Community participation in the Botswana Healthcare system Phyllis Frimpong Department of Nursing University of Botswana INTRODUCTION METHODS ABSTRACT Community participation in healthcare systems has recently become a growing theme in healthcare I made a questionnaire to guide the This research was conducted to investigate whether Botswana’s healthcare system incorporated reforms (Youde, 2009). However, there has been much speculation concerning the importance of interview/ conversations I had with the community participation and to highlight the structures that the government has in the flow of information community participation and whether countries have the structures and resources to successfully seek and people I interacted with at the Ministry of from its populace to the healthcare providers and the government and vice versa. Information concerning incorporate the views and opinions of the populace in the design and implementation of health projects and Health. For the specificity of my project, I this ace to facilitate the research topic was sought through interviews with 2 medical health officers and 1 programs. For purposes of this research, community participation refers to the active engagement of the spoke with the professionals I could contact health promoter at the Ministry of Health in Botswana, Gaborone, Botswana. Results from this study show populace in discussing their health concerns and ideas for improved healthcare delivery. It also refers to who had information and experience that 1. Botswana’s healthcare system does incorporate the views and opinions of it citizens and 2. there is a the communities’ ownership of health projects and their enthusiastic patronage in community oriented relevant for my research as opposed to a structured system for information sharing between the society, healthcare providers and the government. health programs such as Home – based care programs and participate in the process available to them. more conventional random sampling of This system of information sharing utilizes the traditional Kgotla setting , health posts, clinics, local While some do not believe in the incorporation of local opinions and involvement in healthcare provision people. I met with each of them in their government, district officers and the ministry of Health. Overall, the presence of these structures to other nations such as .One study by Abelson , discussed that countries have begun to realize the respective offices for an average of facilitate the involvement of the people, their views and opinions, illustrates the government’s importance of community participation in health care provision yet do not have the required infrastructure 30minutes. understanding for a holistic approach to providing good healthcare and ensuring that the people have their and resources to effectively engage the public. On the other hand, other countries have learned to health concerns addressed. 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 RESULTS facilitate the effective flow of information and ideas concerning healthcare between healthcare providers, From the data I collected during my research I gained insight into a structured form of information sharing that allows policy makers and the respective communities. 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 Health Posts 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 Clinics 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 Hospitals 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 Figure 2: The Ministry of Health of Kgolta/ Kgosi Local Government District Officer people and health workers only, but are patronized by members of the local government and the district officers. The Botswana, Gaborone, Botswana. 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 Member of ACKNOWLEDGEMENTS Ministry of Health higher authority. As illustrated in figure 1. Issues raised at the Kgotla are shared with the members of parliament who Parliament in turn relay the information to the House or to parliament. Local government officials also communicate with the I express much gratitude to the Ministry of health who report to the permanent secretary and vice versa. Finally, the district officers also transmit workers and staff of The Ministry of information to and from the executive arm of government. Through this intricate web of institutions and personnel, Health in Gaborone, Botswana for many of Botswana’s health concerns are communicated between the health decision making bodies and the citizens. I the information I received and their The House/ Permanent The Executive Parliament Secretary found that Botswana’s healthcare system advocates for community participation for the following reasons: 1. generous assistance. I also extend Community ownership and patronage of health programs. 2. To avoid misconceptions of disease control and my gratitude to The World Health prevention measures. 3. Public awareness of health facilities and services and 4. To promote sustainability of Organization, Gaborone Botswana, Figure 1: This is a visual representation of the structure in place to facilitate community participation community health programs. for their kind assistance in linking and information sharing between policy makers, health service providers and the populace. me with the Ministry of Health. I thank Prof. Phoebe Lostroh for her constant guidance and input CONCLUSION throughout the course of my study. CITED SOURCES I appreciate the efforts of The Deducing from the results of my research it is obvious that the government and health sector of Botswana do have Youde, J. (2009). Government AIDS Policies and Public Opinion in Africa. Politikon: South African Journal of University of Botswana in helping measures in place to garner community support and opinions for health projects. By providing these avenues and Political Studies, 36(2), 219-235. Doi: 10.1080/02589340903240161 me secure permission to conduct structures for the community to assume better engagement in the healthcare system, Botswana shows an this research. Lastly I thank my understanding for an integrated approach to catering for the health needs of its citizens that involves its health Abelson, Julia. (2008). obtaining public input for health-systems decision-making: Past fellow ACM class mates and friends professionals, communities and governments. As a follow-up to this research, further investigation should be conducted experiences and future prospects. Canadian Public Administration, 45(1), 70-97. DOI: 10.1111/j.1754- at the University of Botswana , who into whether the people of Botswana are actually aware and utilize the structures established for community 7121.2002.tb01074.x have been a tremendous source of involvement. help and motivation.