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Botswana through its two educational reform philosophies of 1977 and 1994 envisioned a developing education system that is on par with international standards. According to Tabulawa (2009), the education system was developed to produce critical thinkers, problem solvers, and innovative learners. The system was designed to provide opportunities for all students by providing access to all, improve the standards of education, emancipate Batswana from illiteracy, and develop their capabilities to create a social transformation in their lives. Education was to be a vehicle for continuous positive change that would ultimately enable people to build a better world. However, the system is wanting since most students drop out of school, fail the national examinations, or are unemployable graduates. Research shows that the standard and quality of education is deteriorating as evidenced by high rates of failure at primary and secondary schools. This paper established the reasons for deteriorating standards and failure of students; and whether this was a result of the difficulty, the country finds itself in attempting to re-think and change its educational system to improve the standards or any other factors. This paper reviewed the obstacles leading to high failure rate in one primary school and the need to overhaul, rethink, reform and transform the country's education system. This study was carried out at the Ministry of Education and Skills Development, which is presently divided into two sub departments; the Ministry of Basic Education and Tertiary Education, Research, Science and Technology and one (1) primary school in Gaborone through the use of qualitative method.

Nations are tasked with expanding education, increasing its accessibility and quality to develop skilled labour forces needed to compete in the global world. Every nation is under pressure to strive to give their learners an opportunity to explore their potential to achieve the national and global educational goals. In learning, language and culture play a vital role in achieving educational goals at individual, national and international levels. This paper is part of the main study that used the qualitative approach to investigate how the language-in-education policy is implemented in ethnically and linguistically complex classrooms. The policy recognises only two languages of instruction: the national and a foreign language. Therefore, the idea is to see how such a policy is implemented in situations where learners do not speak the two languages. The findings indicate that there are challenges that could impede on achieving both the national and global educational goals especially Education for All goals as regards ethnic minority groups. The study observed that some of the marginalized groups such as BaZezuru and San lag behind due to language barrier and different lifestyle which are not considered in the implementation process. The paper recommends a reconsideration of the language-in-education policy that is inclusive in order to achieve the Education for All goals.

The integration of technology in the education process has immensely improved the acquisition and retention of knowledge. Although e-learning initiatives bring many advantages to the education system, these rewards have not been fully realised in developing countries like Botswana. Therefore, in the current study, authors set out to identify issues that may impede the introduction of an e-learning initiative at the Botswana University of Agriculture and Natural Resources. This paper presents findings from a survey of 50 academic staff of the university, to which 88 % (44/50) of the sample satisfactorily responded. Data was collected using a questionnaire and analysed using Microsoft Excel package. Four major challenges that should be addressed before an elearning initiative can be introduced successfully are identified as: poor infrastructure, inadequate IT support, lack of e-learning policy, and lack of university management support. Recommendations are made on the basis of the main findings, and can further be applied to other universities in a similar situation.

Purpose: Integrating laboratory work into interactive engineering eLearning contents augments theory with practice while simultaneously ameliorating the apparent theory-practice gap in traditional eLearning. The purpose of this paper is to assess and recommend media that currently fulfil this desirable dual pedagogical goal. Design/methodology/approach: The qualitative approach compares the eLearner-content interactivity deriving from Mathematica's Computable Document File (CDF) application, Pearson's myLab and Lucas-Nuelle's UniTrain-I. Illustrative interactive examples written in JavaScript and Java are thereby drawn from an engineering eLearning course developed at the University of Botswana (UB). Findings: Based on its scientific rigour, wide application scope, engineering analytical depth, minimal programming requirements and cross-subject-cum-faculty application and deployment potential, the authors found the CDF to be a versatile environment for generating dynamically interactive eLearning contents. The UniTrain-I, blending a multimedia information and communication technology (ICT)-based interactive eLearner-content philosophy with practical laboratory experimentation, is recommended for meeting the paper's dual eLearning goal as the most adept framework to-date, blending dynamic interactive eLearning content with laboratory hands-on engineering experimentation. Research limitations/implications: The lack of other competing frameworks limited the considerations to only the three mentioned above. Consequently, the results are subject to review as the ongoing research advances new insights. Originality/value: The conclusions help eLearning designers plan ICT-based resources for integration into practical electrical engineering eLearning pedagogy and both CDF and UniTrain-I help dispel the prevailing apparent disquiet regarding the effectiveness of the eLearning-mediated electrical engineering pedagogy. In addition, the cited examples document an original electrical engineering eLearning course developed at the UB.

The study investigates the effective utilization of Information and Communication Technology (ICT) by first year undergraduates of the University of Botswana (UB) in their reading and writing skills. The first year students are not first language (L1) learners of English. They have not utilized computers for learning reading and writing in their basic education and have not been exposed to such Learning Management Systems (LMS) as Blackboard and Moodle at the secondary school level. Consequently, at the university, when they are required to utilize computers in reading and writing in their core courses, this becomes a huge challenge. This paper investigates how UB first year undergraduates utilize the computer as an ICT tool in their reading and writing skills using the quantitative and qualitative research methods. A questionnaire was administered to 200 students enrolled in both ICT 121 and ENG 131 courses during the second semester of 2013/2014 academic year. In addition, interviews and classroom observations over the same period were conducted by the researchers. The constructivist theory of learning formed the theoretical framework. The findings reveal that most first year students have difficulty in downloading and uploading course materials using the LMS platforms; they are also unaware of the silent interactive communication offered by the computer as an ICT tool. The researchers recommend that first year undergraduate students should be given lots of practice on the use of the LMSs and computer skills for effective performance in their academic work.

Examinations play a central role in the educational system due to the fact that information generated from examinations is used for a variety of purposes. Critical decisions such as selection, placement and determining the instructional effectives of a programme of study all depend on data generated from examinations. Numerous research studies have shown that examinations have an influence on the learning and teaching process and that such influence could be either positive or negative. It is imperative that washback effect is evaluated to determine its impact on the quality of learning and teaching that goes on in the schools. This paper presents evidence that point towards presence of examination washback effect on the teaching process as a result of the format and content of the Primary School Leaving Examinations in Botswana. A questionnaire containing quantitative and qualitative items was used to capture opinions of teachers relating to the extent to which final examinations influences topic select, content coverage, teaching methods, and classroom activities. Generally, opinions presented by the teachers point towards presence of a negative washback effect. This apparent negative washback effect on the curriculum presents a challenge to a successful implementation of criterion reference testing system in Botswana.

This paper presents the results of a survey conducted to find out the extent to which teacher trainees understand and observe professional ethics. It also sought the contribution of the Faculty of Education and secondary schools make in promoting teacher ethics among trainees on teaching practice. Data were gathered from randomly chosen 90 participants as follows: 70 teacher trainees on teaching practice at schools, 10 school teaching practice coordinators and 10 lecturers in the Faculty of Education at the University of Botswana. A predominantly qualitative based empirical approach to data gathering that used an open-ended questionnaire was used. The results show that teacher trainees have a fair understanding of what teacher ethics and teacher professionalism entail. However, this knowledge does not translate into practice. Still teacher trainees indulge in love affairs with their students, which the study reveals. Such teacher behaviour undermines the academic performance of students particularly the girls as they are the most affected by such relations. Male teachers have been reported to be the ones who make advances towards girls more than female teachers to the boys on sexuality matters. Such behaviour by teacher trainees, as the survey suggests, has likely been partly influenced by the absence of an enacted code of ethics that teachers can relate to in their practice which has partly contributed to some teachers to flout professional conduct with impunity. The paper ends by recommending that a code of ethics for teachers is very necessary in order to raise the image of teaching as a vocation and that ethics education should be mandatory to all students of education at the teacher training institutions in Botswana.

The performance management system in different forms has been in existence in many countries for some years. In 1999 Botswana like other countries decided to implement a performance management system (PMS) across the entire public service including schools. At its introduction, the government explained the purpose for which this reform was being implemented. Drawing on a grounded theory study about school management's perceptions of the implementation process in senior secondary schools in Botswana, school heads, deputy school heads and heads of houses in twenty-two of the twenty-seven schools were interviewed. The implementation process of the PMS in schools is primarily the responsibility of these management team members. This paper, part of a bigger study conducted to investigate perceptions about the implementation of the performance management system in senior secondary schools in Botswana, explores factors that may have caused senior management to be dissatisfied with their capacity to implement the PMS.

This paper explored the myriad problems associated with undergraduate research supervision in social studies and religious education using one of the primary Colleges of Education near Gaborone, the capital city of Botswana as a case study. The study applied qualitative research involving interviews and focus group interviews to solicit information from eight college lecturers and ten final year students doing research in Religious Education and Social Studies. The respondents were purposively selected on the basis that they would provide rich data on the supervision of research projects. Additional information was generated through document and content analysis. The findings revealed that supervisors and student teachers at undergraduate level experience a large array of problems related to research capacity. The students, for example lacked presentation skills which has resulted in failure to present original work. There is also evidence of a relatively inadequate supervisory skills by college lecturers in terms of executing their supervision duties. The study concludes by calling for both supervisors and their supervisees to consider undergraduate research as a two-way process which requires expertise and adequate skills.

Different forms of the performance management system have been implemented in many countries for some years. As in other countries, in 1999 the government of Botswana took a decision to implement a performance management system (PMS) across the entire public service including schools. The government explained the purpose for which this reform was being implemented. Using grounded theory, school heads, deputy school heads and heads of houses in twenty-two of the twenty-seven schools were interviewed about senior management team's perceptions of the implementation process in senior secondary schools in Botswana. These members of the senior management team are responsible for the implementation process of the PMS in schools. This paper looks at participants' perceptions regarding the expected benefits of the PMS in senior secondary schools.

In this paper I embrace the thinking that writing on one's experiences in the use of qualitative educational research strategies and principles could potentially contribute to furthering knowledge in the field. In adopting an action research framework to guide collaborative work in a policy review exercise in Botswana, I found that collaborative work is itself a challenge. Similarly, given the political nature of policy formulation, significant effort and attention is required to facilitate broader reflection and debate on the adoption and use of qualitative research strategies in policy matters in Botswana. Generally my experience suggests that the strictures of underlying political life could be a powerful framework that profoundly shapes and constrains the perspectives and choices in policy review. I conclude with some statements concerning some lessons learnt during the policy review exercise.

Copyright of Critical African Studies is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper describes the experiences gathered in a Masters of Adult Education course at University of Botswana (UB), where 26 students of the University of Botswana and the University of Georgia (UGA) engaged in discussions within the University of Botswana Learning Management System WebCT. Individual participation patterns in the discussions varied widely in this course. Based on variables found in the literature, student participation patterns were analysed--both in terms of quantity (messages read and written) and quality (status of conversational moves and level of critical thinking). Results show that culture or membership of a specific group did not seem to influence participation patterns. Gender was the major influencing variable for participation patterns in terms of both quantity and quality. Other influencing variables were course design, assessment of discussions and the presence of a learning community.

Purpose: This article examined how institutional factors influencing the promotion of two elephant crop-raiding deterrent innovations (ECDIs) introduced to farmers through a ministry-based extension system in the Okavango Delta, Botswana, have impacted farmers' adoption behaviour. Methodology: A standardised interview schedule was used to elicit responses from 388 randomly sampled subsistence arable farmers on how institutions influenced the adoption of ECDIs in five communities in the study area. This was complemented by focus group discussions to obtain in-depth information on the subject-matter. Key informants interviews were also conducted with purposively selected extension agents, village project committee chairpersons and village dikgosi. Findings: Four institutional factors were found to be critical for the adoption of ECDIs. These include institutional relations, availability and/or supply of deterrent innovation inputs, farmers' contact with extension agents and government support for extension services. Theoretical Implications: Immediate and widespread adoption of ECDIs in the ever-changing socio-economic and political environment can be enhanced by context-specific institutional arrangements in addressing social and organisational constraints to innovation adoption. Originality: This paper invoked organisational theory to contribute to the scholarly debate on how agricultural extension systems influence farming clientele's behaviour and social change. It offers the first attempt in the investigation of the role of extension and associated institutions/organisations in promoting adoption of ECDIs among subsistence farmers in the Okavango Delta, Botswana. Findings indicate that local farmers do not perceive extension agencies to hold monopoly of ideas and solutions to their unique problems.

This paper derives from research carried out in a number of Botswana primary schools on teachers' understanding of curriculum adaptations for learners who experience learning difficulties (LD) as part of implementing inclusive education. Teachers' understanding play a crucial role in how they make curriculum accessible for learners with LD during the teaching and learning processes. Interviews with 12 teachers and classroom observations were conducted in six primary schools in urban, semi-urban and rural areas. The data was analysed using qualitative procedures, and results of the study revealed that teachers' understanding of curriculum adaptations seemed embedded within the concept of remedial education where learners with LD are assisted outside the scheduled time of the lesson. The results also showed that teachers' main focus on completing the set curriculum in preparation for examinations compromised curriculum access of learners with LD in general education classrooms.

This paper examines the micro planning activities that schools engage in to address learners' needs to make education work in rural primary schools of Botswana. The national language plan prescribes the use of English and Setswana only as languages of instruction at the primary school level. However, this plan is not practical in some regions where Setswana is not spoken as a first language, therefore, teachers and school administrators engage in the informal use of some of the learners' mother tongues. The study uses the qualitative approach to investigate the communication strategies adopted to address communication problems. Open-ended questionnaires, classroom observations and interviews were used to investigate the problem. Participants in the study involved teachers, school management and principal education officers as implementers of language policy. The findings indicate that although the language-in-education policy stipulates that Setswana and English are to be used for early learning as languages of instruction, some of the learners in rural primary schools neither speak nor understand the languages of instruction and this scenario creates communication problems during the teaching and learning process. Teachers and school management seek the services of cooks, teacher aide and learners to address the problem. The study concludes that macro-language planning does not adequately produce desired results and therefore teachers and school administrators seek communication strategies at the micro-level to address the needs of learners.

Drawing on post-structural and post-colonial conceptions of gender, this paper explores multiple student masculinities and femininities in the classrooms of four junior secondary schools in Botswana. These gendered identities, it is argued, are negotiated within broader institutional constraints that have been socio-historically produced. Such constraints include the colonial legacy of heavily authoritarian (and inherently gendered) teacher-student relations, which in turn are sustained (and resisted) through the practice of English as the medium of instruction, and a punitive disciplinary regime, which has corporal punishment at its core. Three similar gender performances are identified for both girls and boys: "good classroom students", "classroom rebels", and "docile bodies", though these are discursively produced and interpreted differently, against the norms of masculinity and femininity, and within a pervasive and stereotypical binary gender ideology.

The purpose of this paper is to illuminate that acquisition of knowledge, positive attitudes, skills and identity formation are by-products of primary socialisation and secondary interaction with people and institutions from all walks of family life, environmental experiences, and lifestyles. Based on the first phase of a qualitative case study on the socialisation and learned identities of people in poverty in two (one rural, one urban) selected areas of Botswana, the author agrees with the findings of the study and the title of this journal article that the existential socialisation and experiences of poor people from early childhood have shaped who they are. Miller (2002) echoes similar sentiments that poverty is both structural and individual. These perceptions of poverty include construction of how they are socialised to see themselves, the visions (or lack of visions) they have for themselves to make transitions from poverty to non-poverty, acceptance or non-acceptance of poverty, the search for options if any, their thought processes, and development of poverty identity belief systems. Excessive downward mobility below the Poverty Datum Line that respondents said they experienced as a result of the declining role of subsistence agriculture as a source of livelihood is an important factor in explaining why the poor could not make a transition from poverty to non-poverty. (Contains 1 table.)

Globalization pushes aside social, cultural, and ethical goals of education in favor of marketplace goals. Two stories of the indigenous Ju/'hoansi tribe in Botswana illustrate how even well-intentioned multicultural education programs can marginalize indigenous people, and how "globalization from below," fueled by communities of sentiment, can redirect globalization toward advancing social justice in a sustainable future. (Contains 24 references.) (TD)

This paper analyses community knowledge, perceptions, and experiences of effectiveness of healthcare service provision on malaria prevention/treatment in two disease-endemic villages of the Okavango Delta panhandle in northern Botswana. A stratified random sampling of 355 households was conducted in October–November 2015. Follow-up retrospective cohort interviews were undertaken in August 2016 from 79 households that reported malaria incidences during the household survey. Data were also collected from 16 key informant interviews and 2 focus group discussions participants. Descriptive statistics and content analyses were used to summarise quantitative and qualitative data, respectively. Results indicate that communities in the study sites had positive perceptions about efficiency of health services based on availability, accessibility and utilization, adequacy of prevention and treatment interventions. Local health clinics were crucial information channels used by respondents. Additionally, factors related to acceptability, availability and accessibility are likely to contribute to perceived effectiveness of the interventions provided by healthcare service providers. Affirmation of efficiency health service provision against malaria has public health implications for adherence to treatment/prevention and participation in community health education campaigns and program implementation in the Okavango Delta region. [ABSTRACT FROM AUTHOR]

Botswana has been depicted to be an example of a successful democracy in Africa since gaining independence in 1966. However, the country has dealt with many corruption scandals, and in 1994 established the Directorate on Corruption and Economic Crime (DCEC) followed by promulgation of the Whistleblowing Act in 2016 which is administered by the DCEC. These developments were indicative of a growing problem of corruption that led to the establishment of a specific government agency and legislative initiatives to address the scourge of corruption. The purpose of this qualitative study is to assess the impact and effectiveness of whistleblowing laws and processes. The paper, using grounded theory and 12 expert interviews with participants from different sectors and professions, highlights factors that constrain the effectiveness of whistleblowing laws and processes in Botswana. The findings indicate the main factors which include the lack of protection for whistle-blowers, institutional overlaps and conflict between government agencies, lack of trust in public officials and government, and manipulation of whistle-blower processes by elites. Thus, the study provides modest contributions to the literature on whistleblowing in Africa and offers recommendations to deal with corruption in Botswana. [ABSTRACT FROM AUTHOR]

The purpose of this article is to examine the role of Confucius Institute in Shaping China's National Image in Botswana in the case of CI Students. The Confucius Institute at the University of Botswana (CIUB) is employed as a case study which is identified as the most active Chinese soft power instrument in Botswana. The paper uses a qualitative research method to help better understand the benefits and limitations of CIUB in creating China's positive image in Botswana. Primary data is obtained from questionnaires whilst secondary data is derived from journal papers, thesis, and books. The study is framed by soft power theory to assist in learning how China utilises its soft power to improve its image in Botswana. The analysis revealed that CIUB has been fruitful in promoting Chinese language and culture in Botswana impacting positively on China's national image. The findings of the study show that CIUB has the potential to clear some negative perceptions about China in Botswana. However, the limitation as indicated by the study is that CIUB does not have wide coverage of the population of Botswana as it targets mostly students. It is suggested that CIUB as a single tool cannot fully address all the concerns affecting China's image. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to assess and compare the current state of archival and records systems in two of ESARBICA member countries, namely South Africa and Botswana. Design/methodology/approach - The paper uses a qualitative research approach. To draw inferences and make recommendations, a survey was conducted in national and provincial archival institutions of both countries. Secondary data were derived from literature search and primary data from questionnaires. Findings - While archives and records services in both countries do have legislation, they are not being recognised and given status in the government and public arena. Archivists and records managers in either country are still marginalised by state administration. There is no political champion of archives and records management in either country. There is a shortage of funds and staff, accompanied by poor infrastructure and lack of vision by the leaders of archival institutions in both countries. In South Africa, the national archives have inherited a role from the previous dispensation and it still remains a subordinate functionary within the Department of Arts and Culture, rather than being relatively independent. In Botswana, the national archival system is centralised and is also a subordinate functionary within the Ministry of Youth, Sports and Culture. Practical implications - The findings and recommendations will help in guiding national and provincial archival institutions in both countries to facilitate the effective management of records to determine those of archival value, to preserve them for posterity and to make them accessible to the public. Originality/value - This is the first comparative study on archival and reocrds management systems between Botswana and South Africa. [ABSTRACT FROM AUTHOR]

This paper examines the institutional management of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) in Botswana. We analyse the often contested roles of the state and non-governmental organisations (NGOs) as recipients of GFATM and partners in extending public health service provision to communities. Of importance is that Botswana's first GFATM grant had to be administratively closed, and the country was not awarded any other grant (especially for HIV/AIDS) until over a decade later. Following this, it is of interest to understand the ways in which institutions manage grant programmes. This article concludes that the "big brother" relationship of the state in relation to NGOs is crippling the critical and constructive effects of these organisations to deliver needed community-based health services in Botswana. GFTAM represents a window of opportunity for creating an effective civil society whose local activities will not be seen as being led covertly by the state. This article contributes to both theory and practice within the scholarship of development aid in Africa. Qualitative research methods were used, including in-depth interviews with public sector policy makers, all GFATM principal and sub-recipients, members of the Country Coordinating Mechanism (CCM) and NGOs. [ABSTRACT FROM AUTHOR]

Generations of parents lost to AIDS and other causes have created a vacuum of care for the orphaned children they leave behind. This crisis has resulted in rapid changes in caregiving and family life, with extended family members, having to care for orphaned children. As a result of high numbers of vulnerable orphaned children residing with kinship carers, and the fundamental importance of the relationship between carers and orphaned children, we need to understand more about these relationships. This paper explores the nature of orphaned children-kinship carer relationships in Botswana. Interview guides were used to collect data from 15 caregivers and 15 orphaned children. The results indicate that the nature of relationships between orphaned children and caregivers is influenced by the way the parties communicate, how adolescents behave and the competing responsibilities of caregivers. Lastly, the paper recommends how positive relationships can be developed and nurtured between orphaned children and their caregivers in an African setting. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to evaluate the current practice of facilities management (FM) in Botswana, particularly as it relates to building maintenance. Design/methodology/approach – Both qualitative and quantitative research methods (observations made from visual inspection of buildings and questionnaires) were used to obtain data in order to meet the objective of the study. A survey involving a self-administered questionnaire to facility managers was used. Findings – The study revealed that there was generally a lack of information on facilities managed due to a number of factors. The study also found that maintenance expenditure was not in accordance with recommended best practice ratios, that there was a lack of knowledge on the different types of maintenance and that the focus was mostly on emergency and day-to-day maintenance. Top management in some organisations also seemed to lack an understanding of the importance of FM, while maintenance departments suffered from under funding and budget cuts. Originality/value – From the key findings, recommendations are made in this paper to improve the practice of FM in Botswana. [ABSTRACT FROM AUTHOR]

International learning opportunities for students are sometimes framed as merely tourist experiences. Yet, short-term study abroad programs have the potential to significantly impact students' understanding of themselves as global citizens and contributors to conservation and sustainability efforts. In this study, we investigated a workshop bringing university students together with local farmers to design deterrents for keeping elephants out of farmers' fields in northern Botswana. With faculty mentors, students from four universities collectively designed and built prototypes of locally-feasible solutions that could mitigate human–elephant conflict in the Okavango Delta region. We present students' perceptions, experiences, and learning during and resulting from the workshop, including the differences between students' expectations prior to the workshop and the actual experience, and the qualities of global citizenship gained by partnering students with local people. Findings reveal the workshop's successes include workshop attendees' cross-cultural collaboration, applications of design-thinking and problem-solving to address local challenges in relevant ways, important cultural learning experiences for all participants, and co-created prototypes of machines and devices for local farmers to test and implement. [ABSTRACT FROM AUTHOR]

Botswana has been running Safe Male Circumcision (SMC) since 2009 and has not yet met its target. Donors like the US Centers for Disease Control and Prevention and Africa Comprehensive HIV/AIDS Partnership (funded by the Gates Foundation) in collaboration with Botswana's Ministry of Health have invested much to encourage HIV-negative men to circumcise. Demand creation strategies make use of media and celebrities. The objective of this paper is to explore responses to SMC in relation to circumcision as part of traditional initiation practices. More specifically, we present the views of two communities in Botswana on SMC consultation processes, implementation procedures and campaign strategies. The methods used include participant observation, in-depth interviews with key stakeholders (donors, implementers and Ministry officials), community leaders and men in the community. We observe that consultation with traditional leaders was done in a seemingly superficial, non-participatory manner. While SMC implementers reported pressure to deliver numbers to the World Health Organization, traditional leaders promoted circumcision through their routine traditional initiation ceremonies at breaks of two-year intervals. There were conflicting views on public SMC demand creation campaigns in relation to the traditional secrecy of circumcision. In conclusion, initial cooperation of local chiefs and elders turned into resistance. [ABSTRACT FROM PUBLISHER]

Background: Musculoskeletal diseases are the most common causes of long-term pain and disability worldwide and a growing international public health concern. However, the everyday burden and impact of musculoskeletal conditions are not well understood, especially among people living in low- and middle-income countries in Africa. Since 2011, World Spine Care, a nongovernmental organisation, has collaborated with the Botswana Ministry of Health to open spine care centres and to conduct research. The broad aim of the Muscle, Bone and Joint (MuBoJo) research project is to examine the sociocultural, organisational and clinical characteristics for the burden of living with and caring for people living with musculoskeletal conditions in rural Botswana. In this paper, we describe the community context, theoretical framework, and research methods to address the project aim with a qualitative study. Methods/Design: This focused ethnography is based on eight months (November 2011, April 2013, October 2013-March 2014) of fieldwork in Botswana. The project was theoretically informed by the concepts of explanatory models of illness, social suffering, and biographical disruption. Data collection included fieldnotes, non-participant and participant observations, and informal and in-depth interviews with villagers and healthcare providers. Villager interviews were typically conducted in Setswana with an interpreter. Audio recordings were transcribed verbatim in the language spoken with Setswana contextually translated into English. Computer software supported qualitative data management. Analysis is ongoing using constant comparison and a template organising style to facilitate pattern-finding and reveal insights for the burden and care of musculoskeletal conditions. Discussion: Findings from the MuBoJo Project will document the context of musculoskeletal burden, illness beliefs, self-care behaviours, and healthcare options in a Botswana rural village. These data will inform ongoing efforts to establish spine care clinics for underserved populations in low-middle income countries and sustain these healthcare services through local providers and volunteer health professionals. This study also will generate new knowledge about the burden and impact of muscle, bone and joint disorders for cross-cultural comparisons and patient-centred interventions. Conclusions: Our systematic and transparent methodology to conduct musculoskeletal research in more than one language and in a cross-cultural setting may be useful for investigators and NGO healthcare personnel. [ABSTRACT FROM AUTHOR]

Purpose: This paper sought to document the responsiveness of the University of Botswana towards the academic needs of students with visual impairments. The study examined the academic experiences of students with visual impairments enrolled at the University and explored their information-seeking needs. The study was informed by the theory of social justice. Method: This was a qualitative study. Data was collected from students with visual impairments and academic staff from different faculties at the University of Botswana, through document analysis, interviews and observation techniques. Results: The findings revealed that students with visual impairments experience extra challenges compared to students without disabilities. This is mainly because they do not get full support to enable them to excel academically. Furthermore, lecturers use teaching methodologies that do not accommodate these students, and learning materials are not adapted to formats suitable for them. Access to information is another major concern that hinders the participation of students with visual impairments in tertiary institutions. Conclusion: The study recommends that lecturers need to be trained on suitable methods to teach students with visual impairments and how best to deliver academic content to them. [ABSTRACT FROM AUTHOR]

Students with disabilities are under-represented in higher education (HE) institutions in Botswana. The number of students with disabilities is on the rise but parity has not been attained. The struggle of students with disabilities to access and participate in HE remains an issue of great concern for disability activists and researchers. This paper sought to document the experiences of university students with disabilities in their struggle to access and participate in HE. Seven students with disabilities took part in the study. Data were gathered through semi-structured focus group interviews. Later on these data were triangulated with an access-audit of facilities. Constant comparison methods were used for data analysis. Six themes emerged, namely: attitudinal barriers; resource barriers; structural barriers; policy related issues; lack of support mechanisms; and lack of skills and knowledge. Implications of the findings to institutions of higher learning are discussed in order to promote wider participation for students with disabilities in HE in Botswana. [ABSTRACT FROM AUTHOR]

Copyright of Salud, Ciencia y Tecnología is the property of Fundacion Salud, Ciencia y Tecnologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This study investigates the effectiveness of Presidential Directives in comparison to the traditional policy process in Botswana. More precisely, the study determines whether the use of Presidential Directives is a more efficient and effective means of achieving policy outputs, as compared to the traditional policy process. To achieve this, the study conducted a comprehensive analysis of policies and Presidential Directives in Botswana, examining the processes through which they were formulated, implemented, and evaluated. The methodological approach adopted includes an intrepretivist research paradigm as well as a qualitative research approach for both data collection and analysis. Results reveals that Presidential directives achieve outputs faster and more effectively than the traditional policy process, Presidential Directives may have some advantages in terms of speed and flexibility, they are not necessarily more effective than the traditional policy process in achieving their planned outcomes, policy process, which involves stakeholder consultation, evidence-based decision-making and comprehensive analysis of the policy context, is a more reliable and effective means of policy-making in the long term. However, the study also found that there are some areas where Presidential Directives may be more appropriate, such as in emergency situations or when quick decisions are required. Overall, this research provides valuable insights into the effectiveness of different approaches to policy-making in Botswana, and its findings have important implications for policymakers, practitioners, and researchers in the field of public policy. The study recommends transparency and accountability; stakeholder engagement; evidence-based policy-making and comprehensive policy evaluation. [ABSTRACT FROM AUTHOR]

Background: The recovery‐oriented care approach in mental health is recognised as the vision for mental health. People with a diagnosis of mental illness value the support and the individualistic approach emphasised in the recovery‐oriented mental health care approach as they believe it facilitates their recovery. However, as a developing country, Botswana has a long way to go in availing mental health care resources to people with mental illness, let alone adopting new mental health approaches such as recovery. Aim: The study aimed to explore the perceptions of nurses working in mental health care facilities of recovery‐oriented mental health care. Methods: Four mental health facilities from Botswana consented to participate in the study. A descriptive qualitative approach was utilised to explore nurses' views on how they perceive recovery from mental illness. Thirty nurses participated in the focus group discussions across the four study sites. All participants consented to participate and to be recorded. Tesch's (in Qualitative enquiry and research design: Choosing among five approaches. 3th ed. SAGE, 2013:198) thematic analysis was used for this study. Results: Three main themes were identified in participants' perceptions of recovery‐oriented care mental health: Recovery from mental illness is possible, the Meaning of recovery from mental illness and Factors facilitating recovery from mental illness. Public Contribution: The study offers a perspective into how nurses perceive recovery‐oriented approaches from a developing country and add to the gap existing in recovery‐oriented mental health care approach from the African context. [ABSTRACT FROM AUTHOR]

This study qualitatively explores HIV-related gossip as both a manifestation and driver of HIV-related stigma, which is a known barrier to HIV testing and treatment in Botswana. Data were elicited from 5 focus group discussions and 46 semi-structured in-depth interviews with individuals living with HIV and community members with undisclosed serostatus in Gaborone, Botswana in 2017 (n = 84). Directed content analysis using the 'What Matters Most' theoretical framework identified culturally salient manifestations of HIV-related stigma; simultaneous use of Modified Labeling Theory allowed interpretation and stepwise organization of how the social phenomenon of gossip leads to adverse HIV outcomes. Results indicated that HIV-related gossip can diminish community standing through culturally influenced mechanisms, in turn precipitating poor psychosocial well-being and worsened HIV-related outcomes. These harms may be offset by protective factors, such as appearing healthy, accepting one's HIV status, and community education about the harms of gossip. [ABSTRACT FROM AUTHOR]

Aim: Nurses as front liners have direct contact with COVID‐19 patients during the pandemic. Carrying the heavy burden during the pandemic has a mental health toll on healthcare professionals. The study explored nurses' experiences of psychological distress during the COVID‐19 pandemic in Botswana's two COVID‐19 special care centres. Design: The study used qualitative case study research to solicit nurses' experiences caring for patients with COVID‐19 in selected COVID‐19 centres in Gaborone. Method: Researchers purposively recruited nurses from two COVID‐19 centres in Botswana. Data were collected using semi‐structured telephone interviews and analysed through inductive thematic analysis. Various institutional review boards ethically cleared the study. Results: Six themes emerged from the thematic analysis: feelings of fear and anxiety, hopelessness and helplessness, loneliness, physical distress, support mechanism and commitment to care. Public Contribution: The results offer important insights into the nurses' experiences during the COVI‐19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases are on the rise across sub-Saharan Africa. The region has become a targeted growth market for sugar-sweetened beverages, which are associated with weight gain, cardiovascular diseases and diabetes. Objective: To identify politico-economic factors relevant to nutrition-related fiscal policies, and to draw lessons regarding strategies to strengthen sugar-sweetened beverages taxation in the region and globally. Methods: We collected documentary data on policy content, stakeholders and corporate political activity from seven countries in east and southern Africa augmented by qualitative interviews in Botswana, Namibia, Kenya and Zambia, and stakeholder consultations in Rwanda, Tanzania and Uganda. Data were analysed using a political economy framework, focusing on ideas, institutions, interests and power, and a 'bricolage' approach was employed to identify strategies for future action. Results: Non-communicable diseases were recognised as a priority in all countries. Kenya, Zambia, Rwanda, Tanzania and Uganda had taxes on non-alcoholic beverages, which varied in rate and tax base, but appeared to be motivated by revenue rather than health concerns. Botswana and Namibia indicated intention to adopt sugar-sweetened beverage taxes. Health-oriented sugar-sweetened beverage taxation faced challenges from entrenched economic policy paradigms for industry-led economic growth and was actively opposed by sugar- sweetened beverage-related industries. Strategies identified to support stronger sugar-sweetened beverage taxation included shifting the economic discourse to strengthen health considerations, developing positive public opinion, forging links with the agriculture sector for shared benefit, and leadership by a central government agency. Conclusions: There are opportunities for more strategic public health engagement with the economic sector to foster strong nutrition-related fiscal policy for non-communicable disease prevention in the region. [ABSTRACT FROM AUTHOR]

Alcohol consumption studies in sub-Saharan Africa have largely focused on social control and regulatory mechanisms in specific settings without particular reference to how drinkers negotiate and navigate their drinking selves. Existing studies do not give enough attention to how consumers enact, make sense and experience drinking in light of state regulatory efforts. Using a constructivist grounded theory approach among twenty (20) beer drinkers, this study identifies how beer drinkers in Botswana experienced alcohol. Our findings demonstrate a theoretical category of Negotiating the Drinking Self where beer drinkers constructed and enacted a drinking self throughout the life-course, from the point of exposure at home through adolescence and up to maturity. The drinking self-constitutes an important part of the drinker's identity and adapts to each stage of the life-course. Among the working poor in Botswana, beer drinking is complex, situated and embedded in webs of patterned social interactions. [ABSTRACT FROM AUTHOR]

In this article, two white, Western female researchers reflect on the methodological, ethical, and practical dilemmas experienced while conducting social science fieldwork in Botswana for their doctoral degrees. In addition, their shared research assistant examines her role as a social and cultural interlocutor, which was essential to the researchers' successful navigation in their various field sites. Drawing on distinct but common experiences conducting research in northern and western regions of rural Botswana, the authors reflexively consider a series of interwoven issues tied to their positionalities: the disparity in benefits and return on research investment between the researcher and research participants; the nature of commodified or transactional relations, especially in an impoverished region highly dependent on foreign tourists; the complex nature of researcher–research assistant relationships; and the contradictory dynamics of being female researchers in a patriarchal society while also embodying privileges of whiteness and Western nationality. Building on these reflections, the authors engage with current debates in the social sciences to argue that researcher reflexivity is not an adequate end point and should result in engagement with ethical and epistemological questions regarding the decolonization of research practices more broadly. [ABSTRACT FROM AUTHOR]

Maternal mortality due to unsafe abortion and its complications stands among the three leading causes of maternal death in Botswana. Health care providers (HCPs) including doctors and nurses are at the frontline of providing care to women who have had an unsafe abortion. This qualitative study explored the knowledge, attitudes and perceptions of HCPs towards unsafe abortion in Botswana. We purposively sampled 18 HCPs and used a semi-structured topic guide to engage them in in-depth interviews, which were audio-recorded. These interviews were transcribed and analysed to identify emerging themes. We found that HCPs were knowledgeable about unsafe abortion, local inducers, and its management. However, their religious and moral biases as well as concern for the safety of women biased their view on the subject-matter and of the women themselves. These biases also affected their willingness to provide care, including provision of analgesics. Notwithstanding these biases and the reported lack of clarity on their legal role in managing unsafe abortion, many HCPs recognised their duty-of-care to patients. The continued strengthening of post-abortion services should be implemented in conjunction with engagements with providers to clarify their values and the roles they would be willing to play in abortion and post-abortion care services. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to explore nurse educator academic incivility from the perspectives of nurse educator leaders. Background: The academic environment should be safe and conducive to both teaching and learning. Both the students and faculty should have a sense of belonging and of being valued. Introduction: Faculty‐to‐faculty incivility has been reported as being disruptive to the teaching and learning environment, and is associated with poor work outputs. Method: A qualitative descriptive design, as explained by Sandelowski, was used to explore academic incivility as perceived by nurse educator leaders. Twenty semi‐structured interviews were conducted with nurse educator leaders, representing three levels of management in Botswana. The approach of Elo and Kyngas was used to analyse qualitative data. Their main aim was to compare categories at different periods, as was the case with different categories of nurse leaders in this study. Findings: Three main themes emerged from the data analysis: lack of policy implementation, inadequate leadership skillsandrole modelling. Two subthemes emerged from the theme, lack of policy implementation, namely: poor record‐keeping and hierarchical issues. On further analysis of the theme, inadequate leadership skills,poor hierarchical coordination among nurse educator leaders; and favouritism emerged as subthemes. The last theme, role modelling, needed no further development and described the modelling of incivility as the behaviour that has birthed a generation of incivility among nurse educators. Conclusion: Incivility exists in nursing colleges in Botswana, and it includes unruly behaviour towards one another; late coming; disrespect; and disregard of authority. Implications for nursing education policy: There must be collaboration between nurse educators and health policymakers to strengthen cordial relationships as well as foster disciplinary procedures on incivility. Clear policy on disciplinary procedures focusing on mitigating various forms of uncivil behaviours is imperative. Nurse educator leaders' training on management skill should also be strengthened and made mandatory before nurse educators are appointed to leadership positions. [ABSTRACT FROM AUTHOR]

We conducted a qualitative study using focus groups and in-depth interviews to explore barriers to and facilitators of linkage-to-care and antiretroviral treatment (ART) initiation in Botswana. Participants were selected from communities receiving interventions through the Ya Tsie Study. Fifteen healthcare providers and 49 HIV-positive individuals participated. HIV-positive participants identified barriers including stigma, discrimination and overcrowded clinics, and negative staff attitudes; personal factors, such as a lack of acceptance of one's HIV status, non-disclosure, and gender differences; along with lack of social/family support, and certain religious beliefs. Healthcare providers cited delayed test results, poverty, and transport difficulties as additional barriers. Major facilitators were support from healthcare providers, including home visits, social support, and knowing the benefits of ART. Participants were highly supportive of universal ART as a personal health measure. Our results highlighted a persistent structural health facility barrier: HIV-positive patients expressed strong discontent with HIV care/treatment being delivered differently than routine healthcare, feeling inconvenienced and stigmatized by separately designated locations and days of service. This barrier was particularly problematic for highly mobile persons. Addressing this structural barrier, which persists even in the context of high ART uptake, could bring gains in willingness to initiate ART and improved adherence in Botswana and elsewhere. [ABSTRACT FROM AUTHOR]

This article examines perceptions of sexual functioning, satisfaction, and risk-taking related to voluntary medical male circumcision (VMMC) in Botswana. Twenty-seven focus group discussions were conducted in four purposively selected communities with community leaders, men, and women. Discussions were analyzed using an inductive content analytic approach. Perceptions of VMMC's impact on sexual functioning and satisfaction varied. Increased satisfaction was attributed to improved penile health and increased ejaculatory latency time, whereas decreased satisfaction was attributed to erectile dysfunction and increased vaginal irritation during sex. Most participants thought sexual disinhibition occurred after circumcision; nevertheless, some women said they used male circumcision status as a marker of HIV status, thereby influencing sexual decision-making and partner selection. Messaging should emphasize that VMMC does not afford complete HIV protection. Optimizing VMMC's impact requires increasing uptake while minimizing behavioral disinhibition, with a balance between potential messaging of improved sexual functioning and satisfaction and the potential impact on sexual disinhibition. [ABSTRACT FROM AUTHOR]

Adult women are disproportionately affected by overweight and obesity in Sub-Saharan African (SSA) countries. Existing evidence on the sociocultural context remains unconsolidated. In this qualitative research synthesis, we aggregate research literature on contextual factors that potentially predispose adult women and adolescent girls to overweight and obesity to inform research, policies and programs over the life course. PubMed, CINAHL, PsychInfo, ProQuest Central, EMBASE, and Web of Science were searched to locate qualitative research articles conducted in SSA countries beginning in the year 2000. After assessment for eligibility and critical appraisal, 17 studies were included in the synthesis. Textual data and quotes were synthesized using meta-aggregation methods proposed by the Joanna Briggs Institute. The synthesized studies were conducted in South Africa, Ghana, Kenya and Botswana. The three overarching themes across these studies were body size and shape ideals, barriers to healthy eating, and barriers to physical activity, with cultural and social factors as cross-cutting influences within the major themes. Culturally, the supposedly ideal African woman was expected to be overweight or obese, and voluptuous, and this was associated with their identity. Although being overweight or obese was not acceptable to adolescent girls, they desired to be voluptuous. Healthy food choices among women and adolescent girls were hampered by several factors including affordability of nutritious foods and peer victimization. Both adult women and adolescent girls experienced ageism as a barrier to physical activity. This is the first qualitative research synthesis to amplify the voices of women and girls in SSA countries highlighting the challenges they face in maintaining a healthy body weight. Sociocultural, institutional and peer-related factors were powerful forces shaping body size preferences, food choices and participation in physical activity. Our study findings provide insights for the design of contextually appropriate obesity prevention interventions and lay the foundation for further research studies. [ABSTRACT FROM AUTHOR]

Background: Patients in the Intensive Care Unit (ICU) often experience communication difficulties - usually associated with mechanical ventilation - resulting in psychological problems such as anxiety, fear, and depression. Good communication between nurses and patients is critical for success from personalised nursing care of each patient. The purpose of this study is to describe nurses' experience of a communication skills training intervention. Methods: A convenience sample of twenty intensive care nurses participated in the study. Data was collected by means of interviews with nurses. Data from the interviews were analysed using qualitative thematic content analysis. Results: Six themes emerged: (1) acceptance of knowledge and skills developed during workshops; (2) management support; (3) appreciation of augmentative and alternative communication (AAC) devices; (4) change in attitudes; and (5) the need to share knowledge with others and (6) inclusion of communication skills workshop training as an integral part of an orientation programme for all nurses. Conclusion: The findings of this study indicated that the application of augmentative and alternative communication devices and strategies can improve nurse-patient communication in intensive care units. Therefore, the implementation of communication skills training for intensive care nurses should constantly be encouraged and, indeed, introduced as a key element of ICU care training. [ABSTRACT FROM AUTHOR]

Aim: The qualitative research findings are reported on the perceptions of key participants in Botswana about adolescent sexuality problems and the feasibility (with suggestions) of an adolescent prevention intervention. Methods: Twenty adult key participants who were selected through purposive sampling from schools and youth centers responded to open-ended questions during face-to-face individual in-depth interviews that were conducted between December, 2011 and January, 2012 in Gaborone, Botswana. Results: The data were analyzed by using an inductive content analysis. Five major themes and 12 subthemes emerged from the interviews. The key participants discussed situations that exposed adolescents to HIV, sexually transmitted infections, and pregnancy. They also discussed unsafe sexual practices, the consequences of unprotected sex, poor parent-adolescent communication on sexuality, and the need for a sexuality education program. Conclusion: Policy changes are needed to improve collaboration between adolescents, parents, teachers, and youth officers in order to address adolescent sexuality problems. Further research is needed to explore the ways in which to improve sexuality communication between these groups. The results of the study provide valuable information on the sexuality risks that expose adolescents to HIV, pregnancy, and sexually transmitted infections and the strategies for the prevention of these risks, thus informing targeted interventions for risk reduction for adolescents. [ABSTRACT FROM AUTHOR]

Background: Health systems across Africa are faced with a multitude of competing priorities amidst pressing resource constraints. Expansion of health insurance coverage offers promise in the quest for sustainable healthcare financing for many of the health systems in the region. However, the broader policy implications of expanding health insurance coverage have not been fully investigated and contextualized to many African health systems. Methods: We interviewed 37 key informants drawn from public, private and civil society organizations involved in health service delivery in Botswana. The objective was to determine the potential health system impacts that would result from expanding the health insurance scheme covering public sector employees. Study participants were selected through purposeful sampling, stakeholder mapping, and snowballing. We thematically synthesized their views, focusing on the key health system areas of access to medicines, efficiency and cost-effectiveness, as intermediate milestones towards universal health coverage. Results: Participants suggested that expansion of health insurance would be characterized by increased financial resources for health and catalyze an upsurge in utilization of health services particularly among those with health insurance cover. As a result, the health system, particularly within the private sector, would be expected to see higher demand for medicines and other health technologies. However, majority of the respondents cautioned that, realizing the full benefits of improved population health, equitable distribution and financial risk protection, would be wholly dependent on having sound policies, regulations and functional accountability systems in place. It was recommended that, health system stewards should embrace efficient and cost-effective delivery, in order to make progress towards universal health coverage. Conclusion: Despite the prospects of increasing financial resources available for health service delivery, expansion of health insurance also comes with many challenges. Decision-makers keen to achieve universal health coverage, must view health financing reform through the holistic lens of the health system and its interactions with the population, in order to anticipate its potential benefits and risks. Failure to embrace this comprehensive approach, would potentially lead to counterproductive results. [ABSTRACT FROM AUTHOR]

Background Botswana has a human immunodeficiency virus ( HIV) prevalence of 18.6% and an estimated 137 805 orphans in a population of approximately two million people. Many of these orphans are cared for by their grandmothers, who struggle with caring for orphans suffering from a disease they know very little about. Methods The purpose of this exploratory qualitative study was to explore experiences of grandmothers caring for HIV-positive orphan grandchildren. Results The ages of the grandmothers interviewed ranged from 60 to 80 years, while the number of orphans under their care ranged from one to nine. The themes that emerged included the following: challenges of HIV treatment, HIV-related stigma, disclosure of HIV status, communication of sexuality issues and the adolescent pregnancies. Cultural beliefs prevented them from talking about sexuality and in some cases, accepting HIV as the cause of death. Conclusions Grandmothers were challenged by HIV treatment of orphans and their supportive role as caregivers. The lack of knowledge of the disease must be addressed to improve adherence and communication about HIV. HIV programs need to address older persons' dynamic and diverse needs as individuals. Community home-based care nurses need to support grandmothers caring for HIV-positive grandchildren and refer them to relevant professionals who can assist with the care responsibilities. Implications for practice Nurses working with older people caring for HIV positive orphans need to develop culturally sensitive HIV education programs that address needs specific to. [ABSTRACT FROM AUTHOR]

Background: Globally, about 150 million people experience catastrophic healthcare expenditure services annually. Among low and middle income countries, out-of-pocket expenditure pushes about 100 million people into poverty annually. In Botswana, 83 % of the general population and 58 % of employed individuals do not have medical aid coverage. Moreover, inequity allocation of financial resources between health services suggests marginalization of population-based health care services (i.e. diseases prevention and health promotion). The purpose of the study is to explore perspectives on employed individuals regarding financing population based health care interventions towards Universal Health Coverage (UHC) in order to make recommendations to the Ministry of Health on health financing options to cover population-based health services.Methods: A qualitative design grounded in interpretivist epistemology through social constructivism lens was critical for exploring perspectives of employed individuals. Through purposive and snowballing sampling techniques, a total of 15 respondents including 8 males and 7 females were recruited and interviewed using a semi-structured format. Their age ranged from 23 to 59 years with a median of 36 years. Data was analyzed using Thematic Content Analysis technique.Results: Use of social constructivism lens enabled to classify emerging themes into population coverage, health services coverage and financial protection issues. Despite broad understanding of health coverage schemes among participants, knowledge appears insignificant in increasing enrolment. Participants indicated limited understanding of UHC concepts, however showed willingness to embrace UHC upon brief description. Main thematic issues raised include: exclusion of population-based health services from coverage scheme; disparity in financial protection and health services coverage among enrollees; inability to sustain contracted employees; and systematic exclusion of unemployed individuals and informal sector employees.Conclusion: Increasing enrolment in health coverage schemes requires targeted campaign for information dissemination through use of myriads mass media including: social networks, TV, Radio and others. Moreover, re-designing health insurance schemes is critical in order to include population-based interventions; expand uptake of unemployed and informal sector employees; flexibility in monthly premiums payment plan and use of technology to increase access to payment points. Further study need to evaluate the content of health financing policy in Botswana measured against the World Health Organization Universal Health Coverage conceptual requirements for Low and Middle Income Countries. [ABSTRACT FROM AUTHOR]