Introduction
Worldwide, an estimated 800 women die each day from preventable causes related to
pregnancy and childbirth, the majority in low-and middle-income countries (WHO, 2014:1).
The Safe Motherhood Initiative (SMI) aims to achieve safe pregnancies and childbirth, but
maternal mortality remains a significant problem in Botswana.
Aim and Objectives: The aim of this study was to analyse the implementation process of the
SMI policy in Botswana, with specific reference to the training component. The specific
objectives of the study were to: describe the context of policy implementation; analyse the
content of the SMI policy guidelines; describe the process of implementation of the 2005
SMI policy guidelines; describe the key policy actors, their roles and their influence on the
implementation of the policy; and describe the factors influencing the implementation of the
SMI policy in Botswana.
Methods: The study used a contemporary health policy analysis framework. During 2008,
key informants were selected purposively in the southern health region of Botswana.
Following informed consent, 12 in-depth interviews were conducted with key informants to
obtain their views and perceptions of the content, context, process and the actors of the SMI
policy implementation process. The data were analysed using thematic content analysis.
Results: The study found that there was high level government commitment, with the SMI
driven by the Ministry of Health. Key successes of the SMI policy included: the integration
of the Prevention of Mother-to-Child Transmission (PMTCT) of HIV component into the
SMI policy, the integration of SMI into the midwifery curriculum and the development,
standardisation and distribution of reference manuals or protocols. However, legislative and
health system barriers, as well as unsustainable funding, insufficient consultation with and
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support by stakeholders, and inadequate coordination of the policy process hindered the
successful implementation of the SMI policy.
Conclusion: The findings draw attention to the value of stakeholder involvement in policy
formulation and implementation; the importance of addressing policy implementation
barriers and resource availability; and the need for effective coordination and communication.