30 Oct Three Questions with Dintle Molosiwa: A Perspective on Utilizing Communities in Botswana to Achieve Health for All
Dr. Dintle Molosiwa joins HRH2030 as the new project director for our Botswana activity. Prior to joining Chemonics, Dintle worked as a health management and financing consultant at University Research Co. Additionally, Dintle has worked at the Botswana Ministry of Health in the Department of Clinical Service and, on the academic side of public health, with various universities performing research and serving in leadership positions within administration.
- We would love to learn more about you! What inspired you to work in health?
I started off working as a teacher in the Botswana school system for a little over a year. One day, I was having a conversation with a colleague about how on a single day 12 children had died at one of the nearby referral hospitals. A medical officer and a friend of my colleague’s remarked, “Well, hospitals are where people die.” I was shocked and could not accept how he tried to explain and excuse his statement. I have always felt strongly that hospitals are a critical part of our social infrastructure to make people better and improve their lives. This belief drove me to decide that I wanted to be a part of that, but not as a doctor or a nurse. I respected doctors and nurses quite a lot and felt theirs was a noble vocation that needed to be supported and efficiently maintained, but rather than working directly with patients, I wanted to work in the background to provide them with the support and resources they need to help patients. So, I left teaching to pursue a master’s degree in healthcare management, and then a PhD in epidemiology and population.
What continues to inspire me and shape my growth is observing just how badly synchronized the efforts tend to be in health, between those who provide care and the ones maintaining the health care system. That is why today, health policy and systems research is a field I call home for my professional life. In this field, I put into action my passion for improving how we organize and use our resources to achieve health for all.
I am especially inspired and excited by our current work with HRH2030 in Botswana. The program really embodies a practical way of combining the best of the more traditional scientific approaches with innovative community improvement methods and aspects of complex adaptive system theories – all in service for epidemic control and sustainable health development!
- In your opinion, what are some of the most significant challenges health workers face in Botswana?
As a country, we have made huge progress in reducing the burden of HIV/AIDS. However, reducing the disease remains as one of the leading challenges we face: more than one in four of our people are on permanent lifesaving drugs which requires a lot of money, high functioning systems, and most importantly a motivated, strong, and well-trained health workforce. At present, many of our health workers are feeling overwhelmed, burnt out, or not well supported. A shortage of personnel, inequitable distribution of health workers, and inefficient allocation of the available workforce are the key policy issues. As a single disease, HIV/AIDS has exacerbated the plurality of these challenges.
Health workers in Botswana deal with a high volume of patients who require HIV or HIV-related services. Most of these patients also need assistance with additional care needs, including co-morbidities and psychosocial support. Health workers are asked to provide a wide range of services to patients, sometimes with limited skills due to limited training opportunities. That presents a significant challenge for a health workforce in a large country. The lack of professional development opportunities and delayed progression/promotion are among some of the factors that health workers indicate as most greatly affecting them.
Recently, there have also been growing concerns around the safety and security of health workers. During night shifts, some have been attacked while on duty. While these are isolated events, they do raise concerns especially for health workers that already lack motivation. It is also common that health workers must be active in areas with petty crime which presents a safety risk for them. In addition to these safety issues, transfer policies prove to be a challenge in the lives of health workers as they often disrupt family life, a factor that contributes to high turnover, especially amongst doctors and nurses who also cite other challenges to their work such as poor working conditions including low wages.
- Working with HRH2030, what do you hope to improve in Botswana’s health system?
Botswana is known to have a well-functioning health system as well as an enabling political environment to effectively organize the delivery of health services. However, there are deep-seated inefficiencies that negatively impact patients, health workers, and the system overall. Most critical for us today is continuing a commitment to sustain epidemic control. There is a growing recognition that after 20 years of emergency response to HIV, we need to rebalance the system: from hospital-based to community-oriented and client-centered; from curative and acute care to more preventive measures; from narrow medical and treatment-focused programs to more holistic perspectives. Finally, and most importantly, we need to make patient and clients active partners in their own health, which requires a fundamental shift in care mindsets on all sides: clinicians, the population, health managers, and community leaders.
The government of Botswana has recognized the need to fundamentally transform health and how it is delivered to our people. Our work on behalf of the HRH2030 program in Botswana is therefore entirely geared to support the government in making this effort a practical one, which is to improve services around the needs and preferences of patients while also reducing constraints and care burden on health workers. By facilitating a bottom-up approach to innovate and improve integrated, quality, community-based health services, we are working with facility-based and community-based health workers to deliver services differently to meet people’s needs and preferences while also improving efficiency in service delivery for the benefit of healthcare providers.
Photo: HRH2030 Project Director Dintle Molosiwa catches up with a community health worker at a local football field in Gaborone.