Botswana
“Together we have worked to establish a healthcare leadership and management development programme; to develop children’s’ vision services and screening for diabetic eye disease; to reduce neonatal mortality; and to bring in sophisticated maxillofacial surgery support. We are pioneering new work together, including tackling the growing burden of non-communicable disease.”
– Shenaaz El-Halabi, former Permanent Secretary, Botswana Ministry of Health and Wellness
Eye Health
Despite developments in eye care, vision impairment remains a significant global issue. There are in excess of 19 million visually impaired persons in the world, and 90% of the world’s blind live in low and middle-income settings.[1] Yet given access to healthcare, the majority of sight impairments can be cured. 
Our VISION 2020 LINK with Botswana was established in 2007 by Malcolm Kerr-Muir and Oathokwa Nkomazana. Since then we have worked with National Eye Health Programme in the Ministry of Health and Wellness to develop and strengthen nationwide eye health programmes.
Some of the partnership’s achievements to date:
- Nationwide diabetic retinopathy screening service has been established with dedicated centres
- 75% of ophthalmic nurses were trained in children’s vision services, and 543 primary schoolteachers and community health assistants in screening techniques. This service is now being developed further to support the implementation of a nationwide school screening programme using Peek Vision
- A national Vision Centre, providing low cost spectacles to vulnerable groups. Botswana technicians attended Aravind Eye Institute in India to develop capacity to maintain ophthalmic equipment
- Undertaking a nationwide RAAB survey (Rapid Assessment of Avoidable Blindness). This provided data for the development of the National Eye Health Plan 2015 – 2019
- A North-South-South partnership between Cambridge, Dr Shroff’s Charity Eye Hospital in India and Botswana was established, with the aim of reducing cataract blindness and to build capacity for high-volume high-quality cataract surgery
- Supporting capacity building and strengthening of the ophthalmic nurse training institute.
All partnership activity is aligned with the World Health Organisation’s VISION 2020 Programme and the International Centre for Eye Health VISION 2020 LINKS Programme. Many of our initiatives are supported by Standard Chartered’ s global initiative, ‘Seeing is Believing’ and the cataract partnership has been funded by Combat Blindness International.
[1] http://www.who.int/mediacentre/factsheets/fs282/en/
Neonatal Nurse Education Project
The NNEP partnership began in 2012. The partnership has fostered links with Princess Marina Hospital, University of Botswana School of Medicine, the Ministry of Health and Wellness, and Nyangabwe Referral Hospital in Francistown. The aim of the partnership is to improve neonatal mortality rates through specialist neonatal nurse training.
Since independence in 1966, Botswana has made monumental progress in developing its national health infrastructure, now considered one of the best systems in sub-Saharan Africa. However, infant and child mortality outcomes have worsened1. Currently, nurses on neonatal units in Botswana receive little or no specialist neonatal training. Improving neonate outcomes has become an area of national priority.
The partnership has enabled numerous bi-directional visits between Botswana and the UK. Partnership working focuses on multidisciplinary training and learning, with topics including infant resuscitation, infection control, drug monitoring and equipment use. Over 60 nurses have received direct training through the NNEP partnership, with many more benefitting from the resulting cascade effect of skills and knowledge transfer in neonatal units.
To ensure sustainability, 6 Batswana Practice Development Nurses (PDNs) champion the ongoing training and development of nurses on their respective neonatal wards in Gaborone and Francistown. In June 2016 the six nurses came for a two-week observational placement at the Rosie, followed in 2018 by a Paediatrician leading neonatal services at Princess Marina Hospital who has now started sub-speciality neonatal training in South Africa.
Maxillofacial Surgery
Established in 2009, the aim of the partnership has been to improve care and treatment for patients through the delivery of surgical intervention and training. The partnership developed in collaboration with the Ministry of Health and Wellness, recognising the shortage in maxillofacial services in Botswana. This is the only CGHP health partnership which combines clinical practice with training. 
Issues relating to accessibility and affordability of healthcare in Botswana, mean that patients present at a later stage with more severe symptoms. This delay in presentation means that their condition is often at an advanced stage that requires complex and urgent surgery.
Maxillofacial surgery is an internationally recognised surgical speciality, used to treat a variety of conditions including facial trauma, tumours, cleft palate and lip. It is often complex work which requires more than one surgeon; however, Botswana has only one government employed maxillofacial surgeon. He works singlehandedly at the Maxillofacial Centre at Princess Marina Hospital, where there are approximately 500 maxillofacial referrals per year. As a result, some patients must travel a further 400km to centres in South Africa for treatment.
A team of 3, consisting of two maxillofacial surgeons and one prosthetics technician, travel from Cambridge to Botswana to assist their Batswana colleagues. Together they work through a list of complex cases, sharing knowledge and insights on best practice. The surgical campaign list is pre-prepared by the Ministry of Health and Wellness prior to the visit.
The partnership also supports the training and development of junior specialists and prosthetists, all of whom are working together to deliver a Maxillofacial Centre of Excellence.
Healthcare Leadership and Management Development
From 2011 – 2014, with funding from the US PEPFAR programme the partnership supported the Ministry of Health and Wellness to establish a healthcare leadership and management development programme. This programme had 4 facets – a programme of development for mid-level managers from public healthcare facilities across Botswana, bespoke development for the senior management team at Ministry of Health and Wellness, establishment of an executive coaching programme, and talent management within the Ministry HR department.
“Collaboration and dialogue with medical professionals overseas enables a broader perspective of the needs of less well-off populations, fosters understanding, particularly when treating migrants here in the UK, and leads to a greater appreciation of the NHS… Second hand descriptions are no substitute for being there.”
Peter Gough GP, Cambridge Global Health Partnerships Advisory Committee member and volunteer