Quality and system performance: Progress and gaps across the RMNCAHA+N continuum of care and life course in Botswana
1
Health Promotion and Education, Boitekanelo College, Gaborone, Botswana
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Despite substantial advances over the past four decades, preventable morbidity and mortality related to sexual and reproductive health remain unacceptably high in most developing countries. Evidence indicates that deficiencies in the quality of facility-based care may be a significator contributor to these preventable outcomes. This study examines service quality and system performance, using clients' perceptions of, and satisfaction with reproductive maternal newborn, child and adolescent health, and nutrition services in Botswana.
METHODS:
A facility-based qualitative descriptive study was conducted through face-to-face interviews with 64 outpatients aged 14-78 years between May and June 2025 across ten districts. Inductive thematic analysis was utilized to analyse the data.
RESULTS:
The following major themes emerged from the data: limited or adequate awareness of full Reproductive, Maternal, Neonatal, Child, Adolescent, Health Aging & Nutrition (RMNCAHA+N) service package, mixed perception of service-quality, access barriers, unmet needs and preferences. Participants reported limited access to services due to staff shortages, inadequate transport, medication stock-outs, language barriers for foreigners, staff frustration and burnout, and negative staff attitudes. Overall satisfaction with services was high (80%), neutral and dissatisfied responses accounted for 15.4% and 4.6%, respectively. Similarly, service quality was predominantly rated good (74.6%), with fewer clients reporting neutral (19%) or poor (6.4%) quality. To address gaps in awareness, clients recommended community-based education, targeted engagement of men, hiring health education officers, and utilising social media and IEC materials.
CONCLUSIONS:
This study reveals that despite high satisfaction with services received, key structural gaps undermine access to needed services. Concerted efforts, prioritizing frontline service readiness, adequate human resources for health and supply systems and strengthening community participation, are needed to ensure equitable, high-quality RMNCAHA+N services across the life course.
Despite substantial advances over the past four decades, preventable morbidity and mortality related to sexual and reproductive health remain unacceptably high in most developing countries. Evidence indicates that deficiencies in the quality of facility-based care may be a significator contributor to these preventable outcomes. This study examines service quality and system performance, using clients' perceptions of, and satisfaction with reproductive maternal newborn, child and adolescent health, and nutrition services in Botswana.
METHODS:
A facility-based qualitative descriptive study was conducted through face-to-face interviews with 64 outpatients aged 14-78 years between May and June 2025 across ten districts. Inductive thematic analysis was utilized to analyse the data.
RESULTS:
The following major themes emerged from the data: limited or adequate awareness of full Reproductive, Maternal, Neonatal, Child, Adolescent, Health Aging & Nutrition (RMNCAHA+N) service package, mixed perception of service-quality, access barriers, unmet needs and preferences. Participants reported limited access to services due to staff shortages, inadequate transport, medication stock-outs, language barriers for foreigners, staff frustration and burnout, and negative staff attitudes. Overall satisfaction with services was high (80%), neutral and dissatisfied responses accounted for 15.4% and 4.6%, respectively. Similarly, service quality was predominantly rated good (74.6%), with fewer clients reporting neutral (19%) or poor (6.4%) quality. To address gaps in awareness, clients recommended community-based education, targeted engagement of men, hiring health education officers, and utilising social media and IEC materials.
CONCLUSIONS:
This study reveals that despite high satisfaction with services received, key structural gaps undermine access to needed services. Concerted efforts, prioritizing frontline service readiness, adequate human resources for health and supply systems and strengthening community participation, are needed to ensure equitable, high-quality RMNCAHA+N services across the life course.
| eISSN: | 2654-1459 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
