Health Care In Botswana Research Articles

Analyzing supply-side moral hazard behaviors in Botswana's health care market: A qualitative study

This paper aims to analyse the behaviours and practices of health care service providers that constitute supply-side abuse of the medical health insurance schemes premised on the notion that patients visit doctors precisely to learn what amount and type of care is medically necessary. Using qualitative methods, individual in-depth interviews were carried on private health service practitioners and thematic analysis via SPSS. The study identifies systemic abuses like overcharging, billing for services not provided, and over prescription. Implication of these findings show that Fee-for-Service Payment Models incentivize providers to deliver more services, leading to potential over-utilization and increased costs in Botswana’s healthcare; due to information asymmetry providers may prioritize quantity over quality of care exploiting patients’ lack of knowledge to recommend unnecessary tests or treatments to maximize on revenue but also costs. On how to minimize supply side moral hazards, the propositions is for pursuance of cost containment strategies to ensure the smooth operation of the schemes like price listings, educate beneficiaries on cost implications and sustainability threats. These propositions can be instituted through an industry led bench-marking, on nationally through regulatory frameworks since moral hazards are an economic cost as inefficiencies brings mis-allocation of resources to enhance the sustainability of medical aid-based health care provisioning.

Clinical Data Flow in Botswana Clinics: Protocol for a Mixed-Methods Assessment.

Botswana has made significant investments in its health care information infrastructure, including vertical programs for child health and nutrition, HIV care, and tuberculosis. However, effectively integrating the more than 18 systems in place for data collection and reporting has proved to be challenging. The Botswana Health Data Collaborative Roadmap Strategy (2020-24) states that "there exists parallel reporting systems and data is not integrated into the mainstream reports at the national level," seconded by the Botswana National eLearning strategy (2020), which states that "there is inadequate information flow at all levels, proliferation of systems, reporting tools are not synthesized; hence too many systems are not communicating." The objectives of this study are to (1) create a visual representation of how data are processed and the inputs and outputs through each health care system level; (2) understand how frontline workers perceive health care data sharing across existing platforms and the impact of data on health care service delivery. The setting included a varied range of 30 health care facilities across Botswana, aiming to capture insights from multiple perspectives into data flow and system integration challenges. The study design combined qualitative and quantitative methodologies, informed by the rapid assessment process and the technology assessment model for resource limited settings. The study used a participatory research approach to ensure comprehensive stakeholder engagement from its inception. Survey instruments were designed to capture the intricacies of data processing, sharing, and integration among health care workers. A purposive sampling strategy was used to ensure a wide representation of participants across different health care roles and settings. Data collection used both digital surveys and in-depth interviews. Preliminary themes for analysis include perceptions of the value of health care data and experiences in data collection and sharing. Ethical approvals were comprehensively obtained, reflecting the commitment to uphold research integrity and participant welfare throughout the study. The study recruited almost 44 health care facilities, spanning a variety of health care facilities. Of the 44 recruited facilities, 27 responded to the surveys and participated in the interviews. A total of 75% (112/150) of health care professionals participating came from clinics, 20% (30/150) from hospitals, and 5% (8/150) from health posts and mobile clinics. As of October 10, 2023, the study had collected over 200 quantitative surveys and conducted 90 semistructured interviews. This study has so far shown enthusiastic engagement from the health care community, underscoring the relevance and necessity of this study's objectives. We believe the methodology, centered around extensive community engagement, is pivotal in capturing a nuanced understanding of the health care data ecosystem. The focus will now shift to the analysis phase of the study, with the aim of developing comprehensive recommendations for improving data flow within Botswana's health care system. DERR1-10.2196/52411.

Doctor Attributes That Patients Desire during Consultation: The Perspectives of Doctors and Patients in Primary Health Care in Botswana.

Doctor attributes contribute significantly to the quality of the doctor-patient relationship, consultation, patient satisfaction, and treatment outcomes. However, there is a paucity of research on this topic in many settings in developing countries, including Botswana, where accessibility and availability of care itself are a challenge. The study examined doctor attributes that patients in Botswana desire from the perspectives of doctors and patients in selected public clinics located in four health districts of Botswana. We used a qualitative design and conducted face-to-face interviews with 32 adult patients and 17 doctors selected through the purposive sampling technique. Interviews were audio-recorded and transcribed. Data analysis followed the six steps of qualitative thematic data analysis. We found both discordance and congruence between the doctors and patients on key attributes that patients desire in a doctor during consultation. Both agreed that effective communication and listening skills were key desirable doctor attributes that improve the doctor-patient relationship. Conducting the consultation in the language of the patients enhances effective communication. Doctors cited clinical expertise and competence as key desirable doctor attributes, whereas patients cited interpersonal and social attributes including kindness, empathy, and respect as key doctor attributes that increase trust in the doctor. However, patients expected the doctor to have clinical knowledge, which they perceived as essential to improve doctor-patient interaction and health outcomes. The findings highlight a need to enhance the interpersonal and communication skills of doctors to improve the quality of doctor-patient interactions. To optimise and enhance the consultation, continuing professional development should be adopted as a strategy to improve the communication and interpersonal skills of doctors.

90. Addressing the Treatment Gap in Adolescent Mental Healthcare in Botswana Using the Safe Haven Intervention: A Pilot Study

90. Addressing the Treatment Gap in Adolescent Mental Healthcare in Botswana Using the Safe Haven Intervention: A Pilot Study

Sağlık Bilişimi ve Bilgi Teknolojisinin Kullanımı: Botsvana’daki Durum

Health Informatics (HI) and Information Technology (IT) have enormous potential to improve healthcare quality in countries around the world. A literature review was used to conduct a situational analysis of the use of HI and IT in Botswana's health sector. According to research, there is a significant gap in the available information on the status of HI and the challenges that affect Botswana's healthcare sector. As technology evolves, a frequent situation analysis is required to remedy or improve on challenges encountered during development and implementation, particularly in the health sector. The current study explores present status of HI and IT in Botswana's healthcare system as well as successes, opportunities and challenges faced in the development of e-Health and HI in Botswana. An extensive literature review was carried out to provide a conceptual background of e-Health and HI in Botswana. The paper provides incalculable data on e-Health and HI in Botswana that will be useful in informing future studies, policies and developments in the field of HI and e-Health in Botswana and other developing countries.

Abstract 84: Development and Implementation of a Case-based Virtual Training Program for Oncologic Emergencies in Botswana

Abstract Purpose: Oncologic emergencies contribute to a large proportion of morbidity and mortality for oncology patients, who present unique medical challenges due to disease and treatment complexities. Emergencies training of medical staff is important, particularly if there is high turnover. We describe the development and implementation of a program to enhance timely recognition and treatment of oncologic emergencies. Due to the COVID19 pandemic, sessions were conducted virtually. Methods: Healthcare workers who normally care for oncology patients at Princess Marina Hospital (PMH) were invited to participate in a series of weekly virtual case-based lectures. Didactic content was developed between Botswana and Rutgers faculty and fellows to reflect specific management and resources available at PMH. Participation was through live chat case reviews and pre- and post- session questions. Feedback was elicited through Likert-scale surveys. Results: An average of 19 participants (range 13-29) attended the training sessions. Average make-up per session were as follows: 16% physicians, 26% Medical Officers, 4% Internal Medicine Residents, 32% nurses, 21% other. Healthcare workers from Botswana were invited to participate in content preparation and presentation to their peers; 3 of 8 presentations were by Botswana personnel. Average pre-session test score was 70% (range 40-89%); post-session score was 82% (range 55-97%). In post sessions surveys, average confidence in diagnosis and recognition across emergencies was 84% (range 71-100%); average confidence in management was 81% (range 57-100%). Conclusions: We describe the successful piloting of a case-based virtual training program in oncologic emergencies, which to our knowledge is the first of its kind. The program was adapted to the Botswana health care setting. Overall, confidence in diagnosis, recognition and management of oncologic emergencies appeared to increase after sessions. Plans are in place to expand the series to more sites within the country, most of which do not have dedicated oncology trained staff. Citation Format: Sharon Li, Sadaf Qureshi, Reena Antony, Kara Wilson, Robert Moumakwa, Refeletswe Lebelonyane, Tendani Gaolathe, Mansi Shah, Pallvi Popli, Ashwin Chandar, Sukhdeep Kaur, Richard Marlink, Tina Mayer, Peter Vuylsteke, Tlotlo Ralefala. Development and Implementation of a Case-based Virtual Training Program for Oncologic Emergencies in Botswana [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 84.

Reimagining Botswana’s national security in light of COVID-19

ABSTRACT The Botswana national security complex is fashioned around traditional (military) threats to security. This is demonstrated through the National Security Act and also by the country’s defense expenditure as a component of its GDP. Defense expenditure routinely takes the second largest share of GDP in Botswana. The outbreak of the novel Severe Acute Respiratory Distress Syndrome Corona Virus 2 (SARS-COV-2) or COVID-19, however, suggests a relook at Botswana’s national security towards none traditional security threats- in this case pandemics. The case for this is made clear by the evidently poor readiness to deal with possible mass infections both from a health budgetary perspective, and the availability of medical personal and equipment. This paper argues for securitisation of health care in Botswana- especially in light of the COVID-19 pandemic. This is possible through diversion of a portion current defense spending towards health care.

Developing the Botswana Primary Care Guideline: an integrated, symptom-based primary care guideline for the adult patient in a resource-limited setting.

BackgroundBotswana’s health care system is based on a primary care model. Various national guidelines exist for specific diseases. However, most of the guidelines address management at a tertiary level and often appear nonapplicable for the limited resources in primary care facilities. An integrated symptom-based guideline was developed so as to translate the Botswana national guidelines to those applicable in primary care. The Botswana Primary Care Guideline (BPCG) integrates the care of communicable diseases, including HIV/AIDS and noncommunicable diseases, by frontline primary health care workers.MethodsThe Department of Family Medicine, Faculty of Medicine, University of Botswana, together with guideline developers from the Knowledge Translation Unit (University of Cape Town) collaborated with the Ministry of Health to develop the guideline. Stakeholder groups were set up to review specific content of the guideline to ensure compliance with Botswana government policy and the essential drug list.ResultsParticipants included clinicians, academics, patient advocacy groups, and policymakers from different disciplines, both private and public. Drug-related issues were identified as necessary for implementing recommendations of the guideline. There was consensus by working groups for updating the essential drug list for primary care and expansion of prescribing rights of trained nurse prescribers in primary care within their scope of practice. An integrated guideline incorporating common symptoms of diseases seen in the Botswana primary care setting was developed.ConclusionThe development of the BPCG took a broad consultative approach with buy in from relevant stakeholders. It is anticipated that implementation of the BPCG will translate into better patient outcomes as similar projects elsewhere have done.

Stakeholders' Perceptions on Shortage of Healthcare Workers in Primary Healthcare in Botswana: Focus Group Discussions.

BackgroundAn adequate health workforce force is central to universal health coverage and positive public health outcomes. However many African countries have critical shortages of healthcare workers, which are worse in primary healthcare. The aim of this study was to explore the perceptions of healthcare workers, policy makers and the community on the shortage of healthcare workers in Botswana.MethodFifteen focus group discussions were conducted with three groups of policy makers, six groups of healthcare workers and six groups of community members in rural, urban and remote rural health districts of Botswana. All the participants were 18 years and older. Recruitment was purposive and the framework method was used to inductively analyse the data.ResultsThere was a perceived shortage of healthcare workers in primary healthcare, which was believed to result from an increased need for health services, inequitable distribution of healthcare workers, migration and too few such workers being trained. Migration was mainly the result of unfavourable personal and family factors, weak and ineffective healthcare and human resources management, low salaries and inadequate incentives for rural and remote area service.ConclusionsBotswana has a perceived shortage of healthcare workers, which is worse in primary healthcare and rural areas, as a result of multiple complex factors. To address the scarcity the country should train adequate numbers of healthcare workers and distribute them equitably to sufficiently resourced healthcare facilities. They should be competently managed and adequately remunerated and the living conditions and rural infrastructure should also be improved.

Exploring the Niche and Contribution of Men in HIV/AIDS Palliative Health Care in Botswana: A Literature Review

Exploring the Niche and Contribution of Men in HIV/AIDS Palliative Health Care in Botswana: A Literature Review

Scaling up a Mobile Telemedicine Solution in Botswana: Keys to Sustainability.

Effective health care delivery is significantly compromised in an environment where resources, both human and technical, are limited. Botswana’s health care system is one of the many in the African continent with few specialized medical doctors, thereby posing a barrier to patients’ access to health care services. In addition, the traditional landline and non-robust Information Technology (IT) network infrastructure characterized by slow bandwidth still dominates the health care system in Botswana. Upgrading of the landline IT infrastructure to meet today’s health care demands is a tedious, long, and expensive process. Despite these challenges, there still lies hope in health care delivery utilizing wireless telecommunication services. Botswana has recently experienced tremendous growth in the mobile telecommunication industry coupled with an increase in the number of individually owned mobile devices. This growth inspired the Botswana-UPenn Partnership (BUP) to collaborate with local partners to explore using mobile devices as tools to improve access to specialized health care delivery. Pilot studies were conducted across four medical specialties, including radiology, oral medicine, dermatology, and cervical cancer screening. Findings from the studies became vital evidence in support of the first scale-up project of a mobile telemedicine solution in Botswana, also known as “Kgonafalo.” Some technical and social challenges were encountered during the initial studies, such as malfunctioning of mobile devices, accidental damage of devices, and cultural misalignment between IT and healthcare providers. These challenges brought about lessons learnt, including a strong need for unwavering senior management support, establishment of solid local public-private partnerships, and efficient project sustainability plans. Sustainability milestones included the development and signing of a Memorandum of Understanding (MOU) between the Botswana government and a private telecommunications partner, the publication and awarding of the government tender to a local IT company, and the development and signing of a Memorandum of Agreement between the Ministry of Health Clinical Services department and the local tender winner. The initial system scale-up is scheduled to occur in 2014 and to ensure the project’s sustainability, the system is aligned with the national eHealth strategy and local ownership of the project remains at the forefront (1).

Evaluation of a Well-Established Task-Shifting Initiative: The Lay Counselor Cadre in Botswana

BackgroundEvidence supports the implementation of task shifting to address health worker shortages that are common in resource-limited settings. However, there is need to learn from established programs to identify ways to achieve the strongest, most sustainable impact. This study examined the Botswana lay counselor cadre, a task shifting initiative, to explore effectiveness and contribution to the health workforce.MethodsThis evaluation used multiple methods, including a desk review, a national lay counselor survey (n = 385; response = 94%), in-depth interviews (n = 79), lay counselors focus group discussions (n = 7), lay counselors observations (n = 25), and client exit interviews (n = 47).ResultsInterview and focus group data indicate that lay counselors contribute to essentially all HIV-related programs in Botswana and they conduct the majority of HIV tests and related counseling at public health facilities throughout the country. Interviews showed that the lay counselor cadre is making the workload of more skilled health workers more manageable and increasing HIV acceptance in communities. The average score on a work-related knowledge test was 74.5%. However for 3 questions, less than half answered correctly. During observations, lay counselors demonstrated average competence for most skills assessed and clients (97.9%) were satisfied with services received. From the survey, lay counselors generally reported being comfortable with their duties; however, some reported clinical duties that extended beyond their training and mandate. Multiple factors affecting the performance of the lay counselors were identified, including insufficient resources, such as private counseling space and HIV test kits; and technical, administrative, and supervisory support.ConclusionLay counselors are fulfilling an important role in Botswana's healthcare system, serving as the entry point into HIV care, support, and treatment services.RecommendationFor this and other similar task shifting initiatives, it is important that lay counselors' responsibilities are clear and that training and support are adequate to optimize their effectiveness.

Using the Servqual Model to Evaluate the Impact of Public Service Reforms in the Provision of Primary Health Care in Botswana

The health sector is pivotal to any national development initiative; hence, Botswana has taken seriously the principle of primary health care as contained in the the Alma-Ata declaration of 1978. As a demonstration of their commitment, the government of Botswana has passed a number of National Development Plans, health policies, and numerous reforms with a view of enhancing service quality in this sector. Many reforms and restructuring exercises are still ongoing. This study uses the SERVQUAL model to evaluate the implementation of Work Improvement Teams (WITs) in the hospitals/clinics as a reform initiative adopted by the Botswana government to enhance the productivity, efficiency, and performance of the public sector (particularly the health sector). This discussion will demonstrate that the SERVQUAL model can be used to review the impact of public policy. This will be achieved by measuring the level of service quality and customer satisfaction using the SERVQUAL model through data that were collected from 151 hospital/clinic customers in Gaborone, the capital city of the Republic of Botswana. Descriptive and inferential statistics were used to analyze the data, and the findings indicate that the adoption and implementation of reforms in the public health sector have not improved the level of service quality and customer satisfaction as indicated by a significant gap between customer expectations and perceptions.

Development and evaluation of an international, interdisciplinary palliative care workshop in Botswana

This paper reports the development and evaluation of an interdisciplinary, international palliative care workshop presented in Gaborone, Botswana. A 5-day workshop was held in June 2009 at the University of Botswana. Clinicians, faculty, and students from throughout Botswana were invited to attend at no cost. Participants included nurses, social workers, physicians, pharmacists, chaplains and volunteers. Learning activities included lectures, case studies, and group discussion. Evaluation indicated high satisfaction with the workshop and significant, though modest, gains in knowledge and self-evaluation of palliative care skills. Discussion revealed important clinical issues for attendees and underscored the need to coordinate national efforts to enhance palliative care in Botswana. The international collaborative palliative care workshop increased the knowledge and commitment of attendees. Additional collaborative efforts to educate providers, coordinate care, and change policies and practices are needed to integrate palliative care fully into health care in Botswana.

Community mental health care in Botswana: approaches and opportunities

The purpose of this article is to provide an insight into the developmental trends in community mental health care in Botswana. Different approaches are discussed and the opportunities that have emanated from them. Care of the mentally ill in Botswana is provided at different levels of coverage and sophistication. There is a single mental hospital in the country. Attached to the district hospitals are psychiatric outpatient clinics run by psychiatric nurses and a psychiatrist who visits them on monthly basis. Mental health care in Botswana has gone through a paradigm shift, from the prepenal years, penal years and institutional to community based care, which reflects a philosophy of citizen involvement and collaboration. Several approaches have been utilized in the development of community mental health care. However, difficulties and challenges still exist in the provision of community mental health care.

Household factors are strong indicators of children's nutritional status in children with access to primary health care in the greater Gaborone area

Access to primary health care can improve the nutritional status and survival of preschool children. The effect of the universal provision of primary health care in Botswana on the prevalence, types, and determinants of malnutrition in preschool children is unclear. 522 children 0 - 5 years old from 12 clinics in the greater Gaborone area were studied to address this gap. Children’s weights and heights were measured. Birth weights, age, sex, household’s socio-economic factors, children’s illness status and services sought at the clinics were obtained through care giver interviews and confirmed by the data in the health cards. 11.3 and 13.7% of children were stunted and wasted, respectively. Stunting and wasting ranged from 9.1 and 3.6% in middle-high income neighborhoods to 18.2 and 20.8% in low income neighborhoods, respectively. Households’ socio-economic factors were significantly associated with households’ location. Consequently, households’ location was a strong determinant of nutritional status. Children in higher income neighborhoods had better growth indicators than children in lower income neighborhoods. This was true regardless of the illness status of children and the services sought from the clinics. Therefore, where large socio-economic disparities exist, access to primary healthcare may not equitably support households in improving the nutritional status of children. Key words: Primary health care, stunting, wasting, nutritional status, Botswana.

Adherence to management guidelines in acute respiratory infections and diarrhoea in children under 5 years old in primary health care in Botswana

To evaluate health care providers' adherence to management guidelines for acute respiratory infection and diarrhoea in children under 5 years old in Botswana primary health care. Cross-sectional prospective field survey. Data collection was carried out through observation of consecutive consultations at 30 randomly assigned clinics and health posts in three purposely chosen districts. This study comprises 185 cases of acute respiratory infection and 85 cases of diarrhoea. Criteria for acceptable standards of history taking and physical examination for acute respiratory infection and diarrhoea were defined as well as criteria for categorizing the appropriateness of antibiotic prescription. The percentage of oral dehydration salts provided in cases of diarrhoea was calculated. Acute respiratory infection and diarrhoea accounted for 270 (including 15 missing cases) of all main diagnoses (n = 539). In 262 cases (97%) health care providers were nurses or enrolled nurses; in 3% family welfare educators. Acceptable history taking, physical examination, and both combined in acute respiratory infection was found in 113 (63%), 32 (18%), and 28 (16%), and in diarrhoea in 45 (58%), 26 (34%) and 20 (26%) cases, respectively. Antibiotics were prescribed in 76 of 255 (30%) cases. Prescription was assessed as inappropriate in 56 of 76 (74%) of all cases; in 41 of 52 (79%) cases with acute respiratory infection, in none of the pneumonia cases, and in all 15 cases of diarrhoea. Oral rehydration salts were prescribed in 74 (87%) of the diarrhoea cases. Health care providers' adherence to guidelines on history taking was suboptimal in acute respiratory infection and diarrhoea but poor on examination in both conditions. A high level of inappropriate antibiotic prescription was found in acute respiratory infection and diarrhoea. Overall, there is considerable scope for improving diagnostic and therapeutic management of these major childhood diseases in Botswana primary health care.

Value-Added Tax and its implication for the provision of private health services in Botswana

This paper examines the impact of Value Added Tax on the provision of private health care in Botswana and argues that government cannot succeed in the discharge of its social obligations unless the private sector is also taken on board. The introduction of Value Added Taxation has led to an over-whelming demand for and constraint on government health facilities and a decline in the number of patients seeking private health care service. The government’s success in providing health facilities must be complimented by private sector participation and this can be achieved by providing certain incentives such as zero rating and exempting the provision of certain health care services.

Development Psychiatry: Mental Health and Primary Health Care in Botswana. By D. I. Ben-Tovim. (Pp. 233; illustrated; £12.95.), Tavistock Publications: London. 1987.

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Factors Influencing the Integration of Psychiatric Care Into Primary Health Care in Botswana

(1983). Factors Influencing the Integration of Psychiatric Care Into Primary Health Care in Botswana. International Journal of Mental Health: Vol. 12, Mental Health Care in Developing Countries, pp. 107-122.