Health System-Botswana

Pharmacy Practice PHA 212

Dr. J. Kgatlwane
Objectives
• At the end of the objectives, the learners should be able to:
o Define some terms used in health systems

o Describe the health care system in Botswana

o Discuss the Primary Health Care Concept

o Explain financing of health system in Botswana

 Definition of terms
• Health is defined as “a state of complete physical, mental, and social well-
being and not merely the absence of disease or infirmity”
World Health Organization

• Health system
= “the combination of resources, organization, financing and
management that culminate in the delivery of health services to the
population.” Roemer (1991)

• Health system re-defined as

• “all activities whose primary purpose is to promote, restore, and maintain
health.” including prevention of household poverty associated with
illness. W.H.O (2000)
 Definition of terms
• Health system financing = a system of collecting revenues, pooling financial
risk and allocating revenue (World bank 2007)

• Primary Health Care

= is provision of universal essential health care made accessible to
individuals and acceptable to them, through full participation and at a cost
the community and country can afford. (WHO, 1978)
 Introduction
• key players in health systems:
• Those who utilize the health services i.e. patients, caregivers, families,
and communities,
• Those who provide the health services i.e. Ministries of Health, health
care providers, pharmaceutical companies, health financing organization
etc.
• The roles of key players include:
o policymaking, regulation,
o provision of health service (preventive promotional, treatment)
o financing, and
o managing resources (infrastructure, medicines & medical devices,
medical equipment, health information etc.).
 Introduction
• The Ministry of Health and Wellness (MoHW) consists of:
o Permanent Secretary
o Deputy Permanent Secretaries
o Director of Health Services (oversees health care serives in both public
and private sector)
o Various Technical Departments
• MoHW public services are rendered through:
o Hospitals and
o District Health Teams
 Consisting of administration
 Clinics and health posts
 Autonomous or dependent on the hospital
 Introduction: mandate
• “Ministry of Health exists to promote & provide comprehensive quality
health services to the nation”.
• Ministry of Health and Wellness:
o Provides oversight of health services in both public and private sector
o Formulates policies, regulates norms, standards and guidelines of the
health services.
• Health services are regulated by Public Health Act, 2013.
• Health professionals are regulated/accredited by Botswana Health
Professional Council except nurses (Nurses and Midwives Act)
• However, Bill for regulating/accrediting all health professionals – passed
(July 2018).
• In addition MoHW licenses health professionals to practice in private sector
(general practitioners and pharmacists)
 Overview: National Health Policy
• Provision of health services is guided by the National Health Policy

• National Health Policy, 2011, replaced 1995 version

o Was informed by the Vision 2016 – (now Vision 2036), and Millennium
Development Goals (now Sustainable Development Goals)

oAddressed the National Development Plan (Currently NDP 11)

o Forms the foundation of health care system in Botswana

o Has slogan ‘Towards a Healthier Botswana’

• => encompasses promotion and prevention of diseases through healthy
lifestyles as part of provision of health services
 Overview: National Health Policy
• Major causes of Mortality of Public Health Concern (2013) (Statistics Office)
o Respiratory diseases and TB

o Septicemia

o Cardiovascular diseases including stroke

o HIV and other infectious diseases

o Renal failure
 Overview: Health System Practices
• Types of health system practices in Botswana:
o public sector – most prominent health system with > 95% health facilities
o private for-profit,
o private non-profit and
o traditional medicine practice
• The public sector dominates the health system, operating 98% of the health
facilities.
• The health care delivery system is based on primary health care model.
• Some people still utilize the traditional medicine practice – though not
regulated
 Overview
• health services are:
o Administered through
• Ministry of Health and Wellness (government facilities)
• faith-based organizations/mission and
• mining companies
• Private
o A referral system is used to guide the flow of clients from the lower
level facilities (e.g. clinics and health posts => primary and district
hospitals => referral hospitals.
o Some non-governmental organization e.g. BOCAIP, Tebelopele – provide
HIV counselling and testing services
 Overview: Health System Practices
• Health services in Botswana are:
o decentralized and grouped by districts (27 health districts)
o delivered through a health facilities, arranged in a hierarchical manner,
 With hospitals referral, district and primary hospitals forming < 6% of
health facilities
 The rest, clinics and health posts (~96%) and mobile clinics (800)
 > 90% of population is within 8 km of a health facility
o district hospitals include private, mine and mission (or faith-based
hospitals)
o also delivered through private general practices and community
pharmacies
o 3 private hospitals, ~ 1170 private practitioners and community
pharmacies
Overview: Health Facilities
Facility type No.
Referral hospitals 3
District hospitals 7
Primary hospitals 17
Clinics with maternity 104
Clinics without maternity 124
Health posts 347
Mobile stops 973
Mission hospitals 2
Mine hospitals 2
Private hospitals 3
 Overview: Health Care Providers
• Pharmacists and Pharmacy Technicians
• Doctors
• Nurses
• Dentists
• Physiotherapists
• Dentists
• Psychologists, Social Workers, Lay Counsellors
• Laboratory Scientists and Technicians
• Health Care Auxiliaries, Health Education Assistants
• Hospital Orderlies
• Cleaners and Drivers
• Community health workers
 Health financing
• Botswana health system
• Promotes universal care coverage
• Financed mainly through the government – Ministry of Finance and
Development Planning;
• international agencies contribute mainly to HIV, TB care
• Ministry of Health and Wellness, main custodian of health funds
• Others,
• National AIDS Coordinating Agency
• Medical Aid schemes (health benefits organizations – HMO)
 Health financing
• Part of health funding also goes to
o private financing agents e.g. insurance schemes,
o households and nongovernmental organizations.
• A cost recovery consultation fee:
o < US$ 1 for citizens visiting public health facilities
o And ~ US$ 4 for non-citizens visiting public health facilities
• Antiretroviral and sexual and reproductive services are offered at no cost to
citizens.
Challenges in health services in Botswana
• Shortage of manpower – including pharmacy personnel

• Weak supply chain management systems

• => inadequate availability of medicines
 Integrated Health Service Plan: 2010 - 2020
• “The goal for improving procurement and logistics is to ensure the effective
and efficient delivery of health services to all people living in Botswana”.
• The strategic objectives are:
• To ensure adequate and uninterrupted availability of drugs and medical
supplies at CMS and in all the health facilities
• To ensure that the drugs and medical supplies available in the health
facilities are used appropriately and rationally, and are properly accounted
for
• To support the provision of the Essential Health Services Package (ESHP)
through:
• the continuous availability of serviceable and appropriate equipment
in all the facilities”
 Primary Health Care: Conception
• Primary Health Care
• = essential health care made universally accessible to individuals and
acceptable to them, through full participation and at a cost the
community and country can afford

• Birthed following a Declaration of Alma-Ata

• The International Conference on Primary Health Care in Alma-Ata
(25/09/1978)
• Mandated all governments, all health and development workers, and
the world community to:
• protect and promote the health of all the people of the world
“Health for ALL, by 2010),
 Primary Health Care: Model
• Health care services to be delivered through:
• Primary health care facilities = clinics and health posts
• “first” level of contact between the individual and the health system.
• provide essential health care including preventive care
• majority of prevailing health problems can be satisfactorily managed at
this level
• The closest to the people (< 5 km for majority of the population)

• Secondary health care facilities

• Referral (Tertiary) heath care facilities

Primary Health Care: Model
• Secondary health care = primary and district hospitals
• Deal with more complex conditions
• Provide mainly curative services
• But promotive, preventive services provides at this level

• Referral/tertiary health care

• Provides specialists care
• But Primary and secondary level services still provided at this level
 Primary health care: Elements
1. influenced by the countries’ economic, sociocultural, political climate and
communities;
• and is based on the application of the relevant results of social, biomedical
and health services research and public health experience;

2. addresses the main health problems in the community,

• providing promotive, preventive, curative and rehabilitative services
 Primary health care: Elements
3. Requires:
• education about health problems that affects the community/population
and the interventions of preventing and controlling them;
• promotion of food supply and proper nutrition;
• adequate supply of safe water and basic sanitation;
• provision of maternal and child health care, including family planning;
• immunization against the major infectious diseases;
• prevention and control of locally endemic diseases;
• appropriate treatment of common diseases and injuries; and provision of
essential drugs;
 Primary health care: Elements
4. Requires participation of all related sectors and aspects of national and
community development, such as:
• agriculture, animal husbandry, food, industry, education, housing, public
works, communications and other sectors in addition to the health
sector;
• and demands the coordinated efforts of all those sectors;

5. Requires and promotes maximum community and individual self-reliance

and participation in:
• planning, organization, operation and control of primary health care,
• Utilizing local, national and other available resources to the fullest; and
• Promotion of participation of communities through appropriate
education
 Primary health care: Elements
6. Requires sustainable integrated, functional and mutually supportive referral
systems
• Facilitate progressive improvement of comprehensive health care for all
and
• give priority to those most in need;
7. Depends on:
• health care providers and
• auxiliaries and community workers and
• traditional practitioners
• At various levels of care
 Summary
• Health care services are guided by the National Health Policy
• Botswana has committed to provide the health services though the Primary
Health Care Model
• Botswana Government had committed to making universal care accessible
to citizens
• Health care system is financed mainly thorough government
• To achieve health for all, Ministry of Health and Wellness espouses the
provision of promotive, preventive and curative services
• Health care services are provided through public, private and faith-based
facilities
References
• 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
• Health facility register. Gaborone, Government of Botswana, Ministry of Health,
2008
• HEALTH STATISTICS STATS BRIEF 2007 - 2015
http://www.gov.bw/en/Ministries--Authorities/Ministries/MinistryofHealth-
MOH/Departments-of-MOH/MOA-Departments11111/ b
• Integrated Health Service Plan: 2010-2020
http://www.moh.gov.bw/Publications/policies/Botswana%20IHSP%20Final%20HLSP.pdf
W.H.O. website
• Integrated Health Service Plan: 2010-2020
http://www.moh.gov.bw/Publications/policies/Botswana%20IHSP%20F
inal%20HLSP.pdf