Analytical summary - Community ownership and participation
In Botswana, structures for community participation at the district level include chieftaincy, village development committees and village health committees. Other community structures that act as the voice of the communities are community home-based care committees. The village development committees' function is to identify and prioritize village needs as well as to liaise between the villagers and the politicians and local authorities. The village health committees focus on matters directly related to health.
Chieftaincies dialogue through open community fora (dikgotla) where community members may make development decisions and have the chiefs pass them on to the local authorities. Through these fora, politicians, including the President and his cabinet ministers, public officers and development partners may dialogue with community members. Concerns, needs and feedback on Government’s programmes can be discussed and civil servants may disseminate the Government’s policy. Thus, through a web of institutions and personnel, health concerns are communicated between the health decision-making bodies and the citizens.
The Government media such as radio, television and newspaper are heavily charged with sensitizing and educating communities on health matters. Although personalized health service may be difficult in urban public facilities where client–provider ratios are often unrealistic, in peripheral facilities where the ratios are realistic and where client education on prevailing health problems and determinants of health is a daily norm, meaningful and personalized client–provider interaction is possible.
There is a commendable effort on the part of the Government to provide quality and people-centred care. Between 2009 and 2010, the Ministry of Health commissioned a project in six selected health facilities with the aim of improving health facilities’ readiness to meet the expectations of patients, health care providers and the communities through institution of remedial measures to address identified challenges.
The intervention resulted in facilities improving their range of quality scores from the lowest of 36% and the highest of 42% to the lowest of 41% and the highest of 81%. The introduction of youth-friendly adolescent sexual health and reproductive services, and the wide involvement of young people in the planning and implementation of the adolescent sexual and reproductive health strategy also provide evidence of the Government’s commitment to people-centred care.
Civil society organizations are organized into a structure Botswana Council of Non-Governmental Organisations (BOCONGO) for coordination and easy communication with the Government. The private sector also has an association Confederation of Commerce, Industry and Manpower (BOCCIM) that communicates regularly with the Government. Challenges in community participation include lack of resources for civil society organizations that should play the role of watchdogs for good governance and the welfare of the communities. Civil society organizations depend largely on donor and Government funding. Their capacity should strengthen to allow them to become the voice of the community. Another challenge is thinning out communities’ representation as dialogue moves to higher decision-making echelons.