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Evaluation of Norwegian Health Sector Support to Botswana

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Evaluation of Norwegian Health Sector Support to Botswana Evaluation of Norwegian Health Sector Support To Botswana Annexes to the Final Report Volume II Evaluation of Norwegian Health Sector Support to Botswana Table of Contents 1 Annex 1. Detailed Methodology and Study Instruments ................................................................ 1 1.1 Introduction ............................................................................................................................. 1 1.2 Evaluation Organisation .......................................................................................................... 6 1.3 Health Status Sub-study .......................................................................................................... 6 1.4 Health Systems Sub-study ...................................................................................................... 7 1.4.1 Health Policy ................................................................................................................... 7 1.4.2 Health Services Delivery / Systems Development .......................................................... 8 1.4.3 Human Resources for Health .......................................................................................... 9 1.4.4 Health infrastructure review .......................................................................................... 10 1.4.5 Finance Sub-study ......................................................................................................... 11 1.5 Beneficiaries and Stakeholders Sub-study ........................................................................... 13 1.5.1 Beneficiaries ................................................................................................................. 13 1.5.2 Batswana and Norwegian stakeholders ......................................................................... 18 2 Annex 2. Details of Field Work, itinerary and informants consulted ........................................... 27 3 Annex 3. Terms of Reference ....................................................................................................... 32 4 Annex 4. Sub-study Findings ........................................................................................................ 39 4.1 Study to analyse Norway’s support programme to Botswana .............................................. 39 4.1.1 Leadership & Governance ............................................................................................ 43 4.1.2 Health Services Delivery .............................................................................................. 45 4.1.3 Human Resources for Health ........................................................................................ 50 4.1.4 Health Finance .............................................................................................................. 55 4.1.5 Health Information ........................................................................................................ 56 4.1.6 Health Technologies ..................................................................................................... 57 4.1.7 Community Ownership and Participation ..................................................................... 59 4.1.8 Partnerships for Health Development ........................................................................... 61 4.1.9 Increased capacity to undertake health and health systems research ............................ 62 4.2 Finance Sub-study 2 .............................................................................................................. 65 4.2.1 National Health Accounts ............................................................................................. 65 4.2.2 Development Expenditure on Health (Development Fund) .......................................... 68 4.2.3 Recurrent Expenditure .................................................................................................. 73 4.3 Health Systems Sub-study 3 ................................................................................................. 78 4.3.1 Health Policy Review.................................................................................................... 78 4.3.2 Health Services Systems Delivery Assessment ............................................................ 82 4.3.3 Health Infrastructure assessment................................................................................... 94 4.3.4 Analysis of the Human Resources for Health in Botswana ........................................ 102 4.4 Stakeholder / Beneficiary Sub-study 4 ................................................................................ 111 4.4.1 Purpose of the study .................................................................................................... 111 Final Report - Volume II/ January 2012 Annexes - Page | i Evaluation of Norwegian Health Sector Support to Botswana 4.4.2 Community Perceptions on Health Services and Health Service Developments ....... 111 4.4.3 Description of Community Participation Processes .................................................... 112 4.4.4 The Role of Village Health Committees ..................................................................... 114 4.4.5 Norwegian and Batswana Stakeholders ...................................................................... 116 4.5 Annex NORAD Projects and Programmes ......................................................................... 120 4.5.1 Phase 1: 1972 - 1996 ................................................................................................... 120 4.5.2 Phase 2: 1996 - 2012 ................................................................................................... 125 List of tables Table 1 - Names, dates and value of Norwegian assistance to the Botswana Health Sector from 1972 to the present day - Phase 1: 1972-1996 _______________________________________________ 41 Table 2 - Names, dates and value of Norwegian assistance to the Botswana Health Sector from 1972 to the present day - Phase 2: 1996-2013 _______________________________________________ 42 Table 3 - Norwegian Health Sector Expenditure Phase 1, by area of expenditure _______________ 42 Table 4 - Graduates from various health training programmes 1997-2010 ____________________ 51 Table 5 - Botswana, Health Facilities, 2006 ____________________________________________ 82 Table 6 - Botswana, Proportion of the population with access to primary health care services within 15, 8 and 5 km from a health facility, by urban and rural residence, as of April 2007 ____________ 83 Table 7 - Botswana, Health Facilities, 1974-2006 _______________________________________ 84 Table 8 - Botswana, Hospital beds per 1,000 population, 1974-2006 ________________________ 85 Table 9 - Botswana, Services provided by each type of facility _____________________________ 86 Table 10 - Botswana, Hospital discharges per 1,000 population ____________________________ 87 Table 11 - Botswana, Outpatient attendances per capita 1974 -2006 _________________________ 89 Table 12 - Botswana, Immunisation coverage for children under one year of age _______________ 90 Table 13 - Botswana, Antenatal care coverage, 1988-2007 ________________________________ 91 Table 14 - Botswana, Proportion of live births attended by skilled health personnel, 1984-2007 ___ 91 Table 15 - Botswana, Current use of modern contraceptive methods 1984-2007, percent of all women aged 15-49 years _________________________________________________________________ 92 Table 16 - Botswana, Staff ratios for selected health cadres (per 10,000 population), 1980-2006 _ 103 Table 17 - Botswana, Number of selected health personnel, by category, 1980-2006 ___________ 104 Table 18 - Botswana, Doctors and nurses by nationality (numbers and %), 1988-2008 _________ 109 Table 19 - Regional comparisons – Selected indicators, 2000-2009 ________________________ 109 Table 20 - Regional comparison of staff numbers and ratios, 2000-2009 ____________________ 110 Table 21 - Area of experience of Norwegian inputs for Batswana and Norwegian informants ____ 116 Table 22 - Overall positive responses in relation to the five broad Norwegian support programmes by (i) Batswana stakeholders and (ii) Norwegian Stakeholders ______________________________ 117 Table 23 - Basic Health Services Project _____________________________________________ 120 Table 24 - Development of Dental Health Services _____________________________________ 120 Final Report - Volume II/ January 2012 Annexes - Page | ii Evaluation of Norwegian Health Sector Support to Botswana Table 25 - Improvement of Health Care at Health Centres and Hospitals; Development of the Rural Health Services _________________________________________________________________ 121 Table 26 - Evaluation of the Health Status in Botswana _________________________________ 121 Table 27 - Assistance within the field of health services _________________________________ 121 Table 28 - Botswana Health Programme _____________________________________________ 121 Table 29 - Family Health Project (Co-financed with World Bank) _________________________ 124 Table 30 - Support to Remote Area Development Programme ____________________________ 124 Table 31 - Development and Further Improvement of Health Services ______________________ 125 Table 32 - Actual Expenditure BOT015 to 2013 by component ___________________________ 126 Table 33 - Assistance to the Education of Batswana Students in Norway ____________________ 126
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