Research Papers

Counselors’ Perceptions of HIV/AIDS Counseling in Botswana: Professional Identity, Practice, and Training Issues

Mental health concerns can exacerbate the progression and transmission of HIV/AIDS. Thus there have been calls for increased research and integration of mental health care into HIV/AIDS treatment in Sub-Saharan Africa, where the disease has reached pandemic levels. This qualitative study analyzed the open-ended survey responses of 181 individuals providing HIV/AIDS counseling in Botswana. Several themes emerged regarding the professional identity of counselors, risk of burnout, working conditions and needed resources, the process and provision of counseling in Botswana, as well as training and supervision issues. Implications and recommendations for practice and advocacy are discussed.

Author:
Tebatso Paul
Survey of HIV/AIDS Clients in Botswana: Reactions to Supportive Counselling

A survey of HIV/AIDS clients in Botswana, Africa, all of whom were receiving supportive counselling, was conducted. A total of 328 volunteer clients from randomly selected sites completed the survey related to client perceptions of counselling helpfulness, outlook on life, satisfaction with goal setting in counselling, experience of social stigma, and acceptance by family and others. Overall, clients were very positive concerning the benefits received from counselling, their relationship with their counsellor, the goal setting process, their family/friends support system and their present quality of life. The majority of clients did, however, indicate some level of feeling stigmatized by being HIV-positive. Additional major findings indicated that clients with family incomes of less than 10 K pula per year (around US$1 k) were less positive about their counselling and related experiences than were those with higher levels of family income, with the exception of social stigma where lower family income was associated with less perceived social stigma. Clients reporting counselling sessions lasting more than 15 min were generally more positive in their reactions to counselling and related experiences than were clients reporting sessions typically lasting 15 min or less. A discussion of the findings, along with recommendations for areas needing further study and attention, is provided.

Author:
Tebatso Paul
Organizational Structure of the Botswana Ministry of Health: Impact on Performance

The Botswana Ministry of Health was prompted to review its organizational structure as part of public sector strategies to improve performance, and as a response to an internal review in 2000 which concluded that performance was unsatisfactory. A team of consultants was engaged to review the existing structure. A new structure was adopted in 2005.

This PhD study was designed to assess performance of the Ministry following adoption of this structure. The overall goal of this study was to assess the impact of the 2005 organizational structure on the Ministry’s performance. Taking a case study approach, and using a mixed methods design, this study used the WHO Health Systems Performance Assessment Framework as a conceptual model to assess the Ministry’s performance in four key health system functions:- stewardship, health financing, resource generation and service provision.

Performance indicators were identified for each function and used to assess the Ministry’s performance. Data were collected through document review, interviews with key informants comprising of policy makers, senior Ministry of Health officials, staff in charge of key processes at the Ministry (N=40), key stakeholders (N=14), surveys of health workers (N=389) and health managers (N=42), and focus group interviews (3) of health workers in two referral hospitals. The organizational structure adopted in 2005 fitted well with policy objectives. However, this structure was not adequately implemented, and hence had limited impact on the Ministry’s performance. Failure to fully implement this structure was attributed to ineffective management of the restructuring process and limited human resource capacity to undertake new responsibilities.

The Ministry had limited capacity for policy development, strategic planning and oversight. Rapid turnover of senior management exacerbated the leadership challenges. The health system in Botswana is adequately funded by the government and has the potential to ensure universal access to health care services. However, the Ministry of Health has chronic challenges in financial management including poor revenue collection, inadequate budget management, under-expenditure, and limited use of evidence to support resource allocations decisions. The government made considerable investment in health infrastructure increasing physical access to services for the majority of the population.

Yet, inadequate planning and management of human resources and medical equipment, and ineffective supply management systems, contributed to imbalance in key health system resources undermining delivery of services. Provision of health services in public hospitals was limited by over-centralization of decision-making and control of resources at the Ministry headquarters, inadequate resources, and poorly motivated workforce. Efforts to strengthen the health system in Botswana need to focus on building leadership capacity to support all the functions of the system. Reconsideration of the governance structures of public hospitals to improve performance is essential.

Author:
Dr Seitio Kgokgwe
Development of the National Health Information Systems in Botswana: Pitfalls, Prospects, and Lessons

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.

Author:
Dr Seitio Kgokgwe
Utilization of the District Health Information Software (DHIS) in Botswana: from Paper to Electronic Based System

Concerns on the status of Botswana’s health information systems were raised as early as the late 1980s. Several assessments overtime revealed weaknesses in the system including fragmentation, weak approaches to data collection, management, reporting, dissemination and use. A number of initiatives designed to improve the HIS were also undertaken. The BEANISH (Building Europe Africa collaborative Network for applying Information Society Technologies in the Healthcare Sector) as one of the initiatives aimed to address the issue of poor data coordination, management and reporting through a data warehousing system, the District Health Information Software. Rapid assessment was conducted as part of Routine Data Quality Assessment to determine the capacity of the District Health Management Teams to collect, analyse, and use data. Several challenges were cited including inadequate IT infrastructure including computers and unreliable internet access; limited skills in using the system and inadequate human resource capacity. There is need for more investment and leadership for health information management. 

Author:
Dr Seitio Kgokgwe
Understanding Human Resource Management Practices in Botswana’s Public Health Sector

The purpose of this paper is to assess the management of the public sector health workforce in Botswana. Using institutional frameworks it aims to document and analyse human resource management (HRM) practices, and make recommendations to improve employee and health system outcomes.

Author:
Dr Seitio Kgokgwe
Assessing Performance of Botswana’s Public Hospital System: The Use of the World Health Organization Health System Performance Assessment Framework

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.

Author:
Dr Seitio Kgokgwe
Analysing the Stewardship Function in Botswana’s Health System: Reflecting on the Past, Looking to the Future

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.

Author:
Dr Seitio Kgokgwe

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