A team comprising members from the Country Coordinating Mechanism (CCM), Botswana Country Coordinating Mechanism (BCCM), Global Fund Program Management, and WHO Botswana undertook closeout missions for the Global Fund’s Grant Cycle 6 (GC6), which began on the 10th of February 2025 in Maun and Francistown, respectively. These missions were conducted to assess accountability, review program outcomes, and evaluate implementation efficiency, as the country prepared to transition to Grant Cycle 7 (GC7), scheduled to begin in the second quarter of 2025.
Following the conclusion of GC6 on December 31, 2024., and having focused primarily on HIV and TB, the closeout visits aimed to document key achievements, challenges, and lessons learned, ensuring a seamless transition to GC7. The Ministry of Health, acting as the Principal Recipient, managed several sub-recipients (SRs) and sub-sub recipients (SSRs) tasked with implementation across districts, with WHO Botswana providing vital technical support and oversight.
In Francistown, the CCM Oversight Committee engaged with the District AIDS Coordinator (DAC) under the National AIDS and Health Promotion Agency (NAHPA), who provided a comprehensive background and analysis of the district’s HIV response. Several urban challenges were highlighted, including the proliferation of multiple concurrent sexual partnerships, increasing rates of sexually transmitted infections (STIs) and new HIV infections, rising teenage pregnancies among school-age youth, and a surge in drug use and crime.
The DAC also acknowledged persistent stigmatization, particularly among key populations, which hampers access to essential health services. However, progress has been made, thanks to strong collaboration with community-based organizations (CBOs) and NGOs that are well-positioned to connect with communities. These organizations have been instrumental in undertaking outreach activities often outside regular working hours and on weekends making service delivery more accessible.
The Francistown District Health Management Team (DHMT), led by a Public Health Specialist and supported by the District Matron, Deputy Matron, and Pharmacist, welcomed the Oversight Team. They expressed appreciation for improved service delivery supported by GC6 implementers, which has contributed to meeting key health targets. However, they also raised concerns about the compressed implementation timeline, noting that effective execution only gained momentum in mid-Q1 of 2024, leaving little time to achieve the grant’s full potential before its closure.
The team commended the government for its support during GC6 but cautioned that the delay in transitioning to GC7 was already impacting services, with some CBOs forced to scale down or shut operations altogether due to funding gaps.
At Area W Clinic, the Oversight Committee met with the clinic’s Head and representatives from ACHAP one of the GC6 grant’s key implementing partners. ACHAP’s mentorship and collaboration with clinic staff helped Francistown surpass its Voluntary Male Medical Circumcision (VMMC) targets exceeding 1,000 procedures against an initial target of 200.
ACHAP also played a pivotal role in supporting the Adolescent Girls and Young Women (AGYW) programme through the Youth Friendly Services Centre. Their mobilization strategies significantly increased the number of young girls accessing sexual and reproductive health services in the district.
BOCAIP, subcontracted by BONELA as an SSR, focused on implementing the Human Rights module across Francistown and selected surrounding villages. The visit highlighted the importance of continued induction and capacity building for SSRs, particularly in preparation for GC7. The sustainability of services emerged as a key concern, especially those reliant on external funding. To address this, stakeholders emphasized the need for stronger integration with local government systems.
Nothing For Us Without Us (NFSWU), another CBO under BONELA’s subcontract, implemented human rights programming targeting sex workers in Francistown, Tonota, and Selibe Phikwe. Despite facing challenges such as delayed funding disbursements, reduced allocations, and misaligned targets, the organization reported surpassing their service delivery goals. However, low stipends and transport allowances forced staff to use personal resources to meet expectations.
The Oversight Committee proposed the development of a detailed mission report to be shared with the CCM. Key follow-up actions include:
Engaging Principal Recipients (PRs) to refine contractual mechanisms with SRs and SSRs.Advocating for timely contracting and proper induction of SSRs early in the grant cycle.Encouraging the CCM and Oversight Committee to conduct quarterly site visits for continuous monitoring and support.
As Botswana prepares for GC7, the lessons and insights from GC6 will be crucial in enhancing the HIV and TB response nationwide. WHO Botswana remains committed to providing technical support to ensure the country continues to deliver impactful public health interventions aligned with global standards.
