Redesigning a Ministry of Health's organizational structure: exploring implementation challenges through Botswana's experiences.
BACKGROUND
The Botswana's Ministry of Health redesigned and adopted a new organizational structure in 2005, which was poorly implemented. This article explores factors that influenced the implementation of this organizational structure.


METHODS
This article draws from data collected through in-depth interviews with 54 purposively selected key informants comprising policy makers, senior managers and staff of the Ministry of Health (N = 40) and senior officers from various stakeholder organizations (N = 14).


RESULTS
Participants generally felt that the review of the Ministry of Health organizational structure was important. The previous structure was considered obsolete with fragmented functions that limited the overall performance of the health system. The new organizational structure was viewed to be aligned to current national priorities with potential to positively influence performance. Some key weaknesses identified included lack of consultation and information sharing with workers during the restructuring process, which affected the understanding of their new roles, failure to mobilize key resources to support implementation of the new structure and inadequate monitoring of the implementation process.


CONCLUSIONS
Redesigning an organizational structure is a major change. There is a need for effective and sustained leadership to plan, direct, coordinate, monitor and evaluate the implementation phase of the reform. Copyright © 2014 John Wiley & Sons, Ltd.
Department of Health Policy Development, Monitoring and Evaluation, Ministry of Health-Botswana, Gaborone, Botswana.
Onalenna
O
Seitio-Kgokgwe
Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
Robin D C
RD
Gauld
Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
Philip C
PC
Hill
School of Health Sciences at Canterbury, University of Canterbury, Christchurch, New Zealand.
Pauline
P
Barnett
D001902:Botswana; D003695:Delivery of Health Care / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006077:Government Agencies / Q000458:organization & administration*; D006801:Humans; D007407:Interviews as Topic; D019982:Organizational Case Studies; D009936:Organizational Innovation
Ministry of Health; policy implementation; redesigning organizational structure