CHAPTER FOUR 4. PRESENTATION OF RESULTS
Chart 4.1: Distribution of health worker respondents by source of PIIs knowledge (n=65)
4.7.3 Knowledge of monitoring and evaluation mechanisms for PIIs
4.7.3.1 Assessment of PIIs effectiveness from the point of view of implementer respondents
Table 4.20 Health worker respondents by ownership and perception of PIIs usefulness (n=65)
Ownership PIIs useful PIIs not useful Total
Private Sector 11 (100) 0 (0.0) 11 (16.9)
Public Sector 50 (92.6) 4 (7.4) 54 (83.1)
Total 61 (93.8) 4 (6.2) 65
All private sector respondents (100%) and an overwhelming majority of public sector respondents (93%) sectors indicated that the different types of PIIs implemented at their place of work were useful in improving the quality of health services provided in Botswana.
Table 4.21 Frequency of health Worker respondents by elaboration on usefulness of PIIs (n=65)
Reason for PIIs usefulness Number Percent
PIIs guide work targets 25 38.5
PIIs are work plan measuring tool 10 15.4
PIIs monitor individual performance 9 13.8
PIIs are Government policy to be implemented 6 9.2
PIIs direct individual work plans 5 7.7
PIIs stimulate day to day focus 4 6.2
PIIs are supervision tools 2 3.1
PIIs are not useful 4 6.2
Total 65 100
The statements on Table 4.21 reflect the views of the respondents as to why they thought the initiatives were useful in improving work performance. The 4 health workers who felt the PIIs are not useful for improving their performance, described them as „a routine exercise‟ done periodically.
Table 4.22 Health worker respondents by quality of services offered and hospital ownership (n=65)
Quality of Health Services at Work Place
Private Public Total
Deteriorated 0 (0.0) 2 (100) 2 (3.1)
Improved 11 (31.4) 24 (68.6) 35 (53.8)
Static 0 (0.0) 24 (100) 24 (36.9)
Not sure 0 (0.0) 4 (6.2) 4 (6.2)
Total 11 (16.9) 54 (83.1) 65
Chi square = 11.35 Degrees of freedom = 3
p value = 0.00997996 <---
Above half (54%) of the health worker respondents felt that the quality of health services delivered at their health facilities had improved over the years. In the private sector, all health workers (11) reported that they had observed an improvement in health service provision. On the other hand, 2 respondents from the public service had a difference of opinion, labelling the quality of the health services as „deteriorated.”
It is noted that above one third (37%) of the respondents described the health services, mainly delivered through the public health facilities, as static.
Table 4.23 Health worker respondents by reasons for static quality of health services (n=24)
Reasons for static health service delivery system Number Percent Poor equipment and facilities for quality services 11 45.8
Poor working incentives and rewarding 6 25.0
Low individual commitment 4 16.7
No accountability at all 3 12.5
Total 24 100
For the health service systems described as static, around 46% were hospitals with outdated machinery, old linen and poor hospital diet. About a quarter (25%) attributed the lack of improvement in the quality of health services to poor payment of workers and bad working conditions.
Table 4.24 Health worker respondents by reasons for improved quality of health services (n=35)
Reasons for improved health service delivery system Number Percent Provision of basic essential hospital equipment 15 42.9
Introduction of individual work plans 11 31.4
Availability of essential drugs including ARVs 7 20.0
New health programmes (HIV/AIDS, TB, etc) 2 5.7
Total 35 100
The main reasons given by respondents for regarding the health service delivery system as improved were linked to better equipment and material provision (43%) for the hospitals. The reasons given for deteriorated structures (2) in government institutions mainly included adherence to old hospital equipment, and poor local capacity building.
Table 4.25 Health worker respondents by opinion of how to improve quality of health services (n=24)
Opinion on improvement in performance to achieve objectives Number Percent
Employer to avail more resources for performance 13 20.0
Formal training of health workers on PIIs/public relations 12 18.5 Employer to improve/maintain good working conditions 9 13.8
Improve essential drug stocks including ARVs 9 13.8
Improve PIIs ownership by implementers through training 7 10.8
Reward performers with better salaries 5 7.7
Upgrade/install new hospital equipment 3 4.6
Acess to specialists 2 3.1
Do not know 4 6.2
Total 65 100
Around 13 (20%) indicated the need for more resources in their day to day work to improve their performance. The need for an improvement in drug stocks and the introduction of better working conditions was mentioned by both sectors. Formal training on PIIs was mentioned by 19% of respondents while 11% indicated that there was a need for ownership of the PIIs. There was also a call for the improvement in the remuneration of employees with 8% mentioning this as an important requirement.
Table 4.26 Health worker respondents by opinion on how to enhance the efficiency and effectiveness of PIIs (n=65)
Enhancement Opinion Frequency Percentage
Effective Training for Implementers 17 26.2
Regular PBRS Follow-up 13 20
Reward Employees 9 13.8
PIIs Implementer Ownership 6. 9.2
BSC Regular M&E 5 7.7
Employee Commitment 4 6.2
JPMS Refresher Training 3 4.6
Neutral PIIs Reviewers 3 4.6
JPMS Regular Follow-up 2 3.1
More Operational Resources 2 3.1
Effective Employee Motivation Plans 1 1.5
Total 65 100.0
The majority of health worker respondents suggested on more effective training for implementers (31%), which should be backed by regular follow-up plans (23%) in both private and public health sectors. An improvement in remuneration and the introduction of more attractive working conditions was mentioned by 14% of the respondents.
Table 4.27 Health worker respondents by type of health sector on how to enhance the PIIs (n=65)
List of opinions on how to enhance the efficiency and effectiveness of PIIs
Private Public Total
BSC Regular M&E 5 (45.5) 0 (0.0) 5 (7.7)
Employee Commitment 0 (0.0) 4 (7.4) 5 (6.2)
JPMS Regular Follow-up 2 (18.2) 0 (0.0) 2 (3.1)
JPMS Refresher Training 3 (27.3) 0 (0.0) 3 (4.6)
More Operational Resources 0 (0,0) 2 (3.7) 2 (3.1)
Effective Employee Motivation plans 0 (0.0) 1 (1.9) 1 (1.5)
Neutral PIIs Reviewers 1 (9.1) 2 (3.7) 3 (4.6)
Regular PBRS Follow-up 0 (0.0) 13 (24.1) 13(20.0)
PIIs Implementer Ownership 0 (0.0) 6 (11.1) 6 (9.2)
Reward Employees 0 (0.0) 9 ( 16.7) 9 (13.8)
Effective Training for Implementers 0 (0.0) 17 (31.5) 17(26.2)
Total 11(100) 54 (100) 65 (100)
An assessment of the health workers by type of health sector shows that both the public and private health sectors mentioned the need for more effective PIIs training to enhance their usefulness (private = 27%, public = 32%). Regular follow-up of the programme emphasized on 3 different policies, while payment of good salaries and all other motivational incentives (17%) were echoed by the public service health workers.