Community participation in the Botswana Healthcare system
Phyllis Frimpong
Department of Nursing
University of Botswana
INTRODUCTION
Community participation in healthcare systems has recently become a growing theme in healthcare
reforms (Youde, 2009). However, there has been much speculation concerning the importance of
community participation and whether countries have the structures and resources to successfully seek and
incorporate the views and opinions of the populace in the design and implementation of health projects and
programs. For purposes of this research, community participation refers to the active engagement of the
populace in discussing their health concerns and ideas for improved healthcare delivery. It also refers to
the communities’ ownership of health projects and their enthusiastic patronage in community oriented
health programs such as Home – based care programs and participate in the process available to them.
While some do not believe in the incorporation of local opinions and involvement in healthcare provision
other nations such as .One study by Abelson , discussed that countries have begun to realize the
importance of community participation in health care provision yet do not have the required infrastructure
and resources to effectively engage the public. On the other hand, other countries have learned to
effectively incorporate the community and citizens in way that is geared toward seeking a more
productive and purposeful information –sharing approach (Abelson, 2008). I wanted to know whether
Botswana, especially with the enormous stress of the HIV epidemic, has some structure in place to
facilitate the effective flow of information and ideas concerning healthcare between healthcare providers,
policy makers and the respective communities.
Health Posts
Clinics
Hospitals
Kgolta/ Kgosi
Local Government
Member of
Parliament
Ministry of Health
The House/
Parliament
Permanent
Secretary
District Officer
The Executive
Figure 1: This is a visual representation of the structure in place to facilitate community participation
and information sharing between policy makers, health service providers and the populace.
CONCLUSION
METHODS
I made a questionnaire to guide the
interview/ conversations I had with the
people I interacted with at the Ministry of
Health. For the specificity of my project, I
spoke with the professionals I could contact
who had information and experience
relevant for my research as opposed to a
more conventional random sampling of
people. I met with each of them in their
respective offices for an average of
30minutes.
ABSTRACT
This research was conducted to investigate whether Botswana’s healthcare system incorporated
community participation and to highlight the structures that the government has in the flow of information
from its populace to the healthcare providers and the government and vice versa. Information concerning
this ace to facilitate the research topic was sought through interviews with 2 medical health officers and 1
health promoter at the Ministry of Health in Botswana, Gaborone, Botswana. Results from this study show
that 1. Botswana’s healthcare system does incorporate the views and opinions of it citizens and 2. there is a
structured system for information sharing between the society, healthcare providers and the government.
This system of information sharing utilizes the traditional Kgotla setting , health posts, clinics, local
government, district officers and the ministry of Health. Overall, the presence of these structures to
facilitate the involvement of the people, their views and opinions, illustrates the government’s
understanding for a holistic approach to providing good healthcare and ensuring that the people have their
health concerns addressed.
RESULTS
From the data I collected during my research I gained insight into a structured form of information sharing that allows
citizens in different areas of the Botswana to share their health concerns and ideas with various personnel who in turn
relay these concerns and ideas to the appropriate quarter or parties concerned to take the necessary measures to
effect change. This system is evident at the grassroots level by health posts in all districts and villages I Botswana. I
found that the health posts which are usually run by a team of family welfare educators are the most primary source of
information that also set out to inquire from locals, what health concerns they need addressed. Next are the clinics
who work in close relation to the health posts in sensitizing the community on disease control and prevention methods
and meet with the locals to discuss health issues evident in the community. Clinics feed information to the main
hospitals in the district or villages. One of the most central institutions utilize to promote community participation is
the Kgotla system of traditional governance, which is headed by a Khosi. Still very evident in present day local settings,
the town’s people meet usually weekly in the Kgotla to discuss issues affecting the community. Health issues feature
regularly and thus family welfare educators, nurses and health workers from the health posts, clinics and hospitals are
typically present to address the health concerns of the public as well as disseminate information about public policy,
new programs and services available to the public. In the same vein, once hospitals, clinics and health posts detect the
onset or proliferation of certain disease symptoms they utilize the family welfare educators and the Kgotla to spread
information or awareness about cure, prevention and control. The Kgotla meetings are not exclusive to the town’s
people and health workers only, but are patronized by members of the local government and the district officers. The
presence of these local government officials and district officers serve as a means to relay ideas for improving the
health care system to the decision making bodies in parliament and the executive, as these workers report back to
higher authority. As illustrated in figure 1. Issues raised at the Kgotla are shared with the members of parliament who
in turn relay the information to the House or to parliament. Local government officials also communicate with the
Ministry of health who report to the permanent secretary and vice versa. Finally, the district officers also transmit
information to and from the executive arm of government. Through this intricate web of institutions and personnel,
many of Botswana’s health concerns are communicated between the health decision making bodies and the citizens. I
found that Botswana’s healthcare system advocates for community participation for the following reasons: 1.
Community ownership and patronage of health programs. 2. To avoid misconceptions of disease control and
prevention measures. 3. Public awareness of health facilities and services and 4. To promote sustainability of
community health programs.
Deducing from the results of my research it is obvious that the government and health sector of Botswana do have
measures in place to garner community support and opinions for health projects. By providing these avenues and
structures for the community to assume better engagement in the healthcare system, Botswana shows an
understanding for an integrated approach to catering for the health needs of its citizens that involves its health
professionals, communities and governments. As a follow-up to this research, further investigation should be conducted
into whether the people of Botswana are actually aware and utilize the structures established for community
involvement.
CITED SOURCES
Youde, J. (2009). Government AIDS Policies and Public Opinion in Africa. Politikon: South African Journal of
Political Studies, 36(2), 219-235. Doi: 10.1080/02589340903240161
Abelson, Julia. (2008). obtaining public input for health-systems decision-making: Past
experiences and future prospects. Canadian Public Administration, 45(1), 70-97. DOI: 10.1111/j.17547121.2002.tb01074.x
Figure 2: The Ministry of Health of
Botswana, Gaborone, Botswana.
ACKNOWLEDGEMENTS
I express much gratitude to the
workers and staff of The Ministry of
Health in Gaborone, Botswana for
the information I received and their
generous assistance. I also extend
my gratitude to The World Health
Organization, Gaborone Botswana,
for their kind assistance in linking
me with the Ministry of Health. I
thank Prof. Phoebe Lostroh for her
constant guidance and input
throughout the course of my study.
I appreciate the efforts of The
University of Botswana in helping
me secure permission to conduct
this research. Lastly I thank my
fellow ACM class mates and friends
at the University of Botswana , who
have been a tremendous source of
help and motivation.