Assessing performance of Botswana’s public hospital system: the use of the World Health Organization Health System Performance Assessment Framework

摘要

Background: Very few studies have assessed performance of Botswana public hospitals. We draw from a large research udstudy assessing performance of the Botswana Ministry of Health (MoH) to evaluate the performance of public hospital udsystem using the World Health Organization Health Systems Performance Assessment Framework (WHO HSPAF). udWe aimed to evaluate performance of Botswana public hospital system; relate findings of the assessment to the udpotential for improvements in hospital performance; and determine the usefulness of the WHO HSPAF in assessing udperformance of hospital systems in a developing country.udMethods:This article is based on data collected from document analysis, 54 key informants comprising senior udmanagers and staff of the MoH (N= 40) and senior officers from stakeholder organizations (N= 14), and surveys of ud42 hospital managers and 389 health workers. Data from documents and transcripts were analyzed using content and udthematic analysis while data analysis for surveys was descriptive determining proportions and percentages.udResults: The organizational structure of the Botswana’s public hospital system, authority and decision-making are udhighly centralized. Overall physical access to health services is high. However, challenges in the distribution of udfacilities and inpatient beds create inequities and inefficiencies. Capacity of the hospitals to deliver services is limited udby inadequate resources. There are significant challenges with the quality of care.udConclusion:While Botswana invested considerably in building hospitals around the country resulting in high physical udaccess to services, the organization and governance of the hospital system, and inadequate resources limit service uddelivery. The ongoing efforts to decentralize management of hospitals to district level entities should be expedited. udThe WHO HSPAF enabled us to conduct a comprehensive assessment of the public hospital system. Though relatively udnew, this approach proved useful in this study.