During the period 2003/2004, 80% of those who participated in these
projects in Ngami sub-district were women. Similarly, a higher proportion (65%) of
those who participated in these projects in Okavango sub-district during the period
2002/2003 were women. Studies in other parts of Botswana also reveal that women
are more associated with labour intensive public works programmes (LIPWP) than
men. According to Gobotswang et al (2002), the proportion of women who
participated in LIPWP in Botswana increased from 24% in 1986 to 75% in 2000.
Kgathi et al. (2004) found that most of the women participants in Shorobe were the
heads of households, who tended to be resource poor. Because men had alternative
options, they had a lower participation in drought relief/LIPWP projects as they are
lowly paying (they were paid P10 per 6-hour day).
Other livelihood activities in the Delta cut across age and gender. Noticeably,
children, men and women hunt for fish in the Okavango Delta, either seasonally in
summer in the flood plains or for extended period in the main channels, some wholly
or partially for consumption or sale (Ngwenya and Rammai, 2008; Mosepele, 2001;
16
TDA Botswana HIV and AIDS
Ngwenya and Mosepele, 2008). These resource user groups share certain fishing
grounds while other fishing grounds remain exclusive. Therefore are likely to have
differing and sometimes conflicting needs, interests and priorities. Policies and
natural resource management regimes and development intervention programs
therefore both nationally and basin wide, have to pay attention to gender.
There are also livelihood activities with great overlap between men and women, the
difference being a matter of degree. In some villages, for instance Xaxaba, Shorobe,
Shakawe, both men and women cut grass, river reed and collect veldt products and
water lily (Applied Development Research survey (2001). Men hunt for wildlife and
birds but in some villages they also harvest water lily (tswii), an otherwise
predominantly female activity. This tells us that gender relations can be redefined
through unusual micro-practices and places in everyday life. Assuming that gender
roles are fixed can result in missing the dynamics of natural resource utilization, such
as `resource use switching and or commercialisation' and consequently lead to
inappropriate gender blind policies or programs in the Okavango Basin. There need
for context specific and historically nuanced understanding of gendered property
rights (water and land) (Meinzen-Dick & Zwarteveen, 1998), gender dynamics in
local participation in development programs and community based institutions
(Agarwal, 2001, Cornwall, 2003), gender geographical mobility (Elmhirst, 2008),
livelihoods and resource use (Leach, 1994). Policy and program interventions in the
Okavango basin must make explicit the existing unequal gender roles (with regard to
specific livelihood resource, land, water, fish, CBNRM, tourism etc) and aspects of
the relations that needs to be transformed to enable equitable and sustainable
gender development. Lack proper assessment of gender specific constraints is likely
to entangle implementers in their own gendered behaviors (Buchy and Rai 2008).
2.2. Dynamics of water use and redefining gender roles
Social benefits of access to potable by through community water points include
decreased distance to water point and reduction in water borne diseases. At a more
basic level, provision of safe water is necessary for taking medication and for
reducing the risk of diarrhoea and skin diseases. Water collection for domestic
purposes in the Okavango delta depends on whether or not there is reticulated water
in the village. Those riparian villages with reticulated water are less likely to obtain
large volumes of water from the river or any of its channels.
A socio-economic survey of 645 households in riparian and non-riparian communities
in the Okavango delta undertaken by Applied Development Research Consultants
(2001) reported that 22% of those who collect water from the river directly, use it for
cooking, 45% for washing, and 45% for watering livestock. It is interesting to note
that households in these communities specifically state that water collected directly
from the river is not used for drinking purposes. Water for cooking is boiled water and
hence safe to ingest. Perhaps the influence of public health campaigns has had an
effect on raising awareness among the rural residents. These findings concur with
Ngwenya and Kgathi (2006) study on home-based care giving and access to water.
The study found that caregivers cope with water supply unreliability in respective
villages by specifically reserved and apportioning potable water for their patients to
drink and or take medication. They use water from the river to bathe the patients, do
laundry and for cooking. The respondents in the study were cautious and shied away
from giving untreated water either to their patients or young children. However, inland
Delta rural remote communities such as Jao and Xaxaba, who have no water
reticulation in their villages, and who depend largely on drawing water from the main
17
TDA Botswana HIV and AIDS
river channel, are of the opinion that the water from the main channel is safe to drink
and does not necessarily cause diseases.
Ngwenya and Kgathi (2006) found that households adopted five main coping
strategies when faced with lack of water: 1) economised on the use of water by either
re-using waste-water or using water sparingly, 2) utilised stored water from reserve
tanks 3) collected water from other sources such as rivers and boreholes, collected
water from government institutions and also 5) bought water (Figure 2.1). The above-
mentioned coping strategies are associated with socio-economic and health costs.
For instance, economising on water by reducing the number of meals cooked may
adversely affect the nutritional status of households. This may further weaken the
health of HIV/AIDS patients. Although inland Delta, rural remote communities such
as Jao and Xaxaba where water is less likely to be polluted by domestic animals and
human waste were of the opinion that the water from the main channel is safe to
drink and does not necessarily cause diseases (Ngwenya and Kgathi, 2006).
However, the use of river water by patients (including young children) in response to
water shortage in places such as Gudigwa and Seronga was associated with the risk
of diarrhea and other opportunistic infections.
45
) 40
35
(%
e 30
g 25
ta
n 20
e 15
r
c 10
Pe
5
0
r
r
t
v
'
t
ns
i
z
e
r
v
e
r
t
e
t
s
io
t
e
a
he
ll
ec
go
om
s
e
ll
ec
rce
wa
y w
ot
u
Co
t
it
ut
Re
Co
f
r
om
c
on
Bu
so
i
ns
E
f
r
om
Strategies
Figure 2. 1: Figure Strategies for coping with unreliability of water supply (Source
Ngwenya and Kgathi, (2006).
18
TDA Botswana HIV and AIDS
The literature on water and poverty suggests that the unreliability of water supply
tends to influence household water consumption such that areas with high
unreliability of water supply tend to have low water consumption (Howard and
Bartram, 2003). Ngwenya and Kgathi (2006) study found that the village of Shorobe
had the highest unreliability as well as the lowest per capita consumption. The
majority of households in ungazetted settlements in order to satisfy their domestic
water requirements through abstracting untreated water from river flows and hand-
dug wells when the river is not flowing. It has been found that men with donkey carts
dominate in collecting water in ungazetted settlements in the Delta. The dominance
of men in water collection and use of donkey carts is due to water sources being too
distant from homesteads (Mazvimavi and Mmopelwa, 2006).
2.3 Patterns of water use at household level.
In Botswana, water supply to rural villages such as those of the study areas is the
responsibility of the District Councils. The Department of Water Affairs has the
overall responsibility for supplying water to the major urban villages, whereas the
Water Utilities Corporation is the main supplier of water to the urban centres. A large
part of the population in Botswana depends on groundwater sources for its water
supply (SMEC et al., 1991). Although surface water sources account for 35% of the
total supply, they provide 90% of water used in urban areas. In contrast, the majority
of rural villages obtain their water from groundwater sources which account for 67%
of the total water supply in Botswana (Arntzen et al., 2000). The 2001 Census
revealed that villages with a population of 1000-4999 in Botswana had 96.5% of their
households with access to piped water. Ngwenya and Kgathi (2006) survey revealed
that the proportion of households with access to piped water in their study area was
95%. And water consumption ranged from 50 m3/day in Gudigwa to 183 m3/day in
Sehitwa. In per capita terms the figures ranged from 55 l/c/d in Shorobe to 82 l/c/d in
Sehitwa (Table 2.1). The figures include consumption by schools, health clinics and
the construction sector. The actual household per capita consumption figures
(without consumption by government institutions etc) should be much lower than
these figures.
Table 3: Water demand, standpipes and private connections in the study areas.
Village
1Projected 2Demand Demand Borehole Number of Number of
to 2005
m3/day
l/c/d
supply
Standpipes
Private
population
m3/d
connections
Pn=P(1+r)n
Sehitwa 1796 147.0 81.8 620
20
126
Shorobe 1160 63.4 54.7 76
15
72
Etsha6 3195 183.3 57.4 700
7
120
Seronga 1995 154.5 77.4 176
12
78
Gudigwa 890 49.6 55.7 90
7
20
Source: NWDC, Water and Waste Water Department (2005).
1Used 2001 population data (census). Average growth rate is 4.2% as per DWA design
manual, but on consideration of migration of people after drought problems and CBPP, it has
been assumed to be 5%.
2Calculation of demand has included schools, hospitals, police stations and secondary schools.
19
TDA Botswana HIV and AIDS
2. 4 Household `headship' and resource access.
Household `headship,' is also a factor in access to natural resources. According to
Terry (1986), 57% of 60 weavers interviewed in Gumare and Tubu were from
households headed by women. Kgathi et al. (2004) study, in which 48% of
households were de facto female headed and 52% were male headed, found that of
those households reporting that they received permanent destitute allowance, 13%
were female-headed households as compared to 8.6% of the male-headed
households. The p value for the Chi square was 0.06 (2 df), which is close to the
threshold p value for significance of 0.05, but not significant. The researchers
hypothesised that a significant relationship could be found if the sample was larger.
The association between access to destitute allowance and female-headed
households could reflect the fact that these households are generally poorer
compared to male-headed households. Figures 2.1 to 2. 6 show rankings of income
flows from sources such as molapo farming, dryland farming, CBNRM, livestock and
remittances in five villages of Gudigwa, Seronga, Etsha 6, Sehitwa and Shorobe by
type of household head (Kgathi el al, 2004).
20
TDA Botswana HIV and AIDS
60.0
50.0
40.0
30.0
De facto female
headed
Percentages
20.0
Maleheaded
10.0
1
2
4
Figure 2.1: Ranking Molapo farming
60.0
50.0
40.0
30.0
De facto femaleheaded
percentages
20.0
Maleheaded
10.0
0.0
1
2
3
4
5
Figure 2.2: Rankings Remittances
Figure 2. 2: Rankings Remittances
21
TDA Botswana HIV and AIDS
60.0
50.0
40.0
30.0
De facto female
headed
20.0
Percentages
Maleheaded
10.0
0.0
1
2
3
4
Figure 2.3: Ranking Livestock farming
Figure 2. 3: Ranking Livestock farming
120.0
100.0
80.0
De facto female
60.0
headed
Percentages
Maleheaded
40.0
20.0
0.0
2
3
4
Figure 2. 4: Ranking CBNRM
22
TDA Botswana HIV and AIDS
2. 4.1 Female household headship: `feminization of poverty? Or feminized
poverty?
The 2001 Census results indicate that there were a total of 404, 706 household heads in
Botswana. Of these, 182, 637 (46.14%) were female, while 201, 940 (53.86%) were male (CSO,
2002). Although Ngamiland district as a whole is one among three district with the highest male
headed households (at 70%), however, Ngamiland west has a high rate of women headed
household at 59.3% (CSO, 2006). Also, Botswana poverty map (CSO, 2008) reveal that
headcount poverty rate in Ngamiland is severe (40%) and is above 50% in Ngamiland west
(Figure 2.5 ). Furthermore, when disaggregated by gender and household headship, the depth
and severity of poverty in Ngamiland west is also apparent.
With regard to average household size, again Ngamiland west has 7.9 persons compared to the
national average on 6.48 and a very high incidence of critically ill persons, 2.9% compared to
the national average of 2.7%; 54.1% unemployed females (compared to 45.8% males (CSO,
2006) and literacy rates on people 15 and older of 66% compared to Ngamiland East 89% and
89% at national level of (Botswana Literacy Survey, 2004).
From the above described status quo especially as it pertains to Ngamiland East, a question
can be asked, does the above scenario reflect what has been described in literature as the
`feminization of poverty', and if so, what implications, if any ,does the prevailing status quo have
for natural resource access and control in the Okavango delta.
According to Chant (2006), femininization of poverty means that
- women experience a higher incidence of poverty than men
- women experience greater depth/severity of poverty than men (i. e. more women are
likely to suffer `extreme' poverty than men
- women are prone to suffer more persistent/long-term poverty than men
- women disproportionate burden of poverty is rising relative to men
- women face more barriers to lifting themselves out of poverty
23
TDA Botswana HIV and AIDS
Figure 2. 5: Botswana Poverty Map (source, CSO, 2008)
Ample literature has shown that poverty is a multidimensional process. Although income is
pivotal in assessment of poverty, a gendered framework of deprivation should include inter alia,
· restrictions in access to private and public goods (education, health infrastructure
and so on) which compromise human capability/functioning
· asset poverty, encompassing not only material assets such as land and property, but
also less tangible assets such as social capital which form part of a livelihood
portfolio
· subjective dimensions of poverty such as self-esteem, dignity, choice and power
· aspects relating to social exclusion such as marginalization through lack of political
participation and social dialogue (Chant, 2006).
Care should be taken not to stereotype women headed households, equally, care should be
taken for instance not to gender stereotype natural resource utilization in the Okavango Delta.
Emphasis has to be on the dynamic social, political and contextual relations. These are
mediated by women's complex relations with men, kin and other social actors. Women therefore
dynamically respond to complex environmental realities, and may enter into and engage in
social relationship with men within natural resource institutions in their community.
24
TDA Botswana HIV and AIDS
Chapter 3: HIV Prevalence, incidence, trends and challenges
According to the recent 2008 Botswana AIDS Impact Survey III (BAIS III), national HIV
prevalence rate stands at 17.6% (20.4% females and 14.2 males). The HIV incidence rate
nationally is 2.9% (3.5% for females and 2.3% for males) (CSO, 2009). Figure 3.1 shows
prevalence by age and.
Ngamiland west has a prevalence rate of 16-18.9 % and Ngamiland east is the most hard hit
with a prevalence rates of between 19 and 21.9%. The Ngamiland East district also has `high
incidence zone' of HIV infection (5.0% and above). Incidence is higher among males than
females (CSO, 2009). Figure 3.2 HIV prevalence by district and gender
25
TDA Botswana HIV and AIDS
Figure
3.2. HIV Prevalence by district and by gender (Source, CSO, 2009)
Compared to other African countries, Botswana has comprehensive HIV and AIDS policies and
reasonably resourced national programs intervention aimed at disease prevention, support and
mitigation. But there are new challenges particularly with regard to increasing new rates of
infections especially in Ngamiland East.
Since the first AIDS case in Botswana was reported in 1985, the country adopted its first
strategies) as early as 1993 and again in 2006. In 1999, the National AIDS Coordinating
Agency
(NACA) was formed. NACA was given the responsibility for mobilizing and coordinating a multi-
sectoral national response to HIV and AIDS, and also provides secretariat to the National AIDS
Council (NAC) under the Office of the President. NAC is responsible for formulating the
National Strategic Framework (NSF) for HIV and AIDS (2003-2009), currently under review. The
26
TDA Botswana HIV and AIDS
NSF provides details of anticipated response during the planning period. The key goal areas of
Botswana's NSF are:
· Prevention of HIV infection
· Provision of care and support
· Strengthened management of the response
· Psychosocial and economic impact mitigation
· Provision of strengthened legal and ethical environment.
In 2008, Botswana launch of the "Minimum HIV Prevention Package" (MIP), an aggressive
National Plan for Scaling Up HIV Prevention 2008-2010 (NACA HIV and AIDS Information
Package, 2008)1 towards universal access to treatment. The Plan defines a minimum set of
activities for district, civil society organizations and the private sector intervention plans. These
include:
· Prevention of sexual transmission (reducing multiple and concurrent partners, age
appropriate youth and school based activities, condom education and promotion,
reaching most at risk populations, prevention with positives, voluntary safe- male
circumcision).
· HIV Counseling and Testing (HCT) (Expanding HCT service availability, intensifying
targeting males for HCT, increasing HCT among youth, promoting HCT campaigns,
couples and worksite testing, standardization of national guidelines and protocols).
· Prevention of Transmission from Mother to Child (PMTCT) (intensification of post-test
and supportive counseling to ANC, scaling up-peer mothers Program, promoting male
and couple counseling).
· Management of sexually transmitted infections (STIs) (through active screening for
asymptomatic STIs, increasing partner tracing and management, promoting patient
delivered partner therapy, intensifying programming with sex workers and their clients,
aggressive condom distribution).
· Prevention of blood borne transmission (promoting voluntary non-remunerated blood
donation, strengthening universal precaution).
The current Ngami and Okavango sub-district 2008/009 HIV plan and collaborating partners in
the private sector (especially the tourism sector) and civil society (such as Botswana Family
Welfare Association, Maun Counseling Center, Thuso Rehabilitation Center and so on), amply
reflect provisions of the MIP (MDSAC,2008/009). Furthermore Ngami sub-district is one of the 7
(Chobe, Francistown, Mabutsane, Selebe Pikwe, and Serowe) designated ARV roll-out project
sites eligible for support from ACHAP and receive additional funding to support its core
activities. Funding is made to carry out activities within the NSF geared towards increasing
coverage of HIV/TB treatment services to eligible patients. This is done through three key areas,
infrastructure development (provision of equipment, upgrading health and storage facilities),
capacity building/technical assistance (training of health workers through Kitso program,
salaries) and procurement and distribution of commodities (condoms and IEC material),
partnership with NGOs (BOFWA, BOCAIP, BONEPWA etc) and DMSAC (District Multi-sectoral
AIDS Committee).
Recent preliminary results of the Botswana AIDS Impact Survey III revealed by the Central
Statistics Office (CSO, 2009) show that HIV prevalence in Ngamiland South stands at 19.8%
1 NACA, 2008. The National Response, HIV and AIDS Information Package).
27
TDA Botswana HIV and AIDS
(16.4% for males 22.6% females) and incidence of 4.76% for both sexes. With regard to
Ngamiland North it is at 16.5% (10.9% males and 21.0% females) and incidence of 3.89 %.
The rates of new infections in the district is relatively high such that Ngamiland South incidence
(4.76%) now compares with Selebe Pikwe (4.66% incidence) (CSO, 2009).
It is estimated that in 2007, the Okavango sub-district, has approximately 54 442 people of
which 16.5% (8,982 people are infected). Ngami district has approximately 75 000 people,
assuming that 19.8% or (14 850 people are infected). Because antiretroviral therapy prolongs
life, the numbers of infected is expected to increase over time in most districts as more people
access antiretroviral therapy. The country's population is expected to continue growing,
although at a lower rate than the past (Dorrington, Moultrie, and Daniel, 2006). Figure 3. 1
show different population by 2020 based on CSO and model projections. The CSO and model
projections are very close for Ngamiland West (Okavango sub-district).
Figure 3. 1: Population Census by sub-district by 2020 (Source: Dorrington, Moultrie, and Daniel
(2006, pp:48)
Country wide, the HIV prevalence rates peaked in 2000 (at around 25%. HIV prevalence would
be higher if ART is widely used because of the longer life expectancy of HIV + individuals on
ART. Although death rates from HIV related factors should decline significantly, it is postulated
that with successful ART roll out, the number of HIV + individuals would rise from around 250
000 to 350 000 by 2020. Figure 3.2 gives countrywide estimated new infections each year..
Adult prevalence, a widely used indicator, is the percentage of the population between ages of
15 and 49 infected by HIV. Figure 3.3 gives numbers infected by census district and figure 3.4
estimated by age of all adults over the age of 15 years using BAIS II Survey (NACA, 2008). The
timing and spread of the virus varies considerably between census districts with the epidemic
being early and severe some districts and late in others. The severity of the impacts within and
across livelihood sectors is also likely to vary considerably.
28
TDA Botswana HIV and AIDS
Figure 3. 2: estimated new infections each year (source: Dorrington, Moultrie, and Daniel, 2006,
pp48)
Figure 3. 3: Numbers infected by census sub-districts and year (Source: Dorrington, Moultrie, and
Daniel (2006, pp:50)
29
TDA Botswana HIV and AIDS
Figure 3. 4: Estimated Prevalence by age to all adults: Source, NACA, 2008 HIV/AIDS in Botswana:
Estimated trends and implications based on modeling, pp9).
Figure 3. 5: Gradual spread of the HIV virus across districts .(Source: Dorrington, Moultrie, and
Daniel (2006, pp:49)
30
TDA Botswana HIV and AIDS
3. 1 AIDS service delivery, settlement patterns and access
Delivery of AIDS services faces some challenges regarding access. Some districts face more
challenges than others due to a number of factors. But one of the major service access
determinants in Botswana is determined by the country's National Settlement Policy (1998)
definition of a settlement, and hence its social service entitlement. The Policy defines a village
as a traditional settlement that is established on tribal land, and has a minimum population of
500 people2. There are rural settlements however, which do not meet the 500 people criteria,
but because of their special features, for instance scattered Basarwa localities in the Okavango
Delta, a special consideration is made to accord them a village status although their population
threshold is lower. Rural settlements with populations between 250 and 499 are often referred
to as "remote area settlements."
According to the policy, social service provision (health, education, power, communication,
water and sanitation) follows a hierarchy of settlements according to population size and or
status of the settlement (urban, urban village, rural or remote). Large settlements and district
headquarters receive high order services such as referral and primary hospitals, while small or
unrecognized settlements receive low order services such as health posts and mobile stops
(Table 3.1). The problem is that in Ngamiland, 50% of populations live in settlements less than
500 people which have not been classified as remote area dwellers. Because of the vastness of
the district and predominantly gravel roads/sandy tracks, access to services remains a
challenge. Some health facilities are likely to have physically expansive catchments areas
consisting of scattered satellite settlement in the form of meraka (cattle posts) or masimo
(ploughing fields). Outreach health services to rural and remote areas are managed either by
clinic or health post personnel within a given catchment area. Maun as a district headquarters
has two hospitals (one government and the other private), 12 health clinics (8 publicly owned by
the district council and the remaining 4 either by government departments (Botswana Defense
Force or Department of Prison Services) or an NGO (BOFWA) and 12 health posts. Clinics in
Maun manage about 30 mobile clinics (Table 3.2). All the health posts are publicly owned by the
NWDC (NWDC 2006/7 Annual Report). With regard to Okavango (Ngamiland west/Health
District 1) primary health care services are provided by 9 clinics, 16 health posts, and 30 mobile
stops manned by nurses. Gumare primary hospital is the sub district (Table 3.3).
According to Magole, Ngwenya and Butale (2005), In Ngamiland, 29.7% of residents have
access to a hospital, 89.2% to a clinic, 27.0% to a health post and 18.9% to a mobile clinic
(BAIS II, 2004). In Maun, approximately 39% have access to a hospital, 92% to a clinic, 50% to
a health post, and 25% to a mobile clinic. There is a problem of access. First emanating from
the way in which the Botswana settlement policy defines a village which results in approximately
50% of the districts population disadvantaged from optimizing human services. Secondly, the
district is vast and with poor physical service infrastructure. Most settlement are difficult to
access except through 4 x 4 vehicles which can travel of gravel roads or heavy sandy tracks.
Within district service delivery variation is due uneven infrastructural and institutional
development, resource capacity. Ngami sub-district, for instance has an added advantage over
Okavango as it is one of the 7 designated ARV roll-out project sites eligible for support from
ACHAP. As a ARV roll-out site, Ngami sub-district receive additional funding to support its core
activities whereas Okavango depend on central government funding to carry out activities.
2 The 1991 Population Census defines an urbanvillage as a settlement with a population of 5,000 or more persons
with at least 75% of the labor force in nonagricultural occupation, an urban area is a nonagricultural commercial
center regardless of the population size.
31
TDA Botswana HIV and AIDS
There are no NGO branches such as BOFWA in the Okavango sub-district to can play a gap-
filling service role. These are found in Maun.
However, the picture is likely to changes due to the fact that the National Development Plan 10
(NDP10) has provision for a primary hospital in Shakawe. Ngamiland District Development Plan
(DDP 7 2009/2010 2015/2016) has proposals for infrastructural development under the
Ministry of Health including the upgrading primary hospital in Gumare and possible construction
of a primary Hospital in Sehitwa and the Institute of Health Sciences somewhere for 2009/2010.
Other developments include the Ministry of Works and Transport proposed construction of
Mohembo - Gudigwa road and upgrading the Etsha 6, Gumare and Sehitwa road. With regard
to development of human capital, the proposed education and skill development institutions
under the Ministry of Education include a college of education, three senior secondary schools
(Gumare, Sehitwa and Maun respectively),vocational training college in Sehitwa, a technical
collge in Sepopa and Tsau, non-formal education center in Sehitwa, Etsha 6 and Shakawe.
Whereas all these infrastructural and institutional developments are welcome and will greatly
enhance the district's human capital, population growth centers and centers of commerce,
create employment opportunities, the down side of it is that these changes are also likely to lead
to increased risk factors of HIV transmission. Table 3.4 shows some planned developments to
upgrade existing health posts in Okavango.
32
TDA Botswana HIV and AIDS
Facility
Available Services
Physical description Location and
population
Mobile
Limited PHC services
No fixed facilities
Very remote areas
Stop
Community based worker at first contact,
3 rooms and a toilet
500 1000 in rural
Health
primary health care, case finding/follow-
Staff house in remote
area
Post
up, Period visits by mobile health teams
areas
Maternal/child health, Preventive work (as
5 rooms, covered
5000 10 000 in
Clinic
health post), Diagnosis and Treatment of
area, toilets, vehicle
rural areas
without
common diseases, simple lab work, Case
and 2 staff houses
10 000 or more in
maternity
finding/follow-up with emphasis on TB
major villages and
towns
Clinic with
As above, including deliveries
As above plus
As above. Maternity
maternity
maternity unit, vehicle wards depends on
and 3 staff houses
area's needs
As at clinic, Supervision of clinics and
20 70 beds, 4 12
Mainly in villages
Primary
health posts, General in-patient care, Lab
maternity beds, 16
and remote areas.
Hospital
tests, X-rays and surgery
58 general beds,
Depends on area's
Out-patient facilities
need (Gumare)
As at primary hospital, Specialist services
Primary hospital on a
Major villages and
District
for serious and complicated health
larger scale 70 400
towns
Hospital
problems, Preventive, curative and
beds
(Maun, Letsholathe
rehabilitative care, In-patient care for more
Hospital)
complicate health needs
Referral
As district hospitals, Specialist clinical
400+ beds
Gaborone and
Hospital
services
Francistown
Table 3. 1: Health service delivery hierarchy
33
TDA Botswana HIV and AIDS
Mother Clinic
H/Posts
*maternity
Mobile stops under each clinic
under
Mobile stops under each Health
jurisdiction Post
of mother
clinic
Maun Council Xhoo, Tsutsubega, Gogomoga, Mosu,
Somelo
Marothodi/Hyenaveld
clinic
Nxaraga, Pompong, Nxabega, Chitabe, Komana
Makgalo, Phatswe,
Xigera, Kanana, Sandibe, Xudum,
Boseja clinic
Xhobe, Vumbra, Kaporota, Baines,
Disana
Samedupi
Stainley's camp, Duba camp
Kubung
Thamalakane east
Sedie clinic
Boro, Jao, Jakana, Kwetsane, Seba,
Mathapana
Sexaxa, Boronyane, Matsaudi
Tubu, Macatooh
Xaxaba, Xharaxhao, Gorukhu, Xhoga,
Shashe
Boyei clinic
Thito
Kgantshang, Tsakanoka,
Dikgathong, Shashe bridge,
Xhugana, Camp Okavango, Kwara
camp, Shinde
Thoteng
Makgwelekgwele, Xamote, Tsokung,
Legothwane
Sehithwa*
Phathane, Solabompe, Polokabatho
Bodibeng
Mathamagana, Spanplerk,
Mathabologa
Bothatogo
Pelobotlhoko, Polokabatho
Makalamabedi Bonno, Phenyo, Palamaokue,
Chanoga
Mawana, Tatamoga, Xhana
clinic*
Mphoyamodimo
Phuduhudu
Kareng
Botshelo, Tjevaneno, Mosarasarane
Tsau clinic*
Xhangoro, Mapute, Kaure
Makakung
Xunxa, Matlhomahibidu, Roomane
Semboyo
Naune, Maila
Shorobe
Daunara, Quaxao ,Ditshiping
Mababe
Khwai, Xakanaka
clinic*
Sankuyo
Table 3. 2: Ngami/Health District 14 Clinics and their catchment areas
Clinic with Maternity
Health post
Mobile stop
Shakawe*
Nxamasere, Gani, Nxomokao
Samochima, Tsodilo, Xhauga,
Xaudumo, Diniva, Shaikarawe, Setutu,
Senono, Xaree
Etsha 6*
Etsha 1, Nxaunxau,
Chombona, Xara
Nokaneng*
Habu
Kwende, Boajankwe
Qangwa*
Xaxa
Dobe, Xhooshe, Magopa
Seronga*
Gudigwa, Beetsha,
Jao Flats, Eretsha, Mokgacha,
Gunotsoga, Chukumuchu
Vumbura, Seshokora
Xakao*
Mogotho, Ngarange, Kaauxwi, Kaputura, Tobera
Sekondomboro
Table 3. 3: Okavango/Health District 1 Clinics and their catchment areas
34
TDA Botswana HIV and AIDS
Figure 3. 6: Mobile Clinic Source: Ngami 2008/9 Progress Report
Health post
Population served Kilometers from
nearest health facility
Beetsha 2317
45
Nxamasere 2971 18
Ngarange 2242 15
Kauxwi 2494
5
Nxomokao 1948 10
Sekondomboro 1126
10
Mogotho 1022 35
Gudigwa 1082 71
Tubu 1076
15
Nxauxau 796 121
Chukumuchu 305
102
Etsha 1
800
10
Habu 780
38
Ikoga 887
21
Gunotsoga 666 21
Xaxa 306
45
Table 3. 4: Health posts earmarked to be upgraded in the order in which they appear.
35
TDA Botswana HIV and AIDS
3.2 Access to Antiretroviral Therapy (ART)
In 2002 antiretroviral therapy (ART) was made available through the MASA program for free to
Botswana citizens through public health facilities. By 2005 a phased roll-out plan resulted in a
dramatic increase from initial 4 to 32 treatment sites in all 28 health districts in the country.
Consequently, the treatment deficit was gradually reduced from 36% of those eligible in 2004 to
11% in 2005. In order to further expand access, a number of satellite clinics have been
developed with the capacity to dispense, screen and dispense drugs or screen only.
It is estimated that currently, 80% of all people on treatment are enrolled thorough the public
sector. Figure 3.7 indicate ARV Therapy (ART) enrolment in public sector sites (April 2006
September 2008). In 2008, the enrolment was 90 921 end of September, up from 85 541 at the
end of June, representing an increase of 6.3%. In Ngami sub district, October December 2008
indicates that 2, 268 patients are enrolled on ART and that there has been a steady increase in
the number of patients.
Figure 3. 7: ARV Uptake in Government Masa Sites,(April 2006-September 2008)
In the Okavango, Shakawe and Seronga health facilities that dispense ARV drugs on site,
Xakao, Nokaneng and Etsha 6 only do the screening. In Ngami sub-district, out of the 8 clinics,
6 dispense on site and 2 on outreach (Makalamabedi and Tsau). The District hospital in Maun
screen and dispense (Figure 3.8). This implies that, compared to Okavango, Ngami sub-district
offers more ARV screening and dispensing services to patients. Figure 3.9 map key shows that
36
TDA Botswana HIV and AIDS
compared to other districts, Ngamiland has the highest number of settlements (46%) that are >
60km from an ARV clinic. This implies that approximately 36% of the districts population. Figure
6.2 overlays HIV prevalence by district of both sexes (based on sentinel data of 2006) and the
number of settlements and distance from ARV clinics/services. Figure 3 .10 shows that overall,
94 locations are < than 5 km from the ARV clinic, 287 are within 6 km -30 km; 140 within 31 km
60km; and 56 settlements are > 60 km from ARV clinic. This further demonstrates the problem
of small scattered settlements and access to social services.
Figure 3. 8: Clinics providing ART services in Botswana (Source: Ministry of Health, Department
of HIV/AIDS Prevention and Care, Monitoring and Evaluation Unit
37
TDA Botswana HIV and AIDS
Figure 3. 9: Clinics providing ART services in Botswana (Source: ministry of Health, Department
of HIV/AIDS Prevention and Care, Monitoring and Evaluation Unit.
Figure 3. 10: Clinics providing ART services in Ngamiland (Source: Ministry of Health, Department
of HIV/AIDS Prevention and Care, Monitoring and Evaluation Unit.
38
TDA Botswana HIV and AIDS
Chapter 4: HIV and AIDS and natural resource based livelihood
4. 1 Introduction:
Whereas the revised National Policy on HIV and AIDS (2006) has put some sectors in the fore-
front, the role of natural resource based sectors such as agriculture; fisheries, water and
CBNRM were not clearly defined in the National Policy on HIV/AIDS. Unfortunately, in
Ngamiland, a significant proportion of the district population's livelihoods are derived from these.
Numerous case studies of the linkages between HIV/AIDS and natural resources management
in Kenya, Namibia, South Africa (Johnson and Freeman, 2002), Uganda (Ruhweza and
Thangphet, 2001), Malawi (COMPASS, 2003) and elsewhere (Thangphet, 2001) have
demonstrated HIV/AIDS impacts on natural resources management and provided insights on
how to mitigate the effects (Oglethorpe and Gelman, http://www.frameweb.org/). Erskine's
(2004) comprehensive study on impacts of HIV/AIDS on a conservation agency, rural
livelihoods, natural resource use and management in KwaZulu Natal found that HIV/AIDS
undermined the internal capacity of conservation agencies. The impacts of the HIV/AIDS
pandemic in Botswana, like elsewhere in developing countries, cuts across all livelihood
systems. Logically, the scourge has adversely impacted the natural resources or conservation
sector. These include, but are not limited to, loss of human capacity for natural resources
management (NRM), changes in land use and natural resources access (Africa Biodiversity
Collaborative Group, 2002).
Chapter focuses on the impact of HIV and AIDS on four key natural sectors resources which are
dependent on water related services of the Okavango Delta, namely, water, agriculture, fish and
community based natural resource management (CBNRM) projects. The chapter draws
insights from the Sustainable Livelihood Framework (SLF) (Ellis, 1998, 2000; Scoones, 1998)
as applied by Gillespie (2006) to show how HIV and AIDS affects, and is affected by livelihoods.
The frameworks show how people's risk for contracting the HIV virus will be governed partly by
the susceptibility of a livelihood system and that AIDS has effects on assets and institutions.
According to Gillespie (2006), on the `upstream' of infection, specific socio-economic factors
fuel infection rates including gendered inequalities - which translates to inequities in resource
access and opportunities. These gendered imbalances in turn, make it difficult for example, for
women and girls to negotiate safe sex, and for young girls to avoid in inter-generational and or
transactional sex with older men. With regard to the `downstream' side of HIV infection, AIDS
poses a threat to production, declining through labor productivity, inability to purchase input,
increased spending, changes in livelihood patterns, loss of property, declining yields that
threaten of food and nutrition security, and the emergence of specific forms of vulnerability.
Food insecurity and vulnerability to food insecurity is influenced by institutional, economic,
cultural and political dynamics. Those who are most vulnerable to food insecurity and poverty
are often those facing multiple stresses and overlapping vulnerabilities. These might include, for
example, drought and illness or death of a household member due to HIV and AIDS or other
illnesses. The social groups most vulnerable to poverty and food insecurity in Ngamiland are the
aged, youth, single mothers, female-headed households and the unemployed.
Institutional management of NRI is highly affected by HIV. Mullins (2001) argues that HIV and
AIDS has a two-pronged effect on institutions, namely that institutional staff members are
people living in communities and that, due to the nature of their work, they are more vulnerable
39
TDA Botswana HIV and AIDS
to contracting the virus. Secondly some NRM sectors have high-risk occupations. Workers tend
to be mobile and are likely to work in remote and marginal areas away from their families. When
HIV virus infects a staff member, impacts are felt at four levels at varying degrees; i.e.
household, community, institutional and sector level. Weakened institutional capacity impacts
negatively on organizational ability to carry out its core business and to deliver extension
services and support to client communities. Also, Soeftestad (2001) observed that the workload
for extension workers in Malawi increased as they were forced to look after survivors of their
deceased colleagues. The death of institutional staff members also leads to loss of skills,
knowledge, expertise and institutional memory. Institutional effects are in themselves are a
measure of vulnerability and will determine strategic responses that households or communities
adopt to deal with the threat.
4.2 Access to Portable water and HIV and AIDS
The unreliability of portable water supply in some the Okavango basin villages can last one or
two weeks due to poor communication between the water operator and the office which supplies
fuel for engine which pumps water, and the high frequency of absenteeism from work by water
engine operators mainly due HIV/AIDs related illnesses or attendance of funerals (Mwankenja,
2005, pers comm.). The findings were consistent with some of the problem areas associated
with the HIV and AIDS epidemic in southern Africa as identified by Ashton and Ramasar (2004,
p9). Some of these problems are as follows: 1) decline in productivity as a result of the epidemic
2) increase in staff turnover as a result of the morbidity and mortality of staff and. 3) increase in
the poor quality of drinking water as a result of the deterioration in water personnel which may
lead to "increased public health risks." The findings are also in conformity with the views of
Kamminga and Wegelin-Schuringa (2003) who contend that the epidemic also adversely affects
the quality and quantity of the service provided by the water sector as a result of an increase in
mortality and morbidity of the staff in this sector.
Nxesi (quoted by Kamminga and Wegelin-Schuringa, 2003) argues that access to safe water
and sanitation is one strategy among others for managing AIDS related opportunistic infections.
AIDS infected and affected individuals and families need to stay in hygienic conditions, free of
harmful germs and bacteria. Access to sanitation, especially flush toilets for very sick patients, is
important since they may be too weak to walk outside the house to relief themselves.
HIV and AIDS problem is worsened by the reduced access to potable water supply among
households who collect water from communal standpipes, mainly because of the high
opportunity cost involved in water collection and also because of the intermittent supply of
water. This problem can led to an increase in the use of water of poor quality and other
practices of poor hygiene. The adoption of these practices has the potential to increase the risks
of public health, further worsening the condition of HIV and AIDS patients with impaired immune
systems. In addition, the epidemic also adversely affects the productivity of the water personnel
due to an increase in mortality and morbidity of staff and the general population.
The opportunity cost of water collection was the only factor which could limit water consumption
as water is not purchased by those who collected water from communal standpipes. However
those with private connections (both outdoor or indoor) pay for water, and the tariff structure is
progressive such that the charge for the highest use band (over 41 m3) was P8.15 which is
seven times the charge of the lowest use band (up to 5 m3) of P1.25, the aim being to take
account of the use of water for the basic human needs and also to penalize those who use a lot
of water (DWA, 2004).
40
TDA Botswana HIV and AIDS
On the other hand, water consumption for CHBC households who collected water from
communal standpipes was less than 20 l/c/d. According to Howard and Bartram (2003), at this
level of consumption the minimum basic needs are achieved, but basic hygiene may be greatly
compromised as the water is not sufficient for household use. The average time spent on water
collection from the standpipes per day was 21 minutes, whereas the average distance walked
by 93% of the households to and from the collection points was less than 500 m, and only 3% of
the households travelled more than 500 m to collect water. According to Howard and Bartram
(2003), access to water as determined by distance is considered to be of an intermediate level if
it is between 100 m and 1000 m, whereas in terms of time, it is considered to be of basic level if
it takes about 5 minutes to 30 minutes, and to be of intermediate level if it takes about 5
minutes.
4. 3 Agriculture in the context of HIV and AIDS
Given the fragile nature of the agricultural sector in Botswana caused by climatic limitations and
that a significant proportion of the country's population, almost 80%, depend on subsistence
arable agriculture to sustain their households, one would have imagined that the role of this
sector feature prominently in the revised National Policy on HIV/AIDS. Unfortunately, the role of
the agricultural sector in the country's AIDS prevention, treatment, care and support has not
been made as explicit as for other key ministries and thus remains obscure as it is lumped
together with other ministries and parastatal under section 4.14 of the Policy. The link between
a key food production sector, household food security, poverty and HIV is missing in key policy
documents, notably the National Policy on Agricultural Development (1991), the Revised
National Food Strategy (2000), National Plan on Food Security and National Strategy for
Poverty Alleviation (2003). According to the Ministry of Agriculture's AIDS Coordinating Unit, to
date, no comprehensive study has been done in Botswana to demonstrate how HIV and AIDS
interact with shock prone agricultural sector in the country. It is difficult to imagine how, without
empirical assessment AIDS effects on agriculture, the ministry come up with appropriate
policy/program interventions. A study by Gobotswang et al. (2004) on the impact of HIV and
AIDS on food security and agricultural production in Botswana suggest the following effects:
· Reduction of labour capacity and a shift from productive work to care-giving activities
coupled. Agricultural production is affected through an increase in fallow land, less time
used on livestock health and management, land clearing, cultivation, weeding and pest
control among rural households, notably due to illness, lack of labour and draught
power, as well as the increase in care needs in the household;
· Shift in investments from agricultural inputs and management, e.g. livestock nutrition and
health, to pay for medicines, transports and funerals;
· Migration from urban to rural areas by people that are sick, with resulting increase in
care-giving responsibilities in rural areas;
· Reduction in number of meals eaten per day among illness-afflicted households; and
· In line with the overall population, the extension services are experiencing reduced work
capacity and absenteeism among staff.
Gobotswang et al. (2004) also found that HIV and AIDS tend to lead to changes in decision-
making patters within the household. In the livestock sector, for instance, decision making was
shifting from male head to sons, wives, and sometimes also to daughters, but the general trend
among households affected by the epidemic was that less time is spent on livestock
management.
41
TDA Botswana HIV and AIDS
4.3.1 Gender, agriculture, HIV and AIDS
In Botswana, the majority of the rural population and small-scale farmers are women (2001
Rural Household Survey), and are as such more likely to be illiterate, less informed about
rights, and have less access to information, productive resources and opportunities for paid
employment than urban people and male counterparts in rural areas. Legislative, cultural and
institutional mechanisms are all used to restrict women's rights to land, leading to marked
gender inequality in land tenure.
In Botswana, there are approximately 113,000 agricultural holdings. The majority are headed by
men, while 35% are headed by women (near 40,000). There are 62,000 married or cohabiting
men heading a rural household. It can then be assumed that there are a matching 62,000
married or cohabiting women living in male-headed holdings. In addition, there are almost
40,000 female-headed households, implying that there is a total of 102,000 adult women on
agricultural holdings, indicating that women by far outnumber men in rural areas (total number
of male holders is 73,334) (CSO 2004).
The customary law, under which most women in rural areas are married, also disadvantages
women in that it confers almost all decision making powers for productive assets to men.
Although the Government of Botswana has made efforts to amend the Land Policy and the
Marital Act to allow women to acquire immovable assets, the implementation of these
instruments at local levels and financial institutions remains problematic because officers have
not been retrained on how to interpret the new regulation and thus still continue to deny women
access to land and credit. Even after the removal of marital powers from the Marital Act, some
financial institutions still demand that for women married in community of property need
authorization from their spouses to acquire property. The Marital Power Bill excludes women
married under Customary Law. Similarly, women married in community of property are denied
communal land by land boards in cases where their spouses already have piece of land even
though the policy states that they could be allocated a piece of land.
A study in Zambia reported that most victims of property grabbing normally do not want to take
legal action against the culprits for fear of unnecessary confrontations with relatives of the
deceased. Similarly, as more people die of AIDS, traditional practices of inheritance are
becoming a source of grief and subsequent hardship for widows. The deaths of husbands
worsen women's already low access to productive resources for agricultural production, such as
land, livestock and inputs. In Botswana, widowers tend to remarry to quickly find somebody to
take over the functions of the deceased wife. Widows, however, seem to have more likelihood
of remaining single, thus being left with care responsibilities for children, relying on the labor of
few adult Depending upon existing social networks, they may be able to rebuild their livelihoods,
but are less likely to recover from the shock than a male-headed household. Although the
government of Botswana has committed itself to eliminate all forms of discrimination against
women, inequalities of assets and income in Botswana are still pronounced. While most
countries have put in place policies and laws to allow women access to and use of land, FAO
(2005) has observed that the mere existence of laws does not necessarily change social
practices and customs.
In summary, decline in productivity of the agricultural sector and gender-related challenges in
the context of HIV and AIDS are, inter alia,
42
TDA Botswana HIV and AIDS
Rural-urban migration, leading to an ageing of rural areas, with many households
headed by older women with few livelihood opportunities.
Differences between women and men when it comes to ownership of land, cattle and
other property
Married women in rural are rarely able to buy or sell land in their own capacity, but are
rather expected to produce consent from a husband or male relative. A similar consent
from wives is not demanded.
Evidence in Botswana and elsewhere in Africa indicate that women comprise the
backbone of the agricultural workforce. They are involved in almost all agricultural
operations of ploughing with animal traction. However, extension officers are
predominately male, and extension services are geared more towards male than female
clients;
Demands on time for care giving activities by women and girls leave them less time for
productive and other activities,
Unemployment among young people create specific challenges for young women;
leaving vulnerable to sexual exploitation and risky survival strategies due to limited
employment opportunities. What about young men, what do we know?
Despite the fact that agriculture is the mainstay of the majority of Batswana, the National
AIDS policy does not treat the sector as a priority sector. The medical model
predominates government `multi-sectoral' interventions and approaches.
Limited access to education, training, information and productive resources such as
land, and water coupled with care responsibilities and time constraints inhibit some
women from taking an active part in improving their skills and livelihoods.
4.4 CBNRM and HIV and AIDS
Ngamiland district is a home to a significant proportion of active CBNRM CBOs projects in the
country. There are approximately 21 CBNRM CBOs in Ngamiland covering at least 63 villages
and settlements (Figure 4.1). Additionally, Ngamiland CBNRM CBOs are among the high
income generating institutions, and has a District CBNRM Forum that was started in 2000 with
strong and all encompassing membership from government, CBNRM NGOs and CBOs, private
sector and special interest groups. Ngamiland therefore it presents an ideal setting for
assessing the relationship between CBNRM HIV/AIDS impacts.
43
TDA Botswana HIV and AIDS
Figure 4. 1: CBNRM-CBOs in Ngamiland (Source HOORC GIS Lab)
As discussed in chapter 3, the prevalence and incidence of HIV in Ngamiland is increasing, and
the districts is disadvantaged with regard to HIV/AIDS servicesThis section is based on work by
Ngwenya, Potts and Thakadu's (2007) study of two CBNRM trust, the Okavango Community
Trust (OCT), is a multi-village CBO established in March 1995 comprising of the villages of
Seronga, Gunotsoga, Eretsha, Beetsha and Gudigwa (table 4.1) and their respective satellite
settlements, and Mababe Zokotsama Community Development Trust was established in
August 1998 as a single-village Trust of Mababe village (4.2.
44
TDA Botswana HIV and AIDS
Village Population Ethnic
Health Facilities/HIV-AIDS Service Infrastructure
Educational
2001 CSO
compositio
Facilities
n
Seronga 1
641 WaYei
1 Clinic with maternity
1 Primary School
(1402)3
HaMbukush
HIV/AIDS routine rapid testing
1 Community
u
PMTCT and Isonized TB treatment, IEC material,
Junior
BaKgalagadi
Maternal/child health, Preventive work (as health
Secondary
Bugakhwe
post), Diagnosis and Treatment of common diseases,
School
simple lab work, Case finding/follow-up with emphasis
on TB
Gunutsoga 506 WaYei
1 Health Post, 3 rooms and a toilet, Staff house, store
1 Primary
(50)
HaMbukush
room, community based worker at first contact,
School
u
primary health care, case finding/follow-up, period
BaKgalagadi
visits by mobile health teams
Eretsha 616
HaMbukush
Mobile stop clinic, limited primary health care
None
u
services, no fixed physical infrastructure
WaYei
Beetsha 760
HaMbukush
1 Health Post (same as above)
1 Primary
(669)
u
School
Bugakhwe
Bayei
Gudigwa 732 Bugakhwe
1 Health Post (same as above)
1 Primary
(55)
HaMbukush
School
u
Table 4. 1: the ethnic composition of the OCT villages and social services
Village Population Ethnic composition
Health Facilities/HIV-AIDS Service Educational and
2001 CSO
Infrastructure
other facilities
Mababe 157
Basarwa
1 Health Post, 3 rooms and a toilet
1 Primary School
Staff house, store room, community 1 Community hall
based worker at first contact, primary and office complex
health care, case finding/follow-up, period
visits by mobile health teams
Table 4. 2: Population, ethnicity and social/health infrastructure in Mababe village
4.4.1 Impact of HIV/AIDS on access to and utilization of natural resources
Diverse sources of income in the study villages included cash employment, farming, fishing,
hawking, tour guiding or mokoro (canoe) poling, crafts, basket weaving, beer sale, thatching,
remittances and government assistance. Income from formal employment in the study villages
constitutes about 70%, followed by farming (approximately 59%) and government social
assistance (old age pension, food baskets for orphans, destitute persons, war veteran
allowance and drought relief), 16% government assistance, Other important sources of income
include remittances, fishing and beer brewing (13%).
3 (CSO 2002) - Population of associated localities
45
TDA Botswana HIV and AIDS
Access to and utilization of natural resources in Okavango Delta villages is important for both
domestic and commercial purposes. Households use firewood for cooking and lighting, use
poles and thatching grass for house construction and fencing their fields, harvest foods plants
such as Berchemia discolor (Bird plum) (motsintsila), Grewia sp. (Brandy bush) (moretlwa) to
supplement their diet and collect palm leaves for making baskets (see Table 4.3 ).
Veld product
% Use
% Don't use % Not available
in the area
Firewood 93.3
6.7 -
Poles 85
15
-
Thatching grass
84.0
16
-
Food plants
81.3
18.7
-
Reeds 50.7
25.3
24
Palm leaves
41.3
38.7
20
Medicinal plants
25.3
73.3
1.3
Papyrus 25.3
49.3
25.3
Table 4. 3: Access to and domestic utilization of veldt products
The four villages utilize a high proportion of food plants. A significant proportion of households in
Gudigwa and Eretsha use natural plants for medicinal purposes (see figure 4.2). Table 4.4 Sale
and non-sale of natural resources during period of distress
Plants harvested for medicinal purposes
100%
90%
80%
yes
e
70%
60%
t
ag
no
50%
cen
40%
er
P
30%
not available in this
20%
area
10%
0%
Seronga Mababe Eretsha Gudigwa
Location
Figure 4. 2: Utilization of medicinal plants
46
TDA Botswana HIV and AIDS
Veldt
product
During normal period
During illness episodes
%
%
Not
%
%
Not
Sale
Non
available in Sale
Non
available in
Sale
the area
Sale
the area
Thatching
21.3 78.7 -
12 88 -
grass
Food plants
13.3
86.7
-
9.3
90.7
-
Reeds
12.0
81.3 6.7
8
92 -
Poles 12.0
88.0
-
4
96
-
Palm leaves
10.7
89.3
-
4
96
-
Firewood 5.3
94.7
-
2.3
97.3
-
Papyrus 2.7
97.3
1.3
98.7
-
Medicinal
- 100
-
- 100
-
plants
Table 4. 4: Veldt product utilization during normal and stressful episodes
4.4.2. NRM institution and HIV and AIDS
Botswana HIV and AIDS in the workplace related policies are comprehensive. These include
Botswana National Policy on HIV and AIDS and Employment (2005) (Ministry of Labor and
Home Affairs) whose goal is to provide overall guidance to employers including government and
employees in taking responsibility for managing HIV/AIDS; Botswana Public Service Wellness
Policy (2005) (Directorate of Public Service Management) whose goal is to promote equitably
the wellness of public officers in all occupational setting in the public service through
information, education and counselling, and active participation in the wellness programs by
public service employees. The Public Service Code of Conduct on HIV/AIDS in the Workplace
(Directorate of Public Service Management) articulates the rights, responsibilities and
obligations of both the employer and employee in accordance with Botswana national AIDS
policy. Interestingly, the Ministry of Minerals, Energy and Water Resources (2003) has a
comprehensive HIV and AIDS policy whose objectives are as follows
To provide care and support to ministry staff in view of the fact that HIV/AIDS
issues are sensitive and personal,
To avoid discrimination and prejudice among employees who are HIV positive,
To provide IEC on HIV and AIDS to staff
To mainstream HIV/AIDS activities into the internal and external domain of the
Ministry
To provide ministry management with consistent framework within which on to
understand and confront the reality of AIDS in the workplace
To maintain maximum stability and productivity in the workplace with due
consideration to affected and infected staff
The government natural resources management (NRM) ministries such as Ministry of Wildlife,
Environment and Tourism, Ministry of Agriculture and Ministry of Minerals, and Energy and
Water Resources have workplace HIV and AIDS units modeled after the Ministry of Health
which include the following:
47
TDA Botswana HIV and AIDS
Establishing coordinating structures to facilitate the implementation of the
workplace wellness program (setting up of wellness committees, training peer
educators, identifying focal persons)
Provision of wellness services for workers in a user friendly environment that
promote access to prevention, care and treatment and support
Capacity building and managing work related stress
The NACA, NSF Technical Report (2007) for instance, noted that in the Ministry of Lands and
Housing, 92% of officers are reported to have tested for HIV, and male involvement is promoted
through staff meetings and sports activities. Tsalaile's (2006) study of retail and wholesale
companies in Maun found that employees were interested in knowing their HIV status. A survey
in MMEWR (Butale, 2006) indicated that 79% of sampled employees had tested for HIV, the
majority of whom were males, most likely to be industrial class cadre (as opposed to the
permanent and pensionable P & P).
From informal interviews with ministry based AIDS Coordinating Unit National Coordinators in
Gaborone, notably Ministry of Agriculture, MMEWR and MEWT, it became apparent that
internal domain responses are increasing access to Voluntary Counseling and Testing (VCT) as
noted by the NSF Technical Report and Butale's survey report cited above. Also noted by both
reports is that there has been a strategic shift from discreet HIV and AIDS interventions to
holistic wellness approaches in which testing for HIV is conducted with a package of tests for a
range of life threatening conditions including diabetes, high blood pressure and linking
psychosocial support with determinants of high risk behavior.
Wellness is understood as the capacity for everyday living that enables individuals to perform
work, pursue their social, economic, biological, intellectual, spiritual and mental goals, acquire
skills and education, grow and satisfy personal and work aspirations. The MMEWR for instance,
has twenty-five health and wellness teams spread out in its key department, Mines, Energy,
Geological Survey, Water Affairs and Ministry Management as well as in outpost stations in the
District.
The NSF Technical Report also noted that there was focus is on training peer educators and lay
counselors although it is not clear to what extent they are used, and how their skill are updated
and developed. Where the external domain or is link with resource users is concerned, it is often
by way of fund-raising activities for local community projects such as donation of food,
vegetables for the needy, provision of HIV related information. Butale's survey report shows that
Maun and Gumare Water Affairs Health and Wellness Teams, like their counterparts, itend to
focus on spiritual aspects, health and wellness talks, peer counseling and education and social
welfare activities in their communities. The bottom line is that these Teams are too surprising
that NRM institutions are not able to extend their support services externally to constituent
CBNRM communities. Ngwenya, Potts and Thakadu (2007) findings were that
CBNRM professionals in NRM institutions/NGOs tend to down play or even
neglect the impact of the disease in their sector and assume that HIV and AIDS
intervention is not within their mandate.
As a result of lack of HIV and AIDS workplace policy and poor resource
allocation to AIDS awareness, professionals in NRM institutions/NGOs servicing
CBNRM CBOs and communities have limited knowledge of the general
prevalence of the disease in their own backyard (workplace), let alone the impact
of the disease amongst communities they work with directly. These professionals
48
TDA Botswana HIV and AIDS
tend to `pass the buck' to the public health sector when it comes to issues of
prevention, mitigation, care and support.
Voluntarism makes it difficult to collect disaggregated information on workplace,
community and household prevalence of the disease and worker attrition by
gender, age, household income, including data of emerging household types
(orphan or elder headed households), intergenerational property transfers,
distress migration, and alternative livelihood strategies.
CBNRM professionals do not regularly seek or exchange information with
government health services or civil society organizations working in AIDS
prevention and mitigation. Some CBNRM communities, such as Eretsha, are
completely neglected by both government and non-government organizations.
CBNRM professionals do not monitor specific impacts of HIV and AIDS on
CBNRM projects by documenting how the disease affects resource conservation.
Mullins (2001) cautioned that failure to recognize and mitigate against impacts of HIV/AIDS at
organizational level was tantamount to professional negligence and resource misuse and that
any organization doing so risks chances of ever achieving its objectives. The sub-section below
give a case study of government/private sector partnership coordinated and implement through
the HATAB Health Committee in Ngami sub-district. Prior to this initiative, in 2005, a `one-off'
HIV/AIDS component of the Every River has its People Project, engaged individuals and
communities in a `Road Show' which started in Angola through Namibia and ended in
Botswana under the theme `Everybody has a role impacts of HIV/AIDS (ERP, 2006). Although
there was lack of continuity to this initiative; the road show was the first of its kind and covered
14 villages in the three countries. Information was disseminated through drama, speeches,
poetry, leaflets and posters. Most importantly, basin communities who have always been far
from testing services, had facilities brought to them through arranged mobile health services)
and up to 652 people were tested for HIV during the road show (ERP, 2006).
4.4.3 Government-cum-Delta Safari HIV outreach: private partnerships
The Hospitality and Association of Botswana (HATAB) Health Committee consists of
representatives from Letsholathe Hospital, District Health Team (DHT), clinics in Maun and
safari companies. Data for this section was collected from semi-structured interviews with key
members of the Committee, gleaning Committee meeting minutes, participant observation and
use of grey literature. Because of the nature of the remoteness of tourism inland Delta based
camp, access to AIDS delivery services for these workers was problematic and, although there
has not as yet a systematic study on the impact of AIDS on tourism, and conversely, or the
impact of tourism on AIDS in Botswana, Magole's (2005) and Machoba's (2005) analysis
suggest that the general scenario is that the most favored tourist destination in the country, for
instance, Chobe district and Ngamiland East, tend to have a high HIV prevalence. Lack of
empirical evidence notwithstanding, for the tour operators on the ground, it appears that when it
became apparent that they as part of the larger private sector were not complementing
government HIV and AIDS prevention effort, the need to be involved became paramount. The
HATAB Health Committee was set up and through it, tour operators who are members
committed themselves to flying -in and accommodating clinic based doctors to do health
services outreach visits to the camps. Some safari companies have lay counselors provided and
paid for by Ngami DMSAC who visit the camps on a monthly basis. Others companies have
their own full-time nurse (OWS) or doctor (Desert and Delta). The majority of companies have
49
TDA Botswana HIV and AIDS
welfare officers (Orient Express for example) who are both contact persons and co-coordinators
of outreach visits.
Five Maun based outreach clinics are Sedie, Boseja, Maun Clinic, Boyei and Thito. Shorobe
clinic is also part of the Delta camp safari outreach structure. The HATAB Health Committee
reasoned that, for the partnership with government to be effective, it had to set up coordinate a
coordinating structure with clear lines of communication, reporting and accountability. Each
clinic and each company has a coordinator cum contact person responsible for coordinating
transport and scheduling of medical personnel (doctors/nurses) camp visits. Sedie clinic for
instance, is responsible for providing outreach AIDS related services to eight tourist lodges,
namely Kwetsani, Jacana, Tubu and Jao (owned by Ngamiland Adventure safari), Abu and
Seba (owned by Elephant Back Safaris) Makatoo and Mokolwane owned by African
Horseback Safaris (Table 4.5). All AIDS related outreach activities are reported to the District
Health Team (DHT).
The outreach services reach a significant proportion of employees in the tourism industry who
otherwise would have difficulty paying for flights to Maun either for check-up or medication refill.
Orient Express has been part of the Delta Safari outreach program for 4 years. Orient Express
runs 44 camps with 143 employees who receive monthly visits by either nurse, lay counselors
or a doctor. These are at no extra cost for the safari company since they are being paid for
either by the Council or the Ngami-DMSAC. OWS has approximately 700 employees. The
company has a generic HIV in the workplace policy, has hired a full-time a nurse whose task is
to provide primary health care, counseling (individual and group/couple), testing and STI
screening. Test kits and condoms are procured through DAMSAC. OWS pays for the flight for
workers to go for their appointments in Maun. They get three months supply of ARVs
coordinated through HATAAB Committee. Visits are synchronized with the worker's leave days.
Demand for service varies from 3 5 per day. In addition to primary prevention, patients should
be given advice on diet and exercise or basic anatomy.
Of late, safari companies engaged services of a pastor and they are of the opinion that the
intervention seem to have a very positive effect and employees appreciate these services. T he
pastor spends 2/3 days in each camp. Christian teachings seem to enable people to open up to
talk about issues of sexuality. Support from the DAMSAC includes training of peer counselors,
condom procurement and distribution.
Company/companies
Clinic Outreach
Lodges
Sedie
Kwetsani, Jacana, Tubu and Jao
Ngamiland Adventure
Abu, Seba
Elephant Back safari
Makatoo, Mokolwane
African Horseback Safaris
OWS Private
Vumbura, Kaporota, Duba, Mombo,
Okavango Wilderness Safaris
Little Mombo, Xigera
(OWS)
Boseja clinic
Stanley's Baines, Chiefs and Mombo
Sanctuary Lodges
Nxabega, Sandibe, Karana, Xudum
CC Africa Now & Beyond
Maun Clinic
Pom Pom,
Gunns
Chitabe OWS
Xudum, Kiri
Rann Safaris
Kanana
Kerr & Downy
50
TDA Botswana HIV and AIDS
Boyei
Eagle Island (Xaxaba)
Orient Express
Delta Camp, Odd Balls (Nxoga)
Okavango tours and Safaris
Guns camp, Semetse
Gunns camp
Thito
Xugana, Camp Okavango
Desert and Delta
Kwara and Little Kwara
Kwando safaris
Shinde Kerr
Downy
Little Vumbura
OWS
Shorobe
Camp Moremi
Desert and delta
Xakanaka camp
Moremi safari
Camp okuti
Kerr Downy
Boat Station
Dan Rawson
Kwai river Lodge
Orient express
Mankwe, Mboma
Kgori safaris
Santawana Community
Table 4. 5: HIV Safari Outreach
Safari company employees are `sequested' in the Delta for three months before they can be
given leave to join their families in their home villages. As one respondent put it, `if people are
sequested for 3 months what do you expect them to do with their sexual energy. You have to be
creative in your intervention and discuss issues of sexuality in ways that empowers people and
for them to understand risks associated with the `small house' phenomenon or being excited
about having `fresh meat in the camp' - this is just another code phrase for multiple and or
concurrent partners.
The risks of contracting the HIV virus is perceived to be among co-worker relationships and
government department workers passing through set-up camps, by BDF, Water Affairs and
Wildlife. Government policy which does not transfer married couples to prevent them from
starting new relationships is also perceived as fuelling HIV transmission. As one respondent put
it, `people not understand themselves; people think that if you do not have sex you get sick".
Government campaigns on the other hand plays down the `small house' phenomenon. Although
there is need for empirical evidence, the perception currently is that outreach intervention has
led to a dramatic drop in death rates and absenteeism. People are very open and disclose their
status to the manager without fearing that they would lose their jobs. Those who did not disclose
in the past suffered in silence and could not get medical attention until it was too late.
The advantage of high cost low volume tourism is that it caters for upscale clients who have no
or limited contact with the community, take on a tourist package that has scheduled activities.
The risk would increase with budget tourists who are likely to have greater contact with the local
community. For the high-end tourists it is difficult to talk about HIV and AIDS, it feels like you are
insulting their intelligence or wasting their time.
In summary, like any other program involving many stakeholders, there are logistical problems
on the ground. But these are not insurmountable. The implication is that the Delta Safaris HIV
outreach program, without committed partners and investment of human and financial
resources, would not be feasible. The intervention also demonstrates ways in which
government and the private sector can work together to counter the negative effects of social
mobility by bringing services to the people.
51
TDA Botswana HIV and AIDS
4. 5 Okavango Delta fishery and HIV and AIDS
Fish offers micronutrients, vitamins, minerals, and protein that have been shown to increase the
efficacy of HIV/AIDS treatments (World Fish Centre, 2006). Fishing is a highly labour intensive
occupation (Torrel et al, 2006) and therefore depends heavily on good health status of the
labour force. The multiplier effect of the loss of productive labour and declining productivity due
to HIV and AIDS may ultimately affect the supply of fish, fish products and household food
security strategy (Allison and Seeley, 2004; Gordon, 2005).
According to MAAIF (2006), fish availability can be dramatically reduced as people become too
weak to fish or eventually die with a consequent loss of indigenous knowledge and fishing skills.
Therefore, HIV and AIDS can have a multiplier effect whereby productive pursuits such as
fishing are severely curtailed with a resultant loss of rural employment and provision of food
(Campbell and Townsley, 1996). Although ecosystem variability such as fluctuations in flood
regimes is known to determine fish availability for subsistence in floodplain fishing communities,
there is a provocative school of thought which suggests that HIV and AIDS is fast becoming a
major factor in regulating fish availability to these communities (ID21, 2006). Although small
scale fishing is the main source of livelihood for a significant proportion of populations in
developing countries, the significance of fishing communities are rarely taken into account in
national HIV and AIDS control programs and their socio-economic and environmental
significance have largely been ignored (SFLP Bulletin, 2004). Fishing communities have
particularly limited access to reproductive health services including HIV/AIDS prevention, care,
and support. Poor health and poor sanitation makes people in fishing communities more
vulnerable to illness.
Fishing communities in Africa have been described as `hot-spots' for the spread of the HIV
virus, not only because fishers are mobile, constantly moving between landing sites and water
channels, but also because they live in fish camps away from family and societal sanctions
(Baro, 2004; Forum SYD, 2005; Gordon, 2005; MAAIF, 2005). It has been observed that the
HIV/AIDS prevalence rate among fishing communities in developing countries generally are five
to ten times higher than the general population (http://www.sflp.org/ftpl/others/). Several case
studies have shown that some African fishing communities (e.g. in the DRC, Kenya, Uganda,
Zambia and Tanzania) have higher HIV prevalence rates than `known risk groups' (e.g. truck
drivers and commercial sex workers) (Allison and Seeley, 2006; Tanzarn, 2006; Tanzarn and
Bishop-Sambrook, 2003; SFLP, 2004). In addition, hygiene and sanitation conditions in fishing
camps are usually poor and thus contribute to people's vulnerability to infection (World Fish
Centre, 2006).
McGoodwin (2001) argues that production relations and organization of fishing activities of small
scale fishers in developing countries are very similar even though members have very distinct
cultures. This being the case we can safely assume that fishing communities in Botswana as
elsewhere are therefore vulnerable to HIV infection due to relative absence of a culture of
saving money (World Fish Centre, 2006). As such, availability of cash from fish sales on a
regular basis without tangible investment or savings facilities predispose fisher folk to
`conspicuous consumption' such as paying women for sex. The important question however,
whether or not fishing communities per se have access to savings and credit from financial
institutions in the first place. In the Okavango Delta, when compared to other districts in the
eastern part of the country, savings and credit institutions in Ngamiland are few and far
between. Commercial banks, for instance, are situated in Maun, the district capital, which is
about 600 km or more away from most villages. Also, Botswana Savings Bank, operating
52
TDA Botswana HIV and AIDS
through Botswana Postal Services, has no branches in the majority of fishing communities. This
scenario is less likely to encourage savings and credit competencies both at community and
household levels. However, questions regarding the extent to which the absence of formal
savings and credit institutions in Ngamiland is likely to fuel the transmission of HIV virus among
fishing communities should remain open to empirical investigation such as that of Merten
(2009). Rather than assume the existence of particular sexual relations within fishing
communities, it is also important to make systematic investigation of incidents of transactional
sexual relation in the context of a particular fishing community.
Ample research illustrates that HIV and AIDS disproportionately impacts on women worldwide
due to the subordinate economic and social position of women in society. However, HIV
prevalence rates among women working in fishing communities could be higher. In many
countries, women play an important role in fishing livelihoods, such as processing and
marketing activities (World Fish Centre, 2006). Also, different sexual relations are known to
have developed around these activities which make members to be exposed to sexually
transmitted diseases (SFLP Bulletin, 2004:9). In Botswana, especially in rural areas, women are
more likely to be unemployed than men (CSO, 2004). Given these structural economic
constraints, some women in fishing villages are likely to resort to risky behaviors such as having
multiple partners, engaging in transaction or inter-generational sex, and sale and consumption
of alcohol especially in landing sites. The situation is further compounded by gender and age
inequalities which make women more vulnerable to sexually exploitative relations which places
them at risk of contracting the HIV virus.
A systematic analysis of the impacts of AIDS on fisheries based livelihoods has hitherto
received little attention (Allison and Seeley, 2004, 2006; Gordon, 2005). The ODMP conducted
community consultation and feedback kgotla meetings to enable the teams to identify several
sector related `hot spots' (so called because of their sensitivity and demand for urgent
policy/program intervention) before developing and implementing a comprehensive plan to
manage OD resources in ways that support people's livelihoods in the area. The threats
identified included, inter alia, threats to livelihoods by wildlife such elephants and lions, resource
user conflicts, droughts, livestock diseases, poaching, destruction of crops by elephants, and
chronic outbreak of wild fires (ODMP Report, 2004). The opportunity to identify human induced
threats to fisheries livelihoods was again missed during the second round of kgotla meetings. In
these meetings, discussion focused on conflicts between commercial and sport users,
perceived declining fish stocks and government regulations (ODMP, 2005). Human induced
disease threats to Okavango delta fishery were completely neglected. It is probable that HIV
and AIDS related "hot spot" across villages in the Delta and information about this could be
hidden in district level prevalence and incidence rate data. Lack of fishing sector specific
information of HIV prevalence has been attributed to marginalization of small-scale fishing
communities in public policy, and also lack of knowledge regarding the significant role played by
small scale fisheries in reducing poverty (SFLP, http://www.sflp.org/eng/003/fightaids.htm/).
Ascertaining whether or not a household has HIV/AIDS infected person(s) or has lost someone
due to the disease is difficult given the sensitivity of the information and social stigmatization.
Generally, people are not willing to openly discuss HIV and AIDS (Stokes, 2003). In Zambia,
when respondents were asked about HIV infected people, only 3% indicated the prevalence
rate, in stark contrast to the nationally reported rate of over 20% (SADC-FANR, 2003). For
these reasons, a household survey in Okavango Delta used the presence of continuously ill
person/s (CIPs) over the past five years as proxy indicators of households most likely to be
affected by HIV and AIDS. A CIP can be defined as any person declared by a medical doctor as
terminally ill and has an incurable disease such as HIV/AIDS. Such a person may or may not be
53
TDA Botswana HIV and AIDS
bed-ridden, and is cared for at home either by family member/s, relatives, members of the
community, friends, neighbors or church groups during periods of intense need or social
distress (social crisis).
Ngwenya and Mosepele's (2007) analysis of primary data collected from a survey of 248
subsistence fishers' households in 22 villages found that bout 53% percent of sampled
households cared for continuously ill person/s in the last five years. The prevalence of CIPs
varies across villages indicating that some households were more affected than others. At least
twenty nine percent said the illness seriously impacted on fishing activities. Follow up informal
interviews suggest that serious impacts included sale of family assets, depletion of savings,
switching or abandoning fishing activities. Fish provides a significant proportion of food to CIP
households. Approximately 55% of CIP households get their food from fish products. During
food shortages, CIP households resorted to a hierarchy of strategies which included cutting
down on meals or reducing meal portions, looking for paid work, gathering wild fruit, asking for
food from relatives, selling livestock, and getting social assistance.
Of the 248 fisher households surveyed, 53% indicated that they had cared for continuously ill
person/s in the last five years. The prevalence of CIP varies across villages indicates that some
households were more affected than others. In some cases, all sampled households had a CIP
such as Etsha 6, Sepopa and Samochima. Of the households, at least 29% said the illness
seriously impacted on fishing activities, 9.4% moderately, 10.7% minimally while 51% said that
the illness had no effect at all. Households in other villages indicated that having a CIP either
minimally affected or did not in any way affect fishing activities. Part of the explanation given for
the variation in effect was that some of the CIPs did not do any fishing prior to being ill or fished
only minimally. Follow up informal interviews suggest that serious impacts included sale of
family assets, depletion of savings, and switching or abandoning fishing activities. Some villages
experienced more severe impacts on fishing activities than others. During food shortages, about
24% of households' increased fish catches as their first coping strategy.
In summary, this discussion points to an urgent need for policy interventions to highlight the
impact and effect of HIV infection on fishing communities in the Okavango basin. Because HIV
and AIDS is a major factor regulating fish availability to rural fishers, fisheries need to be
streamlined into the national policy. Because some CIP fishers' households are likely to
alternate between periods of engagement and non-engagement in fishing activities, measures
ought to be taken to protect their income or consumption to prevent them from disengaging
permanently from productive activities.
54
TDA Botswana HIV and AIDS
Chapter 5: HIV and AIDS Program interventions and Demographic
Impacts Introduction: National Program Interventions
This chapter focuses on three key intervention AIDS programs in Botswana with specific
reference to Ngamiland district. These are antiretroviral therapy (ART) roll-out, prevention of
transmission from mother to child (PMTCT), Sexually Transmitted infections. These programs
have key transboundary implication. With regard to ART, there are concerns over primary and
secondary resistance to ARVs, mothers and access to Dry Blood Spot (DBS) of HIV children
born HIV positive, changes in normative behaviors of long term survivors of ARVs and long term
monitoring of virologic failures. With regard to PMTCT, it is poor male involvement in PMTCT.
Pregnancy predisposes a woman to increased risk of exposure to infection. Another challenge
has to do with pressure on women to bear children. More than 80% of HIV positive women and
over 90% of women on HAART reported having more than one pregnancy. Also, pregnancy
occurrences among discordant couples (one partner negative and the other positive) is a
reflection of non or inconsistent condom use. STIs facilitate HIV transmission by increasing
both infectious and HIV susceptibility. The expansion of STI surveillance system in border
crossings and high transit sites is urgent. This also implies that condom distribution and social
marketing campaign to prevention of new infections should be intensified.
Eligibility to ART is assumed to occur at a median of 3 years before AIDS death. The rate of
progression from infection to AIDS death without treatment is 11 years. Other issues relate to
ways in which AIDS related interventions to interactive dynamics of mortality, default, survival,
prevalence and incidence. Simulations of these interactive scenarios are necessary for policy
and program intervention. The last subsection in this chapter considers some likely scenarios in
Botswana.
5.1.1 Key issues in ARV
ART lowers the probability of HIV transmission as it lowers the HIV concentration in the body,
and hence renders recipients less infectious. Figures 5.1 below give four scenario, pre-AIDS
stages, those with AIDS who are yet to receive ART, those on ART and those who have
discontinued ART.
55
TDA Botswana HIV and AIDS
Figure 5. 1: Numbers infected, with AIDS and not on treatment, and on treatment
Although ART has reduced mortality, there is evidence to suggest transmission of drug
resistance HIV strain. Primary resistance in Botswana and other countries in southern Africa, it
has been found to be less than 5% (2nd generation, pp50). The Princess Marina Hospital's
Infectious Disease Control (PH-IDCC) secondary resistance survey conducted in 2004 found
virologic failure to be low, 3.5% (4, 811 patients), and in 2007 a review of 16 245 patients
records who had been initiated on ARVs since 2002, also revealed that secondary rate
resistance remains low, 3.6%. Today, for more than 20 ARV clinics, virologic failure still remains
low at 3%. For highly mobile populations, drug resistance poses a major challenge that must be
monitored nationally and across the borders.
It is estimated that in 2007, 19, 600 children are HIV positive. With no intervention to prevent
mother-to child transmission, about 30% of children born to HIV positive mothers will be
infected. The rate is reduced by about 20% with replacement feeding and even lower through
the use of antiretroviral drugs. Child infection peaked in 1999 and declined sharply as adult
prevalence declined and PMTCT program expanded. By 2007, the number of estimated annual
new child infection has declined to 890 compared to 4, 600 in 1999. Some children progress
from infection to death quickly whiles other progress slowly. The introduction of Dry Blood Spot
(DBS) HIV Testing for Infants has helped increase the number of infants who are tested for HIV
as early as six weeks instead of 18 months as before.
5.1.2 Key issues: Prevention of Transmission from Mother to Child (PMTCT)
In 1999, focus was given to prevention of mother to child transmission (PMTCT) of HIV from
HIV positive mothers to their babies (vertical transmission) when ART was made available
through MASA. PMTCT program has been available in all districts in the country since
November 2001. The scaling up ART Therapy is available in approximately 32 sites and 166
clinics. Trends show that there has been a significant increase in the proportion of women
attending ANC agreeing to test from 71% in 2004 to 80% in 2007. The Routine HIV Testing
(RH)T, which uses lay counselors, was introduced in 2004 countrywide, uses rapid test kit. This
has also contributed to uptake by pregnant women and reduced the burden on nurses and
56
TDA Botswana HIV and AIDS
midwives. In Ngamiland district, the current uptake is 89% and the goal is to increase it to 96%
in 2009. This would be partly achieved by intensifying education on early registration for ANC
and PMTCT, male participation in PMTCT, routine testing for babies born to HIV positive
mothers (NWDC Annual Report, 2007/08).
For HIV positive mothers whose CD 4 count are over 200 and present no clinical signs of AIDS,
prophylaxis (AZT) is given from 28 weeks of pregnancy through to delivery. These may stop
treatment at delivery depending on test results. For those women with a CD 4 count below 200,
the highly active antiretroviral treatment (HAART) is administered to slow down the progression
of the virus and they stay on treatment after delivery. In 2004 the PMTCT uptake increased
from 71% to 83%. (NACA, 2008) In general, there proportion of pregnant women testing HIV+
has remained steady and a major decrease in mother to child transmission from 20 40% to
7% in 2007 (The Mid-term Review of the Botswana National Strategic Framework for HIV/ADS
2003/2009).
The main challenge country wide is male involvement in PMTCT is only in 2006 was 6% and
has slightly improved in 2007 at 9%. Another challenge has been repeated pregnancies in HIV
positive women. More than 80% of HIV positive women and over 90% of women on HAART
reported having more than one pregnancy.
5.1.3 Key issues: Sexually Transmitted infections
The STI Control Program was established in 1989 and syndromic management protocol was
introduce in public health system in 1992. This is a country wide program that provides
treatment of STIs to patients free of charge. STI surveillance system has been established in 8
districts since 2007 and 3 service delivery in cross border and high transit sites in Kasane,
Tlokweng and Serowe/Palapye. Further expansion is planned in five more districts.
In Ngamiland, compared to 2006, there were fewer STI cases in 2007 in different categories
(Table 6.3) This situation could be attributed to the syndromic approach to STI treatment plus
contact follow up. Some patients have difficulty convincing their partners to comply. There is
also a problem of stigma associated with disclosure to partners, resulting in them not getting
treatment. STI infection incidence in the district is 6.4% and the aim is to reduce it to 4% by
March 2009, to improve and intensify partner notification and treatment, improve STI
management and cervical cancer diagnosis. Improved treatment of STIs lowers the probability
of HIV transmission. STIs enhance the risks of HIV transmission when present in HIV- or HIV +
partner. Generally, it is estimated that fertility in Botswana is likely to be reduced by 30% due to
HIV infection among 20 years and older. However, HIV positive women specifically have lower
fertility rates than HIV negative women of the same age. This has been attributed to higher rates
of miscarriage among HIV positive women, higher rates of secondary sterility due to history of
sexually transmitted infections (STIs) (NACA, 2008).
ATTENDANCE FOR STI CARE
SIGNS AND SYMPTOMS
FEMALE
MALE
TOTAL
%
2006 2007 2006 2007 2006 2007 2006 2007
Urethral
Discharge
- - 867
689
5842
4972
15
14
Vaginal
Discharge
1883 1265 -
-
5842 4972 32 25
Genital
Ulcer
241 177 219 230 5842 4972 8 8
Inguinal
Bubo
0 0 0 0 5842
4972
0 0
Lower Abdominal Pains(PID)
641
678
-
-
5842
4972
11
14
57
TDA Botswana HIV and AIDS
Table 5. 1: Cases of Other STIs in Ngami 2006/2007
Source: NWDC , Health Department Annual Report 2006/2007
5.1.4 Demographic Impacts
Botswana's demographic structure has also been impacted by the prevalence of HIV and AIDS.
Nationally, death rates among the 25-29 age group almost doubled from 7.3 to 16 deaths per
1000 people. The rate tripled for the age group 30-34 showing recorded deaths from 8.5 to 23.6
deaths per 1000 (Central Statistics Office - CSO, 2004). As a result of the HIV/AIDS epidemic,
there are adverse changes in key demographic indicators. Figure 5.2 depicts a modeled
demographic pyramid (assuming no AIDS) show an expansive base and funnel top gradually
narrowing at the base. However the recently released population Pyramid with AIDS infection
based on estimated population in which the inner part of the pyramid shows the magnitude of
the infection at each age and sex group. The pyramid bulges 30 - 44 with a prevalence range
40 50% (CSO, 2009).
Figure 5. 2: Age sex-distribution of Botswana population 1981- 2021 assuming no HIV and AIDS (
Dorrington et al 2006 pp 54):
Kgathi et al. (2004) and Majelantle, Ngwenya and Nnyepi (2008) population pyramids shows
that the 0-4 age group bar is shorter than that of children five years and above. Selected village
sites of Ngarange, Shakawe, Mohembo West, Mohembo East and Samochima population
pyramids, also reflect similar characteristics (Figures 5.3a 5.3cc ).
58
TDA Botswana HIV and AIDS
80
sex
75
Males
70
Females
65
60
55
50
45
e
g
40
a
35
30
25
20
15
10
5
0
- 5
- 3
0
3
5
Ngamiland Population Pyramid
Figure 5.3a Ngamiland population pyramid
(Source Majelantle, 2004)
Shakawe Population Pyramid
75+
70-74
65-69
60-64
55-59
50-54
45-49
40-44
% Ma
35-39
30-34
% Fem
25-29
20-24
15-19
10-14
05-09
00-04
8
6
4
2
0
2
4
6
8
10
Percent
Figure 5.3b:Shakawe Population Pyramid
(Source Majelantle, Ngwenya and Nnyepi (2008)
Mohembo East Population Pyramid
75+
70-74
65-69
60-64
55-59
50-54
45-49
40-44
%
35-39
30-34
%
25-29
20-24
15-19
10-14
05-09
00-04
10
8
6
4
2
0
2
4
6
8
10
Percent
Figure 5.3c: Mohembo east Population Pyramid
(Source Majelantle, Ngwenya and Nnyepi, 2008)
Figure 5. 3: A-C Population Pyramids
59
TDA Botswana HIV and AIDS
5.1.6 Modeled Scenarios of AIDS impacts and (non) interventions
Other issues relate to ways in which AIDS related interventions to interactive
dynamics of mortality, default, survival, prevalence and incidence. This sub-section
considers simulations of AIDS related scenarios with regard to the above factors.
The rate of progression from infection to AIDS death without treatment is 11 years
(NACA, 2008) Eligibility to ART is assumed to occur at a median of three years
before AIDS death. Those who receive first- and second line ART experience
extended survival. 85% survive the first year on ART and 95% survive each
subsequent year (NACA, 2008). First year survival is lower than subsequent years
since some people start ART too late and die before it can restore their immune
system.
In Botswana, data shows that 91.3% of ART patients are known to be still alive, and
after five years, 86% patients are still alive. A significant percent are lost through
follow-up, that is their status is unknown and have probably died (NACA, 2008). A
standard measure of adult mortality is the probability that a 15 year old does not
survive to his or her 60th birthday. HIV reduces the population significantly below
what it could have been without the disease. By 2021, the population is estimated to
be 18% - 23% smaller, and the population growth would fall from an estimated 1.9%
p. a without AIDS to between 0. 8 1.1% with AIDS.
A model through which adults are expected to progress before dying of AIDS (in the
absence of ART) was used by Dorrington et al. 2006)to forecast population by age
cohort and `with AIDS' scenario and permits the following interventions, improved
treatment of STIs, Information and Education Campaigns (IEC) and social marketing,
Voluntary Counseling and Testing (VCT, Prevention of Mother to Child Transmission
(PMTCT), and Antiretroviral Therapy (ART). The key assumption being that from
2008, 90% of HIV+ persons eligible for treatment will use ART. The effects of ARVs
are modeled by introducing `people receiving treatment' and `people who has started
treatment and subsequently discontinue'. Three scenarios are modeled are, No
AIDS, AIDS, no ART and AIDS with ART. One effect of not offering ART treatment
would be to `crowd out' non-AIDS deaths. New infection were expected to rise from
1981 and with new treatment expected to fall until 2006 and then increase again with
the gradual increase in the population numbers (Dorrington et al 2006). Because
ART reduces viral load, and could lead to some extent assumptions about changes
in behavior. Prevalence is likely to be higher (15 49) on those on ART with longer
survival due to assumed extended survival of those infected as a result of their better
adherence to treatment protocol. Although the life-extending benefit of ART is shown
in the initial stages with the reduction of deaths (from around 18 000 per annum in
2001 to around 15 000 in 2006, and 11 000 in 2008 under a default with longer
survival scenario), a gradual rise in the number of deaths is expected. Figure 5.4
show the estimated number of AIDS related death 1981 2021 under various
scenarios (that is SO - No AIDS; S1 Default; S1.1 Default with no ART, S1.2
Default with behavioral change and routine HIV Testing (RHT); S1.3 Default with
longer survival on treatment)
60
TDA Botswana HIV and AIDS
Figure 5. 4: Estimated number of AIDS related deaths, 1981- 2021, various scenarios
(Source, Dorrington et al 2006, pp 62).
SO - No AIDS
S1 Default
S1.1 Default with no ART
S1.2 Default with behavioral change and routine HIV Testing (RHT)
S1.3 Default with longer survival on treatment
Figure 5.5 shows various scenarios of projected age sex distribution scenario of
Botswana population allowing for the impact of HIV and AIDS. The impact of the
epidemic concentrate on young adults (ages 30 and below) this is due to a dramatic
impact of AIDS on male population aged 40 years and over and the female
population aged 35 and over. Preliminary Results of the Botswana HIV and AIDS
Impact Survey III (CSO, 2009: 7) show, at national level, prevalence rates plateaus
around 40% in the age rage 30 44 (with women the peaking is nearly earlier 50%
for females within 30 34 while men peak 10 years later and lower at around 44%).
Also, the preliminary results suggest that for both males and females, there appears
to be a surge in the early 50s, and male prevalence is higher than that of females at
60 years and above. For Ngamiland wests, age range 25 49 and 31-49
respectively have a high prevalence rate compared the national average (Table 5.2).
61
TDA Botswana HIV and AIDS
Figure 5. 5: Age-sex distribution of the Botswana population in 2021, various scenarios
(Source Dorrington et al pp55)
SO - No AIDS
S1 Default
S1.1 Default with no ART
S1.3 Default with longer survival on treatment
Table 5.2 Estimated HIV prevalence rate by district and target Age group
Prevalence rate by district and target Age group
District
HIV prevalence by target group
15 - 24 19 - 24 15 -49
20 - 30
25 - 49
31 - 49 50 -64
Ngamiland
8.4
10.4
27.1
23.4
34.9
38.2
20.7
East
Ngamiland
9.1
10.5
26.3
22.6
43.0
44.9
17.5
West
National
8.0
11.0
25
20.7
34.7
38.2
22.2
Source: CSO, 2009.
In summary, AID interventions mentioned above have had differential impacts with
regard to mortality and survival of Batswana. But these interventions also induce
other dynamics which intersect with other variables such as age, gender, marital
status and locality. It is worth noting that in Chapter 1, it was noted that Ngamiland
west has a relatively high rate of poverty, that there are more women than men in the
region and a relatively high proportion of women lead households, the table above
also seem to give a not so good picture with regard to relatively high prevalence
among 25 49 year old. This age group is still in its prime years of production and is
likely to be mobile as well. This implies that at trans-boundary level, more attention
should be given to the burden the disease imposes on this segment of the population
as well as other factors such as drug resistance; multiple pregnancies of HIV positive
women. Also, comparative scenarios of countries within the Okavango river basis
62
TDA Botswana HIV and AIDS
can be modeled. Various scenario can provide useful insights into future planning
and national program formulation.
63
TDA Botswana HIV and AIDS
Summary and Conclusions
Livelihood/income diversification, adaptation to variability, multi-local residences and
migration characterize human activities in the Okavango basin. Arable and livestock
farming, formal employment, government social safety nets, remittances and fishing,
constitute key sources of livelihood for a significant proportion of the Delta
population. Although arable agriculture is primarily dryland or rain-fed and less
dependent on drawing water from the Okavango River, it still remains the key food
system. There is limited, if any, commercial irrigation based arable farming. Molapo
farming (flood recession) along the Okavango River seasonal flood plains, although
hailed by most farmers as the most productive food system, faces tenure rights and
other legislative challenges. Other secondary food systems that are water related in
the basin include fish, veldt products and leafy vegetables and scattered small scale
horticultural/vegetable projects. Non related food sources include imported cereals
and vegetables. A major collapse in arable farming and lack of policy/program
attention in this sector in particular to enhancement of productivity of small-scale
arable farmers, is likely to adversely impact on utilization of Okavango water
resources in the long run. Recognizing the pivotal role of arable farming, the
government of Botswana has initiated the Integrated Support Program for Arable
Agriculture (ISPAA). There is ample evidence that variability of livelihood and or food
systems of Okavango basin residents' speaks to local adaptations to variability in
flood regimes/cycles. Key transboundary issues therefore are that, in order for the
pristine status quo of water resources in the Okavango basin under high/low flood
scenarios, much will depend very much on how, on the one hand, communities/
households adapt contemporaneously or will adapt over time. On the other hand, the
effectiveness of local adaptation is determined by national policies/programs.
Government interventions can either capacitate or incapacitate strategies depending
on whether there is flexibility to address evolving impacts of flood variability on
dynamic interconnectedness between water and non water livelihoods. The
implementation capacity of ISPAA and other similar programs in the Basin should be
enhanced and or program piloted in likely `hotspot' as preventive/proactive trans-
boundary initiative The integrity of Okavango Delta water as a natural resources
cannot be treated in isolation from other symbiotic natural resources based
livelihoods/food system.
Gender, water resources and poverty dynamics in the Okavango basin indicate that
men and women are constrained in different and often unequal ways as potential
participants or beneficiaries' water resources. Whereas generally some natural
resourced based livelihood activities in the are gender specific, others cut across age
and gender. Under conditions of stress however, `resource use often redefines
traditional gender roles to include `gendered switching' and commercialization.' For
this scenario to happen, several variables come into play. These include, but are not
limited to household structure, loosely indicated by type of headship, and asset
profile (wealth and poverty levels). Unfortunately, headcount poverty rate in
Ngamiland is very severe (40% and 50%) in Ngamiland east and Ngamiland west
respectively. Furthermore, Ngamiland west has high proportion of women headed
households with low levels of human capital development. These factors cannot be
ignored and or be relegated to national governments. One direct water related
resource that cuts across age and gender is fishing. To date, program planning
(ODMP for instance) and government policy intervention (the Financial Assistance
Policy FAP) and donor funded national projects (BIOKANGO), have been largely
gender blind and tend to be biased towards so called commercial fishers and sport
fishers. Lesser attention has been given to women fishers who primarily fish with
traditional gears (such as fishing baskets). Studies from elsewhere indicated that
women tend to benefits different from men in the fishing industry (Marketing and
64
TDA Botswana HIV and AIDS
processing). Building on work already done by the BIOKAVANGO Project, other
entrepreneurial venture that include but not limited to aquaculture potential across
the three countries should be ventured A gender analysis framework is proposed
that would include ways in which it intersects with dimensions of poverty (asset and
subjective) and the feasibility of trans-boundary pro-poor, pro-growth small/medium
program. The key issues being that assuming that gender roles at trans-boundary
level cannot be assumed to be fixed. This assumption can result in intervention that
would miss the dynamics of water and other interactive natural resource utilization,
such as, consequently lead to inappropriate policies or programs in the Okavango
Basin.
Although as a country, Botswana has comprehensive HIV and AIDS policies and
reasonably resourced national programs intervention aimed at disease prevention,
support and mitigation HIV Prevalence, incidence, trends and access is sues still
remain a challenge. According to the recent 2008 Botswana AIDS Impact Survey III
(BAIS III), national HIV prevalence rate stands at 17.6% (20.4% females and 14.2
males). The HIV incidence rate nationally is 2.9% (3.5% for females and 2.3% for
males). Ngamiland west has a prevalence rate of 16-18.9 % and Ngamiland East is
the most hard hit with a prevalence rates of between 19 and 21.9%. The Ngamiland
East district also has `high incidence zone' of HIV infection (5.0% and above).
Because antiretroviral therapy prolongs life, the numbers of infected is expected to
increase over time in most districts as more people access antiretroviral therapy.
New challenges include surging rates of new infections (4.76% in Ngamiland).
Although death rates from HIV related factors should decline significantly, it is
postulated that with successful ART roll out, the number of HIV + individuals is
expected rise and there will be a gradual spread of the HIV virus across districts
Delivery of AIDS services faces some challenges regarding access. Some districts
face more challenges than others due to a number of factors, some of which are
policy related, others as a result of uneven regional development interventions
especially those related to social development. Access to treatment is also critical.
Approximately 36% of the districts population are > 60km from an ARV clinic.
However, the picture is likely to changes due to the fact that the National
Development Plan 10 (NDP10) has provision for a primary hospital in Shakawe,
upgrading primary hospital in Gumare and health posts in the Okavango sub-districts
to clinic status. Whereas all these infrastructural and institutional developments are
welcome and will greatly enhance the district's human capital, population growth
centers and centers of commerce, create employment opportunities, the down side
of it is that these changes are also likely to lead to increased risk factors of HIV
transmission.
The link between HIV and AIDS and natural resource based livelihood has been
neglected. Whereas the revised National Policy on HIV and AIDS (2006) has put
some sectors in the fore-front, the role of natural resource based sectors such as
agriculture; fisheries, water and CBNRM were not clearly defined in the National
Policy on HIV/AIDS. Unfortunately, in Ngamiland, a significant proportion of the
district population's livelihoods are derived from these. Case studies from three key
natural sectors resources that are dependent on services of the Okavango Delta are
used, namely, agriculture, fish and community based natural resource management
(CBNRM) projects. The case studies suggest that the impact of AIDS on these
sectors is verifiable, but in general, natural resource institutions (NRM) and HIV and
AIDS have been inward looking with regard to addressing the problem, their program
interventions have shifted away from hard realities of AIDS to soft targets around
"wellness" in the workplace. This is in part because the link between HIV and
environment has not been clearly articulated. A case study of a viable
government/safari HIV outreach partnerships is discussed in the context of policy
65
TDA Botswana HIV and AIDS
and program partnerships in the basin that still focuses on the human crisis
dimension of the pandemic.
Despite massive government resources and extra funding from African
Comprehensive HIV/AIDS Partnerships (ACHAP), from which Ngami East benefit
(and Chobe), Ngamiland west (Okavango) does not. Due to financial constraints, the
AIDS Service infrastructure is likely to experience shortage of skilled staff and the
inadequate availability of equipment, such as vehicles and laboratory equipment.
More fundamentally, HIV is a human crisis. It is not easy therefore to link funding HIV
interventions with natural resource management projects/programs. However,
government/private partnerships transboundary project akin to the one spear headed
by Kalahari Conservation Society (with Safari Operators) between Botswana, Angola
and Namibia.
Evidence from the Botswana Sentinel Surveillance Report (2006) and the Botswana
AIDS Impact Survey II (2004) and Botswana AIDS Impact Survey III (2009),
Francistown Kasane or the Francistown, or the Selebe - Pikwe trade routes, would
be opening up another HIV transmission conveyer belt. The health needs of those
people involved in cross-border trade, as well as those people who offer services to
these people, such as sex workers. The clinic at the Kasungula weigh bridge is a
step in the right direction, as is the fact that Kasane, a border post town, is receiving
significant funding from ACHAP (ACHAP, 2006). The three countries may have to
think about setting up border post health clinic that offer 24 hour services
Although there are numerous HIV and AIDS Program interventions, there are key
ones whose challenges have transboundary implication. Focuses was given to three
key intervention AIDS programs in Botswana. These are antiretroviral therapy (ART)
roll-out, prevention of transmission from mother to child (PMTCT), Sexually
Transmitted infections. With regard to ART, there are concerns over primary and
secondary resistance to ARVs, mothers and access to Dry Blood Spot (DBS) of HIV
children born HIV positive, changes in normative behaviors of long term survivors of
ARVs and long term monitoring of virologic failures. With regard to PMTCT, it is poor
male involvement in PMTCT. Pregnancy predisposes a woman to increased risk of
exposure to infection. Another challenge has to do with pressure on women to bear
children. More than 80% of HIV positive women and over 90% of women on HAART
reported having more than one pregnancy. Also, pregnancy occurrences among
discordant couples (one partner negative and the other positive) are a reflection of
non or inconsistent condom use. STIs facilitate HIV transmission by increasing both
infectious and HIV susceptibility. The expansion of STI surveillance system in border
crossings and high transit sites is urgent. This also implies that condom distribution
and social marketing campaign to prevention of new infections should be intensified.
Other issues relate to ways in which AIDS related interventions to interactive
dynamics of mortality, default, survival, prevalence and incidence. Transboundary
simulations of HIV and AIDS intervention scenarios in relation to mortality, dynamics
of extended survival on ART, demographic shifts, and prevalence and incidence, are
important. All these factors have transboundary implications vulnerability to
flood/climate variability for some social groups
66
TDA Botswana HIV and AIDS
Cited references
Agarwal, B 2001, participatory exclusions, community forestry and gender: An analysis of south asia
and a conceptual framework. World development: 29:1623-1648
Agrawal, A., (2001). Common property and sustainable governance of resources.
World Development 29 (10), 1649-1672.
AIDS Brief. CBNRM Brief for Sectoral Planners and Managers. Development Alternatives,
USAID. http://www.frameweb.org/
Africa Biodiversity Collaborative Group. 2002. Securing Africa's Future: Biodiversity and Health
and HIV/AIDS Workshop. Dar es Salaam.
AIDS Brief, CBNRM. 2005. CBNRM Brief for Sectoral Planners and Managers. Development
Alternatives, USAID. http://www.frameweb.org/
Allison, E. H., and Seeley, J. A., 2004. HIV and AIDS among fisherfolk: a threat to
`responsible fisheries'?
Fish and Fisheries, 5: 215 234.
Allison E. H. and Seeley. J. A. 2006. HIV and AIDS among fisherfolk: What is at stake?
Proceedings of the International Workshop, February 20 -21, Lusaka, Zambia
Allison, E.H., Ellis, F., (2001). The Livelihoods approach and management of small-scale
fisheries.
Marine Policy 25, 377-388.
Arntzen, Y 2005 Livelihoods, agriculture and biodiversity in the Okavango delta, Botswana.
Report prepared for the PDF-B Stage of the GEF project; Building local capacity for
the
conservation and sustainable use of biodiversity in the Okavango Delta
Applied Development Research Consultants (2001) A Report of the socio-ecological survey
of the Okavango river Basin, HOORC Library, Maun
Bishop-Sambrook, C. 2004. Addressing HIV/AIDS through agriculture and natural resource
sector:
A guide to Extension Workers. Socio-economic and Gender Analysis Program, FAO.
Rome
Baro, M., 2004. The dynamics of HIV/ AIDS in the fishing communities of Benin and Uganda.
A synthesis
Report. GTZ
Bene C, Mindjimba, K, Belal, E, Jolley, T, Neiland, A 2003. Inland fisheries,
tenure systems and livelihood diversification in Africa: the case of the Yaere Flood
plains
in Lake Chad Basin African Studies Volume 62, Issue 2, 2003, 187 212
Bene, C., Neiland, A., Jolley, T., Ladu, B., Ovie, S., Sule, O., Baba, M., Belal, E., Mindjimba,
K., Tiotsop, F.
, Dara, L., Zakara, A., Quensire, J., (2003). Inland fisheries, poverty and rural
livelihoods in the Lake Chad Basin. Journal of Asian and African studies.
Berkes, F.. 1977. Fishery resource use in a subartic Indian Community. Human Ecology
:5:289-307
Buchy, M and Rai, B. 2008. Do women only approaches to NRM help women? The case of
community forestry
in Nepal In Elmhirst R., and Resurreccion (eds) Gender and Natural Resource
Management: Livelihoods, Mobility and Interventions London, Earthscan pp127- 149
Butale, B.M (2006) Directory of health and wellness teams AIDS Coordinating Unit, Ministry
of Minerals,
Energy and Water Resources, Gaborone
Cassidy, L., (2001). Improving Women's Participation in Botswana. IUCN/SNV CBNRM
Support Program,
Occasional Paper No.5. http://www.iucnbot.bw
Chant, Sylvia (2006) `Re-thinking the "Feminisation of Poverty" in Relation to
Aggregate Gender Indices', Journal of Human Development, 7:2, 20120.
Central Statistics Office 2004.Botswana AIDS Impact Survey (BAIS II). Ministry of Finance and
Development Planning. Central Statistics Office. Gaborone
67
TDA Botswana HIV and AIDS
Central Statistics Office 2009. STATS BRIEF: Preliminary Results: Botswana AIDS Impact Survey III,
2008.
Ministry of Finance and Development Planning. Central Statistics Office. Gaborone
Central Statistics Office (2002). The 2001 Botswana Population and Housing Census.
Gaborone,
Ministry of Finance and Development Planning
Central Statistics Office, (2008). Botswana Census-Based Poverty Map: District and
Sub-district level Results . Ministry of Finance and Development, Gaborone,
Botswana.
COMPASS. Impacts of HIV/AIDS on Natural Resource Management in Malawi. Document 55.
Blantyre, 2003
Cornwall, A 2003. Whose voices? Whose choices? Reflections on gender and participatory
development
World Development 31:1325 - 1342
Cordell, J and McKean, M. A 1992. Sea and tenure in Bahia, Brazil. In Bromley D. W. (ed).
Making the Commons Work Theory, Practice and Policy. San Francisco: ICS
Press
Cooke, H K. 1978. The problem of drought in Botswana Proceedings of the Symposium on
Drought in
Botswana, National Museum , Gaborone. June 5th 8th Clark University
Press/Botswana Society, 7 - 19
Dube, O.P and Sekhwela, M. B. M. (2008) Indigenous Knowledge, Institutions and Practices
of Coping with
variable climate in the Limpopo Basin of Botswana. In Leary, n., Burton, I., Adejun, J.,
Barros, V., Rodel, L. (eds). Climate Change and Adaptation. Earthscan London
Pp71-89.
Drimie, S., Gandure, S. 2005. The Impacts of HIV/AIDS on Rural Livelihoods in Southern Africa:
An Inventory and Literature Review. FAO/UN Sub Regional Office of Southern and Eastern
Africa. Harare.
Eakin, H. 2005: Institutional change, climate risk and rural vulnerability:
cases from central Mexico .World Development 33, 19231938 .
Ellis, F. 2000. Rural Livelihoods and Diversity in Developing Countries. Oxford University Press. Oxford,
UK.
Elmhirst R., and Resurreccion , B. P.2008. Gender, environment and natural resource
management:
New dimensions, new debates. In Elmhirst R., and Resurreccion (eds) Gender and
Natural Resource Management: Livelihoods, Mobility and Interventions London,
Earthscan pp3-17
Elmhirst, R. 2008. Multi-local livelihoods, Natural resource management and gender in
upland Indonesia,
In Elmhirst R., and Resurreccion (eds) Gender and Natural Resource Management:
Livelihoods, Mobility and Interventions London, Earthscan pp 67-85.
Elmhirst, R. 2002. Daughters and displacement: Migration dynamics in an Indonesian transmigration
area
Journal of development studies 38/5/138-166
Dorrington, R.E., Moultrie, T.A., Daniel, T. (2006). The Demographic Impact of HIV/AIDS in
Botswana:
Modeling the impact of HIV/AIDS in Botswana. Gaborone, UNDP/NACA.
Every River Has its People Project, 2006. ERP Newsletter Vol 5/ Issue 24 /2006. Gaborone.
Erskine, S. Red Ribbons and Green Issues: Exploring HIV/AIDS as an Environmental Concern. Health
Economics
and HIV/AIDS Research Division (HEARD). University of KwaZuluNatal,
http://www.hivan.org.za/admin/documents/Red%20Ribbons%20and%20Green%20Issues.do
c.
68
TDA Botswana HIV and AIDS
Farrington J, Slater, R and Holmes, R,. 2004. The Search for synergies between social
protection and
Livelihood promotion: The Agriculture Case. Overseas Development Institute (ODI)
Working paper 232. London
Financial Assistance Policy (FAP), 2000 Fourth evaluation, Botswana Collection, UB/HOORC
Library, Maun.
Freira,J., Garcia-Allut A.Socio-economic and biological causes of management failures in
European:
the case of Galicia (NW Spain)). Marine Policy 2000; 24:375-384
Forum SYD, 2005. Forum SYD Organizations Collaborating for Global Justice. Annual
Report, Sweden
Freeman, P. H. CBNRM and AIDS in Bushbuckridge, Northern Province. South Africa. An Exploratory
Geographic Analysis. South Africa, http://www.popline.org/doc/1564/174389.html
Geheb, K. Binns, T. 1997. Fishing farmers or Farming Fishers? The quest for household
income and
nutritional security on the Kenyan shores of Lake Victories African Affairs :96:73-93
Gillespie and Kadiyala. 2005. HIV/AIDS and Food and Nutrition Security. Food Policy Review 7.
Washington DC, International Food Policy Research Institute.
Gordon, A., 2005. HIV/ AIDS in the Fisheries Sector in Africa. WorldFish Centre, Cairo,
Egypt.
Gwebu, T.D. (2003). Internal Migration in Botswana, 2001 Population and Housing Census
Dissemination
Seminar, 8th 11 September, Gaborone, Botswana.
Wehbe, M., Eakin, H., Seiler, R., Vinocur, M., Avila, C and Marutto., C. 2006. Local
perspectives on Adaptation
to climate change: Lessons from Mexico and Argentina. AIACC working paper # 39.
www.aiaccproject.org
Hitchcock, R K 1978. The Traditional Response to drought in Botswana. Proceedings of the
symposium on
Drought in Botswana, National Museum , Gaborone. June 5th 8th Clark University
Press/Botswana Society, 91 96
Hunter, L., & Twine, W. Adult Mortality, Natural Resources and Food Security: Evidence from the
Agincourt field site in rural South Africa. Centre for African Ecology, University of
Witwatersrand, South Africa, 2005
Johnson, T. Challenges and Responses to Impacts of HIV/AIDS on CBNRM in a Transboundary
Context.
South Africa. 2002.
Keulder, C 2006. Ships, trucks and clubs: The dynamics of HIV Risk Behavior in Walvis Bay,
Namibia .
Proceedings of the International Workshop, February 20 -21, Lusaka, Zambia
Kgathi, D. L., Bendsen H., Blaikie., P., Mbaiwa, J., Ngwenya, B. N., Wilk, J 2004. Rural
livelihoods,
Indigenous Knowledge systems and the political economy of access to natural
resources
in the Okavango Delta, Botswana. HOORC Library, UB Maun campus.
Kgathi, Dl, Kniveton, D, Ringrose, S, Turton, T, Vanderpost, C, Lundquist, Savenije, H,
Seelely, M,
Mendelson, E, 2006. Rural Livelihoods, Indigenous Knowledge Systems and Political
Economy of Access to Natural Resources
Kgathi, Donald L., Ngwenya, Barbara N. and Wilk, Julie ,2007.'Shocks and rural livelihoods in the Okavango Delta,
Botswana', Development Southern Africa, 24:2, 289 308. DOI: 10.1080/03768350701327186
Kgathi, D.L., Mmopelwa, G., Mosepele, K., ( 2005). Natural Resources assessment in the
Okavango Delta, Botswana: Case Studies of Some Key Resources. Natural
Resources Forum 29, 70-81.
Leach, M. 1994. Rainforest relations Gender and resource use among the Mende of Gola, Sierra leone.
Edinburgh. University of Edinburgh press
69
TDA Botswana HIV and AIDS
Lesetedi, N. G., (2003). Household Perspectives of Women and Men in Botswana, 2001
population
and housing census dissemination, 8th 11 September, Gaborone, Botswana.
Mauambeta, D. D. C. HIV/AIDS Mainstreaming in Conservation: The Case of Wildlife and
Environmental Society of Malawi.
http://www.rmportal.net/library/hh_main/hh_hivaids/HiVandConservation
Mainstreaming.pdf/?searchterm=participatory%20planning.
Magole, L., Ngwenya, B. N. and Butale, B. M. 2006. Does Institutional Capital Matter for
Community Caregivers Central Statistics Office, Ministry of Finance and
Development, Gaborone).
Majelantle R.G, Ngwenya B. N, Nnyepi, M. S, Dintwa, K. F. A (2008) Socio-economic Survey of the
Small-scale fisheries in Rural Livelihood Diversification in the Upper Panhandle Okavango
Delta. Research Report SES/ F06/08, BIOKAVANGO Project, Fishery Sector, HOORC, UB
Maun http://www.orc.ub.bw/biokavango
Mazwimavi, D and Mmopelwa, G 2006. Access to water in gazetted and ungazetted rural
settlements
in Ngamiland, Botswana. Physics and Chemistry of the Earth 31: 713 722.
McGoodwin, J. R. 2001 FAO Technical Paper 401
http://www.fao.org/docrep/004/y1290E/v1290e00.htm
Meinzen-Dick, R & M Z zwarteveen 1998, Gender participation in water management:
Issues and illustrations from water users' associations in south asia, Agriculture and human
values 15, 337-345
Meinzen-Dick, R., Brown, L.R., Feldstein, H.S., Quisumbing, A.R., (1997). Gender, Property
Rights,
and Natural Resources. FCND discussion paper 29.
Merten, S. and Haller, T., (2008). "We are Zambians- Don't tell us how to fish!" Institutional
Change,
Power Relations and Conflicts in the Kafue flats fisheries in Zambia. Human Ecology
36:699-715.
Ministry of Agriculture, Animal Industry and Fisheries (MAAIF), 2005. Uganda Strategy for
Reducing the Impact of HIV and AIDS on Fishing Communities (summary document).
Kampala, Republic of Uganda
Ministry of Health (2007). Botswana ANC Second Generation HIV/AIDS Sentinel Surveillance
Technical Report. Gaborone, Botswana.
Mmopelwa, G. Ngwenya, B. N &. Sakwape, B. 2008. The dynamics of fishing as a Natural
Safety Net
in the Okavango Delta, Botswana. In Allam Ahmed (editor) Managing Science and
Technology for a Sustainable Future, Book: the 6th International Conference, World
Sustainable Development(WASD), Brighton, UK 27th 29th August pp141 - 152.
www.worldsustainable.org
Mochaba, M 2005.the impact of HIV/AIDS on the tourism sector in the Okavango Delta.
Harry Oppenheimer Okavango Research Centre Library, University of Botswana,
Maun
M'Boussou, F. 2006. HIV/AIDS Response in fishing communities: the experience of the
Republic
of Congo Brazzaville. Proceedings of the International Workshop, February 20 -21,
Lusaka, Zambia
Mosepele, K. 2001. Description of the Okavango delta fishery. Technical Report to the Fisheries
Section,
Ministry of Agriculture, Gaborone, Botswana.
Mosepele, K. 2003. Trends in Fisheries Development and Fish Utilization in
the Okavango Delta. <http://www.okavangochallenge.com/>
Mosepele, K; Ngwenya, B. N. and Bernard, T. 2006. Artisanal Fishing and Food Security in
the
Okavango Delta, Botswana. In Allam Ahmed (editor) World Sustainable Development
Outlook. Pp 159- 168 Geneva Inderscience www.inderscience.com
Mullins, D. 2001. Land Reform, Poverty Reduction and HIV/AIDS. Paper presented at the SARPN
Conference on Land Reform and Poverty Alleviation in Southern Africa. Pretoria.
70
TDA Botswana HIV and AIDS
National AIDS Coordinating Agency, (2008). The National Response: HIV and AIDS
Information Package,
NACA, Gaborone.
National AIDS Coordinating Agency, (2008). Progress report of the National Response to the
UNGASS
Declaration of Commitment on HIV/AIDS. Gaborone, Ministry of Sate President.
National AIDS Coordinating Agency, (2006). The Economic Impact of HIV and AIDS in
Botswana Report.
National AIDS Coordinating Agency, (2008). HIV/AIDS in Botswana: Estimated trends and
implications based on surveillance and modeling. NACA, Gaborone
Ngwenya, B.N., Potts, F,. and Thakadu, O.T. 2006 The Impact of HIV/AIDS on CBNRM in
Botswana:
The Case of Ngamiland, (edited by B. Schuster). IUCN CBNRM Support Program
http://www.iucnbot.bw
Ngwenya B. N. and Thakadu, O. T. 2007. HIV/AIDS Morbidity/mortality, Access to Social Support
and Household Utilization of Natural Resources in Ngamiland, Botswana. In Tiezzi E,
Marques, J. C and Brebbia, C. A and Jorgensen, S. E (eds) Ecosystemms & Sustainable
Development
Vol
6
WIT
Press.
pp
http://library.itpress.com/pages/PaperInfo.asap?PaperID+18234
Ngwenya, B. N. Mosepele, K. 2007. HIV/AIDS, Artisanal, Fishing and Food Security in the
Okavango Delta, Botswana. Physics and Chemistry of the Earth 32 (15 -18): 1339-
1349. www.elsevier.com/locate/pce DOI 10.1016/j.pce.2007.07.032
Ngwenya, B. N and Kgathi, D.L. 2006. Access to Water and HIV/AIDS: A Case Study of
Home Based Care in Ngamiland. Physics and Chemistry of the Earth 31 (15-16) 669-
680. http://dx.doi.org/10.1016/j.pce.2006.08.041
NorthWest District Council District Health Team Health Department 2006/2007 Annual
Report, Maun
Oglethorpe, J., Gelman, N. HIV/AIDS and Conservation. Impacts and Ways to Reduce them. Fact Sheet
for
the Conservation Community. http://www.frameweb.org/
Orindi, V., and Huggins, C., (2005). The Dynamic Relationship property rights, water
Resource Management
and Poverty in the Lake Victoria basin. International workshop on "African Water
Laws: plural legislative Framework for rural water management in Africa" 26th 28th
January, Johannesburg, South Africa. Pp 33-1 33-9
Ruhweza, A. Exploring the Relationship Between HIV/AIDS and Community Based Natural Resource
Management
(CBNRM).
Uganda.
2001
http://www.gbf.ch/ab_received.asp?no=37&lg=EN&app=&now=2#2
Leach, M., Mearns, R., Scoones, I., (1999). Environmental Entitlements: Dynamics and
Institutions in
Community-Based Natural Resources Management. World Development 27 (2),
225-247.
Majelantle R. (2004) Ngamiland Demographic Indicators. Resource Paper for the WERRD Research
project.
HOORCUniversity of Botswana, Maun (Botswana).
Merten, S and Haller, T., (2008). Property Rights, food security, and child growth: Dynamics
of insecurity
in the Kafue Flats of Zambia. Food Policy 33, 434-443.
Tsalaile, G. 2006. HIV/AIDS in Workplace: A Survey of Selected Retail and Wholesale
Sectors in Maun,
HOORC Library, Research
Terry, E. (1984). A Survey of Basketmakers, Etsha Ngamiland, Botswana. Botswanacraft
Marketing Company, Etsha.
Page, S. 2003. The impact of the HIV/AIDS on the ability of Malawian communities to manage
their Natural Resources. COMPASS Document 55. Malawi.
71
TDA Botswana HIV and AIDS
Prah, K.K., (1978). Some Sociological Aspects of Drought. In Proceedings of the symposium
on
drought in Botswana, (edited M T Hinchey) National Museum, Gaborone. June 5th
8th Clark University Press/Botswana Society 87 -90
Ruhweza, A. 2001. Exploring the Relationship Between HIV/AIDS and Community Based Natural
Resource Management (CBNRM). Uganda.
http://www.gbf.ch/ab_received.asp?no=37&lg=EN&app=&now=2#2
SADCFANR Vulnerability Assessment Committee, 2003. Towards Identifying Impacts of HIV/AIDS on
Food Insecurity in Southern Africa and Implications for Response. Findings from Malawi,
Zambia and Zimbabwe. Harare, Zimbabwe.
SADC, 2001. Protocol on Fisheries. Associated Press
Sarch M. T, Allison E H. 2000. Fluctuating Fisheries in Africa's inland waters: well-adapted
livelihoods,
maladapted management. Proceedings on the 10th international conference of the
Institute of Fisheries Economics and Trade. Corvallis, Oregon, July 9th-14th, 2000
http://osu.orst.edu/dept/IIIFET/200/papers/sarch.pdf
Scoones, I, 1998. Rural livelihoods: a framework for analysis. IDS working paper
72. Brighton, United Kingdom: Institute of Social Studies, University of Sussex.
Stringer, L.C., Dyer, J.C., Reed, M.S., Dougill, A.J., Twyman, C., Mkwambisi, D., (2009).
Adaptations
to climate Change, Drought and Desertification: Local insight to enhance policy in
southern Africa. Environmental Science and Policy. Doi:10:1016/jenvsci.2009.04.002
Soeftestad, L. 2001. The CBNRM Net Newsletter. Number 14. World Bank Common Property
Resources Management Network.
72
TDA Botswana HIV and AIDS
The Okavango River Basin Transboundary Diagnostic Analysis Technical Reports
I
Transboundary Diagnostic Analysis to establish a
n 1994, the three riparian countries of the Okavango
base of available scientific evidence to guide future
River Basin Angola, Botswana and Namibia
decision making. The study, created from inputs from
agreed to plan for collaborative management of the
multi-disciplinary teams in each country, with
natural resources of the Okavango, forming the
specialists in hydrology, hydraulics, channel form,
Permanent Okavango River Basin Water
water quality, vegetation, aquatic invertebrates, fish,
Commission (OKACOM). In 2003, with funding from
birds, river-dependent terrestrial wildlife, resource
the Global Environment Facility, OKACOM launched
economics and socio-cultural issues, was
the Environmental Protection and Sustainable
coordinated and managed by a group of specialists
Management of the Okavango River Basin (EPSMO)
from the southern African region in 2008 and 2009.
Project to coordinate development and to anticipate
and address threats to the river and the associated
The following specialist technical reports were
communities and environment. Implemented by the
produced as part of this process and form
United Nations Development Program and executed
substantive background content for the Okavango
by the United Nations Food and Agriculture
River Basin Transboundary Diagnostic Analysis
Organization, the project produced the
Final Study
Reports integrating findings from all country and background reports, and covering the entire
Reports
basin.
Aylward, B.
Economic Valuation of Basin Resources: Final Report to
EPSMO Project of the UN Food & Agriculture Organization as
an Input to the Okavango River Basin Transboundary
Diagnostic Analysis
Barnes, J. et al.
Okavango River Basin Transboundary Diagnostic Analysis:
Socio-Economic Assessment Final Report
King, J.M. and Brown,
Okavango River Basin Environmental Flow Assessment Project
C.A.
Initiation Report (Report No: 01/2009)
King, J.M. and Brown,
Okavango River Basin Environmental Flow Assessment EFA
C.A.
Process Report (Report No: 02/2009)
King, J.M. and Brown,
Okavango River Basin Environmental Flow Assessment
C.A.
Guidelines for Data Collection, Analysis and Scenario Creation
(Report No: 03/2009)
Bethune,
S.
Mazvimavi,
Okavango River Basin Environmental Flow Assessment
D. and Quintino, M.
Delineation Report (Report No: 04/2009)
Beuster, H.
Okavango River Basin Environmental Flow Assessment
Hydrology Report: Data And Models(Report No: 05/2009)
Beuster,
H. Okavango River Basin Environmental Flow Assessment
Scenario Report : Hydrology (Report No: 06/2009)
Jones, M.J.
The Groundwater Hydrology of The Okavango Basin (FAO
Internal Report, April 2010)
King, J.M. and Brown,
Okavango River Basin Environmental Flow Assessment
C.A.
Scenario Report: Ecological and Social Predictions (Volume 1
of 4)(Report No. 07/2009)
King, J.M. and Brown,
Okavango River Basin Environmental Flow Assessment
C.A.
Scenario Report: Ecological and Social Predictions (Volume 2
of 4: Indicator results) (Report No. 07/2009)
King, J.M. and Brown,
Okavango River Basin Environmental Flow Assessment
C.A.
Scenario Report: Ecological and Social Predictions: Climate
Change Scenarios (Volume 3 of 4) (Report No. 07/2009)
King, J., Brown, C.A.,
Okavango River Basin Environmental Flow Assessment
Joubert, A.R. and
Scenario Report: Biophysical Predictions (Volume 4 of 4:
Barnes, J.
Climate Change Indicator Results) (Report No: 07/2009)
King, J., Brown, C.A.
Okavango River Basin Environmental Flow Assessment Project
and Barnes, J.
Final Report (Report No: 08/2009)
Malzbender, D.
Environmental Protection And Sustainable Management Of The
Okavango River Basin (EPSMO): Governance Review
Vanderpost, C. and
Database and GIS design for an expanded Okavango Basin
Dhliwayo, M.
Information System (OBIS)
Veríssimo, Luis
GIS Database for the Environment Protection and Sustainable
Management of the Okavango River Basin Project
Wolski,
P.
Assessment of hydrological effects of climate change in the
Okavango Basin
Country Reports
Angola
Andrade e Sousa,
Análise Diagnóstica Transfronteiriça da Bacia do Rio
Biophysical Series
Helder André de
Okavango: Módulo do Caudal Ambiental: Relatório do
Especialista: País: Angola: Disciplina: Sedimentologia &
73
TDA Botswana HIV and AIDS
Geomorfologia
Gomes, Amândio
Análise Diagnóstica Transfronteiriça da Bacia do Rio
Okavango: Módulo do Caudal Ambiental: Relatório do
Especialista: País: Angola: Disciplina: Vegetação
Gomes,
Amândio
Análise Técnica, Biofísica e Socio-Económica do Lado
Angolano da Bacia Hidrográfica do Rio Cubango: Relatório
Final:Vegetação da Parte Angolana da Bacia Hidrográfica Do
Rio Cubango
Livramento, Filomena
Análise Diagnóstica Transfronteiriça da Bacia do Rio
Okavango: Módulo do Caudal Ambiental: Relatório do
Especialista: País: Angola: Disciplina:Macroinvertebrados
Miguel, Gabriel Luís
Análise Técnica, Biofísica E Sócio-Económica do Lado
Angolano da Bacia Hidrográfica do Rio Cubango:
Subsídio Para o Conhecimento Hidrogeológico
Relatório de Hidrogeologia
Morais, Miguel
Análise Diagnóstica Transfronteiriça da Bacia do Análise Rio
Cubango (Okavango): Módulo da Avaliação do Caudal
Ambiental: Relatório do Especialista País: Angola Disciplina:
Ictiofauna
Morais,
Miguel
Análise Técnica, Biófisica e Sócio-Económica do Lado
Angolano da Bacia Hidrográfica do Rio Cubango: Relatório
Final: Peixes e Pesca Fluvial da Bacia do Okavango em Angola
Pereira, Maria João
Qualidade da Água, no Lado Angolano da Bacia Hidrográfica
do Rio Cubango
Santos,
Carmen
Ivelize
Análise Diagnóstica Transfronteiriça da Bacia do Rio
Van-Dúnem S. N.
Okavango: Módulo do Caudal Ambiental: Relatório de
Especialidade: Angola: Vida Selvagem
Santos, Carmen Ivelize
Análise Diagnóstica Transfronteiriça da Bacia do Rio
Van-Dúnem S.N.
Okavango:Módulo Avaliação do Caudal Ambiental: Relatório de
Especialidade: Angola: Aves
Botswana Bonyongo, M.C.
Okavango River Basin Technical Diagnostic Analysis:
Environmental Flow Module: Specialist Report: Country:
Botswana: Discipline: Wildlife
Hancock, P.
Okavango River Basin Technical Diagnostic Analysis:
Environmental Flow Module : Specialist Report: Country:
Botswana: Discipline: Birds
Mosepele,
K. Okavango River Basin Technical Diagnostic Analysis:
Environmental Flow Module: Specialist Report: Country:
Botswana: Discipline: Fish
Mosepele, B. and
Okavango River Basin Technical Diagnostic Analysis:
Dallas, Helen
Environmental Flow Module: Specialist Report: Country:
Botswana: Discipline: Aquatic Macro Invertebrates
Namibia
Collin Christian &
Okavango River Basin: Transboundary Diagnostic Analysis
Associates CC
Project: Environmental Flow Assessment Module:
Geomorphology
Curtis, B.A.
Okavango River Basin Technical Diagnostic Analysis:
Environmental Flow Module: Specialist Report Country:
Namibia Discipline: Vegetation
Bethune, S.
Environmental Protection and Sustainable Management of the
Okavango River Basin (EPSMO): Transboundary Diagnostic
Analysis: Basin Ecosystems Report
Nakanwe, S.N.
Okavango River Basin Technical Diagnostic Analysis:
Environmental Flow Module: Specialist Report: Country:
Namibia: Discipline: Aquatic Macro Invertebrates
Paxton,
M. Okavango River Basin Transboundary Diagnostic Analysis:
Environmental Flow Module: Specialist
Report:Country:Namibia: Discipline: Birds (Avifauna)
Roberts, K.
Okavango River Basin Technical Diagnostic Analysis:
Environmental Flow Module: Specialist Report: Country:
Namibia: Discipline: Wildlife
Waal,
B.V. Okavango River Basin Technical Diagnostic Analysis:
Environmental Flow Module: Specialist Report: Country:
Namibia:Discipline: Fish Life
Country Reports
Angola
Gomes, Joaquim
Análise Técnica dos Aspectos Relacionados com o Potencial
Socioeconomic
Duarte
de Irrigação no Lado Angolano da Bacia Hidrográfica do Rio
Series
Cubango: Relatório Final
Mendelsohn,
.J.
Land use in Kavango: Past, Present and Future
Pereira, Maria João
Análise Diagnóstica Transfronteiriça da Bacia do Rio
Okavango: Módulo do Caudal Ambiental: Relatório do
Especialista: País: Angola: Disciplina: Qualidade da Água
Saraiva, Rute et al.
Diagnóstico Transfronteiriço Bacia do Okavango: Análise
Socioeconómica Angola
74
TDA Botswana HIV and AIDS
Botswana Chimbari, M. and
Okavango River Basin Trans-Boundary Diagnostic Assessment
Magole, Lapologang
(TDA): Botswana Component: Partial Report: Key Public Health
Issues in the Okavango Basin, Botswana
Magole,
Lapologang
Transboundary Diagnostic Analysis of the Botswana Portion of
the Okavango River Basin: Land Use Planning
Magole, Lapologang
Transboundary Diagnostic Analysis (TDA) of the Botswana p
Portion of the Okavango River Basin: Stakeholder Involvement
in the ODMP and its Relevance to the TDA Process
Masamba,
W.R.
Transboundary Diagnostic Analysis of the Botswana Portion of
the Okavango River Basin: Output 4: Water Supply and
Sanitation
Masamba,W.R.
Transboundary Diagnostic Analysis of the Botswana Portion of
the Okavango River Basin: Irrigation Development
Mbaiwa.J.E. Transboundary Diagnostic Analysis of the Okavango River
Basin: the Status of Tourism Development in the Okavango
Delta: Botswana
Mbaiwa.J.E. &
Assessing the Impact of Climate Change on Tourism Activities
Mmopelwa, G.
and their Economic Benefits in the Okavango Delta
Mmopelwa,
G.
Okavango River Basin Trans-boundary Diagnostic Assessment:
Botswana Component: Output 5: Socio-Economic Profile
Ngwenya, B.N.
Final Report: A Socio-Economic Profile of River Resources and
HIV and AIDS in the Okavango Basin: Botswana
Vanderpost,
C.
Assessment of Existing Social Services and Projected Growth
in the Context of the Transboundary Diagnostic Analysis of the
Botswana Portion of the Okavango River Basin
Namibia
Barnes, J and
Okavango River Basin Technical Diagnostic Analysis:
Wamunyima, D
Environmental Flow Module: Specialist Report:
Country: Namibia: Discipline: Socio-economics
Collin Christian &
Technical Report on Hydro-electric Power Development in the
Associates CC
Namibian Section of the Okavango River Basin
Liebenberg, J.P.
Technical Report on Irrigation Development in the Namibia
Section of the Okavango River Basin
Ortmann, Cynthia L.
Okavango River Basin Technical Diagnostic Analysis:
Environmental Flow Module : Specialist Report Country:
Namibia: discipline: Water Quality
Nashipili,
Okavango River Basin Technical Diagnostic Analysis: Specialist
Ndinomwaameni
Report: Country: Namibia: Discipline: Water Supply and
Sanitation
Paxton,
C.
Transboundary Diagnostic Analysis: Specialist Report:
Discipline: Water Quality Requirements For Human Health in
the Okavango River Basin: Country: Namibia
75
TDA Botswana
TDA Botswa
HIV and AIDS
and AIDS
76
Document Outline
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ
- þÿ