By Lieutenant Colonel Chris Wyatt, Chief, U.S. Office of Security Cooperation Botswana
Can one take an idea, nurture it, influence human behavior and improve the lives of an entire nation almost overnight? This is a fair question and one which Tebelopele, a Botswana-based non-governmental organization (NGO), can make a legitimate claim to have done over the course of nearly a decade of service in Botswana. Tebelopele, a Setswana word which translates in English as “moving forward,” has provided free, anonymous voluntary HIV counseling and testing services across the entire country of Botswana since it first formed in 2000. To date, over 700,000 different adult clients have used its services in Botswana. In a country with approximately 1.9 million citizens, this figure represents well over half the entire adult population! Rarely can one idea or one organization have such a pervasive impact and affect so many.
Created at a time when the HIV prevalence rate among adults in Botswana (based on antenatal clinic testing) was estimated at nearly 40 percent and HIV counseling and testing facilities were extremely limited or nonexistent in much of the country, Tebelopele has made a serious positive and enduring contribution to society by making critical services available to a client base that had few options before Tebelopele came along. Antenatal HIV prevalence rates have fallen from approximately 38 percent about a decade ago to around 22 percent today. Additionally, according to Government of Botswana studies, the adult HIV prevalence rate today has dropped to 17 percent. Tebelopele has doubtlessly played a significant role by making it possible for individuals to know their HIV status and modify their sexual behavior as a result of that knowledge. It has also improved the lives of HIV positive Batswana by referring those who test positive to competent medical authorities for care and treatment.
“An Amazing Project that Blossomed into an NGO”
Tebelopele is a unique NGO in that it first started as an activity co-sponsored by the U.S. Centers for Disease Control (CDC) and the Government of Botswana, which operate together in Botswana as part of the Botswana-USA or “BOTUSA” cooperative program to counter HIV and AIDS. Since its inception, Tebelopele has rapidly expanded its client base. It has done so through a system of voluntary counseling and testing centers (VCTC) placed around the country so as to be within 50 kilometers of over 90 percent of Botswana’s population. To reach more remote areas Tebelopele uses mobile VCTCs that counselors use to travel to hard to reach locations; places so remote so as to make it extremely difficult for clients to travel to the closest VCTC. The U.S. military funded and oversaw the construction of 13 of the 16 satellite centers through the Office of Security Cooperation at the American Embassy in Gaborone, Botswana, initially through the U.S. European Command and later through the U.S. Africa Command.
While U.S. Government ties and contributions to this highly successful NGO are easy to identify (its origins with CDC, Department of Defense financing and oversight for the overwhelming majority of its VCTC and the placement of Peace Corps volunteers working with Tebelopele), Tebelopele is clearly a Botswana NGO, one that owes its success in large part to the efforts of its own indigenous staff and army of counselors who have made Tebelopele so successful.
Tebelopele now provides free HIV testing services to over 150,000 clients a year at its 16 VCTC, 26 outreach sites and through the use of mobile testing stations.
The Tebelopele vision, “working towards an HIV/AIDS free Botswana by empowering individuals and couples to make positive decisions about their future,” is central to the NGO’s sense of identity and drives its mission to provide immediate, confidential and high quality voluntary HIV counseling, testing, and referral services throughout Botswana. Tebelopele’s core values include integrity, compassion, confidentiality and innovation. Throughout its brief history, Tebelopele has been an innovator. To inculcate a habit of HIV testing among Batswana, Tebelopele established 16 dispersed counseling and testing centers. To reach remote communities Tebelopele pioneered mobile testing stations. Recognizing the pull of celebrity, Tebelopele introduced the “Zebras for Life” campaign. This effort capitalizes on the popularity of soccer players on the Botswana national team, the Zebras, to encourage behavior change and HIV testing among youth. Today, after a decade of sustained success, Tebelopele continues to seek new and innovative ways to reach neglected groups like the disabled and handicapped with HIV services. Its most recent focused campaign “crazy, sexy, cool” (aimed at couples) instantly resulted in an increase in the numbers of couples seeking services at Tebelopele.
Tebelopele is truly a unique non-profit organization and a great success story. It is hard to imagine civil society in Botswana today without Tebelopele. If one turns back the clock to 1999 when Botswana stood at the precipice of a national catastrophe with nearly 4 of every 10 adults infected with HIV, Batswana had almost no way to get tested and become aware of their status. This lack of knowledge undoubtedly contributed to the spread of the virus and great human tragedy as a result. But that all began to change as Tebelopele came along and began offering counseling and testing services free of charge and the Government of Botswana took action, acknowledging the causes of the pandemic and calling for behavior change, then in 2004 introducing the world’s only universal anti-retroviral treatment program.
Tebelopele’s free and anonymous services, coupled with the government’s decisive action have had a dramatic impact on reducing HIV prevalence and prolonging lives in Botswana. Rarely can one point to a project like Tebelopele that has had such a profound positive affect on a nation at such a broad scale. If you think about it, what Tebelopele has accomplished is remarkable. Today over half the entire adult population of Botswana is or has been a client of Tebelopele. The U.S. Department of Defense’s contributions have also made a significant difference by helping Tebelopele expand services for a far larger number of clients than would have been possible without the 13 centers the European and Africa commands funded.
For several years the Executive Director of Tebelopele was Dr. Jan Raats, a South African. However, in 2009 Dr. Bangwato Sikwa, a Botswana national, became the first local director. With her appointment the organization is now led and operated by Batswana.
Dr. Sikwa, who completed her medical studies in Denmark, is happy to be in Botswana working for Tebelopele. When asked what she views as Tebelopele’s most valuable contribution to Botswana, she said that it is fair to say that at a time of great fear and inaction Tebelopele, is largely responsible for making HIV testing “cool.” Tebelopele helped make HIV testing an acceptable practice in Botswana. She also mentioned that it is in an invaluable contribution because knowing one’s HIV status allows individual Batswana to make informed decisions. It is also fair to add that many would agree that Tebelopele has benefited the state as a whole in part because the government by itself could not have delivered the services which Tebelopele has provide to over half the adult population of Botswana since its inception. She added that before Tebelopele people were reticent to get tested and “If you don’t know your status, you can’t get treatment. Testing and counseling allow people to know their status and access treatment and services.” Tebelopele opened the door to all those people who otherwise would not have known their HIV status.
While Botswana and Southern Africa continue to confront the immense challenges of HIV infection and AIDS, genuine progress has taken place, especially in Botswana. The public today is well aware of the danger and methods by which HIV spreads and getting tested for HIV is no longer difficult or costly in Botswana. The challenge today remains behavior change. Tebelopele also seeks to affect behavior change among Batswana through their counseling and testing services. For more than 700,000 Batswana who have passed through Tebelopele’s doors, the bright shining sun logo emblazoned with the words “Make a New Start Today” is a real possibility.
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