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INTRODUCTION

HUMAN RESOURCE POLICY ISSUES (COUNTRY EXPERIENCE BOTSWANA) Presentation by: A. K. Morapedi, RN, RM, MA G. Feringa, RN, MEd. INTRODUCTION. Botswana is a landlocked, semi-arid country. of 582 000 square kilometers and has a population of 1.7m.

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INTRODUCTION

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  1. HUMAN RESOURCE POLICY ISSUES (COUNTRY EXPERIENCE BOTSWANA)Presentation by: A. K. Morapedi, RN, RM, MAG. Feringa, RN, MEd

  2. INTRODUCTION Botswana is a landlocked, semi-arid country. of 582 000 square kilometers and has a population of 1.7m. It is one of the sub-Saharan African countries located in Southern Africa.

  3. The population growth rate in Botswana has been declining from as high as 4.5 percent between 1971-1981 to the current rate of 2.4%. This decline is attributed to the: - HIV/AIDS pandemic. - Declining fertility rates. - Access to better health care. Life expectancy at birth decreased from 65.3 years in 1991 to 55.7 in 200, and is even lower now due to HIV/AIDS.

  4. Health Care System and Service Delivery • Health Care in Botswana is delivered through a decentralized model with Community/Primary Health Care being the pillar of the delivery system. • Health services are under the management of both Ministry of Health (MOH) which represent all hospitals and Ministry of Local Government (MOLG) (clinics).

  5. Health Care System and Service Delivery cont…. • Nurses in Botswana constitutes 60 - 70% of the health work force; this makes them the back bone of the heath care system. • Approx. 7,500 nurses are practicing in Botswana. • Approx. 7 % of the nursing work force constitutes non-local nurses. • Approx 7% of the local nurses have migrated. • There are approx. 2.65 nurses per 1000 inhabitants. • This is more than in some countries in the region and less than in others, but far less than in western countries.

  6. Health Human Resource Policy • Botswana does not have Health, Human Resource Policy however a Human Resource Plan is developed (Draft Document in place), which will be used as a guide for Health Human Resource Issues.

  7. The Purpose of the Human Resource Plan • To develop a new comprehensive national human resource plan and policy document, which includes: • Equitable distribution of human resources. • Accessible services through the availability of human resources. • Guidelines on implementation of the human resources plan including recruitment and retention strategies. • The time frame for the (draft) Human Resource Plan to be effected, implemented and operational (10) years. • To include all short to medium term planning done for both Ministries of Health and Local Government developments impacting on the health service delivery.

  8. Critical Health Issues facing Botswana Issues related to: • The organization and function of the health system (availability of resources). • The epidemiological profile of Botswana, the most prominent being HIV/AIDS. This places great pressure on nurses working with: • Hospital in-patients services that have to cope with large numbers of people with late stage disease and high mortality, and • High patient loads at clinics, being the first contact of clients with the health workers in the PHC context.

  9. Challenges 1. Absenteeism and poor time management. • Current utilization of sick leave is unaffordable. • Current utilization of compassionate leave is unaffordable. • Annual and long leave planning results in wards and other units being short staffed. • Training “leave” is a huge problem in that nurses are withdrawn from their workplace for extensive periods without provision of “hands”. • Adherence to working hours and lack of monitoring and management of working hours.

  10. 2. Shortage of nursing staff. • Is indeed a concern in Botswana, whereby the functioning of health facilities is to such a large extent dependent on nursing personnel. • Inadequate numbers of nursing personnel causes facilities to be understaffed, or at times certain facilities/wards not having being operational at all. • Shortage of staff causes increase of stress, ultimately leading to job dissatisfaction and attrition.

  11. Shortage of Nursing staff cont… • Poor quality care and nurses leaving the public service (Presidential commission on the condition of service, October 2007). • Shortage of nursing staff may lead to increased mortality rates among patients. • A relationship exists between workplace stress and nurses morale, job satisfaction, commitment to the organization and the intention to quit (ICN, 2007).

  12. MIGRATION OF NURSES • Nurses leaving the profession is a concern in Botswana and exacerbates the already existing shortages. • Botswana experiences exodus of knowledgeable, skilled and experienced nurses (see table). • Implications of the exodus include: brain drain, poor quality care, burnout and reduced intake in health training institutions. Source * DLGSM, Personnel Register Source** MOH

  13. ATTRITION The attrition rate is due to: - Resignations - Early retirement - Deaths due to the HIV/ AIDS - Chronic illnesses Resignations are due to: • Unsatisfactory conditions of service • Low salaries • Inadequate housing • Lack of continued education opportunities • Lack of recognition of cont’d education • HIV/AIDS • Lack of promotions Source: Migration studies (2007).

  14. ATTRITION cont… • Recruitment by foreign countries: - Loss of investment. - Loss of manpower. • Recruitment by international bodies operating in the Botswana, such as: • Harvard HIV/AIDS Institute (USA) • African Comprehensive HIV/AIDS Programme (ACHAP-USA) • BOTUSA (Botswana / USA) • UN agencies (e.g. WHO) • Health Insurance Companies

  15. TRIPATITE ROLE/MODEL • Government of Botswana: - Planning - Recruitment - Retention • Regulatory Body (NMCB) - Standards - Ratio’s - Licensing • NNA (NAB) - SEW: - research (migration studies) - advocacy and negotiations: - (submissions to salary commission) - (amendments to Schemes of Service) - policy development input - HIV/AIDS - extended scope of practice - Professional Development (projects) - Caring for the Caregiver

  16. PLANNING Government and Organisations have plans in place for: • Recruitment of human resources. • Material and financial resources. • Availing health facilities for delivering of health services (15 km radius). • Training to build capacity.

  17. RECRUITMENT Local, regional and international recruitment strategies are in place, however these do not meet required numbers.

  18. RETENTION Retention policies are inadequate: • Better pay structure, better working conditions and provision of the on job training are needed. • Recognition of cont’d education. • Lack of promotions. • Manpower ceilings. • Distribution of equitable benefits to all health care providers.

  19. SUMMARY • Good relation exists between government, NMCB and NAB. • Although Botswana is recognized as a middle income country, health resources, especially manpower is still very limited. • The Government is good in recruiting staff but less so in retaining them. • Importance of human resources for health is recognized, hence government: - Is in the process of drawing a human health development plan. - A salary commission has been commissioned. - The schemes of service for health personnel is being revised.

  20. Thank you !!!!!!!!!!Le Ka Moso!!!!!

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