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