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.


September 30, 2013
Year of publication
Resource types
Conference materials
Botswana, monitoring and evaluation, M&E, performance assessments, health workers, health delivery, health facilities, MSH BLC

Similar Resources

Capacity development - so what?

Capacity development with civil society organizations (CSOs) providing HIV services has become an area of high donor investment to ensure cost-effectiveness and maximize the quality of services.

In 2012 and 2013, AIDSTAR-One piloted the South-to-South Technical Exchange on Integrating PEPFAR Gender Strategies: Framework and Toolkit in collaboration with PEPFAR, Stepping Stones International in Botswana, and the Sonke Gender Justice Network in South Africa.

The Primary Health Care Performance Initiative (PHCPI) is a new partnership that brings together country policymakers, health system managers, practitioners, advocates and other development partners to catalyze improvements in primary health care (PHC) in low- and middle-income countries through…

Infants exposed to an antiretroviral regimen of tenofovir, emtricitabine and efavirenz (Atripla) from conception experienced fewer adverse birth outcomes compared to other three-drug regimens, according to a study of births in Botswana between 2014 and 2016, presented on Tuesday at the …

This Excel workbook is designed to assist PEPFAR orphans and vulnerable children (OVC) country programs to estimate the size of two groups of potentially vulnerable children.

Shifts to less frequent clinic visits and medication pick-ups to free up healthcare resources and make life easier for people living with HIV are being implemented successfully in some African countries, but still need fine tuning, several studies presented on Monday at the …

To improve antiretroviral coverage (ART) and help reach the 90-90-90 treatment targets, differentiated approaches to care are necessary, including reduced frequency of clinic visits for stable patients.

The U.S. President's Emergency Plan for AIDS Relief (PEPFAR) delivers life-saving services to people affected by the HIV/AIDS epidemic in 36 country and regional programs. Founded in 2003, PEPFAR is the largest investment in combating a single disease by a single country in history.

Programmes offering voluntary medical male circumcision (VMMC) as part of HIV prevention are now starting to expand in a number countries in sub-Saharan Africa, delegates at the recent 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)heard.