3 research outputs found
Assessing performance of Botswana’s public hospital system: the use of the World Health Organization Health System Performance Assessment Framework
Background:
Very few studies have assessed performance of Botswana public hospitals. We draw from a large research
study assessing performance of the Botswana Ministry of Health (MoH) to evaluate the performance of public hospital
system using the World Health Organization Health Systems Performance Assessment Framework (WHO HSPAF).
We aimed to evaluate performance of Botswana public hospital system; relate findings of the assessment to the
potential for improvements in hospital performance; and determine the usefulness of the WHO HSPAF in assessing
performance of hospital systems in a developing country.
Methods:
This article is based on data collected from document analysis, 54 key informants comprising senior
managers and staff of the MoH (N=
40) and senior officers from stakeholder organizations (N=
14), and surveys of
42 hospital managers and 389 health workers. Data from documents and transcripts were analyzed using content and
thematic analysis while data analysis for surveys was descriptive determining proportions and percentages.
Results:
The organizational structure of the
Botswana’s public hospital system, authority and decision-making are
highly centralized. Overall physical access to health services is high. However, challenges in the distribution of
facilities and inpatient beds create inequities and inefficiencies. Capacity of the hospitals t
o deliver services is limited
by inadequate resources. There are significant challenges with the quality of care.
Conclusion:
While Botswana invested considerably in building hospitals around the country resulting in high physical
access to services, the organization and governance of the hospital system, and inadequate resources limit service
delivery. The ongoing efforts to decentralize management of hospitals to district level entities should be expedited.
The WHO HSPAF enabled us to conduct a comprehensive assessment of the public hospital system. Though relatively
new, this approach proved useful in this study
Analysing the Stewardship Function in Botswana’s Health System: Reflecting on the Past, Looking to the Future
Background: In many parts of the world, ongoing deficiencies in health systems compromise the delivery of health
interventions. The World Health Organization (WHO) identified four functions that health systems need to perform
to achieve their goals: Efforts to strengthen health systems focus on the way these functions are carried out. While a
number of studies on health systems functions have been conducted, the stewardship function has received limited
attention. In this article, we evaluate the extent to which the Botswana Ministry of Health (MoH) undertook its
stewardship role.
Methods: We used the WHO Health Systems Performance Assessment Frame (HSPAF) to guide analysis of the
stewardship function of the Botswana’s MoH focusing on formulation of national health policies, exerting influence
through health regulation, and coalition building. Data were abstracted from published and unpublished documents.
We interviewed 54 key informants comprising staff of the MoH (N=40) and stakeholder organizations (N=14). Data
from documents was analyzed through content analysis. Interviews were transcribed and analyzed through thematic
analysis.
Results: A lack of capacity for health policy development was identified. Significant policy gaps existed in some areas.
Challenges were reported in policy implementation. While the MoH made efforts in developing various statutes that
regulated different aspects of the health system, some gaps existed in the regulatory framework. Poor enforcement of
legislation was a challenge. Although the MoH had a high number of stakeholders, the mechanisms for stakeholder
engagement in the planning processes were weak.
Conclusion: Problems in the exercise of the stewardship function posed challenges in ensuring accountability and
limited the health system’s ability to benefit from its stakeholders. Ongoing efforts to establish a District Health System
under control of the MoH, attempts to improve service delivery at a national level and political will to strengthen
public-private engagement mechanisms are some of the prospects that can improve the MoH’s stewardship function
Development of the National Health Information Systems in Botswana: Pitfalls, prospects and lessons
Background: Studies evaluating development of health information systems in developing countries are limited. Most of the available studies are based on pilot projects or cross-sectional studies. We took a longitudinal approach to analysing the development of Botswana’s health information systems.Objectives: We aimed to: (i) trace the development of the national health information systems in Botswana (ii) identify pitfalls during development and prospects that could be maximized to strengthen the system; and (iii) draw lessons for Botswana and other countries working on establishing or improving their health information systems.Methods: This article is based on data collected through document analysis and key informant interviews with policy makers, senior managers and staff of the Ministry of Health and senior officers from various stakeholder organizations.Results: Lack of central coordination, weak leadership, weak policy and regulatory frameworks, and inadequate resources limited development of the national health information systems in Botswana. Lack of attention to issues of organizational structure is one of the major pitfalls.Conclusion: The ongoing reorganization of the Ministry of Health provides opportunity to reposition the health information system function. The current efforts including development of the health information management policy and plan could enhance the health information management system.Keywords: Disease outbreaks, electronic health records/classification, machine learning, natural language processing, public health informatics, public health surveillance/method