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The Health System

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The health system consists of public, private for-profit, private non-profit and traditional medicine practice. The public sector dominates the health system, operating 98% of the health facilities. The health care delivery system is based on the primary health care model.

The services are decentralized to the district level and delivered through a hierarchical network of health facilities, ranging from referral hospitals (0.5%) to district (2%) and primary hospitals (3%), and finally to clinics (43%) and health posts (52%) operated by the Government of Botswana through the Ministry of Health, faith-based organizations and mining companies (see table).[1] In addition to the network of health facilities, there are over 800 mobile services to populations in remote areas or those outside the 8 km radius of a health facility.

List of health facilities in Botswana[2]

The flow of clients along the hierarchy of the health facilities, particularly from the lower facilities to referral hospitals, is through a referral system. In the formal private sector there are about 167 private practitioners and two private hospitals. There are a number of nongovernmental organizations providing mostly HIV/AIDS-related services such as counselling and testing. Within the public sector, the Ministry of Health is mandated with the oversight of health services. It is responsible for the formulation of policies, regulation and norms, standards and guidelines of the health services.

The public health services of the country are being regulated by a Public Health Act 2002 (Chapter 63:01). For both the public and private sector, professionals are accredited by professional councils in accordance with the Medical, Dental and Pharmacy Act and the Nurses and Midwives Act. In addition to the professional accreditation, the Ministry of Health is also responsible for the registration of private facilities through recognized standards.

Although many people use the services of traditional health practitioners, the country is yet to formulate a Bill for the regulation of traditional medical practice, which currently operates informally. Most of the population (95% of the total population, 89% of the rural population) lives within 8 km of a health facility. However, access to health facilities does not always translate into utilization of high-impact interventions.

In the context of providing services as a package, the lowest coverage of high-impact interventions is not less than 80%. All public hospitals and selected clinics, including those with a maternity wing, operate 24 hours. Other clinics and health post are open 8 hours, with on-call services for emergencies. A nominal fee of US$ 70 is charged for health services in the public sector, while sexual reproductive health services and antiretroviral therapy services are free. Nobody is denied health services based on his or her inability to pay.

References

  1. Master health facility list. MOH/WHO collaboration report on developing an integrated response of health care systems to rapid population ageing using hypertension and stroke as tracers to the health needs of the elderly (554.09kb). Geneva, World Health Organization and Gaborone, Government of Botswana, Health Statistics Unit, 2009
  2. Health facility register. Gaborone, Government of Botswana, Ministry of Health, 2008