Botswana Operational Plan Report FY 2013

The U.S.-Botswana health partnership remains strong and effective. HIV-associated mortality has been reduced by more than half since treatment became available, and the rate of new infections has declined. Botswana's HIV treatment and Prevention of Mother to Child Transmission (PMTCT) programs are models for their coverage and quality of services. The rate of mother to child HIV transmission in Botswana has declined to <4%. The Masa treatment program now covers over 98% of Batswana eligible for treatment at CD4 <350. The percentage of donated blood that is positive for HIV declined from 7.5% in 2003 to 1.0% in 2010. In light of scientific advances such as the HPTN 052 study*, President Obama and Secretary of State Clinton have outlined a strategy to focus on evidence-based interventions that will have the maximum impact on the incidence of new infections. To achieve our shared goal with the Government of Botswana (GOB) of an "AIDS free generation", PEPFAR-Botswana remains committed to evidence-based interventions and continues to evaluate the efficacy of our programs. The program outlined in the FY 2012-2013 two-year COP cycle aims to maintain the impact of past investments, increase sustainability, and continue the evaluation of cost-effective investments. We remain committed to transitioning thoughtfully and appropriately responsibility for programs to the GOB and moving towards greater country ownership. This approach is consistent with the PEPFAR "Blueprint for Creating an AIDS-free Generation," which underscores the importance of program end states in which partner countries lead, manage, and coordinate and over time increasingly finance the efforts needed to achieve an AIDS-free Generation. Botswana's relatively high per capita GDP ($14,753) is impressive, and considered in isolation, it suggests Botswana is a prosperous country with little reason to worry about its future development. However, Botswana's development has been uneven. The relatively high per capita GDP obscures a high degree of income inequality. The top 20 percent of income earners in Botswana account for 70 percent of the country's household consumption, while over one fifth of Botswana's population survives on less than $1.25 per day. These figures underscore that there remains much development work to be done in Botswana, including in the health sector Senior GOB officials have signaled that Botswana will not meet MDG 4 and 5, "reduce child mortality" and "improve maternal health" respectively and warned that its impressive gains combating HIV/AIDS, malaria and other diseases (MDG 6) were threatened by "developing country ills."