Analytical summary - Health system outcomes
The Government of Botswana's revised National Health Policy (2011) places emphasis on health system strengthening through integration and coordination of existing policies for the improvement of performance. Key result areas are:
- leadership and governance
- health service delivery
- behavioural determinants of health
- health resources
- health information management system.
Leadership and governance
A major development towards improvement of the health system has been the reorganization of the health system in 2010 whereby the responsibility for primary health care services was transferred from the Ministry of Local Government to the Ministry of Health and the direct authority of the Ministry of Health over hospital services was devolved to the district health management teams.
The move was aimed at improving coordination and regulation of the system. However, it is too early to tell if the intended objectives are being realized.
Health service delivery
Much has been achieved in health service delivery. For instance, 96% of the urban population lives within 8 km of a health facility (see table).
Health care is accessible and affordable to all people at a highly subsidized fee through a network of health facilities ranging in sophistication from referral hospital at the highest level through district and primary hospitals at the middle level, to health posts and mobile stops at the lowest level.
Behavioural determinants of health
Working in partnership with civil societies, the private sector and development partners, the Government is engaged in sensitizing the public on the influence of lifestyle on health through health education. One recent initiative has been the increase in the alcohol levy to address alcohol abuse. The National Sports Council has established a number of gymnastic centres to encourage physical exercise. However, it will take time to establish the impact of these initiatives on behaviour.
Although access to health care has been achieved, much still needs to be done in the provision of the right numbers of human resources for health with the right skills. One achievement has been the establishment of a medical school in 2007 with the first intake of students in 2009. The school will slowly relieve the acute shortage of doctors. The rating of Botswana as an upper middle income country has left the Government responsible for providing over 80% of health funding at a time when its economy is not as robust as it has been during the past few years.
Health information management system
The Ministry of Health has taken a number of initiatives to improve the health information management system, including training of health providers on health information management, computerization of health operations and improvement of web-based communication within the system. However, much is till to be achieved to address weaknesses in planning, timely interventions, data capturing and processing, and monitoring and evaluation.