PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
09.P.PM05: MOH-Infant Nutrition Support
ACTIVITY CONTINUING UNDER PERFORMANCE PASS
ACTIVITY UNCHANGED FROM FY2008
From COP08:
The Botswana draft Infant and Young Child Feeding (IYCF) policy states that HIV-infected women will be
counseled about the risks and benefits of breastfeeding and formula feeding, and will be guided to choose
formula only if it is acceptable, feasible, affordable, sustainable, and safe (AFASS) to do so. This policy has
been in draft since 2001 and training to support the policy has not been conducted. In practice, HIV-infected
women are advised to feed their infants formula, and in 2006, 97% of all HIV-exposed infants were started
on formula at birth.
The Botswana Child Welfare card was recently updated to include HIV, PMTCT, and improved nutritional
information. The Botswana Nutrition Surveillance System (BNSS), which is based on data from the child
welfare card recently completed an assessment that recommended strengthening data collection methods
and quality and training of health workers in use of nutritional data.
2007 Accomplishments
The Food and Nutrition Unit (FNU) adapted the WHO/UNICEF 5-day IYCF counseling course and began
training government health workers using the adapted training. The training incorporates counseling on
exclusive breastfeeding, exclusive formula feeding and optimal nutrition.
2008 plans
To improve the effectiveness of the adapted WHO/UNICEF training course, the FNU will print course
materials, purchase teaching aids and produce IEC materials for mothers. The FNU will continue to train all
PMTCT health care providers (nurses, midwives and counselors) as well as Pathfinder senior staff and
Peace Corps Volunteers assigned to government health facilities.
The USG will support printing and distribution of the new child welfare card that includes HIV, PMTCT and
nutrition information. Health workers will train on its use for clinical management of children and for program
reporting. Technical assistance will update the software for capturing information about growth, HIV
exposure status and feeding method in-line with the new child welfare card. The USG will provide technical
assistance to assist with the regular creation of reports on child nutrition as it relates to HIV exposure and
infant feeding method. FNU staff will make site visits within the SADC region to learn about other nutrition
programs and share experiences.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17264
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17264 11297.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $0
Disease Control & Botswana 5-
Prevention Strengthening
Prevention,
Care &
Treatment
through Support
to Programs
Managed by the
Government of
Botswana
11297 11297.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $1,000,000
Disease Control & Botswana U62/CCU02509
Prevention 5
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $450,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
09.P.PM01: MOH - PMTCT Program Support
CONTINUING ACTIVITY UNDER PERFORMANCE PASS:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In the last three years, United States Government (USG) funded salaries of 14 Government of Botswana
(GOB) positions in the Prevention of Mother to Child Transmission (PMTCT) Program. In FY2009, only one
position will continue to be funded by USG in PMTCT. Eleven positions will be absorbed by the GOB as part
of ensuring sustainability. Two positions have been moved to the Human Capacity Development Section,
which has since become a separate section from PMTCT. Savings from these positions will be used to
implement more activities including: (1) review and printing of PMTCT registers; (2) evaluation of the
Counseling and Testing strategy; and (3) evaluation of the Information, Education, and Communication
(IEC) strategy.
From Cop 08:
This activity is a direct support to the MOH and addresses the PMTCT strategic plan, including improving
human capacity and the quality of PMTCT services.
In FY2008, the USG will continue to support several project positions in the national and regional PMTCT
program and related MOH departments, including one national coordinator, two regional coordinators, two
IEC officers, one nutrition officer, and one training coordinator. This component complements the Botswana
government's effort in building human resource capacity to manage the PMTCT program both at the
national and district levels.
Health care providers' knowledge and skills will improve through in-service training programs. The
Botswana PMTCT Handbook was revised and harmonized with the WHO/CDC PMTCT generic training
package to provide health workers with the latest evidence-based PMTCT information and
recommendations to enable providers to deliver quality PMTCT services. Efforts are ongoing to integrate
PMTCT content into the current pre-service curricula at the Institutes of Health Sciences (IHS). This will
ensure that health workers will be familiar with PMTCT services upon graduation from health training
institutions. Meanwhile the need still exists for regular in-service training in PMTCT at all levels. The USG
will support workshops for 300 lay counselors, 150 trainers and 24 focal persons.
The USG continues to strengthen information, education, and communication (IEC) activities. The PMTCT
social marketing campaign targets men as influencers and gatekeepers to increase their support of
pregnant women. The campaign will develop an overall mass media effort that helps the community link to
PMTCT with special messages through radio and theatre drama that show men engaged in PMTCT
services and supporting their use. Health learning materials are part of the campaign and their strategic
placement to ensure that consumers encounter them in the normal path activities is part of the strategy.
Continuing Activity: 17265
17265 4454.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $120,140
9800 4454.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $720,000
4454 4454.06 HHS/Centers for Ministry of Health, 3357 1039.06 Technical $1,000,000
Disease Control & Botswana Assistance
Prevention
Estimated amount of funding that is planned for Human Capacity Development $660,000
09.P.PM04: MOH - Family Planning
ACTIVITY HAS NOT CHANGED FROM FY2008
Data from surveys in Francistown in 2003 and 2004 indicated that 65% of pregnancies among HIV positive
and HIV negative women were unplanned and 35% of them were unwanted. Family planning is available in
all clinics, but these data suggest there are problems in use of family planning by women generally, and that
unintended pregnancies among HIV-positive women are common. A recent assessment conducted by
UNFPA and GOB on reproductive health commodity security indicated that since the advent of HIV/AIDS,
condoms are promoted above other methods of contraception, though condoms are not sufficient
contraception for women wishing to avoid pregnancy. Existing local guidelines advocate for informed
decision making in the choice of method as well as use of dual method (using a condom and another
method of family planning). For HIV-positive women, contraceptive drugs are not provided in ART clinics,
though condoms are usually available. A 1996 curriculum on family planning is still in use, and does not
include adapted, evidence-based family planning counseling for women with HIV or primary HIV prevention
messages.
2008 Plans
The Sexual & Reproductive Health (SRH) Unit will collaborate with the PMTCT Unit to increase access to
dual protection (condoms plus contraceptive drugs) through every relevant service including maternal child
health clinics, family planning clinics, maternity units and ART clinics. PEPFAR will support the SRH to
review existing family planning policies, guidelines and curriculum to incorporate adapted, evidence-based
guidance on family planning for HIV-positive women, ensure the reproductive rights of HIV-positive women
are respected and ensure that primary HIV prevention messages are incorporated into family planning
counseling. Once the curriculum review is complete health workers will be trained on its use. MOH staff will
make on site visits to other countries in the SADC region to learn about their family planning programs and
share experiences.
Continuing Activity: 17314
17314 17314.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $0
Estimated amount of funding that is planned for Human Capacity Development $85,000
09.P.AB03: MOH - Prevention with Positives
ONGOING ACTIVITY WITH NO ADDITIONAL FY2008 FUNDS
DELAYED IMPLEMENTATION IN FY2008
This activity focuses on strengthening the primary prevention components of existing, major HIV-related
services (both clinical and community-based) that target large numbers of PLWHA. It is largely a positive
prevention activity. This follows steps completed in FY06 and FY07, whereby USG supported an
assessment of opportunities to strengthen prevention in clinical and community services and an activity to
strengthen the prevention content of the interventions that Tebelopele and other counseling and testing
partners provide. This latter activity has involved the adaptation of a provider-delivered intervention that
promotes prevention, development of informational materials that help counter stigma around PLWHA, and
will also involve identification of one additional service area for similar assistance (to be determined [TBD],
awaiting assessment results). USG also supports the alcohol-HIV trainings to health care workers begun by
Blossom two years ago and will ensure incorporation of alcohol issues into the other prevention materials
and interventions they develop or adapt. To date, achievements include completion of the assessment,
adaptation of the US Centers for Disease Control and Prevention (CDC) developed "PwP flipchart
intervention" for use in Tebelopele's new supportive counseling program, and training of counselors in use
of that intervention (Sept 07).
In 2008, as this activity expands to more program areas and increases in scale, the USG will compete the
award through an appropriate, long-term mechanism. Therefore the prime partner is TBD.
The activities in 2008 will continue with program development and implementation and will focus on
collaboration with the tuberculosis (TB), prevention of mother to child transmission (PMTCT), counseling
and testing, and private sector HIV treatment programs. Specifically, the prime partner will adapt evidence-
based prevention interventions for incorporation into these existing services. It will examine closely the
interventions being developed under the Office of the Global AIDS Coordinator (OGAC) special initiative for
positive prevention, for consideration of adaptation in Botswana. It will train providers in the use of these
materials and protocols, monitor utilization, and work with local organizations to support the roll out of these
initiatives. A key component of the services provided is alcohol abuse risk reduction and prevention, in
addition to the core themes of HIV prevention, including abstinence, be faithful and condom promotion
(ABC), disclosure, and partner testing. The specific content of each intervention or tool developed will
depend on the target program and clients, but sensitization and training in alcohol-related interventions will
continue in this activity.
In the TB area, the activity will target HIV-infected TB patients. The prime partner will develop/adapt
appropriate HIV prevention service enhancements and/or interventions to the local TB care setting. This will
involve the development of relevant material (IEC, curricula, job aids, protocols, training packages, etc.),
training and sensitization of approximately 60 clinical and community service providers about the
interventions and their implementation, in collaboration with the Botswana National Tuberculosis Program
(BNTP). This intervention will initially be provided in the southern part of the country. These activities will
support Botswana's Round 5 TB grant from the GFATM, which among other goals, seeks to strengthen
TB/HIV collaborative activities.
In the PMTCT program, the focus will be supporting the promotion of family planning and unintended
pregnancy prevention among HIV+ women and their partners. This activity will begin in the Francistown
area, where CDC has a PMTCT demonstration program. Activities will include community mobilization
through local drama and related discussion forums, in addition to supporting implementation of the existing
PMTCT protocols by health care workers within clinical settings, which include active promotion of family
planning to clients. About 30 lay counselors, 30 family welfare educators, and 100 nurses will be involved in
these refresher trainings. The prime partner will also develop IEC materials for use in those settings, to
promote these themes.
In the counseling and testing settings, the focus will be strengthening interventions for discordant couples.
There is a high rate of HIV discordance in Botswana; at least 21% of couples who test at the Tebelopele
VCT centers are discordant (Tebelopele data 2000-2005). USG will support development of additional
prevention materials and interventions to use in counseling and testing settings for discordant couples,
based on experiences with the development of supportive counseling programs in Tebelopele and other
counseling and testing centers, the pilot test of the home-based testing program, and completion of the
adaptation of the CDC couples counseling curriculum through the Institute for Development Management.
The prime partner will draw on lessons learned and best practices in this area from other PEPFAR
countries, especially Uganda and Kenya, to further inform the training and scale up of activities.
Specific activities will include training of at least 60 counselors from civil society and government in
counseling discordant couples, development of counseling protocols and cue cards for the discordant
couple sessions. This will include job-aids like flip charts, referral directories and brochures. Through
assistance by the prime partner, the testing sites involved will be expected to provide on-going prevention
and supportive counseling to an estimated 270 discordant couples, in about 27 sites; form and maintain at
least 5 support groups for discordant couples; provide mentoring and supervision to the counselors
supporting discordant couples; coordinate and share lessons learned among themselves, and document
their experiences, both positive and negative.
In the area of palliative care and antiretroviral treatment (ART), the primer partner will work with the
Associated Fund Administrators Botswana (Pty) Ltd (AFA) to enhance the prevention services provided
within its ART program. AFA is an administrator of two medical aid schemes/insurance organizations
namely, Botswana Public Officers' Medical Aid Scheme (BPOMAS) and Pula Medical Aid Fund (PULA).
Through its managed care program, AFA facilitates the provision of ART to insured patients and GOB
Activity Narrative: funded patients, as well as provision of continuous medical education and KITSO training to private
practitioners (doctors, pharmacist etc). In 2008, with the assistance of the prime partner, AFA will
strengthen its HIV prevention strategies for its HIV positive clients, including development of additional
patient education materials and other appropriate job aids, to be determined later. This activity is expected
to promote behavior change and reduce risky behaviors among clients. It is estimated that 600 HIV positive
new patients will be enrolled in FY08, and all will benefit from this activity.
Jointly supporting all of these efforts are funds from the AB and C/OP program areas. Those funds also will
support technical assistance in positive prevention and alcohol-HIV issues for a limited set of existing
primary prevention interventions, some of which may not sufficiently target these issue but want to. This
may involve provision of additional material, content, and approaches to include in existing peer education
programs (e.g. Pathfinder male-focused activity), training in those additional intervention components, and
follow up support as needed.
Continuing Activity: 17458
17458 17458.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $430,000
Table 3.3.02:
09.P.OP03: MOH - Prevention with Positives
ONGOING ACTIVITY WITH NEW PARTNER AND NO ADDITIONAL FY2008 FUNDS
collaboration with the TB, PMTCT, counseling and testing, and private sector HIV treatment programs.
Specifically, the prime partner will adapt evidence-based prevention interventions for incorporation into
these existing services. It will examine closely the interventions being developed under the Office of the
Global AIDS Coordinator (OGAC) special initiative for positive prevention, for consideration of adaptation in
Botswana. It will train providers in the use of these materials and protocols, monitor utilization, and work
with local organizations to support the roll out of these initiatives. A key component of the services provided
is alcohol abuse risk reduction and prevention, in addition to the core themes of HIV prevention, including
abstinence, be faithful, condom promotion (ABC), disclosure, and partner testing. The specific content of
each intervention or tool developed will depend on the target program and clients, but sensitization and
training in alcohol-related interventions will continue in this activity.
support Botswana's Round 5 TB grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria
(GFATM), which among other goals, seeks to strengthen TB/HIV collaborative activities.
In the area of palliative care and ART, the primer partner will work with the Associated Fund Administrators
Botswana (Pty) Ltd (AFA) to enhance the prevention services provided within its ART program. AFA is an
administrator of two medical aid schemes/insurance organizations namely, Botswana Public Officers'
Medical Aid Scheme (BPOMAS) and Pula Medical Aid Fund (PULA). Through its managed care program,
AFA facilitates the provision of ART to insured patients and GOB funded patients, as well as provision of
continuous medical education and KITSO training to private practitioners (doctors, pharmacist etc). In
2008, with the assistance of the prime partner, AFA will strengthen its HIV prevention strategies for its HIV
Activity Narrative: positive clients, including development of additional patient education materials and other appropriate job
aids, to be determined later. This activity is expected to promote behavior change and reduce risky
behaviors among clients. It is estimated that 600 HIV positive new patients will be enrolled in FY08, and all
will benefit from this activity.
programs and training in those additional intervention components, and follow up support as needed.
Continuing Activity: 17637
17637 10144.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $172,000
10144 10144.07 HHS/Centers for Academy for 5396 5396.07 GAP 6 $390,000
Disease Control & Educational
Prevention Development
Table 3.3.03:
09.C.AC04: MOH - Training and Mentoring Prevention with PWP
ONGOING ACTIVITY FOR WHICH NO ADDITIONAL FY2009 FUNDS ARE REQUESTED - DELAYED
IMPLEMENTATION
services (both clinical and community-based) that target large numbers of PLWHA. This follows steps
completed in FY06 and FY07, whereby USG supported an assessment of opportunities to strengthen
prevention in clinical and community services and an activity to strengthen the prevention content of the
interventions that Tebelopele and other counseling and testing partners provide. This latter activity has
involved the adaptation of a provider-delivered intervention that promotes prevention, development of
informational materials that help counter stigma around PLWHA, and will also involve identification of one
additional service area for similar assistance (TBD, awaiting assessment results). USG also supports the
alcohol-HIV trainings to health care workers begun by Blossom two years ago and will ensure incorporation
of alcohol issues into the other prevention materials and interventions they develop or adapt. To date,
achievements include completion of the assessment, adaptation of the US Centers for Disease Control and
Prevention (CDC) developed "PwP flipchart intervention" for use in Tebelopele's new supportive counseling
program, and training of counselors in use of that intervention (Sept 07).
these existing services. It will examine closely the interventions being developed under the Office of Global
AIDS Coordinator (OGAC) special initiative for positive prevention, for consideration of adaptation in
Abstinence, Be faithful, Condom promotion (ABC), disclosure, and partner testing. The specific content of
planning to clients. About 30 lay counselors, 30 Family Welfare Educators, and 100 nurses will be involved
in these refresher trainings. The prime partner will also develop IEC materials for use in those settings, to
positive clients, including development of additional patient education materials and other appropriate job
Activity Narrative: aids, to be determined later. This activity is expected to promote behavior change and reduce risky
Continuing Activity: 17667
17667 17667.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $450,000
Table 3.3.08:
09.C.AC11: MOH - Palliative Care Support
ACTIVITY UNCHANGED FROM FY08
The USG provided financial support to train 250 health workers in FY05 and 100 health workers in FY06.
Funds were allocated to development of training modules. Capacity in the Palliative Care Unit has been
strengthened with recruitment of three officers; two have expertise in Palliative Care and one in NGO
support. Clinical guidelines for management of opportunistic infections were revised in 2004 and will
continue to be revised periodically.
The GFATM fund has supported the recruitment of 204 lay counselors who were trained in basic HIV/AIDS
counseling. Strengthened psychosocial support is needed for families and communities that provide care to
ill PLWHA in their homes. Some PLHWA and their care givers experience care related burdens and/or
stigma. Hence the need to continue training of lay counselors and family welfare educators to effectively
provide psychological support in the community.
In 2008, PEPFAR funds will support the following activities:
Basic Palliative Care training: The training will target service providers from health care institutions and from
NGOs, CBOs, FBOs dealing with Palliative Care. This will be achieved through the TOT model so as to
facilitate the roll out of palliative care training country wide and ensure sustainability. A total of 280 Health
Care providers will be trained in Basic Palliative Care.
Review of the Clinical Guidelines: The government intends to review clinical guidelines for management of
opportunistic infections to integrate TB, PMTCT, and ART and to strengthen the pediatric component and
train clinicians, lay counselors and family welfare educators on the use of the revised guidelines. Training
will be done in collaboration with HAVARD master training and Baylor University for provision of technical
expertise in adult and pediatric palliative care.
Printing of Nutritional Guidelines: In order to enhance the nutritional status of PLWA and other chronically ill
patients the Units will print nutritional guideline to be used in training and to guide service providers.
Strengthen collaboration with CBO/NGO: The civil society plays a very critical role in provision of palliative
care at community level. There is need to establish a strong linkage for improvement of quality care to
patients as well as strengthen referral system from civil society to health care facilities.
Continuing Activity: 17266
17266 4456.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $0
9801 4456.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $300,000
4456 4456.06 HHS/Centers for Ministry of Health, 3357 1039.06 Technical $610,000
Estimated amount of funding that is planned for Human Capacity Development $540,000
09.T.AT11: MOH - Airborne Lifeline Foundation
ACTIVITY HAS CHANGED SIGNIFICANTLY IN THE FOLLOWING WAYS:
Airborne Lifeline Foundation provides the first regularly scheduled preventative medical air service in Africa,
with its primary emphasis on HIV/AIDS treatment. It not only transports specialists from Princess Marina
and Nyangagbwe hospitals to remote clinics on a scheduled basis, thereby allowing medical professionals
to spend time to both treat, as well as train, but also transports anti-retroviral (ARV) drugs, other drugs and
medical equipment to these remote clinics in a secure and timely manner.
The needs for the service have been identified by key members of the Ministry of Health, and as these
needs change, the service will adapt its schedule to these changes. It was demonstrated that although
Botswana has upgraded the rural medical facilities, the facilities were not staffed with the necessary Health
Care Specialists to tend to the local population as most of the Health Care Specialists were living in
Gaborone and Francistown. The need for a timely and efficient transport system was required to transport
these specialists to the rural areas, so as to cover the population of Botswana with medical services more
effectively.
Airborne Lifeline Foundation began flight operations in Botswana in May 2007, initially funded by its
founder, Johnathan Miller and his wife Elizabeth Thompson. Airborne has since signed a Memorandum of
Understanding with the Ministry of Health in August 2006 and received its first PEPFAR grant in April 2008.
Airborne originally flew specialists from Gaborone to Hukuntsi, Tsabong, Ghanzi and Gumare on a regularly
scheduled basis. Based on feedback from MOH, the clinics and the health care professionals that utilized
the service, the schedule was expanded and changed in July, 2008. Airborne continues to fly from
Gaborone to Ghanzi, Hukuntsi and Tshabong, but has added service from Francistown to Kasane, Maun
and Gumare.
It is anticipated that this recently expanded service will continue in FY2009, and that additional service will
be added to Orapa to serve the villages of Lethlakane and Rakops, and Shakawe should funds become
available.
In May of 2007, Airborne Lifeline Foundation (herein referred to as "Airborne"), a US registered 501 (c) (3)
non profit corporation, commenced the operation of what is regarded as the first regularly scheduled
medical air service in Africa- to provide regular health care and health monitoring service to underserved
areas. After substantial analysis, Airborne chose remote portions of Botswana to commence service.
This service was undertaken, following the signing of a Memorandum of Understanding (MOU) between
Airborne and the Botswana Ministry of Health (herein referred to as "MOH") in August 2006. Minister of
Health. The purpose of the MOU was "The implementation of regularly scheduled medical air service to
hospitals and clinics in the Republic of Botswana".
The core benefits of the program are:
- To substantially improve the utilization of scarce medical profession talent by dramatically reducing travel
time of professionals to remote areas. Turboprop aircraft are substantially faster than overland
transportation options.
- Introduce "regular" service, and therefore inspire confidence in patients that doctors, medications, etc. will
be there and their travel from the bush to hospital/clinic will be justified.
- To ensure lab samples are transported with dispatch to laboratory facilities- in terms of hours instead of
days-with increased reliability and less risk of contamination and spoilage.
- Ensure that patients in remote locations might have the ability to establish regular, same physician doctor-
patient relationship-with increased benefits to patients and the broader medical community in terms of
collecting and tracking health information. From the inception, it was made crystal clear that the raison
d'être of this proposed air service was driven by the desire to take HIV/AIDS treatment, testing, training,
education, etc. to remote parts of Botswana. While this scheduled air service would be available (if capacity
existed) to other health care services, HIV/AIDS treatment was deemed paramount.
Presently Airborne aircraft are organized through its chartered air provider NAC Botswana, and are flying
capacity loads on three flights a week on two routes. Both routes carry both medical cargo and health care
professionals. The Tuesday route, flown both in the morning and evening, goes from Gaborone to Hukuntsi
and Tshabong. The second route, flown on Thursday, flies from Gaborone to Ghanzi, Gumare and Maun.
Depending on the amount of cargo carried, each flight can carry up to 10 passengers.
Airborne is carrying large amounts of ARV boxes to all five locations presently being flown. We have also
been flying infant CD4 samples on a regular basis back to the Harvard Lab from locations, such as Gumare.
We also carry test results and cool boxes back from the Harvard Lab to these locations.
In addition to the cargo, we have been ferrying medical personnel engaged in HIV/AIDS work.
There have already been requests to expand the number of flights to other locations. Once we get past this
initial start up and assessment phase of operations, we intend to expand it to additional cities/routes and/or
a larger plane. Additional stops conceivably would include, but not be limited to, Kasane , Shakawe ,
Francistown, Orapa/Lethlakhane, and Selibe Phikwe..
Airborne's scheduled service will support the USG PEPFAR's treatment, care, monitoring and evaluation
programs in Botswana by transporting ARVs and medical personnel to rural areas, as well as samples to
the Harvard Lab. Currently, health care to these areas are erratic as the only way providers can access
Activity Narrative: these areas are by road, which can take up to 8-hours travel time. Airborne's regularly scheduled flights
already has resulted in an increase in the number of patients supported by the various HIV/AIDS programs
as medical personnel can now treat more patients.
Continuing Activity: 19621
19621 19621.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $350,000
Table 3.3.09:
09.C.PC03: MOH - Human Resource Support
The Pediatric ART program has witnessed tremendous progress in the past five years. Starting from scratch
with no HIV-experienced Pediatricians, Botswana has moved to becoming one of the largest Pediatric
HIV/AIDS treating countries in the world. There are close to 4,000 children now on treatment in the two
referral hospitals and local medical staff had built up expertise in Pediatric antiretroviral treatment.
With the improvement of treating staff, especially specialist Pediatricians, emphasis is now being shifted to
decentralizing therapy, rolling it out to peripheral facilities. These are then supported by outreach visits by
the specialists from PMH, the COE and NRH. We are now able to effectively participate in the weekly
outreach visits to selected facilities in Botswana, thanks to the support we received under COP06 and
COP07 for two Pediatricians each in PMH and NRH.
Since more HIV-infected children are now surviving, we are now seeing a gradual rise in those presenting to
our Specialist Pediatric Clinics with co-morbid chronic conditions requiring long-term follow up, such as LIP,
bronchiectasis, tuberculosis; and non-HIV associated diseases such as asthma, diabetes, heart diseases.
AT the HIV clinic we are also seeing a steady rise in resistant viral mutations. The general clinics see at
least 100 patients a week on the average, in both facilities, and over half of whom are children with
HIV/AIDS.
The Pediatric KITSO training is now well established and PMH and Baylor Centre form the core training
team going. Trainings are conducted in clusters around the country on biweekly schedules. The trainings
are supported by UNICEF Botswana. The four PMH-based PEPFAR-funded Pediatricians have made it
possible to strengthen these training activities.
The Departments of Pediatrics at PMH and NRH conduct scheduled outpatient-based specialist clinics four
days of the week (PMH and five days a week, (NRH). These are mainly to follow up children who would
have been admitted to the Pediatric Medical Ward treated and discharged; but because a long-term follow
up is required, they are registered in these clinics usually under the same specialist that looked after them
while on admission. Secondly the clinics in these two hospitals also receive referrals from all hospitals in
Botswana. These are usually cases that require specialist consult and management on a long-term basis.
Most of these cases have several co-morbid conditions that require an integrated approach to their
management.
There is only one dedicated room for the clinic per week in the MCH clinic complex in PMH and in NRH.
This is certainly inadequate. It has become increasingly difficult to accommodate them at the current sites
The UB Pediatrics residency training will begin in 2008. The new UB medical school will also start in 2008.
These undergraduate and postgraduate medical training programs will require adequate space. There is
therefore a growing need to provide adequate clinic space that will be used for the care of patients as well
as for teaching purposes. University of Pennsylvania is assisting UB in the development of these academic
activities and we are collaborating with them on these issues.
The Nutrition Rehabilitation Centre for children (supported by PEPFAR) is on the offing in both hospitals
and we shall be collaborating with our Dietetics colleagues to provide the out patient medical care for the
malnourished children being managed at the centers.
During FY07 four Pediatricians were supported in the FY06/ FY07 to strengthen the pediatric ARV service
delivery as well as capacity building of health care providers in the country. Their activity include as well an
outreach component to try and cover thee country.
In FY08, these pediatricians will continue to provide clinical care to HIV/AIDS children in the two hospitals,
conduct outreach services, train health care workers and run the outpatient clinics.
Continuing Activity: 17273
17273 4964.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $0
9814 4964.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $400,000
4964 4964.06 HHS/Centers for Ministry of Health, 3357 1039.06 Technical $300,000
Estimated amount of funding that is planned for Human Capacity Development $210,900
Table 3.3.10:
09.C.TB13: MOH - Prevention with Positives in TB Settings
ONGOING ACTIVITY WITH NEW PARTNER FOR WHICH NO ADDITIONAL FY2009 FUNDS ARE
REQUESTED - DELAYED IMPLEMENTATION
TB care settings represent critical opportunities to provide HIV prevention services, messages and
interventions because 60-86% of TB patients in Botswana are also infected with HIV. Botswana has also
offered all TB patients routine HIV testing and counseling (opt out strategy) since 2005. Consequently, the
majority of approximately 10,000 TB patients registered annually in the country know their status. Most of
these patients are also sexually active, making TB patients prime targets to prevent primary HIV
transmission. General HIV prevention interventions are routinely provided at most TB care settings and
primary prevention (e.g. abstinence, be faithful, and condom promotion [ABC]) often forms a part of these
services, though this component of service delivery needs to be strengthened.
Prevention services and interventions will target HIV-infected TB patients. FY08 funds are requested to
support a new activity on PwP, again through the behavioral change communication (BCC) section.
Prevention services and interventions will target HIV-infected TB patients by adapting simple tools that
health care providers can deliver within their current scope of work. It is likely that the CDC's PwP material
will be adapted to the local TB care setting and delivered through one-on-one interactions between health
care workers and TB patients.
This will involve the development of relevant material (IEC, curricula, job aids, protocols, training packages,
etc.), training and sensitization of 60 clinical and community service providers about the interventions and
their implementation, in collaboration with the Botswana National Tuberculosis Program (BNTP).
A major component of collaborative TB/HIV activities is the reduction of the burden of HIV among TB
patients, one of which activities is the reduction of HIV transmission. These activities therefore will support
Botswana's Round 5 TB grant from the GFATM, which among other goals, seeks to strengthen TB/HIV
collaborative activities.
Continuing Activity: 17745
17745 17745.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $50,000
Health-related Wraparound Programs
* TB
Table 3.3.12:
09.C.TB01: MOH - TB/HIV and IPT Support
ONGOING ACTIVITY FOR WHICH NO ADDITIONAL FY2009 FUNDS ARE REQUESTED - LARGE
PIPELINE
FY07 funds were used to support the finalization of the national TB management manual. The new manual
incorporates guidance on the management of HIV-related TB and drug-resistant TB, which are consistent
with current international recommendations. The manual is now the basis for training of all health cadres in
Botswana on TB management and control.
A significant increase in HIV/TB activities was programmed in FY07 to further integrate HIV/TB care with
core programs for people living with HIV/AIDS (PLWHA). PEPFAR funds expanded RHT among pediatric
and adult TB clients to fund supervisory visits from the national level to the districts. In January 2007, 24 TB
coordinators were trained on IPT, Community-based TB care (CTBC), and TB/HIV surveillance.
Francistown, and Kgalagadi South trained 114 health care workers on TB/HIV surveillance and 64
community volunteers on TB/HIV.
The IPT program is well accepted and available in all 24 districts. FY07 funds were used to train 33 trainers
of trainers (TOTs) on IPT, and 51 health workers were trained on IPT. The IPT Program has registered
more than 50,000 HIV-infected persons since 2001. FY07 funds will support the comprehensive external
evaluation of the program, which will provide Botswana (and other focus and non- countries) with essential
data on the implementation of a national Isoniazid Preventive Therapy (IPT) program. A Drug Resistance
Survey (DRS) began with FY07 support and will provide data to guide programmatic policy and
To improve coordination of TB/HIV activities, FY2007 funds resuscitated the national TB/HIV advisory
committee, a key component to establishing mechanisms of coordinated TB/HIV care at all levels of the
health sector. This committee met for the first time in a year in August 2007, and revised its terms of
reference.
PEPFAR funds support nine posts at the national and regional level of the IPT program. To strengthen the
technical capacity of the BNTP staff, FY07 funds were used to send two participants to the WHO Global
TB/HIV course in Sondalo, Italy and two staff to the International Union Against Tuberculosis and Lung
Disease (the UNION) TB management course in Arusha, Tanzania. To provide a perspective on the
practicalities of implementing nation-wide interventions, FY07 funds will support a team of three staff from
the central BNTP to go on a study tour to Malawi focusing on community based TB/HIV collaborative
activities, and to send three staff to the Annual IUATLD Conference in Cape Town, South Africa.
FY08 funds will be used to continue supporting the BNTP to conduct supervision and monitoring visits and
trainings. To bolster the capacity of the NTRL to perform its activities as a reference laboratory, it is
proposed to use FY08 funds to meet the salaries for two laboratory technicians who will be based at the
NTRL. Funding is also requested to support quarterly meetings of the national TB/HIV Advisory Committee
and to support quarterly meetings of two regional TB/HIV advisory Committees to be formed for the north
and south regions.
General program support to the BNTP is requested to continue training health care workers on these
guidelines to increase the number of TB patients diagnosed and successfully treated, including enhanced
referral to HIV care services. USG funds will be used to conduct a cross-sectional survey in a 50% sample
of high HIV-burden districts to measure HIV testing uptake, determine impediments to testing uptake, and
develop strategies to overcome them.
These activities support Botswana's Round 5 TB grant from the GFATM which seeks to scale up community
TB care, improve treatment success rate, strengthen TB/HIV collaborative activities and strengthen
supervision, monitoring and evaluation.
Continuing Activity: 17267
17267 4457.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $0
9802 4457.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $710,000
4457 4457.06 HHS/Centers for Ministry of Health, 3357 1039.06 Technical $627,000
Construction/Renovation
09.C.OV03: Ministry of Health - Nutrition Rehabilitation for OVC
There has been an increase in the budget for this activity to enable the program to bridge the gap between
the clinical and community approaches to combating malnutrition in children infected with and affected by
HIV/AIDS. The program will scale-up its community efforts by mobilizing and training communities on the
care and management of malnutrition. The program managed to recruit staff in FY2007 and FY2008 and
this will facilitate the roll out of the program to districts surrounding Francistown and Gaborone.
The project entailed the renovation of two buildings at Nyangabgwe Referral Hospital (NRH), Francistown
and Princess Marina Hospital (PMH), Gaborone. The overall goal of this project is to ensure an effective
and comprehensive nutritional management of malnourished children affected and infected with HIV/AIDS.
Specific objectives include: registering of new clients; nutritional assessment, counseling and monitoring of
orphans and vulnerable children; provision of psychosocial support; training of care givers on meal
preparation and feeding of OVC.
The project recruited an expert in child nutrition to train 20 health care professionals (Pediatricians,
Dietitians, and Nurses) with skills in the management of malnourished children, affected and infected with
HIV/AIDS. About 500 children were enrolled and benefited from the project. The USG funded the
recruitment of two Principal Dietitians, two Social Workers and two Home Economists. A needs assessment
established nutritional needs of OVC and developed nutritional care standards.
The FY2008 activities will be a continuation and scale up of activities. The project equips OVC serving
CBOs with skills on care for malnourished OVC. An additional 2,000 OVC will be enrolled into the program,
100 more health workers will be trained as well as 100 representatives from CBO/NGO/FBOs serving OVC.
Human resource capacity will be strengthened at the two referral hospitals to increase availability of quality
services to OVC. One Project Manager will provide oversight for the two Centers.
In order to improve the care of HIV infected children, the project will create linkages with the PMTCT
program, the Infectious Disease Care Clinic (IDCC, the sites for ART) for children in PMH and NRH to come
up with a nutrition monitoring program for HIV infected children. The Botswana PMTCT programme in
collaboration with HHS/CDC/BOTUSA has initiated a program for testing for HIV infection on HIV exposed
infants at 6 weeks. The MOH also has a nutrition surveillance program that monitors children's weight for
age every month. Comprehensive monitoring of the growth of HIV infected children has been a gap in
service delivery. This gap will be addressed by the Nutrition Rehabilitation Centres in Princess Marina and
Nyangabgwe hospitals.
Nutritional assessments will be performed at every visit and early recognition of problems and appropriate
remedial interventions applied. Monitoring of these children will include identification of the multiple factors
which contribute to poor growth, including the environment in which the child is raised. Accordingly, the
centres will closely monitor the growth and development of HIV infected children seen at primary care
health facilities and at the Baylor Children's Centre of Excellence (for those on ART).
During 2008, the nutrition rehabilitation centres will work with MLG's DSS to advocate for development of a
food basket for HIV infected children. It has been documented that HIV infected children enrolled in nutrition
rehabilitation centres, even those that recover to normal nutritional status, take longer to recover completely
and often relapse if additional nutritional support is not available. Currently, the DSS provides food baskets
to orphaned children without regard to their HIV or nutritional status, except for the few referred by dieticians
(with individualised food basket prescriptions). Guidelines for food basket contents and placement will lead
to more targeted use of food support for OVC.
The rehabilitation project will continue to collaborate with MOH's Food and Nutrition Unit, DSS, UNICEF and
other relevant stakeholders.
The expected results for 2008 include: Project Manager added to manage program, Nutrition Rehabilitation
Project evaluated, additional 2000 OVC enrolled and benefiting from the project, 200 health workers and
CSO staff trained, sites for rolling out identified and community needs determined, monitoring of HIV
infected children in the program and food baskets and implementation guidelines developed for HIV infected
children.
Continuing Activity: 17268
17268 4458.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $305,000
9803 4458.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $0
4458 4458.06 HHS/Centers for Ministry of Health, 3357 1039.06 Technical $311,000
Gender
* Increasing women's access to income and productive resources
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $126,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $85,000
Estimated amount of funding that is planned for Economic Strengthening $25,000
Table 3.3.13:
09.C.CT09: MOH - Prevention with Positives Counseling and Testing
ONGOING ACTIVITY WITH NEW PARTNER WITH NO ADDITIONAL FY2009 FUNDS - DELAYED
will also involve identification of one additional service area for similar assistance (TBD, awaiting
assessment results). USG also supports the alcohol-HIV trainings to health care workers begun by
adaptation of the CDC-developed "PwP flipchart intervention" for use in Tebelopele's new supportive
counseling program, and training of counselors in use of that intervention (Sept 07).
Global Aids Coordinator (OGAC) special initiative for positive prevention, for consideration of adaptation in
abstinence, be faithful, and condom promotion (ABC), disclosure, and partner testing. The specific content
of each intervention or tool developed will depend on the target program and clients, but sensitization and
In the area of palliative care and ART treatment, the primer partner will work with the Associated Fund
Administrators Botswana (Pty) Ltd (AFA) to enhance the prevention services provided within its ART
program. AFA is an administrator of two medical aid schemes/insurance organizations namely, Botswana
Public Officers' Medical Aid Scheme (BPOMAS) and Pula Medical Aid Fund (PULA). Through its managed
care program, AFA facilitates the provision of to insured patients and Government of Botswana (GOB)
funded patients, as well as provision of continuous medical education and KITSO training to private
Activity Narrative: patient education materials and other appropriate job aids, to be determined later. This activity is expected
Continuing Activity: 17804
17804 17804.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $250,000
Table 3.3.14:
09.C.CT02: Ministry of Health - Counseling and Testing Unit
In addition to the on-going activities from FY2008, the Ministry of Health (MOH) will develop a standard
training curriculum for HIV lay counselors and will review and update the generic training curriculum for HIV
Counseling.
2007 accomplishments
A rapid assessment of the capacity of civil society organizations to provide C&T resulted in the selection of
six NGOs/CBOs/FBOs to be supported to provide services. An in-depth evaluation of the selected sites has
led to the development of a capacity building plan.
The USG supported the MOH in training of health workers in various aspects of C&T service delivery. To-
date, the MOH trained over 80 trainers in couples HIV counseling and testing (CHCT), and over 200 health
workers and counselors. Training has so far covered 11 of the 24 health districts.
Through routine HIV testing (RHT), 178,176 tests were performed in 2006, representing a 25% increase
from the previous year. Eventually, the program aims to expand routine testing to the private sector as well.
Over 300 health workers were trained in how to perform the rapid HIV tests, including 35 from the private
sector. Through follow-up and support visits conducted to public facilities by MOH in 2007, a number of
challenges facing RHT were identified. These included: inadequate on-site support supervision and
mentoring of lay counselors; inconsistent supply of rapid HIV test kits in some facilities; health facilities lack
the human resources needed to take on increased HIV testing and counseling; policy guidelines are not
available to most health workers, and the private sector has not been adequately brought on board to
provide routine testing. PEPFAR funds were approved for an evaluation of routine HIV testing in 2007,
however, a contractor is still to be identified to carry out this activity.
In FY 2007, a consultant was engaged to work with the MOH and a reference group of key stakeholders to
develop national guidelines for counseling and testing, based on recent release from WHO of guidelines for
provider-initiated C&T. These include guidelines for C&T in the various settings (e.g. client-initiated and
provider-initiated CT services). WHO/AFRO has provided a technical officer to provide assistance in this
activity.
The identification of a contractor to support the development of the counselor supervision curriculum and
training of a core team of trainers is underway. Applicants have submitted proposals to MOH and the review
and selection process is in progress.
Plans for 2008
The goal of the Botswana NSF is for 95% of sexually active adults counseled and tested by 2009. At this
point, it is estimated that at least 50% of adults in Botswana know their HIV status. USG funds will support
MOH in increasing access to and availability of VCT through the six civil society organizations. Activities will
include provision of services, training of 18 lay counselors, mentoring support and monitoring and
evaluation. The new sites will become part of the referral networks that have been established in various
locations to enhance referral of clients to care and treatment and to community-based support groups. An
estimated 7,718 first-time testers will receive services at these sites.
Funds for FY2008 will support on-going monitoring and quality assurance efforts by MOH. Activities will
include rolling out of CHCT to the remaining 13 health districts not yet covered, support supervision and
mentoring to counselors.
The USG will continue to support capacity development by funding the salaries of two program counselor
trainers in the MOH/C&T unit.
PEPFAR funds will also support the development of IEC materials for RHT and VCT, targeting groups, e.g.
couples, children, youth and men.
Continuing Activity: 17269
17269 4459.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $200,000
9804 4459.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $346,000
4459 4459.06 HHS/Centers for Ministry of Health, 3357 1039.06 Technical $446,000
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
09.T.AD01: Ministry of Health- Central Medical Stores Support
CONTINUING ACTIVITY UNDER A PERFORMANCE PASS
CMS is a unit of Pharmaceutical Services which is under the Department of Clinical Services in the MOH. It
is entrusted with the responsibility of providing the nation with good quality and cost effective
pharmaceuticals, laboratory and related medical supplies timely. It serves all government health facilities,
missions, mine hospitals and non-governmental organizations in Botswana.
The GOB provides free ART to PLWHAs since 2002. Since its inception the program has grown and serves
62 ART facilities (32 hospitals and 30 satellite clinics) with approximately 90,478 patients on treatment (July
2007). The projected number of patients on ART is 102,500 by end of 30 September 2008.
This objective of the program is achieved through procurement, quality assurance, warehousing and
distribution by CMS. The program is faced with a number of challenges such as shortage of staff,
inadequate storage space, inadequate logistics skills, inadequate quality assurance skills, inadequate ARV
security infrastructure, and lack of offices as well as limited funds. In the past the GOB received assistance
from partners such as PEPFAR, Bill and Melinda Gates Foundation, Merck Foundation, Boerhinger
Ingelheim, UNFPA, Cliniton HIV/ADS Initiative (CHAI) and Pfizer in the form of donations of ARVs and
drugs for the treatment of OIs and price reductions. CMS has been able to procure ARVs, strengthen the
security system, pre-qualify suppliers and train 15 employees on supply chain management and 15
employees on quality management system to improve organizational efficiency and effectiveness through
2007.
In 2007, 63% of the PEPFAR funds were used to procure generic drugs, while 21% of the funds were used
for procurement of pediatric formulations. The DRU, which has been receiving support from PEPFAR, is in
the process of registering generic ARVs which will enable CMS to increase drug purchase and make
savings. The NDQCL has also been receiving support from the USG to improve their analytical skills to
assist in testing of procured generic ARVs. Through the cooperative agreements between the GOB and
partners, the MOH (CMS) will use FY2008 funds to supplement procurement and distribution of drugs for
ART and commodities used in treatment of OIs in the management of HIV/AIDS. Supplies will help support
HIV/AIDS Care/Treatment services for PLWHAs their families, children, caregivers. The purchased drugs
will be distributed to 50 more clinics operated by the MLG thereby greatly expanding access in 2008. CMS
will also secure provision of ARV drugs to 180 legal refugees from the Dukwe refugee center.
There is acute shortage of skilled staff at CMS. The employment period of two Chief Supplies officers and
one pharmacist to implement and monitor the project will be extended to additional two years. The
employed officers will be deployed as follows: the Pharmacist will be employed at Quality Assurance Unit to
support the continuous prequalification following work done by the consultants. He/she will perform quality
assurance activities of a selection of suppliers, technical evaluation of tender quotations to support
purchasing unit and also address quality matters throughout the supply chain. The Chief Supplies Officers
will strengthen the procurement, receipt, inspection and distribution of ARVs, drugs used in the treatment
and management of OIs. The services provided by them will lead to an effective system of ensuring that
orders will be received, processed and distributed to the health facilities timely and cost effectively.
In order for CMS to improve its organizational efficiency and effectiveness in provision of ARVs there is
need to continue with the outsourced technical assistance from SCMS to strengthen the implement a quality
management system and the quality assurance system and training of CMS staff on the systems. The
program will review and strengthen forecasting and quantification of national needs for ARV drugs and
related products used in the management and treatment of HIV/AIDS related diseases through the ART
program.
Continuing Activity: 17271
17271 4460.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $7,945,000
9805 4460.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $10,680,587
4460 4460.06 HHS/Centers for Ministry of Health, 3357 1039.06 Technical $10,064,409
Estimated amount of funding that is planned for Human Capacity Development $91,000
Table 3.3.15:
09.T.AD04: Ministry of Health- National Drug Quality Control Laboratory Support
The NDQCL is a unit in Pharmaceutical Services within the Department of Clinical Services in MOH.
NDQCL ensures that medicines and related medical products produced, imported, exported, distributed and
used in Botswana are of acceptable quality, safety and efficacy through testing. There has been heavy
dependence on manufacturer's documentation on the quality of medicines and related medical products
imported, distributed and used in Botswana due to shortage of skilled manpower and inadequate
infrastructure. The NDQCL has lacked independence. The Botswana Government has since approved and
supported the construction of an independent NDQCL by the end of the National Development Plan (NDP)
9, as stipulated in the Botswana National Drug Policy of 2002 in assuring the quality, safety and efficacy of
medicines in the country.
The NDQL used USG support to:
--Train two staff in pharmaceutical analysis for eight weeks at the Medicines Control Authority of Zimbabwe
--Train staff in courses on Advanced Technical Techniques, Instrumentation, Good Laboratory Practice,
Stability studies in-county.
--Train two staff in understanding ISO/IEC 17025 at Botswana Bureau of Standards
--Procurement of reference textbooks that contain official test methods of ARV medicines, other relevant
reference books and international standards
--Procurement of pharmacopoeial primary reference standards of ARV medicines, opportunistic infection
medicines and other drugs
--Study tour / visits to organizations / laboratories with in South Africa with LIMS installed.
USG funds for FY2008 will continue to assist in strengthening the quality control of ARV medicines for OIs
imported, distributed, and used in the country.
Training as the major activity for the laboratory will continue to improve staff analytical skills and
competence as the number of staff involved in testing increases and new improved instruments/equipment
are produced to improve testing of pharmaceuticals. The impact of the training of staff will be seen as the
testing of ARVs and other medicines increases yearly and the establishment of a quality management
system in the laboratory in accordance to ISO 17025 Standards is done. Documentation and other
operating procedures will visibly improve in the laboratory ensuring that accurate test results are produced.
USG funds will continue to supplement GOB funds in the procurement of reference textbooks and ARV and
OIs primary reference standards.
Since testing of ARVs is now being performed it is important that the required resources such as primary
reference standards and other laboratory consumables are available at all times.
Training of staff (old and new) will be the major new activity. Training will be done through attachment
training and short courses, to improve staff analytical skills, enhance proficiency in testing; getting
acquainted with new analytical techniques and new instruments / equipment that will assist in producing
accurate test results in the shortest time possible. The training will also include ISO/IEC 17025 Standard in
order to establish a quality management system in the laboratory.
The continuation of the procurement of reference textbooks that contain official specifications and test
methods of ARVs and medicines for OIs and the procurement of ARV pharmacopoeial primary reference
standards in order to continue testing each batch supplied in the country.
Study tours to other laboratories are necessary to assess the operations of the laboratory. Study tours /
visits to at least three laboratories will allow NDQCL to benchmark its operations with other laboratories and
assist it to develop methods of improvement. The locations for the study tours are being identified.
Challenges
One major challenge that the laboratory foresees is being able to sustain testing of each batch of ARV
medicines and OIs medicines supplied in the country with the limited skilled manpower and current
laboratory space until the construction of the new laboratory building. Further, the laboratory is also tasked
with the responsibility to test all other medicines and related medical products distributed and used in the
country. Such testing of each batch of ARV medicines and OIs circulating in the country is pivotal, as it will
assist in detecting counterfeit or substandard drugs increasingly used worldwide.
Currently there are more than 2,000 medicines in the Drugs Regulatory Unit List of Drugs Allowed in the
Botswana market Document and more than 2,000 medicines and related medical products that are supplied
and distributed to the public sector through CMS Stores to all Government Health Facilities, Mission and
Mine Hospitals and some non-governmental organizations. These medicines and related medical products
require quality testing to be performed on continuous basis for registration / pre-market authorization, post-
marketing surveillance and national procurement.
Continuing Activity: 17270
17270 10216.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $50,000
10216 10216.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $200,000
Estimated amount of funding that is planned for Human Capacity Development $80,000
09.T.AD03: Ministry of Health- Drug Regulatory Unit Support
CONTINUING ACTIVITY UNDER A PERFORMANCE PASS:
The Drug Regulatory Unit (DRU) activity has a PASS, but there is a new component to be added to the
continuing activities. There are plans to develop a regulatory system for condoms, which will consist of the
development of regulations and guidelines, as well as training on the developed tools.
The DRU is a unit within the MOH responsible for the regulation of medicines in Botswana. With the
expansion of the MASA program and increase in number of patients on ART, the Ministry faced a number of
challenges in the provision of the medicines including increased costs of medication. The increasing costs
necessitated looking at different options of sources of medicines, including generic ARVs. To ensure that
the quality of the products used would not be compromised it was necessary to strengthen the regulatory
unit, hence DRU became one of the beneficiaries of the PEPFAR funds. The areas for strengthening
included the inspectorate, the registration; and the setting up and training of a pharmacovigilance section.
The activities for FY2007 continued the previous two years work. These include further training activities
within the DRU as well as training of other health care professionals in reporting of adverse drug reactions.
The need to develop a monitoring and evaluation of the processes within the unit was also recognized. Part
of the funds for FY07 budget period developed a quality management system. The unit will have quality
manual, updated standard operating procedures as well as the staff trained in the system by the end of
2007. The system now has a monitoring and evaluation component which will help with the continuous
improvement of processes and procedures to allow for effective regulation of medicines.
The DRU proposes to increase human resources by at least two officers with regulatory skills. For more
generic ARVs to be registered, bioequivalence data needs to be evaluated to ensure equivalence with the
innovator products. The pharmacovigilance section must be able to process and evaluate adverse drug
reaction reports. These officers will also help in review and updating processes and procedures to minimize
multicycle evaluation of dossiers for registration. The unit plans to continue with the activities of registration
and pharmacovigilance next year.
Continuing Activity: 17272
17272 4461.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $0
9806 4461.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $200,000
4461 4461.06 HHS/Centers for Ministry of Health, 3357 1039.06 Technical $575,000
Estimated amount of funding that is planned for Human Capacity Development $125,000
09.T.LS01: MOH - Laboratory Support
ACTIVITY HAS BEEN CHANGED IN THE FOLLOWING WAYS:
In FY2007 and FY2008, the Government of Botswana's MOH and the Association of Public Health
Laboratory (APHL) conducted an assessment to initiate the development of a Laboratory Information
System (LIS) for district and primary hospital laboratories in order to improve the laboratory testing and the
turn around time.
In FY2008, funds were requested for a LIS administrator consultant to coordinate the program, develop
processes, and monitor the function of the software on the different sites selected to pilot the program.
FY2009 funds are requested to continue to support the consultant and to roll out the program in all the
laboratories. Funds will also be used to purchase additional computers for the laboratories and interface the
program to the laboratory equipment, namely, chemistry, hematology, serology, CD4, and viral load. The
implementation of the LIS will improve the monitoring and evaluation of processes in the laboratory
including reagents and other consumables usage, quality of results and services offered to patients on anti-
retroviral (ARV) medication. The system will assist in obtaining statistics, which will be used in planning for
the laboratories.
In FY2008, funds were requested to strengthen the NHL to support the HIV ANC (antenatal care) sentinel
surveillance in Botswana, validate new techniques and new tests using dried blood spots (DBS), and show
that the ANC sentinel surveillance can be done using DBS instead of plasma as in the past. FY2009 funds
will help carry forward the 2009 ANC sentinel surveillance testing on HIV serology, incidence and resistance
testing. Funds are requested to provide a short term position to support the testing and the analysis of the
data.
Additionally, HIV rapid tests were rolled out in Botswana and a training and EQA program developed. New
test kits have been evaluated and a new testing algorithm developed and now there is a need to revise the
existing training manual by including the newly validated kits. Funds are requested to support the revision
and the printing of new manual to support the training program and to organize training to VCTs, clinics and
hospitals for non-laboratory staff performing HIV rapid test.
The MOH and the American Society of Microbiology (ASM) have worked together since 2007 to strengthen
the Microbiology diagnostic and the bacteriology section of the National Health Laboratory to support
surveillance testing for infectious diseases. FY2009 funds will help continue the development of the
laboratory by supporting training, the procurement of laboratory supplies and reagent for STI surveillance
and the development of new techniques at the central level and in the peripheral laboratories. FY2009 funds
will assist in improving cytology and histology diagnostics at the National Health Laboratory and at
Nyangabgwe Referral Hospital by providing supplies, training, and software for the management of results.
In 2002, the MOH, APHL, and CDC developed the five-year quality assurance program (QAP) strategic
plan, which was implemented between 2002 and 2007 and evaluated in February 2008. Funds are
requested to address the recommendations of the evaluation and develop the next five-year plan for 2009-
201. Funds will be also used to continue to strengthen the quality assurance laboratory by providing training
to the national quality officer, support the Proficiency Testing and EQA programs, and provide for an onsite
supervisory visit for the QAP and a meeting of the National Quality Assurance committee.
Human resources have been a challenge to the Government of Botswana (GOB), hence at the request of
the Ministry of Health (MOH) and the Institute of Health Sciences (IHS), PEPFAR provided 14 strategic
positions to laboratories and to the department of Medical Laboratory Technology (MLT) in FY2008.
FY2009 funds are requested to continue supporting the 14 positions. The positions offered by PEPFAR
have helped the school to increase the intake of students, because of the increased demands in the
country, and it is expected that there will be 30 graduates as compared to 15 in the past.
FY2009 funds are requested to continue supporting those positions and a new position at MOH laboratory
services at the request of clinical services. The National Quality Assurance manager position has been
empty for the last two years, a position that was created at the recommendation of CDC and APHL for the
implementation of the five year plan for the Quality Assurance Program. The lack of a national coordinator
of the quality assurance program has been an issue for its implementation.
Activity 1: Quality Assurance (QA): $40,000
In FY2007 funding was requested to improve the QA laboratory. Equipments were purchased, and training
for two staff members was provided.
FY2008 funds will continue the activities at the QA laboratory: carry on the EQA program for all the
laboratory tests, rapid test EQA for voluntary counseling and testing (VCT) and hospital laboratories,
hematology and chemistry EQA, continue the development of national laboratory standards for hematology,
chemistry, and CD4. Funds will also support the QA Unit to conduct the annual laboratory assessment and
provide one additional staff to the unit to support the QA program in the country because three critical
laboratory scientists from the QA unit resigned leaving the unit without manpower to carry on the activities.
Activity 2: Development of a laboratory maintenance service at NHL and NyangagbweHIV reference
laboratory: $60,000
Frequent break down of laboratory equipment has been one of the main problems in the laboratory system
in Botswana, equipment purchased or donated are not under service contracts or have to wait for several
weeks before maintenance because repair services are not available. FY2008 funds will procure
maintenance equipment and support training for biomedical engineers for the support of the reference
Activity Narrative: laboratories in Gaborone and Francistown.
Continuing Activity: 17274
17274 4462.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $100,000
9807 4462.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $700,000
4462 4462.06 HHS/Centers for Ministry of Health, 3357 1039.06 Technical $2,400,000
Estimated amount of funding that is planned for Human Capacity Development $350,000
Table 3.3.16:
09.X.SI05: MOH - DHAPC Surveillance and Strategic Information Support
MOH DHAPC - Surveillance and strategic information support
Activity 1: Salaries of Surveillance Staff in MOH's DHAPC
Estimated cost: $75,280
USG will continue to support the salaries of officers conducting surveillance activities in MOH's DHAPC as
surveillance is the cornerstone of monitoring and evaluation of the national HIV response.
The Surveillance Section has conducted and will continue to conduct the antenatal HIV prevalence among
pregnant women aged 15-49 years. This year the ANC HIV surveillance will include incidence testing, HIV
drug resistance tests and HIV prevalence testing.
The team also compiles, analyses and disseminates data on HIV routine testing in government health
facilities
For the FY08, the MOH will require $75,280 to pay the salary of these personnel. These positions are to be
absorbed into the public structure in the future. The pay structure will be similar to that of the GOB to
facilitate the integration of the new positions in the public structure.
Activity 2: Evaluation of new techniques for surveillance
Cost: $50,000
Dried Blood Spot (DBS) has increasingly proved to be the simplest and cost-effective technique of
specimen collection for HIV testing in resource limited settings. Its use in early diagnosis of HIV infection
among infants using the polymerase chain reaction method has opened opportunities to improve pediatric
access to HIV/AIDS care and treatment. We are planning to test this specimens' collection method if it can
replace the current sample collection methods for HIV infection testing, HIV incidence testing and ARV
resistance tests among pregnant women attending ANC services.
In FY08 USG funds will be used to evaluate the sensitivity, specificity and positive predictive values of DBS
in HIV diagnosis, HIV incidence testing, and ARV resistance testing by comparing findings obtained through
routine specimen collection techniques for these tests. Representative sample of de-identified specimens
will be obtained and subjected to the standard test procedures for HIV testing, incidence testing and ARV
resistance tests.
The USG funds in this section of the COP will mainly cover the fieldwork, result dissemination and other
logistic costs while funds coming from the laboratory infrastructure section will cover the cost of specimen
collection, purchase of laboratory supplies and reagents and the actual conduction of laboratory tests.
Activity 3: PIMS Upgrade and HIV Data Warehouse
Cost: $175,000
With the planned scale up of the national ART program to serve over 100,000 patients in the future and the
need for enhanced patient monitoring, the scalability of the current MS Access system, PIMS, is an issue. In
2007, MOH began the process of upgrading PIMS. Thus far, they have finished gathering requirements
and are planning site visits to Kenya and Rwanda to evaluate their patient monitoring systems as possible
replacements for PIMS in order to meet the future needs of the program. Once an IT solution is selected,
USG will assist MOH in 2008 in acquiring additional IT resources for the development, testing, and
implementation of the upgraded system, including deployment to the current ART sites.
MOH will require two IT consultants for a minimum of six months until the new system is deployed in all 28
sites. Deployment will consist of travel across Botswana to each site for installation, conversion of data to
the new system, and training of users. At least two teams will be required so that all sites get deployed
within three months to minimize the time sites are using different patient monitoring systems. The upgraded
system will improve data collection and provide the necessary data for creating appropriate indicators for
more effective monitoring of the ART program. In addition, the system will provide data to the national HIV
data warehouse, which is under development.
Because Botswana has several independent systems for capturing health data, it is not possible to get a
comprehensive picture of the services PLWHA access, much less how effective these services are, unless
a longitudinal record is created for each patient. To address this problem, the MOH decided to develop a
national HIV data warehouse to store integrated patient level data on health services provided to PLWHA.
The data warehouse will allow various health personnel, such as program managers, healthcare workers,
researchers, etc. access to up-to-date information for patient management and outcome monitoring. The
data for the warehouse will come from diverse information systems, each with its own data formats and
coding standards.
In order to link patient data together, MOH is in the process of evaluating Identity Systems' Identity Search
Server (ISS) software to match patient identifiers from disparate systems. If ISS is purchased in 2007, in
2008 USG will fund the maintenance cost (18% of purchase price), which becomes due three months after
delivery of the software and upon each anniversary of the delivery of the software. The maintenance fee
allows MOH to benefit from enhancements, software fixes, and upgrades.
Activity Narrative: Linking patient data is only one part of the data warehouse process, however. Specialized programs must
be developed to obtain the data from each system, clean and convert the data, integrate the patient data
after the identifiers have been linked, and load the integrated data into the data warehouse. USG will
support MOH in building IT capacity via a skills transfer from an experienced data warehouse developer,
who will be contracted for a minimum of 6 months to assist in coding the required programs. In addition,
once the data warehouse is operational, data analysts will need access to the data for reporting purposes,
ad hoc queries, and research to improve patient care and outcomes. In 2008 USG will support the MOH in
procuring terminal service licenses for user access and Business Intelligence (BI) software for analysis and
reporting.
Continuing Activity: 17275
17275 4464.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $175,000
9809 4464.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $150,000
4464 4464.06 HHS/Centers for Ministry of Health, 3357 1039.06 Technical $280,000
Table 3.3.17:
09.X.SI06: MOH - DDPME Strategic Information Support
Activity 1: Salaries of Staff in MOH's DDPPME
Cost: $ 136,290
With USG financial support, GOB is in the process to recruit short-term staff to address immediate and short
-term workforce requirements. These are key positions within government agencies. The planned positions
will strengthen the ability of DPPME to support different existing HIV/AIDS M&E systems within MOH,
integrate them to improve reporting, linkages among these programs and support accountability.
The implementation of this activity was delayed and it is yet to yield results. These positions include one
chief health information officer, one principal systems analyst, two IT officers, and one senior systems
analyst programmer
The senior System Analyst and the Chief Health Information Officer will work closely with the consultant
who will develop the national HMIS strategic framework. They will be the drivers behind the implementation
of the recommendations to be formulated in the strategic framework.
With the support of all the IT and system analyst and programmer, this team will work towards an integrated
system with harmonized HIV/AIDS indicators, user friendly and facilitating information sharing among all
stakeholders.
These positions are to be absorbed into the public structure in the future. The pay structure will be similar to
that of the GOB to facilitate the integration of the new positions in the public structure
Activity 2: ICD-10 Training
Cost: $80,000
This is a continuation activity from 2007. The Health Statistics Unit (HSU) remains the focal point for all
issues relating to health information system in the MOH. It facilitates the data collection, processing,
verification, analysis and dissemination of health service data throughout the country. It also coordinates
health data sharing with other stakeholders.
The HSU revised its data collection tools in 2004 using the International Classification of Diseases 10th
Edition (ICD-10). In order to build capacity in ICD-10, USG supported the training of 15 staff from HSU in
ICD-10 in FY 2007. For cost effectiveness, this training will be organized in Botswana by staff from
Queensland University of Technology in Australia in January 2008. This training will ease the coding
problem HSU is faced with and therefore speed up the production of the annual health reports.
Despite this training, there is a dire need to support the training of records keepers in all the 32 government
hospitals in the country and to support the sensitization of health care workers about the importance
mortality and morbidity coding and the necessity to write properly the diagnosis in their patients' charts.
These initiatives will facilitate the coding process at central level and therefore allow HSU to produce the
annual Health statistical reports, necessary for planning, in a timely manner.
Part of these funds will be used to purchase at least one set of ICD-10 reference tools for each hospital in
the country and add 6 computers and software to the current infrastructure to allow extra data entry points
to speed up the production of the health statistics reports.
Therefore, the MOH's DPPME, is requesting PEPFAR funds to urgently train all 18 HSU staff in the use of
ICD-10. This will allow the office to be effective, efficient, and able to promptly report quality data that meet
international standards.
Activity 3: Botswana Health Information Strategic Plan
Cost: $70,000
Botswana has several information systems for capturing data on health services, resulting in a fragmented
approach to patient management and outcome monitoring. Program data are stored on independent
systems that run on different platforms and collect data at different levels of detail, e.g. patient level,
aggregated. This creates a challenge to integration of health information systems, as well as integration of
health data into a longitudinal patient record for the national HIV data warehouse. In 2008 USG will support
the development of a national health informatics strategic plan to provide a framework for future information
systems development by all stakeholders in Botswana (GOB, donors, etc.) that includes appropriate
international ICT standards and guidelines, as well as addresses long term sustainability of health
information systems.
Activity 4: Roll-out of District Health Information System (DHIS) at district level
Cost: $ 55,000
Botswana is facing a challenge of proliferation of vertical information systems in the MOH. The problem is
accentuated by the current use of multiple data collection tools, multiple formats of data collection and
multiple data flows. There is also excessive collection of data that ends up not being efficiently converted to
indicators used for planning and management. There are delays in data capturing, data analysis and
production of statistical reports. This results into poor availability of timely and quality health data affecting
Activity Narrative: the decision-making.
The implementation of EU-funded BEANISH (Building Europe Africa Network for applying Information
technologies in the Healthcare Sector) project was initiated in 2005 whereby the DHIS software was piloted
in 4 health districts. The pilot phase of this project gave a lesson that timely and accurate information
collection and compilation in all primary health care programs including HIV/AIDS will be made easy in
Botswana. Through funding from the EU, DHIS will rollout to 8 health districts before the end of 2007.
Training of Health Information Management Officers, Public Health Specialists, Matrons and others in the
districts is essential part of the roll-out.
As the funding from EU ends by December 2007, USG funds will support the MOH to complete the rollout in
the remaining 16 health districts in FY08. MOH is putting emphasis on training of support personnel (IT
Officers) in the districts as well as at the centre to ensure sustainability of the DHIS. It is planned that the
central support team shall visit the districts half-yearly, conduct short-term refresher courses for users, and
support personnel.
Continuing Activity: 17904
17904 17904.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $342,000
09.X.SS13: MOH - HIV/AIDS Pre-service Training
ACTIVITY HAS CHANGED IN THE FOLLOWING WAYS:
This is a continuing activity at the Institutes for Health Sciences under which support is provided for both
faculty development in HIV/AIDS and the HIV/AIDS workplace program for faculty and students.
During FY2009, faculty training will continue and the workplace program will be established at four
campuses of the health training institutes, which are in Gaborone, Serowe, Francistown and Lobatse,
making one of the outputs for this project that workplace programs will be established in 50% of the
Institutes of Health Sciences. Additionally, a printer will be purchased for headquarters.
The Institutes of Health Sciences (IHS), a tertiary institution for the training of health personnel, trains the
vast majority of nurses and other allied health workers for the country. The IHS, which falls under the MOH,
consists of eight health training institutes with over 1,500 students. A basic diploma is offered in general
nursing, medical laboratory technology, pharmacy technology, dental therapy, health education and
environmental health. Post-basic level courses are offered in midwifery, family nurse practice, community
health nursing and nurse anesthesia.
Since 2003, USG has provided technical assistance to IHS for the strengthening of pre-service training in
HIV/AIDS for nurses and other allied health professionals. In addition to this technical assistance, an HIV
Training Coordinator supported by USG began working in MOH in 2005. This officer is responsible for staff
development and training in HIV, strengthening HIV content in all programs/courses and bridging the gap
between in-service and pre-service training. This officer works closely with technical assistance
contractors, implements local capacity building activities and leads the workplace program initiative.
In addition to curricula and faculty development, a workplace program to provide HIV education and
services to both faculty and students is currently being established at all the Institutes.
This activity support the coordinator's salary, training and resources for faculty and the development of the
workplace program.
2007 achievements:
Provided journal subscriptions, HIV/AIDS guidelines and in-service curricula to all 8 institutions; conducted
annual PMTCT update for 16 midwifery faculty; conducted HIV/AIDS annual update for 17 faculty of first
year students; trained 51 lecturers in research methods; trained 38 lecturers in HIV/AIDS treatment
(KITSO); conducted situational analysis of workplace activities; developed draft workplace policy; trained 16
peer educators/counselors and 12 workplace focal persons
2008 plans:
Capacity Building: Conduct PMTCT update for 35 midwifery lecturers; conduct HIV and AIDS update
workshop for 45 participants; conduct pediatric HIV/AIDS care training for 30 faculty; conduct a workshop
for 35 participants to develop competencies for Pharmacy Technology, Dental Technology, Medical
Technology programs and strengthen HIV and AIDS content in the curricula
Workplace Program: Conduct update workshops for 16 peer educators and 12 focal persons; provide
materials for workplace programs, e.g. condom dispensers
Continuing Activity: 17277
17277 9900.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $50,000
9900 9900.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $75,000
Workplace Programs
Estimated amount of funding that is planned for Human Capacity Development $83,000
Table 3.3.18:
09.X.SS01: MOH - Human Resource Development Support
ACTIVITY HAS BEEN CHANGED IN THE FOLLOWING WAYS
This activity, which is a 21-month project implemented over the course of FY2007 through FY2010, has
different activities that are undertaken each year according to this plan: 2007 Pre-project phase; 2008
Inception phase; 2009 Implementation phase; and 2010 Exit phase.
In FY2009, the following will be undertaken during the Implementation phase:
-Development of the Essential Health Package (EHSP).-Development of a Revised Human Resource
Plan.
-Development of a Monitoring and Evaluation Strategy.
-Development of a Health Financing Framework.
-Development of a Procurement Framework.
-Capacity building and Continuous Professional Development (CPD) activities comprising MOH and MLG.
The outputs from this activity include a Prioritized Essential Health Services Package (EHSP) with
necessary support systems; a revised HR plan aligned with the EHSP; a Monitoring and Evaluation
Strategy; a Health Financing Framework; a Procurement Framework; a revised health service priority goals
for MOH corporate plan; a cost analysis of implementation plan with recommendations; recommendations
on key policy issues; a capacity development report; and a 10-year implementation plan.
This project began in 2004 as part of the Southern Africa Capacity Initiative (SACI) with initial financial
support from the United Nations Development Program (UNDP) and technical assistance from both UNDP
and the World Health Organization (WHO). In 2005, the USG provided funding for an assessment of
human resources and health service, resulting in a revised ten-year human resource plan that takes into
account the HIV/AIDS epidemic and the GOB's response. The assessment revealed major inequities in the
distribution of health services in the country. These inequities, exacerbated by the recent and rapid
expansion of national HIV/AIDS prevention, care and treatment services by the Government, have led to an
urgent need for the development of an integrated service delivery framework that will make possible the
implementation of quality health programs.
In 2006, PEPFAR provided funding to the MOH's Department of Policy, Planning, Monitoring and
Evaluation (DPPME) to undertake this next phase of the project. The overall purpose of this two-year
activity is to develop an integrated service plan and framework to enable the health sector in Botswana to
cope with changes in workload brought about by the HIV/AIDS pandemic, to rectify inequities in service
delivery and to improve quality health care. DPPME is a new department in the MOH and as such is
currently experiencing huge capacity shortages. Therefore, it will be critical that the process used to
implement this project develops the capacity of the MOH. With the ultimate aim of providing appropriate and
equitable access to all levels of service for the general population, an integrated national framework and
plan will provide:
•A national overview of the current status of service provision.
•A detailed assessment of actual service requirements through analysis of patient/case referrals and
services offered.
•A service configuration plan that is affordable and sustainable and that ensures that resource use is
effective and efficient.
•A basis for a long term vision to enable integration of key initiatives (such as capital development and
equitable human resource distribution); aspects that can be implemented only over extended time frames.
•A basis for ensuring (1) that all levels of service delivery are addressed, and (2) that primary health care
and hospital care are integrated.
•A rational basis for addressing health needs and national health priorities in a resource-constrained
environment.
The health service delivery framework will guide the provision of accessible, affordable, and equitable
health services to the population of Botswana. The framework will include service delivery standards and
facilitating policies and will be used to realign the type, number and location of health facilities in Botswana,
the magnitude of services that should be rendered and the optimum mix of resources needed.
Because of funding and bureaucratic delays, it was not possible to award this project to a contractor during
year one (FY07). In addition, funding provided by PEPFAR in COP 06 and COP 07 was inadequate to cover
the cost of a project of this magnitude. Therefore, we are requesting additional funding in COP 08 to cover
the cost of the second year of this two-year project.
By the end of 2009, results will include:
1. A 10-year Integrated Service Delivery Plan for Botswana's Health Services
2. Revised national HRH plan aligned to the health service plan
3. Recommendations on aligning the MOH Corporate plan to the health service plan
4. Cost analysis of implementing the plan, with the recommended most feasible scenario of financing the
plan that takes into account issues of equity and sustainability, including strategies of bridging the identified
financial gaps (i.e. the recommended resource allocation formulae)
5.Implementation guidelines, including the monitoring and evaluation mechanisms and Facility Management
Toolkit and Procedure Manual
Activity Narrative: 6.Recommendations of key policy issues and how they impact on/should influence the current National
Health Policy
7.Strengthened capacity within the Department of Policy Planning Monitoring and Evaluation
Continuing Activity: 17276
17276 4544.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $0
9812 4544.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $140,000
4544 4544.06 HHS/Centers for Ministry of Health, 3357 1039.06 Technical $340,000
Estimated amount of funding that is planned for Human Capacity Development $650,000
09.X.SS17: MOH - Health Care Workers Wellness Program
This is a continuing activity that supports a new national wellness program for health workers that is moving
from the development to the implementation phase. In FY2009, training will continue, a follow up tool will
be developed, mentoring support will be provided at district level for the establishment of the program,
particularly in District Health Teams, and support groups will be organized. Emphasis will be placed on
closely monitoring select facilities. It is planned that this activity will establish wellness programs in 50% of
the districts.
The impact of HIV/AIDS on Botswana's healthcare system, coupled with health workforce shortages, has
substantially increased the physical and emotional demands placed on health workers. Throughout the
epidemic, health workers have been in the forefront of care and prevention activities, managing greatly
increased numbers of severely ill patients and assuming responsibilities for new HIV/AIDS services. At the
same time, many health workers have found it more difficult to respond to the demands of work because
they are HIV infected themselves or are personally affected by ill family members or friends. Though
knowledgeable about HIV/AIDS, many health workers are the last to seek HIV treatment and care services.
The Government of Botswana seeks to ensure that the present and future health workforce is able to cope
with the demands of the epidemic and effectively perform its duties and, to this end, has developed a
national Wellness Program for Health Workers. This program aims to provide a minimum package of
services which include: health services for staff that incorporate wellness (physical and emotional) services
and workplace safety; stress management programs (e.g., workshops, social and emotional support
committees; networking opportunities, e.g., support groups, resources for rest/tea breaks at work, recreation
(e.g., choir, football, social celebrations); training and staff development (e.g., workplace safety, team
building, stress management); health worker recognition/appreciation initiatives.
MOH is leading this program with PEPFAR funds and technical support. The program coordinator, who
began working in 2005, is supported by PEPFAR. To date, a national needs assessment has been
conducted, program structures are in place and foundation materials have been developed.
2007 Achievements:
Developed national structure for the program; visited the wellness center for health professionals in
Swaziland to learn best practices; conducted a hospital readiness assessment; developed the foundation
materials (three-year program implementation plan, program guidelines - Implementation, Support Groups,
Staff Morale), promotional materials (brochure, poster), training materials; established coordination
structures (workplace wellness committees in 18 hospitals and 3 headquarters units); disseminating
guidelines; conducting quarterly support visits to monitor implementation and provide technical assistance;
training facilitators on the formation of support groups; training trainers and health workers in stress
management and team building; developing additional brochures and program launch
2008 Plans:
Conduct quarterly support visits to monitor the implementation of the program and provide technical
assistance; train 250 health workers in HIV/AIDS, Stress Management, Team Building, Occupational Health
and Death and Dying
Continuing Activity: 17925
17925 12398.08 HHS/Centers for Ministry of Health, 7710 1039.08 U62/CCU02509 $200,000
12398 12398.07 HHS/Centers for Ministry of Health, 5281 1039.07 CoAg # $147,000
Estimated amount of funding that is planned for Human Capacity Development $200,000
09.X.SS25: MOH - KITSO HIV/AIDS Training Coordinating Unit (KITCU)
Since the first case of AIDS was reported in Botswana in 1985, the Government of Botswana has
responded proactively to the epidemic by creating training programs for health workers to support the
provision of HIV/AIDS prevention, care and treatment programs. With the President's Emergency Plan for
AIDS Relief (PEPFAR) support in 2004, the Ministry of Health (MOH) strengthened the coordination and
integration of various training programs by establishing the KITSO Planning Committee to assist with the
development of the KITSO Expansion Plan (2004), a document that guides MOH and its partners in training
coordination. It is against this backdrop that the Department of HIV/AIDS Prevention and Care established
the KITSO HIV/AIDS Training Coordinating Unit (KITCU) to ensure comprehensive, standardized,
coordinated HIV/AIDS trainings and to bring all existing and future HIV/AIDS-focused in-service training
under the leadership and direction of the MOH. The MOH has also established the National HIV/AIDS
Training Steering Committee to guide and advise the Coordinating Unit. This coordination effort has been
aided by supporting PEPFAR-funded activities including the introduction of the Training Information
Monitoring System (technical assistance from JHPIEGO), human resource support to the unit, development
of an electronic inventory of training curricula, development of training standards and guidelines,
establishment of a web-based resource center and further development of HIV/AIDS trainers (technical
assistance provided by ITECH).
In FY2009, support to the Unit will complement the technical assistance provided by ITECH and be used to
purchase equipment, including a photocopier, print guidelines, reports and other documents pertinent to
their function, and hold stakeholders meetings.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $100,000
