USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project | Botswana


USAID and the U.S. Centers for Disease Control and Prevention (CDC) in Botswana invited URC to conduct a rapid analysis of existing quality improvement initiatives being implemented by the Ministry of Health (MOH). Botswana has invested heavily in the health care sector, developing multiple improvement frameworks under various names. However, the country is still not seeing improvements in key health indicators. For example, the most recent 2011 national maternal mortality rate (MMR) statistics indicate that the national MMR increased from 163 per 100,000 live births to 189 in 2011, roughly equal to the 2009 MMR. The top three causes of maternal death were eclampsia (12 cases unspecified as to time period), post-partum hemorrhage (11 cases), and post-abortion complications.

During interviews and visits with key MOH staff and site visits to Princess Marina Hospital and Nkoyaphiri Clinic in August 2012 (under USAID funding provided to the Health Care Improvement Project, or HCI, ASSIST’s predecessor project), the URC team found a gap between planning and implementation. Despite issues with execution, the building blocks for success were/are present: The team found that Botswana has a competent and committed health workforce with a strong desire to identify and fix problems and that workforce members are forthcoming about problems and weaknesses in a constructive way, looking for ways to improve.

Key Activities

  • Recommend modalities for integration and enhancement of existing initiatives in order to yield tangible results that are in line with the Ministry strategy.
  • Outline ways to empower and enhance the participation of senior management in quality improvement activities.
  • Support the Ministry of Health in pursuing its national level goal of reducing maternal mortality from 160 to 80 per 1000 live births (Millennium Development Goal 5), setting a clear implementation schedule with explicit delegation of responsibilities and aligning activities at all levels to meet the national level goal.
  • Use this experience to instill a strong culture focused on execution and build the capabilities to execute other improvements.
2013 to present
US Agency for International Development (USAID), Bureau for Global Health, Office of Health Systems
Regions/ Countries 
Geographic Scope 
National level