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Analytical summary - Service delivery

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In Botswana, health services are delivered in public, private for-profit, private non-profit and traditional medicine practice settings. The public sector is the main provider of services delivered through a network of health facilities using the primary health care approach. Other health care providers complementing the public sector are faith-based organizations (two district hospitals), mining companies (three hospitals) and a few nongovernmental organizations. The health facilities are spread over 29 health districts operated by the district health management teams.

In 2006, referral and district hospital beds constituted 69% of total bed capacity while primary hospitals and clinics constituted 19% and 15%, respectively. Health services are accessible in both rural and urban areas with 95% of the population living within 8 km radius of a health facility. The private sector mainly provides services to insured clients. However, the uninsured do access private sector service through out-of-pocket payment.

Primary health care facilities are mainly staffed by nurses and midwives. Doctors visit health posts on schedule while some clinics, especially those in urban areas, have doctors and pharmacy personnel on staff. In addition to doctors, nurses and midwives, all hospitals have pharmacy, laboratory and radiology personnel. Referral hospitals have specialized care services. All health facilities have ambulance services for referrals and emergency calls.

The public and private health services in Botswana are regulated by a Public Health Act of 2002 (Chapter 63:01). Health professionals are accredited by professional councils in accordance with the Medical, Dental and Pharmacy Act and the Nurses and Midwives Act. The Ministry of Health assesses and registers private facilities through recognized standards. Regulatory mechanisms for traditional medical practice are yet to be established.

Disparity in access to the services between rural and urban areas still prevails, and shortage of human resources for health is a long-standing challenge. Underutilization and inefficiency in service utilization have also been reported and can be due to factors such as the population’s health-seeking behaviour and an ineffective referral system, among other things.