With a population of just 2.2 million people, Botswana has one of the highest HIV prevalence rates in sub-Saharan Africa. According to UNAIDS, the 2015 HIV prevalence rate among adults was 22.2 percent, which translates to 340,000 people between the ages of 15 and 49 living with HIV — approximately 190,000 of whom are women. About 60,000 children have been orphaned as a result of Botswana’s AIDS epidemic and 8,500 youth aged 0 to 14 are living with HIV. The virus has long had a dramatic impact on the country’s healthcare system, including approximately 17 percent of all healthcare workers lost to AIDS between 1999 and 2005 alone. Other public health challenges in Botswana include a high risk of infectious diseases, such as typhoid fever, tuberculosis, and malaria, which is a particular problem in the Northern regions of the country.
In Botswana, a severe shortage of skilled health workers is one of the main challenges limiting delivery of high quality healthcare services and greatly undermining health system performance. The Ministry of Health has therefore tasked the country’s health education and training institutions with reorganizing and redesigning their programs to meet the health system’s changing needs and challenges related to providing quality care to the population. This has resulted in greater need for technical assistance and support for health systems strengthening, in particular interventions that develop sustainable capacity to train human resources for health.
With support from PEPFAR and the United States Government team in country, AIHA began working in Botswana in 2007. We’ve managed a total of seven partnerships in country, along with a Volunteer Healthcare Corps (VHC) program. Three partnerships are currently active, while the other four have successfully graduated from our technical assistance program.
Botswana Institute of Health Sciences / African Palliative Care Association
(2007 – Present)
This south-south partnership is strengthening the Institute’s capacity to provide pre- and in-service training on palliative care and helping integrate palliative care concepts into existing pharmacy technology, health education, and dental therapy programs.
The Institute of Health Sciences in Gaborone (IHS) has been partnering with the African Palliative Care Association (APCA) since 2007 to strengthen its capacity to provide quality palliative care education and training for pre-service and post-basic students. Partners focus on faculty development in topics related to palliative care and are also working to introduce palliative care into the Institute’s existing pharmacy technology, health education, and dental therapy programs. Other activities focus on organizational development for planning, research, and monitoring and evaluation.
Following targeted sensitization activities for IHS faculty, staff, and community stakeholders to introduce the concept, partners successfully incorporated palliative care into teaching programs and curricula at the main campus, all seven IHS Health Teaching Institutes, and within community-based hospices and hospitals. They established a palliative care resource center in the library at IHS-Gaborone, which features laptops, journals, and palliative care reference books.
Partners also trained new and existing lecturers, strengthening their capacity to teach the palliative care modules that have been integrated into the curricula. In addition, IHS students now complete week-long rotations in hospices to gain hands-on experience in providing palliative care services to their patients. APCA is helping to build the capacity of IHS staff in Gaborone to continue to roll out the palliative care training to the six other IHS campuses in the country.
In March 2014, members of this south-south partnership launched the Botswana Hospice and Palliative Care Association to help the advocacy efforts in care and treatment for HIV/AIDS. APCA and IHS have since been focusing on building the new association’s capacity in strategic planning, fundraising, and research.
Institute of Health Sciences / Ohio University College of Health Sciences and Professions
(2013 – Present)
Partners are working together to strengthen nursing education and better integrate HIV/AIDS-related information and training into the curriculum at the Institute of Health Sciences in Gaborone.
In response to local needs and health strategies, AIHA launched in 2013 a nursing partnership linking the Institute for Health Sciences in Gaborone with Ohio University College of Health Sciences. Together, partners are working to build capacity to upgrade IHS’s current nursing diploma program to a full degree program. In particular, partners are focusing on curriculum and faculty development with an emphasis on integrating problem-based learning and evidence-based care, as well as targeted treatment and care for people living with HIV or AIDS.
The U.S. partners have been supporting a core team of four to six IHS faculty, who are pursuing Master’s Degrees through Ohio University’s online programs. Upgrading the qualifications and skills of these faculty members is essential to improving the quality of teaching needed to successfully implement a degree program. Experts from Ohio University have also provided technical assistance to improve clinical teaching methodologies utilizing simulation and skills labs, as well as the clinical assessment of students. AIHA is further supporting learning and teaching resources for the nursing program, including the use of tablet devices to facilitate access to evidence-based, point-of-care information during clinical training.
In alignment with PEPFAR 3.0 priorities, partners conducted a workshop on HIV integration and subsequently jointly developed two new HIV nursing courses — one entry-level course that is now required for all basic diploma students at IHS and one advanced course that is required for all post-basic diploma students. IHS has integrated related HIV/AIDS course modules on HIV epidemiology and pathophysiology; clinical manifestations of HIV; diagnosis and staging; assessing readiness for ART; HIV/AIDS counseling; pediatric and adolescent issues; comprehensive clinical assessment; ART management; treatment failure and/or resistance; HIV-related malignancies; nutrition; and ethical, legal and human rights issues in HIV.
In addition, partners are helping to establish a research culture in Botswana. In early 2016, experts from Ohio University conducted the third in a series of research training workshops. The event was attended by 14 IHS faculty drawn from various disciplines, including dental therapy, medical laboratory technology, midwifery, nursing, nurse anesthesia, pharmacy technology, and public health. Research skills developed through these workshops are providing IHS faculty with the skills they need to more effectively plan and conduct research on their training programs, including the programs with updated HIV and palliative care content supported by AIHA’s Twinning Center.
Botswana Ministry of Health / Foundation for Professional Development
(2014 – Present)
This south-south partnership is working to address Botswana’s growing problem of gender-based violence, which has emerged as a major priority area across many sectors in the country.
A 2011 study released by Gender-Links in Botswana revealed that 67 percent of women in Botswana have experienced violence in their lifetime, either at the hand of a partner or otherwise. The intersection between HIV and gender-based violence (GBV) is widely acknowledged, as is the fact that GBV fosters gender inequality and creates barriers to HIV services for women and girls.
In Botswana, GBV has been identified as a growing problem and major priority area across many sectors in the country.
With support from CDC/Botswana, AIHA in 2014 established a south-south partnership linking Botswana’s Ministry of Health with the South Africa-based Foundation for Professional Development to develop an evidence-based GBV training program for health professionals in Botswana.
Healthcare providers, particularly frontline caregivers such as nurses, community health workers, social workers, and counselors, are often the earliest point of contact for women and girls who are experiencing GBV. As such, they can play an important role not only in care and treatment, but also in education, outreach, and prevention of GBV.
As one of their first steps, AIHA and our partners held a series of key opinion leaders meetings to bring together stakeholders drawn from a broad range of sectors to inform the curriculum. They subsequently developed an in-service training program that incorporates Botswana’s Health Sector GBV Framework, as well as protocols and service standards for prevention and management of GBV for healthcare providers.
Partners conducted an initial training-of-trainers workshop in March 2015 and worked to develop 80 local master trainers with the goal of reaching a total of 180 healthcare workers by September 2015. Since then, they have been collaborating to train a critical mass of healthcare providers in support of the national roll-out of GBV protocols.
The training program developed through this South-South partnership is helping to ensure that healthcare providers can support evidence-based programming, adequate documentation, data collection, reporting, monitoring, and evaluation of key GBV indicators within the national health system.
Media Institute of Southern Africa – Gaborone / Zambia Institute of Mass Communication
(2007 – 2013)
This south-south partnership worked to improve the quality and scope of HIV/AIDS-related information available through the mass media by providing targeted training to journalists and editors in Botswana.
People in Botswana often receive inaccurate information about HIV/AIDS through the media because reporters lack basic knowledge about the virus and have limited access to reputable sources and evidence-based resources. This inaccurate information fosters stigma and does little to stem the spread of HIV.
Twinning Center partners at the Media Institute of Southern Africa (MISA) in Gaborone and the Zambia Institute of Mass Communication (ZAMCOM) in Lusaka worked to change this through a targeted effort to improve the quality, quantity, and scope of HIV/AIDS reporting in Botswana. With the objective of increasing public awareness of HIV/AIDS and its impact on all sectors of society, this south-south partnership provided skills-based journalism training for reporters and editors, as well as timely, accurate, issue-based information on HIV.
Through the multi-country Hearts & Minds Campaign, partners worked to combat media fatigue and change the way people think, feel, and behave about HIV and people living with the virus. They conducted a situational analysis of HIV/AIDS reporting in Botswana and, as a result, developed and implemented multiple training programs to educate reporters and editors. They jointly developed a publication, “Inspiring HIV and AIDS Reporting in Africa,” which was distributed to participants at the Highway Africa Conference in South Africa in 2008 and 2009, and conducted a number of “Mafoko Mathlong,” a type of community forum or open conversation about HIV/AIDS that were recorded and later broadcast to the public.
This partnership graduated from AIHA’s HIV/AIDS Twinning Center Program’s technical assistance in 2013.
Marang Childcare Network / The Children’s Place Association
(2008 – 2014)
With the goal of improving community-based support services available to orphans and vulnerable children in Botswana, this partnership focused on building the institutional capacity of Marang and its constituent organizations that provide OVC care.
In January 2008, AIHA’s HIV/AIDS Twinning Center launched a south-south partnership linking Marang Childcare Network in Botswana with Tanzania’s Human Development Trust (HDT) with the goal of strengthening Marang’s capacity to support its network members in their efforts to deliver high quality, comprehensive care and support services to children living with, or affected by, HIV in Botswana.
The Chicago-based Children’s Place replaced HDT in 2010 to better respond to the technical assistance needs of Marang. Children’s Place experts provided ongoing technical assistance across a broad range of topics, including training on resource mobilization, psycho-social support for adolescents, and how to deal with HIV disclosure issues within families.
The U.S. partners also helped Marang staff engage in ongoing fundraising efforts targeting local businesses and other potential donors and launch a small grants program to assist network members with resources to implement their own programs. AIHA placed a VHC volunteer at Marang to help further these efforts and provide long-term onsite support. AIHA also awarded Marang a sub-grant and provided training on grants management and accounting procedures to staff.
Following a competitive application process, Marang selected the first five member organizations to receive grants. The small grants program has led to an increase in Marang membership, with more members paying their dues, so they can remain eligible to apply for the funding.
This partnership achieved great success at strengthening Marang’s capacity to support its network members and, in July 2014, AIHA graduated it from our HIV/AIDS Twinning Center Program. At the closing workshop, partners disseminated lessons learned with stakeholders from member organizations, the local government, and civil society. They also shared “Let’s Talk” (or “Are Beong” in Setswana), a comprehensive OVC manual on HIV-related psycho-social care for adolescents that they jointly developed and conducted a final training of trainers session on it.
U.S. partners from the Children’s Place will continue to support Marang using their own funding, as well as through a new private sector initiative called Healthcare Partnerships for Children.
Tebelepole VCT / Liverpool VCT
(2007 – 2013)
This south-south partnership worked to strengthen Tebelepole’s institutional capacity with the goal of improving voluntary counseling and testing services, prevention and outreach programs, and quality assurance capabilities.
With the goal of improving access to quality HIV prevention services, including voluntary counseling and testing, AIHA supported a south-south partnership linking Tebelopele VCT with the Kenya-based Liverpool VCT.
The partnership formally graduated in late 2013, but LVCT is supporting Tebelopele in the development of a strategic transition plan to address issues in human resources and leadership, as well as a long-term business strategy.
Over the course of the partnership, the team worked together to expand HIV counseling, testing, prevention, care, and support services and make these more readily available to children and adults. They also developed and implemented a comprehensive quality assurance program at Tebelopele and created a comprehensive Supportive Counseling Program to facilitate the provision of quality VCT services.
In addition, Liverpool experts taught Tebelopele staff how to build the capacity of smaller community-based organizations that want to provide VCT services. As a south partner, Liverpool VCT brought to the table many best practices from the African context to effectively strengthen Tebelopele’s organizational capacity, as well as the services they provide.
Botswana Christian AIDS Intervention Program / The Foundation for Professional Development
(2007 – 2012)
Similar to the Tebelepole/Liverpool VCT alliance, this south-south partnership worked to improve access to high quality HIV prevention, counseling, and testing services by building institutional and human resource capacity.
This partnership was launched in 2007 with the goal of improving access to quality HIV prevention services, including voluntary counseling and testing. That year, the HIV/AIDS Twinning Center linked the Botswana Christian AIDS Intervention Program (BOCAIP) and the AIDS Support Organization in Uganda (TASO). In 2009, The Foundation for Professional Development (FPD) in South Africa replaced TASO as the resource partner.
The overall goal of this south-south partnership, which concluded its joint work in 2012, was to strengthen the capacity of BOCAIP to provide quality HIV counseling and testing programs in Botswana.
At the outset of the partnership, TASO conducted an organizational capacity assessment of BOCAIP to guide activities and trainings, as well as to ensure a coordinated effort among donor organizations. Based on that assessment, partners worked to:
- Improve organizational capacity as a means of making HIV counseling, testing, prevention, care, and support services more readily available to children and adults;
- Strengthen organizational capacity and quality of service by developing and implementing a quality assurance program;
- Develop a comprehensive Supportive Counseling Program; and
- Share experiences of both TASO and FPD regarding implementation of an organizational capacity building program for CBOs.
This partnership worked closely with a second, very similar VCT partnership that paired Tebelepole VCT in Botswana with the Nairobi, Kenya-based Liverpool VCT.
Liverpool VCT experts trained and mentored BOCAIP and Tebelopele staff in the establishment of post-test clubs. The support focused on developing post-test protocols and procedures, including a proper exit strategy for clients and improved linkages to existing support services.
Partners also developed informational materials for clients and a comprehensive Supportive Counseling Program. This included a training-of-trainers for three Botswana partners and counselor supervision training for staff from BOCAIP, Tebelopele, and the Botswana Defense Force.