Midtveisgjennomgang av støtte til helsesektoren i Botswana

HIV/AIDS represents the greatest development challenge to Botswana, with an estimated prevalence of 17.1 % in the general population. The government of Botswana has responded with a number of initiatives, including the Anti-Retroviral Therapy (ART) programme. ART roll-out has significant human resource requirements, however adequate health personnel has long been a serious problem in Botswana. Based on a request from the President of Botswana to the Norwegian Ministry of Foreign Affairs an agreement for Human Resources Assistance to Botswana's Ministry of Health was signed for the period December 2004 to 2008. The goal of the project is to improve the delivery of health care services through increased capacity of the National Anti-Retroviral Therapy programme and the Institutes of Health Sciences. The project objectives include, the recruitment of fifteen health professionals to support ART roll-out and to complement staff in the Institutes of Health Sciences, to build capacity for the training of health personnel with a view to meeting some of the human resource requirements and to improve ART uptake through enhanced capacity.

The project implementation started immediately after the signing of the agreement with a sub-contract between implementing partners Haukeland University Hospital and Botswana's Ministry of Health, and the first Norwegian personnel began work in Botswana in September 2005.

Interesting Findings

•The project has made significant positive contributions to the delivery of Botswana's health service, and has proved to be very relevant to the human resource needs in the health service. However, the project has partly moved away from the objective of strengthening the system for Anti-Retroviral Therapy (ART) roll-out, towards a more general direction of meeting Botswana's need for medical expertise.
•There is no systematic programme for skills and knowledge transfer except from the lectures held by the Norwegian personnel at the Institutes of Health Sciences, despite the fact that one of the main objectives of the project is capacity building.
•The coordination between Botswana's Ministry of Health and Haukeland University Hospital is suffering from lack of communication and information exchange.
•The indicators are inadequate for measuring the project's achievements.
•The project architecture with Haukeland University Hospital having a central role as the primary employer of the Norwegian personnel is not in keeping with the principle of recipient responsibility, and the dual employer contracts create confusion as to the obligations and entitlements of the Norwegian personnel, the Government of Botswana and Haukeland University Hospital.

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