Action strategies for enhancing the implementation of performance improvement initiatives within the health sector in Botswana.
Kachingwe, Lasting Ketsile.
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This study investigates the extent to which performance improvement initiatives are efficiently and effectively implemented in the Botswana health sector. The study is prompted by numerous public complaints through various media, the results of customer satisfaction surveys that lowly rated the delivery of health services, and the acknowledgement by public officials that the provision of services, particularly health services, left a lot to be desired. The perceived under-performance in the delivery of health services to the public was in spite of the significant health sector expenditure that is in line with the Governments‟ efforts to prioritise the improvement of the health status of the nation and the introduction of performance improvement initiatives. The study assesses the evidential base for sustaining a three-fold hypothesis, that is: performance improvement initiatives were imposed in a top-down manner in the Botswana health sector with the noble belief that they were valuable in contributing towards the achievement of the goals of Vision 2016; there is limited knowledge on the part of the health workers at the operational level regarding the usefulness of the performance improvement initiatives and this contributes to their low uptake of the initiatives in Botswana health sector; and the frequency of complaints by health services consumers is a reflection of the poor quality of health services provided in the health sector in Botswana. The perceptions of staff and patients regarding the quality indicators of efficiency, effectiveness, empowerment and equity were examined. Data collection was triangulated through the use of different data collection methods and the collection of data from different sources such as self-administered questionnaires for senior management in the Ministry of Health, in-depth interviews of health workers and consumers of health services in the form of patients and Focus Group Discussions for community members. The health facilities under study in the public sector were stratified according to the level of operation with systematic sampling used to select hospitals from each level. The conclusions of the study, based on the empirical work, is that although the staff proved to be knowledgeable of the existence of the performance improvement initiatives, there was a moderate effectiveness of the initiatives in the public health sector with a higher success rate in the private health sector. The efficiency with which the initiatives were implemented was compromised by the perceived internal inequities and poor conditions of service as well as low remuneration packages for health sector staff. The consumers of health services indicated their satisfaction with the equitable distribution of services. There were weaknesses in the empowerment mechanisms for both health workers and consumers of health services. The findings revealed inadequacies in the implementation of the initiatives. Positive results were noted for the empowerment of employees through their participation in the planning for health services delivery. Recommendations include: the need to strengthen the community interface with health service providers; the inculcation into health workers of values that prioritise the interests of clients; the involvement of all stakeholders in planning; and the contextualisation of the performance improvement initiatives.
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