Meet Goabaone Rankgoane-Pono, Public Health Advisor and Lecturer at the University of Botswana

This month Rachel Archer got to chat with Dr. Goabaone Rankgoane-Pono, a Public Health Advisor and Lecturer in Botswana. Goabaone has worked as a Public Health Physician in the Ministry of Health and has carried out a range of research to inform planning and policy.  

Last year, you were part of a study estimating the costs of COVID-19 vaccine delivery in Botswana. Can you tell us more about this work?

This was a nationwide study to find out the costs involved in delivering the COVID-19 vaccine. We gathered information on direct financial costs and opportunity costs such as staff time incurred at the national and district level.

What were your main findings?

Human resources was a major cost driver, Botswana hired a large number of staff to roll out the vaccine. The economic cost per dose delivered was estimated between US$19 and US$33, this was a lot higher than cost estimates per dose for routine immunization for under-fives. We also found inequitable access to resources across the different districts in terms of number of vehicles used, staff hires, and the calibre of staff utilized. This calls for better guidance on the resources needed per district and standardization within emergency response management.

In addition to resource management, what were the other lessons learned from this exercise?

We found that documentation was very poor. Documentation was mainly done manually, and we had to gather all the receipts and invoices when collecting the data, which was laborious. This demonstrated the need for proper digital systems, such as a public financial management system that is integrated with the health information system.

There is also a need for accurate vaccine forecasting. At the start of the rollout, we had issues with supply shortages in the region. When we were finally able to procure more vaccines, we procured too many, as we did not properly estimate how much was needed, which led to a lot of expiries.

How did these findings inform the Ministry of Health with planning and policy making?

We conducted a workshop with Ministry of Health staff. The Department of Policy, who are heavily involved in health financing, were also present. The study highlighted that there were no standard prices for consumables, and urged the Ministry of Health to look into introducing tariffs for the delivery of services. Following the COVID-19 vaccine procurement issues the Ministry faced, they are also working on developing an electronic procurement system.

What are you currently working on?

I am currently supporting the Ministry with revising, reviewing, and implementing, the National Action Plan for Antimicrobial Resistance (AMR), which was drafted in 2017. A risk assessment carried out by University of Washington and the University of Oxford found that one of the biggest risks for Botswana is AMR, so we need to develop a strategy to combat it. We are currently busy with costing the activities in the action plan, and are 50% there!

I’m also working on a project focused on primary health revitalization for Botswana and building the investment case. We are documenting what Botswana can leverage from the successes of the HIV response to ensure people have access to the needed services across primary health care. Botswana has achieved the UNAIDS-established 95-95-95 targets for people with HIV and do not have issues of stockouts. There are lessons to be learned there.

I also serve on the NITAG for Botswana.

You sound very busy Goabaone, what is the NITAG’s current focus?

We are currently focused on tackling the decline in routine immunization coverage since the beginning of the COVID-19 pandemic. We have had issues of stockouts of routine vaccines and children not being able to access facilities during the pandemic. And therefore, we recorded lower vaccination rates for children under 5 compared to before the pandemic.

We met at the IHEA pre-congress meeting in Cape Town last year, how did you experience the meeting?