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1. Nkomazana, Oathokwa. Determining the causes for the shortage of human resources for primary health care in Botswana and developing a pilot intervention to address the problem.

Degree: PhD, Family and Emergency Medicine, 2017, Stellenbosch University

ENGLISH SUMMARY : The global policy on universal health coverage is a commitment to ensuring that all people have access to comprehensive health services without suffering financial hardship. Furthermore, primary healthcare has been recognised as a vehicle to achieving equitable access to comprehensive and cost effective health services. Effective primary healthcare services in many low– and middle-income countries, however, have been hampered by severe shortages and inequitable distribution of the health workforce. Internal migration of health workers from rural to urban areas and from public to private or non-governmental organisations, coupled with regional and international migrations, have exacerbated the shortage and inequity in many of these countries. Multiple strategies have been employed to address the shortage of healthcare workers with varying degrees of success. These include training, fiscal, regulatory and professional or personal support. Thse strategies concur with the World Health Organisation’s policy recommedations for the retention of healthcare workers in rural and remote areas. The causes of shortages in human resources for health are many and complex and effective mitigating strategies should therefore be comprehensive and context-specific and derived from an adequate understanding of the context. Although Botswana is reported to have a shortage of human resources for health, which is worse in rural areas and primary health care, there is a paucity of readily-accessible, integrated and comprehensive information on human resources for health. Moreover, there has not been any research to determine the cause(s) of the shortage which negates evidence based interventions. A situational analysis of the human resources for primary health care in Botswana was conducted using an analysis of the existing databases as well as conducting focus group discussions with health care workers, the community and policy makers in three health districts. The findings of the situational analysis then informed the subsequent intervention: creating more supportive health management for primary healthcare workers using a cooperative inquiry group method. The cooperative inquiry group, based on what they learnt from the inquiry, developed a consensus on the prerequisites for effective supportive supervision. This thesis has quantified the numbers of healthcare workers in the primary and hospital care as well as rural and urban areas. It has elucidated the perceived causes of the shortage of healthcare workers as well as potential solutions. It has also highlighted the need for Botswana to explore how to implement the World Health Organisation’s policy recommendations for retention of healthcare workers which were deemed to be inadequately addressed. This is a thesis by publication. The abstracts of the four articles are given below: Article number 1: Human resources for health in Botswana: the results of in-country database and reports analysis Background: Botswana is a large middle-income country in Southern… Advisors/Committee Members: Mash, Robert, Phaladze, Nthabiseng, Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care..

Subjects/Keywords: Primary health care  – Medical personnel  – Botswana; Medically underserved areas  – Botswana; UCTD

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APA (6th Edition):

Nkomazana, O. (2017). Determining the causes for the shortage of human resources for primary health care in Botswana and developing a pilot intervention to address the problem. (Doctoral Dissertation). Stellenbosch University. Retrieved from http://hdl.handle.net/10019.1/102885

Chicago Manual of Style (16th Edition):

Nkomazana, Oathokwa. “Determining the causes for the shortage of human resources for primary health care in Botswana and developing a pilot intervention to address the problem.” 2017. Doctoral Dissertation, Stellenbosch University. Accessed October 20, 2018. http://hdl.handle.net/10019.1/102885.

MLA Handbook (7th Edition):

Nkomazana, Oathokwa. “Determining the causes for the shortage of human resources for primary health care in Botswana and developing a pilot intervention to address the problem.” 2017. Web. 20 Oct 2018.

Vancouver:

Nkomazana O. Determining the causes for the shortage of human resources for primary health care in Botswana and developing a pilot intervention to address the problem. [Internet] [Doctoral dissertation]. Stellenbosch University; 2017. [cited 2018 Oct 20]. Available from: http://hdl.handle.net/10019.1/102885.

Council of Science Editors:

Nkomazana O. Determining the causes for the shortage of human resources for primary health care in Botswana and developing a pilot intervention to address the problem. [Doctoral Dissertation]. Stellenbosch University; 2017. Available from: http://hdl.handle.net/10019.1/102885

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