Why Pathfinder Works in Botswana
Botswana, a landlocked nation of over two million people in the heart of southern Africa, is perhaps the continent's most notable economic success, yet it is home to one of the worst outbreaks of HIV and AIDS in the world. Thanks to a stable political and economic environment, created by a successful diamond mining industry and nearly 40 years of uninterrupted civilian leadership, Botswana has transformed itself from one of the world's poorest countries to a middle-income nation. Current per capita income is approximately $13,000, over six times that of the sub-Saharan African average.
Decades of economic gain, however, are threatened by the country's devastatingly high prevalence of HIV, currently estimated at 25 percent of the adult (ages 15-49) population. This has reduced average life expectancy to just 53 years and created tens of thousands of AIDS orphans. For the past 12 years, Pathfinder has worked in Botswana to address the high prevalence of HIV and AIDS and improve the overall sexual and reproductive health of both adults and adolescents. Currently, Pathfinder is implementing a five-year HIV-prevention-counseling program funded by the Centers for Disease Control and Prevention. The program provides prevention, care, and support services to HIV-positive women, their partners, and families. Pathfinder's innovative approach emphasizes the HIV-associated risks from male partners, while also incorporating prevention for HIV-negative women into its activities. Pathfinder also supports the development and implementation of peer-counselling programs in which HIV-positive women, HIV-negative women, and their partners are provided with education, counseling, and support services in community and government clinics in conjunction with existing counseling structures.
Evidence for Decision-Making
A key aspect of Pathfinder's approach to systems' strengthening is collecting evidence that enables public, private, and community partners to make informed health-related decisions. In Botswana, examples of the kinds of evidence we collect to range from "the number of local organizations provided with HIV-related technical assistance" and "the number of registered HIV-positive women who disclosed their HIV status to their partner" to "the number of service providers trained to provide psychosocial and peer counseling services." Some illustrative data from Pathfinder's work in Botswana suggests that over the course of the CDC-supported "Expansion of HIV Prevention, Counseling, Psychosocial Support and Outreach Service" project:
- 3,011 male partners of PMTCT mothers were registered into the program
- 1,308 infants born to registered HIV-positive mothers were referred to other services, including HIV testing and antiretroviral therapy
- 8,669 women have been registered into the PMTCT program, including more than 4,000 HIV positive women, to hear messages about exclusive breastfeeding, safer sex, counseling, and testing
Building Capacity, Strengthening Systems
In Botswana, Pathfinder integrates capacity building interventions at a community level in order to enhance sustainability, awareness, and engagement with community health issues and service delivery. Pathfinder builds strong collaborative networks with existing local community structures, including community leaders, NGOs, and community and faith-based organizations. By strengthening existing community structures, Pathfinder decentralizes project implementation, builds local capacity, and allows for more community level participation in project activities.
In our work addressing HIV in Botswana, Pathfinder works with local organizations to build the necessary health infrastructure to fight the disease, while educating and providing local community and government organizations with the knowledge and equipment to bring reproductive and sexual health services to the country.
The aim is to increase prevention of mother to child transmission service successes and male involvement programming by integrating services, strengthening, and increasing health facilities and districts providing counseling and psychosocial support.
Final Report for Botswana
AYA - Final Adolescent Reproductive Health Reports - Botswana
Clinic Assessment of Youth-Friendly Services: A Tool for Improving Reproductive Health Services for Youth
This tool helps program managers and clinicians determine the extent to which current reproductive health services are youth-friendly.
Botswana: TSA BANANA-Social Marketing of Reproductive Health Services to Youth (Harris, 1999)