Joy Phumaphi

Joy Phumaphi began public service in Botswana as a local government auditor. From 1994 to 2003, she went on to serve in Parliament and then became Minister of Health in the midst of the country’s AIDS crisis. She later became the assistant director general for the Family and Community Health Department at the World Health Organization and the vice president of the Human Development Network at the World Bank. She is currently the Executive Secretary of the African Leaders Malaria Alliance.


I was born in a rural village in Botswana. It was in October, and my grandmother was the midwife.

It was malaria season. And of those babies born during that plowing season, only 40 percent of us survived. I have carried that with me my whole life; I always felt I was fortunate – I survived.

Access to education about family planning can help a woman decide when and if she wants to have more children, especially in the context of poor countries where problems like drought are enormous.

When I was quite young, around four years old, my younger sister died of German measles; we had not been immunized. In my culture, when someone dies in the family, children are kept away. I hadn’t seen my mom for two days, and I decided to sneak in and see her. I saw my sister in a coffin, a plain wooden coffin. My mother was on a mat, on the ground, weeping. That memory will never leave me.

When I started primary school, we were taught under a tree, writing on slates with chalk stone. There was an outbreak of German measles, almost two years after my sister had died, and that sad experience left a deep impression on me. My schoolmates and I had the idea that in Germany, there must be even more children dying of measles than in Botswana. We wrote letters to the German people, telling them how sorry we were their children were dying!

These experiences gradually made me realize how important skilled healthcare is – the importance of antenatal care services, protecting the health of newborns and children, whether through immunization or nutrition. I have also realized the importance of family planning – it is vital for a woman to have information about how to space her children.

When I was Minister of Health of my country, I received a letter written by a seven-year-old boy. He had a huge problem, he wrote. He was living with his grandmother, his mother was dead, his father was dead, and he had HIV/AIDS. He was told that because he was HIV positive he didn’t have many years to live, but there
were medicines to help him. He had already traveled a long distance with his grandmother to a healthcare facility, and they told him the medicines were not available. “Can you help me?” he wrote in his neat, careful penmanship.

Some time after I received his letter, I visited him and his grandmother. He was a brilliant little boy. He received straight As in his classes. He told me he wanted to be a doctor; he knew he was very sick and he wanted to help others like him. My young friend did go on antiretroviral (ARV) medication, but it was too late for him. When he died at age thirteen, I was out of the country. When I returned, I went with his grandmother to his grave. To me, my young friend signified an important turning point in the fight against HIV/ AIDS. He represented the plight of a new generation of children who had no parents – all across the region. These are the children of mothers who had no access to services for family planning, maternal healthcare, and prevention of mother-to-child transmission of HIV.

When I started my work as health minister, I didn’t have a budget allocation for AIDS drugs. So I went outside the country to look for money. This was a time when African governments had not introduced ARVs in the public  sector;  although they were widely available elsewhere. In fact, I had other health ministers in Africa who thought that the program would be unsustainable encouraging me not to introduce ARVs. They said it was too expensive, that we must wait until the price was low enough. That what I wanted was unrealistic.

I told them that we could not wait – we have children like my young friend. I wanted every single person in Botswana who needed treatment to get treatment. And so Botswana became the first country in Africa to introduce a comprehensive HIV/AIDS treatment program, in both the public and private sectors.

If my young friend’s family had had community healthcare workers, his parents would not have died. His parents would have learned about how to protect themselves  from HIV early; they would have had access to and been coached on the consistent use of condoms to avoid infection; his mother would have been given the reproductive and maternal healthcare she badly needed, so that even if she was infected, she would not infect her baby. He would not be orphaned, and he would not have died at age thirteen. The community healthcare worker would have educated the whole community about HIV/AIDS, and followed up with each household. The community healthcare worker would have made sure that if one parent was HIV-positive, they would be using condoms. But because at that time Botswana had just completed the exercise of phasing out family welfare educators (Botswana’s version of community healthcare workers) we didn’t educate people in villages about HIV until it was too late; we had children like my young friend.

Community healthcare workers can also educate about women, newborn and child health, and communities’ nutrition – an especially important issue in many developing countries. Poor nutrition can be disastrous for children, pregnant women, and in turn the health of the unborn baby. Poor nutrition can have terrible consequences on the cognitive development of the baby’s brain and future skills development – which has been proven to reduce their productivity and earning potential in later life. Healthcare workers can teach about drought preparedness and nutrition, and about breast-feeding. Access to education about family planning can help a woman decide when and if she wants to have more children, especially in the context of poor countries where problems like drought are recurring.

We know how critical breast-feeding is for the development of the child, and yet there are many countries in Africa where exclusive breast-feeding can be lower than 10 percent, because families – without the right knowledge – start giving the baby supplements when breast milk alone during the first six months is recommended by the World Health Organization. In an alternative scenario, a community healthcare worker, armed with information about family planning and maternal, newborn and child health; actively participating in the community, can be very effective.

One example of such a success is a family I know of in which the teenage girl in this family had a baby, but her story – unlike so many stories of teen pregnancy – has a happy ending. A community healthcare worker connected that girl to maternal and newborn healthcare, and when the baby was born, she monitored that child and made sure the girl was educated about taking care of a newborn. She made sure that the girl herself was able to go back to school and continue with her own skills development, realizing her own potential. The healthcare worker was engaged effectively with this family, with this community – it was her community, after all, and she felt a certain ownership of both the challenges they faced and the responsibility to identify and implement solutions.

One of our responsibilities as members of the Global Leaders Council is to make sure that we use whatever platform we can to effectively engage in our spheres of influence and help effect change. We don’t have to wait until the next meeting; we don’t have to wait until there is a conference.  We don’t have to wait for the next death, disability, or sickness.

The fact of the matter is that we cannot wait. We must push and work for effective solutions – and there are many, chief among them access to family planning and reproductive healthcare – for all women, for all children. I think of my own experiences, multiplied again and again, generation after generation. I think of my young friend, always in my heart, who wrote me that beautiful letter. And I think back all those years to when I was born – and I survived, one of the privileged few. And I cannot wait. Life and good health cannot be a privilege; it is a human right.