Human resources for health in Botswana: The results of in-country database and reports analysis

Abstract

BackgroundBotswana is a large middle-income country in Southern Africa with a population of just over two million. Shortage of human resources for health is blamed for the inability to provide high quality accessible health services. There is however a lack of integrated, comprehensive and readily-accessible data on the health workforce.AimThe aim of this study was to analyse the existing databases on health workforce in Botswana in order to quantify the human resources for health.MethodThe Department of Policy, Planning, Monitoring and Evaluation at the Ministry of Health, Ministry of Education and Skills Development, the Botswana Health Professions Council, the Nursing and Midwifery Council of Botswana and the in-country World Health Organization office provided raw data on human resources for health in Botswana.ResultsThe densities of doctors and nurses per 10 000 population were four and 42, respectively; three and 26 for rural districts; and nine and 77 for urban districts. The average vacancy rate in 2007 and 2008 was 5% and 13% in primary and hospital care, respectively, but this is projected to increase to 53% and 43%, respectively, in 2016. Only 21% of the doctors registered with the Botswana Health Professions Council were from Botswana, the rest being mainly from other African countries. Botswana trained 77% of its health workforce locally.ConclusionAlthough the density of health workers is relatively high compared to the region, they are concentrated in urban areas, insufficient to meet the projected requirements and reliant on migrant professionals.

Stakeholders’ Perceptions on Shortage of Healthcare Workers in Primary Healthcare in Botswana: Focus Group Discussions

“…Botswana has a population of just over 2 million, 59.4% of whom live in urban areas [ 12 ]. The healthcare system is based on a primary healthcare model and services are provided through a network of 3 national referral hospitals, 7 district hospitals, 14 primary hospitals, 265 primary care clinics (101 with maternity beds), 343 health posts and 861 mobile clinic sites [ 9 ]. Management of the health services, including recruitment and deployment of HCWs, procurement and distribution of equipment and drugs, is centralised at the Ministry of Health headquarters.…”

“…The country therefore has more health workers per population than many countries in the region [ 8 ]. That, notwithstanding, the country has a documented deficiency of healthcare workers which hinders it from providing universal primary health care [ 8 , 9 ].…”

“…Although Botswana has a recognised inadequacy of human resources for health, which is worse in primary healthcare, [ 9 ], no research has been done to investigate its determinants. Therefore, the qualitative research reported in this article explored the perceptions of HCWs, policy makers and members of the community on the shortage of HCWs in Botswana, and to identify the perceived causes and potential solutions.…”

Going rural – protracted immersion or toe-wetting: Does it matter?

“…[1] However, unless the severe shortages and inequitable distribution of healthcare workers, especially in many low-and middle-income countries, are addressed, [2,3] universal access will, similar to 'Health for all by the year 2000' , go down in history as a desirable but unattainable goal. The dearth of healthcare workers follows an 'inverse care law' , [4] with the direst shortages in areas of greatest need, mostly rural areas.…”

“…The dearth of healthcare workers follows an 'inverse care law' , [4] with the direst shortages in areas of greatest need, mostly rural areas. [2,3] In a bid to address the challenge in sub-Saharan Africa, many new medical schools with larger class sizes have sprung up in the past 20 -30 years. [5,6] There is strong evidence, mostly emanating from the USA, Australia, the Philippines, Thailand and Canada, linking rural-based training of healthcare workers with increased retention.…”