Botswanan trainers lead the way in roll-out of national primary care guidelines

PCI’s partnership with the Botswanan Ministry of Health and Wellness (MoHW), and Letshego Financial Services, really demonstrates the value of a cascade training approach. Read our guest blog from Dr Gontse Tshisimogo, a public health doctor working in the Botswanan MoHW, to hear about the impact so far.

“The mandate of the Non-Communicable Diseases (NCDs) Programme, within the Department of Public Health in the Ministry of Health and Wellness is to reduce morbidly and mortality of NCDs which are leading killers in Botswana. Botswana’s national primary care guidelines for adults were endorsed in 2016 and will facilitate decentralization of services and integration of quality NCD care at the primary care level. The guidelines provide a guiding tool to doctors and nurses on management of NCDs including diabetes, hypertension and other cardiovascular conditions.

Following development of the guidelines, there was a need to not only disseminate the guidelines but to ensure their systematic implementation.

To support this, our partnership with PCI and Letshego Ltd began in 2017. The project strengthens primary care services through a cascade training programme for doctors, nurses and other community-based health professionals, to deliver diabetes and cardiovascular care, to 1 million people across 8 districts. It is delivered by the MOHW NCD programme with start-up investment from Letshego Ltd and technical expertise from PCI.

Structured and cascaded trainings were planned to facilitate effective implementation, similar to KITSO trainings that were used to scale up standardized HIV care.

PCI supported us to develop curriculum and training materials as well as lead the cascade training programme. Within this, 32 Training of Trainers (ToTs) from 8 districts were trained, with the aim for these Trainers to then train other healthcare workers in their own districts.

Healthworkers trained

PCI’s clinical team inspired and sustained a dedicated cohort of trainers – This is a notable achievement when it was mostly done at a distance and there was almost a year’s gap between some Trainers being trained and them delivering the training in their districts.

In total, 174 workers received training on diabetes and cardiovascular diseases management at primary care level. All recorded an increase in knowledge of NCD care following the training.

In an evaluation from Lobatse, participants described the changes they planned to make following the training:

“Patient centred approach while consulting; More emphasis on prevention rather than cure; More detailed history taking; When to initiate a newly diagnosed diabetic patient on medication and which meds to use; Improved skills on diabetic foot examination.”

We are really delighted with the results of this partnership: the primary care guidelines have been rolled out successfully with multidisciplinary healthcare teams in all eight pilot districts and we plan to replicate this model in other districts soon. The trained districts will see a programme of structured observations and mentoring of those just trained, to ensure quality of care and sustainability. We also increasingly see the potential for nurses in NCD care and will be advocating to allow general nurses to prescribe NCD drugs. This work will really make sure that our National Primary Care Guidelines translate into real improvement in the quality of people’s lives in Botswana.”