Community improvers impress district and national officials in Mahalapye, Botswana
Participants in a Community Improvement Learning Session in Botswana. Photo by URC.
On August 2-3, ASSIST Botswana conducted a very interactive and lively Learning Session in Mahalapye Sub-District. For two days, community improvers from across the district shared their experiences and the lessons they learned from applying quality improvement in their villages and wards, supported by ASSIST. Joined by important actors from the district-level administration and national stakeholders, the learning session also served as a basis for exploring how community-directed improvement can be connected with formal coordination of service delivery, both by Government facilities and NGO providers. District actors were impressed and showed great interest in institutionalizing the innovative ideas communities developed to improve the delivery of services, thereby addressing critical bottlenecks in achieving epidemic control of HIV and related conditions. This was their experience.
"I was speechless. I was expecting something else."
These were the first words by Dr. Kunal Bose, Head of the District Health Management Team (DHMT), as he spoke for the first time in the closing segment of the Community Improvement Learning Session in Mahalapye Sub-District. The Botswana ASSIST team had organized the session as a platform for the six community improvement teams that the project had been coaching in the district during the past few months.
Pusetso, Remmogo, Mosekaphofu, Pathfinder, Bophelo and Bosabosele: these are the Setswana team names communities had chosen for themselves, reflecting both their commitment to local change and their independence from ASSIST as an external project. From the start, members of the ASSIST team had consulted with traditional leaders in the district to explain the role of ASSIST and the power of quality improvement as a practical and effective tool for problem-solving.
Offering the support of the project and explaining the approach, ASSIST coaches had also been careful to manage expectations. Too many projects, they had been told by Dikgosi - the traditional tribal chiefs - had come and left again in recent years. Most of them had been focused on HIV/AIDS, but few had left a lasting impact or benefits for communities.
Working with Dikgosi and chairs of village development committees (VDCs), ASSIST coaches had formed the community improvement teams as a way to strengthen existing community structures in their respective contexts. Community leaders had embraced the idea of improvement, and responded enthusiastically to an invitation to meet members of other community improvements teams from the same district to share and learn from each other. All of them had already undertaken in-depth problem analyses, brainstormed and prioritized change ideas – and had first-hand experiences with the implementation of their top ideas. These teams addressed what members felt were urgent quality issues around HIV testing and facility efforts to reach out to patients who had stopped treatment. Now they were eager to spread their learning to other like-minded teams who shared their commitment to what they had developed, tested and experimented with.
Overview of participants and stakeholders invited to the Learning Session
In addition to around 50 community members that joined the Learning Session in August, ASSIST also invited other key partners from facilities and nongovernmental service providers, the majority of them funded under PEPFAR Botswana as part of the broader effort to achieve epidemic control in Botswana. As the community volunteers arrived, they were excited to share their experiences and results – but also their frustrations – realizing that for the first time they had officials and other professionals from facilities, providers, local and central government who were coming to listen to them. Officials from the DHMT were not alone in expressing their respect and enthusiasm for this new approach of collaboration between the formal medical system and community platforms. Representatives from District Administration, District Council and tribal leaders alike expressed their hope that re-activated community leadership and structures would ensure a broad buy-in and a shared learning curve for everyone to learn together how to improve the functioning of the health system. They also emphasized their request to ASSIST to work with them to ensure sustainability and long-term institutionalization. They were particularly impressed when watching how ‘ordinary villagers’ presented hand-drawn graphs and other data, annotating and explaining what had happened, and why.
"It shows that you know what you are doing,” Dr. Bose affirmed. “We [as DHMT] need to work together [with ASSIST-supported community improvement teams] not just on HIV – on everything improving health."
Similar Learning Sessions were conducted in other ASSIST project districts in Botswana, including in Kanye, Moshupa and Goodhope (October 2016), Gaborone and Kweneng East (December 2016).