title: Establishing a health information workforce: innovation for low- and middle-income countries.
abstract: BACKGROUND
  To address the shortage of health information personnel within Botswana, an innovative human resources approach was taken. University graduates without training or experience in health information or health sciences were hired and provided with on-the-job training and mentoring to create a new cadre of health worker: the district Monitoring and Evaluation (M&E) Officer. This article describes the early outcomes, achievements, and challenges from this initiative.
  
  
  METHODS
  Data were collected from the district M&E Officers over a 2-year period and included a skills assessment at baseline and 12 months, pre- and post-training tests, interviews during stakeholder site visits, a survey of achievements, focus group discussions, and an attrition assessment.
  
  
  RESULTS
  An average of 2.7 mentoring visits were conducted for M&E Officers in each district. There were five training sessions over 18 months. Knowledge scores significantly increased (p < 0.05) during the three trainings in which pre/post tests were administered. Over 1 year, there were significant improvements (p < 0.05) in self-rated skills related to computer literacy, checking data validity, implementing data quality procedures, using data to support program planning, proposing indicators, and writing M&E reports. Out of the 34 district M&E Officers interviewed during site visits, most were conducting facility visits to review data (27/34; 79%), comparing data sets over time (31/34; 91%), backing up data (32/34; 94%), and analyzing data (32/34; 94%). Common challenges included late facility reports (28/34; 82%), lack of transportation (22/34; 65%), inaccurate facility reports (10/34; 29%), and colleagues' misunderstanding of M&E (10/34; 29%). Six posts were vacated in the first year (6/51; 12%). A total of 49 Officers completed the achievements survey; of these, common accomplishments related to improvements in data management (35/49; 71%), data quality (31/49; 63%), data use (29/49; 59%), and capacity development (26/49; 53%).
  
  
  CONCLUSIONS
  The development of a cadre of district M&E Officers has contributed positively to the health information system in Botswana. In the absence of tertiary training related to health information, on-the-job training and mentoring of university graduates can be an effective approach for developing a new professional cadre of M&E expertise and for strengthening capacity within a national health system.
authors.affiliation: Department of Global Health, University of Washington, Seattle, Washington, USA. ledikwe@u.washington.edu
authors.forename: Jenny H
authors.initials: JH
authors.lastname: Ledikwe
authors.forename: Letitia L
authors.initials: LL
authors.lastname: Reason
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Burnett
authors.forename: Lesego
authors.initials: L
authors.lastname: Busang
authors.forename: Stephane
authors.initials: S
authors.lastname: Bodika
authors.forename: Refeletswe
authors.initials: R
authors.lastname: Lebelonyane
authors.forename: Steven
authors.initials: S
authors.lastname: Ludick
authors.forename: Ellah
authors.initials: E
authors.lastname: Matshediso
authors.forename: Shreshth
authors.initials: S
authors.lastname: Mawandia
authors.forename: Mpho
authors.initials: M
authors.lastname: Mmelesi
authors.forename: Baraedi
authors.initials: B
authors.lastname: Sento
authors.forename: Bazghina-Werq
authors.initials: BW
authors.lastname: Semo
mesh_terms: D001902:Botswana; D005069:Evaluation Studies as Topic; D017144:Focus Groups; D063005:Health Information Systems / Q000458:organization & administration* / Q000600:supply & distribution; D006282:Health Personnel / Q000458:organization & administration; D006301:Health Services Needs and Demand; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D011203:Poverty; D016730:Program Development / Q000379:methods*; D036301:Qualitative Research; D012107:Research Design