Conference Paper: Routine monitoring and performance assessments enable health workers to identify and address health delivery challenges in Botswana: Experiences in six health facilities
Botswana is classified as a middle income country. However due to unequal distribution of wealth, about 28% of the population live on less than a dollar a day. With a life expectancy at birth of about 55 years for both sexes, the country carries a high disease burden. The Infant Mortality and the Under Five Mortality Rates remain high, with 40% of infant deaths occurring in the first week of their birth (National Health Policy 2011). Morbidity and mortality for all ages are dominated by infectious diseases with HIV and AIDS, TB, and other communicable diseases responsible for about half the deaths. Botswana’s adult HIV prevalence rate of 24.8% is the second highest in the world. Despite significant progress, Botswana is unlikely to meet its Millennium Development Goals to reduce child mortality, improve maternal health, and combat HIV and AIDS, malaria and other diseases by 2015. Achieving health targets depends on equitable access to a health system that delivers high quality services depending on the country context. According to the World Health Organization (WHO) different contexts all require adequate financing; a well-trained workforce; quality information on which to base policy and management decisions; logistics that get medicines, technologies and vaccines to where they are needed; well-maintained facilities organized as part of a referral network; and leadership and governance that provide clear direction and harnesses the energies of all stakeholders—including communities. In Botswana, the health delivery system is challenged with shortages of skilled health workers and poor staff motivation and low productivity contributes to poor quality. This is further compounded by weak leadership and management practices and poor information management systems. At facility level, information is not consistently generated to inform decision-making. These challenges are highlighted in the the Botswana Ministry of Health’s (MoH) Corporate Plan 2000–2005, the National Development Plan 9.1, and the National Health Policy 2011, all identify additional health facility challenges including retaining staff, information management, and leadership and management skills. urthermore, these challenges are more pronounced in rural health facilities as a result of unfavorable working conditions.