**6. Disease surveillance and prevention**

Ministry of Health & Wellness Multi-Sectoral Strategy for the Prevention and Control of Non-Communicable Diseases 2018–2023 identified four priority areas: (a) prevention and health promotion, (b) diagnosis and treatment, and (c) monitoring, surveillance, and research. The fourth priority area, governance and coordination, requires strengthening and is critical to accelerating national NCD prevention and control efforts. In addition, reduce risk factors through awareness, promoting healthy lifestyles and creating enabling environments to create a legislative and policy [16].

The Centres for Disease Control and Prevention (CDC) established an office in Botswana in 1995 to strengthen tuberculosis prevention and control. In 2000 HIV prevention, treatment, and strategic information program development was incorporated to combat the HIV epidemic. CDC collaborates with the Botswana Ministry of Health and Wellness (MOHW), providing technical assistance and research to support HIV and TB control programs, injury prevention, and emergency response operation (https://www.cdc.gov/globalhealth/countries/botswana/). Botswana has made significant progress in adopting the Integrated Disease Surveillance and Response (IDSR) guidelines to facilitate surveillance and timely response to disease outbreaks. The experiences in managing HIV and other disease outbreaks were used to control and manage COVID-19 [17].

#### **6.1 Non-communicable diseases**

Botswana faces a transition in disease patterns shown by a decline in infectious diseases and an increase in chronic non-communicable diseases and their associated risk factors [25]. There are four major Non-Communicable Diseases (NCDs) which include cardiovascular, diabetes, cancer and chronic respiratory diseases, which account for NCDs-related morbidity and mortality in the population [16].

Cardiovascular diseases are estimated to cause 18% of mortality in the country [16]. Cardiovascular is responsible for repeat outpatient visits in both government and private facilities in Botswana. With the changing lifestyle and screening, more disease cases are diagnosed and managed. Another condition that is on the rise is diabetes mellitus which is estimated to cause 6% of all deaths in Botswana. Diabetes is the main cause of avoidable blindness leading to diabetic retinopathy. Chronic respiratory disease contributes to 4% of all deaths, while Asthma is one of the significant causes of childhood morbidity. Cancer disorders are rising, accounting for 7% of cancers in adults and children [17].

Prevention and management of diabetes are the responsibilities of the government through the Ministry of Health. All clinics in the various districts provide screening, education and management support to diabetic patients. In addition, private clinics and hospitals also provide services to some clients through government aid or individual medical insurance. The community collaborates with the government through the Diabetes Association of Botswana [24]. The main goal is to conduct support groups providing medical devices and health promotion activities. One clinic in the capital city has been designated for management of clients with diabetes. The clinic receives referrals from other parts of the country.

Improving Cancer Care and Prevention in Botswana was intensified in 2019. As a result, the five **critical** domains of care were identified: (1) Enhance workforce capacity in cancer and other NCDs involving personnel training, (2) Improve the supply of drugs and secure funds to avoid drug and equipment failure, (3) Build a standard of practice in oncology practice guidelines and Create policies that protect the public, for example, Smoke-free policies and HPV vaccinations. (4) Improve prevention education, screenings, and diagnostics in ambulatory settings, and (5) Establish screening guidelines for common cancers, such as HPV vaccination programs and breast cancer screening [18].

Primary prevention uses both community and facility as antenatal services, child welfare clinics, and vaccinations (e.g., HPV, hepatitis B). Clinics and communitybased HPV), as well as enhancing awareness, advocacy, and community buy-in of the preventive services available at health facilities (e.g., hepatitis B vaccination and various types of screening).

HIV introduces excess risk to NCDs, such as cardiovascular diseases and cancers. Thus, treating HIV is also an effective strategy for preventing some NCDs [24].

Primary prevention interventions entail early detection through screening clients in health facilities and the community. Then, treatment starts for all eligible as well as care, and support is given through several structures such as home-based care programmes, hospice and community support.

### **6.2 Communicable diseases**
