Africa region: Botswana

Botswana, a stable sub-Saharan democratic nation of approximately 2.4 million people, got its independence in 1966. Although originally poor, the nation is now considered upper-middle-income. National healthcare expenditure is relatively high, with reasonably developed universal healthcare, and most people live well within reach of a health facility. Notwithstanding Botswana’s progress, a recent United Nations report suggests that the nation has “fallen below expectations,” in part due to an ongoing battle with high rates of HIV/AIDS and noncommunicable diseases and a shortage of rehabilitation services and professionals. Globally, people live longer and thus more live with disability; Botswana has been similarly affected. The increased prevalence of disabilities is due both to communicable and noncommunicable diseases, with the greatest contributors toward disability-adjusted life years (DALYs) being mental disorders (13.7%), HIV and other sexually transmitted diseases (13%), musculoskeletal disorders (9.9%), neurological disorders (8.0%), and sense organ diseases (6.2%). During a recent survey of Botswana’s rehabilitation professionals, lack of recognition by the government, severe staff shortage, poor reimbursement by insurers, and absence of local rehabilitation equipment manufacturing were identified as some of the key challenges in rehabilitation. A need for improvement in rehabilitation services and capacity has been proposed, with government prioritization of rehabilitation through increased funding, staff training, better facilities, and the promotion and support of local manufacturing. Multidisciplinary research innovation among engineering, computer science, rehabilitation, medicine, neuropsychology, and others will be essential for advancing robotics and other technology-driven approaches to rehabilitation, especially for patients with cognitive and motor deficits due to HIV, stroke, and other diseases. Leveraging years of a fruitful partnership between the government of Botswana, the University of Pennsylvania, and the University of Botswana have recently established a multidisciplinary laboratory to develop affordable rehabilitation robotics, prosthetics, and other technologies, while building capacity among faculty and students.