Botswana HIV Sustainability and Transition Roadmap
THE PROBLEM
Botswana has been a pioneer in the fight against HIV. It was the first country in sub-Saharan Africa to establish a free national antiretroviral treatment program. In 2022, it became the third nation globally to meet the UN’s ambitious 95-95-95 HIV control targets. Now, as an upper-middle income country with the highest GDP per capita in the region, it is again poised to break new ground as one of the first African nations to significantly transition away from donor aid for HIV and towards enhanced self-reliance. Accomplishing this while maintaining the tremendous progress made to date will require accurate anticipation of financial and operational risks across the program, as well as the timely implementation of decisive mitigation actions.
The Third National Strategic Framework (NSF III) for HIV and AIDS (2019-2023) demonstrated the Government of Botswana’s commitment to continue expanding upon a strong record of success in combatting the HIV epidemic. Progress towards the ambitious HIV control targets has been robust, with treatment cascade results of 95-98-98 demonstrated in the 2022 Botswana AIDS Impact Survey. UNAIDS Spectrum estimates from 2023 place the total number of people living with HIV at 343,914 (20.8% of adults over the age of 15) and the annual incidence rate at 0.29 new cases per 100 people, a dramatic 63% decline since 2010 in new adult infections occurring annually. With 4,320 new infections and 3.822 AIDS-related deaths estimated to have taken place in 2022, the NSF III goal of epidemic control is nearly within grasp.
While Botswana’s HIV response can still be improved, a primary objective at this stage is to sustain the exemplary achievements made to date in the face of resource constraints and the impending prospect of declining donor funding.
THE PHAROS SOLUTION
Pharos was engaged by the Government of Botswana, with support from UNAIDS, to work with key stakeholders and assess the most important risks to sustainability and transition for HIV in Botswana. This work resulted in a Sustainability and Transition Risk Assessment (STRA) and Roadmap, which can be read in full below.
The project was completed in three phases:
Inception Phase: The Pharos team engaged with country stakeholders and conducted a desk review to build a high-level picture of sustainability and transition risks in Botswana’s HIV program. To identify and refine specific focus areas for the assessment, the team held preliminary discussions and informational interviews with a wide range of stakeholders from government, CSOs, donors, and development partners. These initial findings were included in an inception report, which was approved by all stakeholders, to guide the subsequent phases of the project
Sustainability and Transition Assessment Phase: The Pharos team reviewed more than 150 source documents including strategic plans, progress reports, budget and expenditure data, epidemiological studies, investment cases, and efficiency analyses provided by government agencies, CSOs, donors, development partners, and academic institutions. The team also conducted more than 70 interviews and meetings, individually and in focus groups. Pharos then visited Gaborone from May 30 to June 9th to meet in-person with key stakeholders and better understand and experience the key components and risks of Botswana’s HIV program. Using the additional inputs gathered from the visit, the team produced the Sustainability and Transition Assessment (STRA) report.
Sustainability and Transition Roadmap Phase: Following review of the STRA by key stakeholders, the Pharos team developed an HIV Sustainability and Transition Roadmap recommending specific evidence-based actions to address the risks described in the STRA. These actions were mapped to specific implementing organizations, monitoring frameworks, and timelines. A draft Roadmap was discussed and validated in a stakeholder workshop held in Gaborone from October 22-27. Incorporating feedback from the final workshop, Pharos shared a final STRA and Roadmap with the Government of Botswana and UNAIDS to begin implementation of the recommended actions at the start of 2024.
Status: Completed, April 2023 – December 2023
Team Members Involved: Mila Dorji, Abaleng Lesego, Keitseope Nthomang, Qinani Dube, Robert Hecht
For more information, contact Jeremy at [email protected].