Seeing the impact of cascade training in Botswana

PCI is working with the Ministry of Health in Botswana to strengthen the primary care system through a sustainable cascade training programme for doctors, nurses and other community based health professionals. Dr. David Mazza, one of PCI’s clinical team, recently revisited our partners in Botswana to observe and mentor a cohort of ‘Master trainers’ whom PCI trained in 2017.

 “We are training to be life savers because NCDs shorten people’s lives” Master Trainer from Selibe Phikwe, Botswana

The project is part of our Letshego Holdings Ltd funded multi-country Healthcare Innovation Programme. Through Letshego Holdings we formed a partnership with the Botswanan government to maximise the project’s reach there. The Botswana Ministry of Health already had a strong vision for tackling the growing epidemic of Non-Communicable Diseases (such as high blood pressure and diabetes) – the country is among the first in the region to publish national evidence-based primary healthcare guidelines. Botswana is a middle-income country with a relatively well resourced primary healthcare system with services available for free to 95% of the country. The country achieved great success in addressing HIV, whose prevalence was among the highest in the world in the early 2000s.  That NCDs might threaten health and development gains from confronting HIV helped elevate NCDs as a national priority.

Our partnership is therefore timely and can capitalise on PCIs expertise in strengthening systems using a family medicine approach to care –all our trainers are practising GPs with current and real-life experience of the NCD epidemic.  PCI worked closely with Botswanan government clinicians and policy makers to jointly design and deliver an NCD training package to cascade to frontline healthcare professionals across eight districts, serving a population of some 1 million of the country’s citizens.

Last year, PCI delivered the initial training to the ‘Master Trainers’– clinicians selected by the Ministry of Health to cascade knowledge and skills about prevention, treatment and management of NCDs to primary healthcare colleagues across the country.  Knowledge is often easier to share, at PCI we aim to develop skills too which requires more time and interaction.

My recent visit was an opportunity to continue PCI’s role of mentoring and strengthening the technical skills and clinical knowledge of the lead trainers and, together, review ways of improving the trainings to be rolled out across 6 other remaining districts.

The trainings I observed were extremely well delivered, with tangible improvements in clinical care of those attending. I was able to observe the lead trainers explain concepts that can be most difficult to convey to clinicians who are not used to the chronic nature of NCDs – for instance, the need for continuity of care, using patient records for logical clinical decision making, not just doing what you or someone else has always done before, as well as  providing practical and patient-centred advice about lifestyle change. The team of Master Trainers were clearly well equipped to apply the materials effectively to deliver the training to their colleagues at a District level. One of our Botswana colleagues recognised that the team are now able to “manage patients according to the guidelines and not just copy how it has been done in the system in the past.”

A Ministry of Health official reported a noticeably reduced burden on acute services because there has been a shift away from hospital referrals for diabetic patients, to managing their condition at primary care level.

I flew out of Gaborone struck by the strategic vision of the Botswana Ministry of Health and satisfied to see how the cascading of training has gained momentum and is underway.  It is evidence of PCI’s replicable ‘Trainer’s Toolkit’ package that is sustaining training and launching NCD ‘champions’ out into primary care system strengthening roles in the diverse contexts in which we work.