Nursing & Midwifery Leadership in Botswana and the AIDS response Prof. Sheila Tlou

1. Nursing & Midwifery Leadership in Botswana and the AIDS response Prof. Sheila Tlou Co-Chair, Nursing Now Co-Chair, Global HIV Prevention Coalition Former UNAIDS Regional Director Former Minister of Health, Botswana

2. MAIN GOAL • Share personal perspectives and experiences in executing role as Global Nurse Leader with mission to ” improve the wellbeing of people and their environments through research, education, and advocacy”. • Discuss areas of Nursing and Midwifery Leadership that can lead to gendered policy reform, health system reform, partnerships and financing for positive outcomes in the AIDS response Expected Outcome: Participants will identify pathways to maximize the impact of nurses and other frontline health workers in population and individual health outcomes, especially in the area of HIV and AIDS.

3. HIV/AIDS: A Communicable Disease at Centre of the SDGs Since 2000, over 35 million new HIV infections and 10 million deaths have been averted BUT, AIDS is still unfinished business • 36.9 millionpeople globally living with HIV • 1.8 million became newly infected with HIV, hence the Global HIV Prevention Coalition • 1.0 million died from AIDS-related illnesses • Encouraging News: More PLWH are accessing antiretroviral treatment (75-79-81)

4. Primary Health Care: Health For All by 2000 (Alma Ata, 1978 and beyond) • Accessible, acceptable, affordable, and universal. • Community participation in all aspects. • Caters for vulnerable, neglected groups (men, women and girls, older adults, key populations, indigenous people, etc.). • Botswana embraced above principles around 1975, and all Primary Health Care was by Nurses, Midwives and Primary Health Care Workers. • #Great success, I got interested from a Human Rights/Gender perspective

5. Academic, Scholar, Consultant, Activist • Generation of Knowledge through research: documented impact of HIV/AIDS on African women. Evidence at ICPD 1994 and Beijing 1995 (Power of Association) • As Educator, disseminated generated knowledge to ‘influence change’….trained nurses as Gender and HIV/AIDS service providers, scholars and activists (Managerial Positions: Ministerial HIV/AIDS Coordinators) • Community Activism- Founder, Society for Women and AIDS in Africa (SWAA, 1988); Botswana NGO Coalition (1993) • Documented impact of community-based interventions in HIV/AIDS prevention, treatment, care and support ( CSOs were great source of support and success as Minister).

6. Head of department/ WHO Collaborating Centre • Nursing and Midwifery Development in Primary Health Care (role in eMTCT, follow-up with pregnant women , point of care early infant diagnosis) • Convening nurses to accomplish desired goals and objectives using available resources efficiently and effectively • Strategic information for integration of HIV/AIDS in Curriculum planning, design and evaluation • Action research to produce better data to influence change ( Power of Evidence , not opinion)

7. Involvement in MDGs Process…for 2015 • Eradicating extreme poverty, combatting malnutrition, esp. among infants and ensuring food security for all; • Achieving at least universal primary school education; promoting gender equality and empowering women; • Reducing infant mortality; improving maternal health and reducing maternal mortality; • Combatting HIV/AIDS, TB, Malaria, and other major diseases; • Improving access to safe drinking water and promoting environmental sustainability; • Consolidating global partnerships for achieving development goals….ODA, Shared Responsibility & Global Solidarity.

8. Self as Politician/Minister, SADC/AU Chair 2004: Specially-elected MP, Minister of Health Research and good use of Knowledge Power……and Collaboration to Influence legal and Policy reform : • Abolition of Marital Power Act (2005). Gave women equal rights in acquisition, administration and disposal of property as well as inheritance, land and personal rights. • Domestic Violence Bill (2008) to promote peace and security in the home environment, plus advocacy at community level • HIV/AIDS: Comprehensive Prevention, Treatment, Care and Support Program, with 22% of budget to Health( still a Model).

9. Politician…HIV and AIDS… • Free PMTCT Services since 1999, in all health facilities (100% access). MTCT rate reduced 30% in 2002 to 4% in 2008, now less than 1%. • Free ARV program since 2001. Uptake over 90 %..( 60% are women). MMR due to AIDS reduced from 31% to 10% by 2008 • All accomplished with Nurses, Midwives and Civil society --trained in AIDS prevention, treatment & care….drug prescription & follow up patients, adherence rates of 90%. • Still a Model of deployment and interprofessional collaboration in resource-limited settings Botswana is one of few countries to have reached 90-90-90 targets. Serendipitous Outcome: More health professionals standing for political office……..great leadership !

10. Nursing/Midwifery Research and Care within the Sustainable Development Framework Integrated, Indivisible, Universal and Ambitious

11. SDG 3 for Nurses & Midwives: healthy lives & promote well-being at all ages, by 2030 • Reduce global maternal mortality ratio to less than 70/100,000 • End preventable deaths of newborns and children under 5, reducing neonatal mortality to 12 per 1,000, and under-5 mortality to 25 per 1,000 live births. • End epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases ……..and other communicable diseases. 4. Reduce, by 1/3, premature mortality from non-communicable diseases, and promote mental health and well-being. 5. Ensure universal access to sexual and reproductive health-care services……..and integration into national strategies/programs 6. Achieve UHC, access to quality health services, & access to safe, effective, affordable essential medicines and vaccines for all

12. HIV and AIDS in the SDGs • Ultimately, ending the AIDS epidemic will require advocacy in: • dramatically advancing education, esp. for girls • equality, and respect for human rights • food security and economic prospects for all • good governance and implementation across all areas of development. • *Nursing Now! Leadership in Nursing and Midwifery Education, Scholarship and Interprofessional Practice.

13. Nursing Now Campaign 2020 • Launched globally on 27 February 2018, run in collaboration with the WHO and ICN …www.nursingnow.org • To raise the status and profile of nursing • To empower nurses to take their place at the heart of tackling 21st Century health challenges.  • To improve perceptions of nurses, enhance their influence and maximise their contributions to ensuring that everyone everywhere has access to health and healthcare. • Main Advocacy: Nurses are a key part of the solution to today’s health challenges – if properly deployed, valued and included in health decision-making. • Involvement of citizens, the nursing community, and political leaders, esp. Ministers of Health in the campaign.

14. Champions…

16. Lessons Learned: Nursing and Midwifery Leadership • Knowledge is Power, so nurse/midwife-led care is effective when evidence-based. • Nurses/midwives are the health professionals people know and trust; they are still the backbone to reaching HIV treatment and prevention targets for 2020 and 2030. • Great results when nurses/midwives are adequately educated, trained, remunerated, and supported. • Engagement of communities for service provision, promotion of human rights, ending stigma/discrimination, esp. in health settings. • Political office for nurses/midwives for good governance & commitment to SDGs and gender-responsive legislation and services…

17. "When spider webs unite, they can tie up a lion”. Let’s pull together as nurses and midwives to end HIV & AIDS by 2030 Thank you very much!