Background: Botswana has been hit hard by HIV/AIDS, and while largely successful, its national response has been costly, characterized by intensely vertical disease control efforts. Botswana''s health system - once renowned for its proud embrace of Alma Ata and primary health care - was transformed through this emergency approach. Today, as the country is determined to think beyond HIV and re-balance its health system, focus is on the role of communities. With more than one in five Batswana living with the virus, there is a strong call for an integrated community perspective that characterized Botswana before HIV.
Description: Under PEPFAR Botswana, the USAID-funded Applying Science to Strengthen and Improve Systems (ASSIST) project followed a community health system approach that applied quality improvement methodologies across seven districts in Botswana. Alongside local NGOs scaling HIV services under USAID''s community platform, ASSIST reactivated existing but dormant community structures and reconnected them with district health systems. Community teams under the mandate of traditional leaders received dedicated coaching to drive local efforts to improve HIV care. Tangible improvements in testing, retention and adherence were possible once community and providers coordinated their activities around community preferences, and ''re-wired'' local accountability loops. These efforts achieved the return of unclarified (or ''lost'') patients to ART at rates between 38% and 100%.




[Spreading ''''what works'''': Addressing acute gaps in community ART retention across 5 districts]


Lessons learned: During dedicated ''Learning Sessions'', community teams presented their results to national and district officials, ranging from community-led HIV testing to retention and adherence strategies. This demonstrated their willingness and capacity to contribute to common health goals, and the power of innovation that came from partnering with local providers to improve community health. In Botswana''s unique context, traditional structures hold the promise of successfully revitalizing primary health care without undermining HIV control. In fact, they directly help in sustaining epidemic control- provided Botswana dedicates the necessary support to institutionalize new community partnerships.
Conclusions/Next steps: We continue to advise government on community-led service delivery strategies that differentiate care around community preferences and patient needs to improve integration and client orientation. The HRH2030 program will support the re-alignment and operationalization of health workforce frameworks to innovative models of care to ''deliver differently'' in Botswana.

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