Health Promotion and Disease Prevention in Botswana

Abstract

This chapter discusses health promotion and its usefulness in preventing diseases in Botswana. Document analysis, published and non-published, was conducted to illustrate how health promotion is implemented in Botswana. First, the contextual definition and meaning of health promotion is given, emphasising the cultivation of positive health behaviours in individuals, communities and the nation to prevent numerous health problems and diseases that Botswana faces. Next, health promotion models, programs, strategies and interventions applicable to the Botswana situation and the achievements made were examined. Finally, the chapter concludes by assessing health promotion processes and measures that have enabled people to increase control in improving their health and cultivating a positive health concept through participation and involvement are examined.

1. Introduction

The Botswana health care system has made significant strides in providing health care services since independence in 1966. The impetus to this realisation was partly due to the health status of the people and the context under which health care delivery was premised. From the onset, Botswana needed to position itself better to offer promotive, preventive and curative care services since most people needed access. Thus, preventive and health-promotive services were imperative. Health promotion and preventive services were also conceptualised before the Alma Ata Declaration on Health for All by 2000 and beyond.

Although a universal concept, health promotion is shaped and influenced by its operative context. Its central tenets focus on individuals’ development to take responsibility for their health. From the Botswana perspective, health is a primary responsibility of every individual and the health care provider is responsible for empowering each person to embrace this responsibility.

Many define health promotion differently, but its essence cuts across many healthcare systems. Health promotion is defined as enabling people to increase control over and improve their health [1]. This definition was crystallised at the first International Conference on Health Promotion in Ottawa in 1986 and became known as the Ottawa Charter. The basic strategies for health promotion identified in the Ottawa Charter are advocacy to boost the factors which encourage health, allowing all people to achieve health equity and mediation through collaboration across all sectors [1]. Since then, the WHO Global Health Promotion Conferences have established and developed the global principles and action areas for health promotion.

According to WHO, the concept of health is particular because it covers the extent to which a group or individuals can fulfil their aspirations and needs on the other hand and evolves with or adapts to the environment on the other [1]. Further, health is seen as a resource for everyday life and not just a life goal. It is a positive concept emphasising social and individual resources and physical capabilities [1]. Thus, health promotion is not just a health issue but goes beyond healthy lifestyles to well-being.

The Ottawa Charter identifies the prerequisites of health promotion as peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice and equity. It further pinpoints the action areas as building public health policy, creating a supportive environment, strengthening the country’s action, developing personal skills and re-orientating health care delivery services towards prevention of illness and promotion of health, bearing in mind the prevailing contextual conditions [1].

2. Methodology

This chapter analysed and examined the concept of health promotion in Botswana and utilised document review to explore health promotion and disease prevention in Botswana. According to Centres for Disease and Prevention [2], document review “is a way of collecting data by reviewing existing documents”. This entailed the review of available Botswana health policies and the different health programs implemented, the Ottawa Charter, and other unpublished documents to gain a contextual understanding of how Botswana promotes health and prevents diseases.

2.1 Analysis, conclusions and interpretations

The following discussion outlines the analysis results, conclusions and inferences on how health promotion and disease prevention are implemented in Botswana. The discussion also examined the fundamental conditions required for health promotion to be implemented successfully. These include but are not limited to how the health care system is organised and the resources, processes, programmes and interventions implemented.

3. Botswana health care system

Two healthcare systems run concurrently in Botswana: Western and traditional healthcare. Every Motswana (a person living in Botswana) has access to traditional health, and only some have access to Western health care. People’s beliefs, customs and values influence the selection of which healthcare system to access. The common practice is that people exhaust the traditional healthcare services before consulting Western healthcare, especially if one suffers from an illness that needs to be clearly understood. Therefore, healthcare providers must take into cognisance the operations of these systems and fully comprehend the belief system of the people they serve to strike a balance between the two health systems.

3.1 Western health care

At independence in 1966, Botswana inherited a largely curative, hospital-based health care delivery system from the British, with most of the population without access to services [3]. Therefore, hospital-based health care challenged the government to provide health care for most people, thus necessitating the building of basic health facilities throughout the country. The main objectives were to strengthen the primary health care services, equitably distribute them to all people with more emphasis in the rural areas and improve hospitals to ensure adequate referral services [3]. The emphasis of the health policy N0.1 of 1970 was directed towards preventing more life-threatening health problems such as maternal and child health and combating communicable diseases such as childhood conditions, tuberculosis, and malaria. The policy trend has not changed significantly since its inception, but it has also infused the prevention of non-communicable diseases [4].

The health delivery philosophy in Botswana is to provide quality and affordable health services to Batswana. It is based on a decentralised model, with primary health care being the cornerstone in delivering health services. This system comprises a network of health facilities organised at different levels of sophistication and coverage [1]. Initially, the population and distance guided the infrastructure development [3]. Therefore, a 15-kilometre radius and a population of 500 people were prerequisite criteria [5]. Currently, the population of Botswana is about 2.346,179 million [5]. Health facilities are distributed according to the population and catchment areas they are to serve. It is currently estimated that most of the population lives within 5 km of a health facility [6].

Botswana has 27 health districts comprising the lowest and the highest referral services [7]. The mobile stops or outreach (921) are at the lowest level, where services are generally provided under a tree or at a school. Then follows health posts (351), clinics without beds (206), Clinics with beds (101), 17 primary health hospitals, 15 districts and three referral hospitals at the top [8, 9]. Finally, a teaching hospital at the University of Botswana, a quaternary public health facility providing highly specialised services, has recently been opened. However, the operations of the latter are still at very rudimentary stages.

Botswana provides universal health care to all citizens through the public health care system by operating 98% of the health facilities. However, privately run health care is also available and accessed by a privileged few with their resources [10].

The primary care model is the foundation of Botswana’s healthcare system. Primary healthcare is the most economical way of achieving universal health coverage. Comprehensive care is offered throughout the lifespan and should include preventive, curative, and promotional health services [11].

The clinics primarily provide outpatient services within reach of communities, including general consultations, health prevention, and promotion services. Health posts offer limited services, whereas mobile stops need a permanent structure and are serviced by clinics and health posts within their catchment area. In the lowest-level facilities are health posts run by at least two general nurses and a health care assistant or a health education officer.

This extensive network of health facilities is well integrated to complement preventive, promotive, and rehabilitative health services and treatment and care of common health problems for citizens [11]. Primary health care services include immunisations, maternity care, children’s health, prevention of communicable diseases, environmental health, nutrition, school health services, first aid, drug education, accident prevention, emergency services, and assistance with family life education [9]. In addition, health Education Assistants conduct health promotion activities by providing basic healthcare advice and health education materials to families and communities [12].

Botswana’s healthcare system advocates for community participation in health promotion and prevention. Community involvement through community leaders and support groups to improve health promotion and prevention. The support groups’ mission is to work with expectant mothers before and after pregnancy, expectant mothers who are HIV-positive pregnant, teenagers, and underage children engaging in sexual activity. There are discussion groups known as “Botsogo Pitso”, a different approach aiming to promote interaction with patients and the communities, inform them of the services provided, and solicit their feedback.

These different health strategies and approaches have greatly influenced the improvement of health indicators and access. However, all the country’s health concerns have not been alleviated because, like many countries in Sub-Saharan Africa, Botswana is still battling high rates of HIV and AIDS, other infectious diseases and currently with an upsurge of non-communicable diseases.

3.2 Traditional health care

The traditional healthcare system operates on beliefs, values and cultural doctrines. According to traditional Tswana philosophy, illness, death and misfortunes are never accepted as natural occurrences. Instead, they are attributed to the supernatural intervention of external agents such as ancestral spirits, supreme God powers, and sorcerers [13]. Ancestral spirits are regarded as the guardians of familial and tribal morality. They can sanction punishment for deviation from or violating familial and tribal norms with illness and misfortune [13]. Further, the supreme God, the creator of the universe and controller of everything, can inflict punishment on people by sending famine, diseases and death [13]. Lastly, the sorcerers cause illnesses and misfortune through witchcraft and manipulation of roots and herbs so that illness, death and misfortune would befall an individual [13].

Therefore, treatment interventions for people who hold these beliefs will depend on what is believed to have caused it. For example, if the illness is believed to be caused by ancestral spirits, certain rituals, such as prayers or offerings, are held to appease the spirits. If the illness is believed to be caused by sorcerers, traditional healers will be consulted to counteract the sorcery. Various traditional healers use different treatment modalities and approaches to counteract acts of sorcery. The beliefs also determine the health prevention modalities and interventions that will be instituted.

The Botswana health care system has utilised the Primary Health Care (PHC) approach to undergird its health programmes, strategies and interventions. This approach was the most feasible, realistic and relevant for an emerging nation with meagre resources and health infrastructure.

4. Primary health care strategy

PHC is viewed as an essential function in driving the country’s development. As early as the 1980s, PHC was given priority in terms of funds allocation in the national development budgets, indicating the country’s commitment to health care for all citizens [14].

Central to PHC are the concepts such as community participation, universal coverage and accessibility, appropriate technologies, inter-sectoral collaboration, appropriate, timely referrals and the use of community-based healthcare providers. While all concepts are essential, community participation is deemed a very critical strategy in PHC, where individuals and members of the communities assume the responsibility of improving and maintaining their health [14].

Primary Health Care is considered essential healthcare at the operational level. It includes education on current health issues and related preventive and control strategies, promotion of supply of food and appropriate nutrition, provision of safe water and basic sanitation, maternal and child healthcare, immunisations against major communicable diseases, prevention, and control of locally endemic diseases, appropriate treatment of common diseases, and provision of essential drugs.

Primary Health Care service delivery has changed due to the recent increase in non-communicable diseases in Botswana. These services are now part of the entire hospital and healthcare services range. These organisations offer treatment services for common illnesses as well as preventive, promotional, and rehabilitative health services [15].

The Ministry of Health in Botswana further adopted the World Health Organisation’s package of essential non-communicable diseases (WHO PEN) recommended for low-resource settings to integrate non-communicable diseases (NCDs) into PHC [16]. The recommendations guided the development of the Botswana Primary Care Guidelines (BPCG), which the country implemented in 2017 to strengthen health promotion initiatives. The guidelines seek to aid healthcare professionals in identifying signs and symptoms of common illnesses and their management. In addition to evidence-based treatment decision support for healthcare providers, the guidelines emphasise the promotion of patient self-management through individual counselling by a nurse and a dietitian, as well as group health education, defaulter tracing and strengthening coordination of care [16].

Like other African countries, Botswana has endured increasing demands on the health care system. There have been great success stories in some areas, especially the battle against HIV and AIDS. However, despite the country’s high middle-income status, Botswana has not been as successful in other areas, such as childhood malnutrition and infant and maternal mortality [17].

4.1 Health promotion processes and strategies

Botswana as a member of the World Health Organisation (WHO), was part of the Ottawa Chatter Conference (1986) agreement whose primary purpose was to enhance the health and well-being of the public [18]. The Ottawa Chatter Conference demanded that the WHO member states orchestrate five main strategies: build public policy; create supportive environments; Strengthen community action; develop personal skills and reorient health services.

Since the inception and adoption of the Ottawa Chatter agreements, Botswana has put processes and strategies in place that are geared towards attaining its vision. At the top of the strategy is the Ministry of Health MOH), whose function oversees the country’s health needs, mainly through public health [19]. The mission of MOH is to “provide integrated, holistic, and sustainable preventative, curative and rehabilitative quality services in the country.” MOH has eight departments: Cooperate services, clinical services, public health, HIV and AIDS prevention and care regulatory services, Health policy development monitoring and evaluation and Health hub.

The Department of Public Health provides health prevention and promotion initiatives in Botswana under Child Health, Health Promotion and Education, Sexual and Reproductive Health, Disease and Control, Environmental and Occupational Health, Nutrition and Food Control, Rehabilitation and Mental Health, Oral Health, Alcohol and Substance Abuse and Prevention of Blindness Units.

To promote health and achieve the Ottawa Chatter mandate, Botswana, through the lead of the MOH, has adopted international strategic goals such as Millennium Development Goals and the United Nations Sustainable Development Goals (SDGs) (2015). In 2000 Botswana government signed the United Nations Millennium Development Goals (MDGs), which mandated the UN member states to commit to eight goals: to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women by 2015. However, the MDGs have been superseded by The United Nations Sustainable Development Goals (SDGs), which envisioned a world free of poverty, hunger, and disease. The main emphasis is on SDG3, which prompts countries to promote member states’ health by 2030. In addition, health promotion initiatives recognise that social determinants of health go beyond the health sector.

In response to these strategies in 2010, the Botswana government, through the help of the American Centre for Disease, developed the “The Essential Health Service Package for Botswana, [20]. The EHSP is a set of health interventions that are promotive, preventive and curative, and rehabilitative that should be available to the entire population of the country.” The essence of EHSP is that essential health care should be cost-effective, accessible and readily available to people. Furthermore, the provision of care through the EHSP is based on the ethical principles of need, cost-effectiveness and human dignity. Therefore, it is integral that health care is provided within an integrated area where public members can access care within one area rather than through a fragmented piecemeal.

The goals of the EHSP in Botswana were to ensure that all Botswana people have universal coverage of essential health care services. Accordingly, a revised National Health Policy was launched in 2011 [21] to guide the implementation. The policy strives to provide an environment where everyone in Botswana can achieve and maintain the highest health and well-being. The policy operates through the guidance of guiding principles as per Table 1.

Guiding Principle	Description
Ethics	Respect for human dignity, rights, confidentiality and cultural beliefs.
Norms and Standards	Good management practices and quality assurance in service delivery.
Equity	Equitable distribution of resources to guarantee accessibility to quality services at every point of demand, especially for the vulnerable, marginalised and underserved, irrespective of political, ethnic or religious affiliations and place of domicile.
Ownership	Involvement/participation of all stakeholders (providers and users) of health services in defining policy as well as the implementation framework.
Evidence-based	The policy will be based on evidence, particularly about Botswana.
Innovation	Continuous exploration of new ideas in health care delivery, e.g. geographical targeting, to benefit high-priority areas; health insurance coverage for the disadvantaged sections of society; public-private partnership; demand-side financing; etc.
Gender Equity	Addressing gender-sensitive and responsive issues, including the equal involvement of men and women in decision-making, eliminating obstacles (barriers) to services utilisation, and the; prevention of gender-based violence.
Client Satisfaction	Ensuring efficient 24-hour quality health services that are more responsive and sensitive to Customer needs.
Skilled staff retention and circulation	Attractive service conditions (package) and job satisfaction encourage a net inflow of critically required skills.
Partnerships	Increasing community empowerment; active involvement of the private sector, NGOs, local government authorities and civil society, and effective development partner coordination.

Table 1.

Guiding principles of the Botswana National Health Policy.

**Adopted from The guiding principles/values of the Botswana Health Policy Ministry of Health 2011.

4.2 Health promotion strategies in Botswana

Throughout the years, the Ministry of Health, through the Public Health Department, has made a concerted effort to develop and implement health promotion activities across the lifespan and to respond to the SDGs. These efforts incorporated strategies that promote health and well-being from childbirth across a life span. They include:

4.2.1 Early childhood

Strategies intended to promote childhood health include under-five feeding, childhood immunisation and expanded programmes on immunisation, and school health programme.

4.3 Under five feeding and immunisation programme

Botswana has put strategies in place to promote the health of children. The strategies include monitoring children’s growth through local clinics and mobile stops nationwide. The services are offered by healthcare assistants under the guidance and supervision of the nurses. In addition, Botswana has a strong Integrated Management of Childhood Disorders (IMCI) programme that is implemented through the Child Health Care Division. Its aim is to reduce infant and children’s mortality and promote development [22]. To achieve this, all the under-five children are expected to attend the clinics and are provided with monthly feeds under the feeding policy of the under-five. In addition, every child under five attends the child warfare clinics and receives free scheduled childhood immunisations. Furthermore, all those attending the clinic receive a package of essential feeds.

4.3.1 School health

The children enter primary education from 6 to 13 years, followed by secondary education from 14 to 17 years. The health promotion activities for these age groups are provided in schools and coordinated by the District Health Management Teams throughout the country under the National School Health Policy and Manual of 1999, whose mandate is to promote the health and well-being of school-going children in Botswana. Botswana’s significant school health providers are mainly nurses of different nursing specialities.

4.3.2 Adolescent health

Most adolescent health promotion activities are provided through Youth Friendly Clinics nationwide. These clinics’ mandate is to provide young people with free, confidential and barrier-free health services without intimidation. Some of the services provided include health education and counselling on adolescents’ sexuality and reproductive health, living positively with HIV and other health-related issues such as information on substance abuse, mental health and prevention of rape and HIV prevention, including information on access to post-exposure prophylaxis, in case of rape. [23].

5. Young adults and older adulthood

The safe motherhood initiative framework was adopted, and it is used to ensure the safe health of childbearing families. The six pillars of the initiative include family planning, antenatal care, obstetric care, post-natal care, post-abortion care and control of sexually transmitted diseases. In addition, the country has invested in several programs as part of the global strategy for women, children and adolescent’s health strategy (2016–2030), as a way to improve the health and well-being of people, including the involvement of males [24] National Guidelines on Health Services Integration.

5.1 Disease prevention and health promotion

The MOH utilises the strategic plan approach, a problem-solving strategy, to identify problems and map out possible solutions. The strategies are applied at all levels of implementation by healthcare workers under the MOH, and the reviews are quarterly to assess the progress and measure the impact of the action. The following health promotion disease prevention strategies are directed at controlling both non-communicable and communicable diseases are discussed:

6. Disease surveillance and prevention

Ministry of Health & Wellness Multi-Sectoral Strategy for the Prevention and Control of Non-Communicable Diseases 2018–2023 identified four priority areas: (a) prevention and health promotion, (b) diagnosis and treatment, and (c) monitoring, surveillance, and research. The fourth priority area, governance and coordination, requires strengthening and is critical to accelerating national NCD prevention and control efforts. In addition, reduce risk factors through awareness, promoting healthy lifestyles and creating enabling environments to create a legislative and policy [16].

The Centres for Disease Control and Prevention (CDC) established an office in Botswana in 1995 to strengthen tuberculosis prevention and control. In 2000 HIV prevention, treatment, and strategic information program development was incorporated to combat the HIV epidemic. CDC collaborates with the Botswana Ministry of Health and Wellness (MOHW), providing technical assistance and research to support HIV and TB control programs, injury prevention, and emergency response operation (https://www.cdc.gov/globalhealth/countries/botswana/). Botswana has made significant progress in adopting the Integrated Disease Surveillance and Response (IDSR) guidelines to facilitate surveillance and timely response to disease outbreaks. The experiences in managing HIV and other disease outbreaks were used to control and manage COVID-19 [17].

6.1 Non-communicable diseases

Botswana faces a transition in disease patterns shown by a decline in infectious diseases and an increase in chronic non-communicable diseases and their associated risk factors [25]. There are four major Non-Communicable Diseases (NCDs) which include cardiovascular, diabetes, cancer and chronic respiratory diseases, which account for NCDs-related morbidity and mortality in the population [16].

Cardiovascular diseases are estimated to cause 18% of mortality in the country [16]. Cardiovascular is responsible for repeat outpatient visits in both government and private facilities in Botswana. With the changing lifestyle and screening, more disease cases are diagnosed and managed. Another condition that is on the rise is diabetes mellitus which is estimated to cause 6% of all deaths in Botswana. Diabetes is the main cause of avoidable blindness leading to diabetic retinopathy. Chronic respiratory disease contributes to 4% of all deaths, while Asthma is one of the significant causes of childhood morbidity. Cancer disorders are rising, accounting for 7% of cancers in adults and children [17].

Prevention and management of diabetes are the responsibilities of the government through the Ministry of Health. All clinics in the various districts provide screening, education and management support to diabetic patients. In addition, private clinics and hospitals also provide services to some clients through government aid or individual medical insurance. The community collaborates with the government through the Diabetes Association of Botswana [24]. The main goal is to conduct support groups providing medical devices and health promotion activities. One clinic in the capital city has been designated for management of clients with diabetes. The clinic receives referrals from other parts of the country.

Improving Cancer Care and Prevention in Botswana was intensified in 2019. As a result, the five critical domains of care were identified: (1) Enhance workforce capacity in cancer and other NCDs involving personnel training, (2) Improve the supply of drugs and secure funds to avoid drug and equipment failure, (3) Build a standard of practice in oncology practice guidelines and Create policies that protect the public, for example, Smoke-free policies and HPV vaccinations. (4) Improve prevention education, screenings, and diagnostics in ambulatory settings, and (5) Establish screening guidelines for common cancers, such as HPV vaccination programs and breast cancer screening [18].

Primary prevention uses both community and facility as antenatal services, child welfare clinics, and vaccinations (e.g., HPV, hepatitis B). Clinics and community-based HPV), as well as enhancing awareness, advocacy, and community buy-in of the preventive services available at health facilities (e.g., hepatitis B vaccination and various types of screening).

HIV introduces excess risk to NCDs, such as cardiovascular diseases and cancers. Thus, treating HIV is also an effective strategy for preventing some NCDs [24]. Primary prevention interventions entail early detection through screening clients in health facilities and the community. Then, treatment starts for all eligible as well as care, and support is given through several structures such as home-based care programmes, hospice and community support.

6.2 Communicable diseases

6.2.1 Tuberculosis

Tuberculosis (TB) is a communicable disease that is a major cause of ill health and one of the leading causes of death worldwide [26]. In Botswana, the incidence of TB is 235/100000, including also occurring as HIV/TB comorbidities. In addition, some patients develop Multi-Drug Resistant (MDR) infections with about 15/1000. Low-income populations with poor housing are mostly affected.

The Ministry of Health in Botswana established the National Tuberculosis Programme (BNTP) in 1975 to fight the spread of tuberculosis. A community-based care approach that reaches patients in the community was established [26]. The country adopted the Centres for Disease Control and Prevention (CDC) 1995 treatment strategy focused on tuberculosis and HIV prevention. In addition, the African Comprehensive HIV/AIDS Partnerships (ACHAP) contributes to eradicating the diseases in line with the WHO and the United Nations (UN) Member States’ strategy. The effort focuses on preventative treatment, poverty alleviation and research to reduce the infection rate by 90% in 2035 [26]. As a result, the treatment success rate is high, including in patients with HIV on treatment [27].

6.2.2 Human immunodeficiency virus (HIV)

The HIV infection is monitored and evaluated using Surveys. The (BAIS V) conducted in 2021 revealed an annual incidence of HIV among adults aged 15–64 years in Botswana was 0.2%, which is 2200 new cases of HIV per year among adults. HIV incidence was 0.4% among females and 0.0% among males [28]. Females are the most affected, with a prevalence of 26.2 and 15.2% among males. HIV infection among children aged 0–14 in Botswana was 0.8%. That is 5600 children living with HIV. The study revealed high viral Load suppression among adults aged 15–64 years living with HIV in Botswana [29]. Botswana has greatly succeeded in combating the infection, and now the country strives for zero infection.

6.2.3 Malaria

Malaria cases are mainly found in six districts in the northern-most part of Botswana: Bobirwa, Boteti, Chobe, Ngamiland, Okavango, and Tutume. However, some cases were reported in the district in the central-eastern part of the country due to increased rainfall and stagnant water in those areas. A national team leads the control and elimination strategies for malaria. Malaria cases are estimated at 0.6/100000 by 2021 [30].

6.2.4 COVID-19

Clients with acute respiratory symptoms are screened and tested for COVID-19. Supportive care is given to patients who test positive for COVID-19. The infection is classified under notifiable diseases, recorded and reported daily to the COVID-19 task team. An average number of cases is computed every 7 days. The incidence is 19 cases per million people in 2023 [17]. The Ministry of Health controls the spread of infection in partnership with the Centre for Disease Control (CDC). The CDC coordinates the activities regarding; surveillance, diagnoses and capacity building, quarantine, case investigation, infection prevention and control [31]. The fight against the epidemic was a success because the experiences and capacity used in managing other public health problems that occurred in the past were used to conduct health prevention strategies such as quarantine, disease surveillance and case management.

7. Maternal and child illnesses

Most women (97.2%) attend Antenatal Care (ANC) and deliver in hospitals under the care of midwives and doctors. However, maternal mortality continues to be a concern, with an increase in Maternal Mortality Ratio (MMR) of 166.7/100000 live births in 2019 [32]. The deaths of women are attributable to haemorrhage (28%), puerperal sepsis (24.7%) and hypertension (17%). Nonetheless, the infant mortality rate is declining. Botswana’s infant mortality rate in 2023 is 26.744 deaths per 1000 live births.

7.1 National campaigns

The MOHW conducts health campaigns annually to respond to the country’s health needs. They mainly include under-five polio and measles campaigns, where children are given vaccines depending on their needs. There are also malaria campaigns in wet areas of the country. The Public Health and Environmental Health Department, under the Ministry of Health’s leadership, plays a significant role in preventing and controlling malaria throughout the country [33].

7.2 Health education strategies

The Health Education Unit is critical in facilitating the country’s health information, education and communication campaigns. Health educators and nurses lead in educating the communities on public health issues. In addition, different media platforms, such as the National Television and Radio, and social media are used [34].

7.3 Challenges

Botswana is trying to meet the SDGs and Ottawa Chatter agreements, but some things must be fixed [25]. For example, the country needs more healthcare personnel to implement health promotion initiatives. There is also a need for more resources such as funds, human capital, infrastructural development and transport to render other areas of the country accessible to basic amnesties.

8. Conclusion

This chapter has discussed health promotion and disease prevention in Botswana. It situated health promotion within Botswana by outlining the health care system. It described primary health care as the main framework on which health promotion and services are based. Further, the health promotion strategies, approaches, programmes, and interventions that promote health promotion were discussed. These are approaches that promote early childhood, immunisation programmes, care of the under-fives and immunisations, school health disease surveillance and disease prevention, health campaigns and health education strategies. Health promotion and disease prevention are very critical in any healthcare setting. Not only do health promotion strategies ensure equitable resource distribution, but they also guarantee access to health care delivery. Finally, this chapter has illustrated the implementation of health promotion in Botswana. It concluded by outlining the processes, strategies, health programmes and approaches that have been put in place for its implementation.