A benchmark qualitative study of health service delivery in Botswana in 1989: Nurse assessments of the primary healthcare system before the nationwide spread of HIV/AIDS

An evaluation of the "watershed" Meharry-Botswana nurses training program in 1989 (Linn and Fako, 1990) confirmed that the maternal, child health, and family planning nursing practices taught by the multi-year education intervention in the 1970s had been widely disseminated and adopted. Based on a national sample of over 350 practicing nurses, this was strong evidence of the high clinical capacity of the primary healthcare system which was soon to be challenged by a generalized epidemic of HIV/AIDS. While the quantitative data from this evaluation was published, the qualitative information, which includes in-depth local nurse assessments of important parameters of the national primary healthcare system was reported, but remained unpublished until included in this manuscript. From this detailed information, we can develop a deeper understanding of the nurse clinician perceived strengths and weaknesses of Botswana’s primary healthcare system in 1989, immediately prior to the nationwide spread of HIV/AIDS. The findings show the high professionalism and resilience of the Botswana nurses-- qualities that helped them to successfully address the HIV/AIDS pandemic several years later.