Infection Prevention and Control in Botswana: National AMR Context
Botswana is facing a growing antimicrobial resistance (AMR) burden, with healthcare-associated infections (HAIs) increasingly driven by multidrug-resistant organisms. Outbreaks involving resistant pathogens have been documented in referral hospitals, particularly in neonatal intensive care units and high-risk wards. Botswana’s National Action Plan on AMR (2025–2029) prioritises improvement of infection prevention and control, surveillance, antimicrobial stewardship, and strengthened governance, as strategies to combat AMR and HAIs rates. However, gaps remain in IPC infrastructure, surveillance systems, workforce capacity, and sustainable financing. Botswana recently joined the WHO GLASS platform and is strengthening national AMR surveillance and laboratory systems. This project directly supports Botswana’s AMR priorities by strengthening IPC systems and reducing HAIs across referral and district hospitals.
Problem
HAIs remain a major challenge across hospitals in Botswana, contributing to preventable morbidity, mortality, prolonged hospital stays, and increased antimicrobial use. Neonatal wards continue to experience outbreaks caused by multidrug-resistant organisms, presumably driven by weak IPC systems, inconsistent adherence to protocols, and limited surveillance capacity. Existing IPC interventions are challenged by limited resources and require adaptation to local contexts to ensure sustainability. Additionally, the economic burden of HAIs and AMR has not been intricately quantified. This project addresses these gaps by co-developing, implementing, and evaluating tailored IPC bundles to strengthen patient safety, improve IPC practices, and reduce HAI incidence.
Project overview
This three-year implementation research project will co-develop, pilot, implement, and refine IPC bundles across Princess Marina Hospital, Scottish Livingstone Hospital, and Deborah Retief Memorial Hospital in Botswana. The project will focus on NICUs and other high-risk wards such as surgical, obstetric, and intensive care units. Activities include baseline IPC assessments, healthcare-associated infection surveillance, stakeholder mapping, qualitative assessments, staff training, development and implementation of unit-specific IPC bundles. The project also includes a health economics component to quantify implementation costs, cost savings from prevented HAIs, and return on investment. Findings from the project will inform updates to Botswana’s national IPC guidelines and future scale-up plans.
Intended outcomes
The project aims to reduce healthcare-associated infections (HAIs) and HAI-attributable mortality in participating wards by 10–20% from baseline. Expected outcomes include strengthened IPC capacity, improved HAI surveillance systems, increased adherence to IPC practices, reduced inappropriate antimicrobial use, and improved patient safety culture across participating hospitals. The project will also generate evidence on the feasibility, effectiveness, and economic value of IPC bundle implementation in Botswana. Ultimately, the project seeks to contribute to reduced AMR selection pressures, improved patient outcomes, and strengthened sustainable infection prevention systems in Botswana.
“Botswana is demonstrating strong leadership in advancing its national antimicrobial resistance agenda. Through this project, we are co-developing practical, locally adapted infection prevention and control solutions that strengthen patient safety, reduce healthcare-associated infections, and generate evidence to inform sustainable scale-up and national policy. This reflects ICARS’ commitment to supporting country-led, evidence to action approaches that strengthen health systems and preserve the effectiveness of antimicrobials.”
Mabel De Leo, Science Officer and Project Lead, ICARS
*Funded by Wellcome.
