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