Trust and the utilization of maternal and child health services in the context of hiv/aids in Palapye, Botswana

The current interest in and momentum for improving health outcomes for women and children in sub-Saharan Africa through stronger health systems presents an opportune time for researchers, policy makers and healthcare providers in the region. Access to and utilization of available health services by women and children is one area in which, although research abounds, solutions to ensure access and optimal use of services remain problematic. Methods: Using mixed research methods, women's and children's access to and utilization of maternal and child health services are examined using the notion of trust in healthcare as an overarching paradigm. The study was conducted in Palapye, Botswana. Quantitative data were extracted from a sample of 942 obstetric booklets and related hospital registers for births that occurred at Palapye Primary Hospital in the five-year period between April 1st 2005 and March, 31st 2010. Thirty-six recently delivered women and 11 healthcare providers, including Ministry of Health bureaucrats, were interviewed in-depth to provide qualitative data for the thesis. Results: Findings from the study revealed a mismatch between women's access to and utilization of health services. First, the near universal attendance of ANC (95.8 percent with at least one visit and 85.8 percent with at least four visits) stood in contrast to frequent late first attendance (84.8 percent) and poor confirmed PNC attendance (only 21.3 percent). Second, the near universal enrolment (95 percent) of HIV-positive women into the PMTCT program stood in contrast to poor adherence in the program (53.4 percent defaulted for AZT initiation at 28 weeks, 36.2 percent defaulted on ingestion of AZT at labour/delivery, 73.6 percent of HIV-negative women who should have re-tested at 36 weeks failed to do so, and 6.9 percent of women were definitely lost to follow up before delivery, with another 13.3 percent also possibly lost to follow up). The results further revealed that variations in health service use among women could only be marginally explained by differences in women's socio-demographic characteristics. Trust was found to be a very significant element influencing women's access to and utilization of health services. This influence was best captured using three phases of trust. Naive/blind trust was characterized by an element of untested optimism in the provision and reception of needed care. But because expectations can lead to disappointment, women expressed a sense of disenchantment, mostly characterized by anxiety and frustration with their healthcare, and often leading to delayed use of services and poor adherence. Seeking to address their health needs, women's naive/blind trust and/or disenchantment evolved to re-constructed trust. In this phase women demonstrated low levels of trust in healthcare providers and the health system in general, often characterized by reluctance to use services and excusing healthcare providers' negative behaviours or attitudes. This phase of trust was also characterized by high levels of trust in certain healthcare providers and not others. Conclusion: Women in Palapye have adequate access to maternal and child health services but poor patient-provider relationships, and therefore a breakdown of trust negatively affects their health service use

Southern African responses to the COVID-19 pandemic : a study of Botswana and South Africa

BACKGROUND : Southern African countries adopted diverse responses to the challenge posed by the COVID-19 pandemic outbreak, which manifested itself as both a health and economic disaster. AIM : Using a case study approach of two South African countries, namely Botswana and South Africa, the article assessed their response measures to the COVID-19 pandemic. SETTING : Southern African countries applied ‘domesticated’ forms of responses thus, there has been no one-size-fits-all approach to managing the pandemic. METHODS : The study adopted a qualitative approach. Two case studies namely Botswana and South Africa were used. Documentary evidence was drawn from these case studies. RESULTS : To ensure that Southern African countries and indeed the world in general navigate the challenges posed by the COVID-19 pandemic, the World Health Organization (WHO) developed operational planning guidelines that had sought to balance the demands of responding effectively to COVID-19 and the need to serve economies from collapse. However, an analysis of the programmes of responses in South African countries such as Botswana showed the ‘domestication’ of the guidelines. Nevertheless, the guidelines, although having met with criticism in some cases had significantly contributed to the effective management of COVID-19 health and economic effects. CONCLUSION : The COVID-19 pandemic required the state and its institutions to exercise effective leadership and unified action. In South African countries such as Botswana and South Africa, this pandemic showed the importance of governments in shaping the effectiveness of national responses, strategies and approaches in tackling the crisis.http://www.apsdpr.orghj2021School of Public Management and Administration (SPMA

Post-doctoral research fellowship as a health policy and systems research capacity development intervention: a case of the CHESAI initiative

BACKGROUND: Building capacity in health policy and systems research (HPSR), especially in low- and middle-income countries, remains a challenge. Various approaches have been suggested and implemented by scholars and institutions using various forms of capacity building to address challenges regarding HPSR development. The Collaboration for Health Systems Analysis and Innovation (CHESAI) – a collaborative effort between the Universities of Cape Town and the Western Cape Schools of Public Health – has employed a non-research based post-doctoral research fellowship (PDRF) as a way of building African capacity in the field of HPSR by recruiting four post-docs. In this paper, we (the four post-docs) explore whether a PDRF is a useful approach for capacity building for the field of HPSR using our CHESAI PDRF experiences. METHODS: We used personal reflections of our written narratives providing detailed information regarding our engagement with CHESAI. The narratives were based on a question guide around our experiences through various activities and their impacts on our professional development. The data analysis process was highly iterative in nature, involving repeated meetings among the four post-docs to reflect, discuss and create themes that evolved from the discussions. RESULTS: The CHESAI PDRF provided multiple spaces for our engagement and capacity development in the field of HPSR. These spaces provided us with a wide range of learning experiences, including teaching and research, policy networking, skills for academic writing, engaging practitioners, co-production and community dialogue. Our reflections suggest that institutions providing PDRF such as this are valuable if they provide environments endowed with adequate resources, good leadership and spaces for innovation. Further, the PDRFs need to be grounded in a community of HPSR practice, and provide opportunities for the post-docs to gain an in-depth understanding of the broader theoretical and methodological underpinnings of the field. CONCLUSION: The study concludes that PDRF is a useful approach to capacity building in HPSR, but it needs be embedded in a community of practice for fellows to benefit. More academic institutions in Africa need to adopt innovative and flexible support for emerging leaders, researchers and practitioners to strengthen our health systemsIS

Management of the Global Fund aid programme in Botswana : challenges and prospects for health services delivery

This paper examines the institutional management of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) in Botswana. We analyse the often contested roles of the state and non-governmental organisations (NGOs) as recipients of GFATM and partners in extending public health service provision to communities. Of importance is that Botswana’s first GFATM grant had to be administratively closed, and the country was not awarded any other grant (especially for HIV/AIDS) until over a decade later. Following this, it is of interest to understand the ways in which institutions manage grant programmes. This article concludes that the “big brother” relationship of the state in relation to NGOs is crippling the critical and constructive effects of these organisations to deliver needed community-based health services in Botswana. GFTAM represents a window of opportunity for creating an effective civil society whose local activities will not be seen as being led covertly by the state. This article contributes to both theory and practice within the scholarship of development aid in Africa. Qualitative research methods were used, including in-depth interviews with public sector policy makers, all GFATM principal and sub-recipients, members of the Country Coordinating Mechanism (CCM) and NGOs.The Global Development Networkhttp://www.www.tandfonline.com/toc/raar202020-05-01hj2019School of Public Management and Administration (SPMA