Innovation and Implementation Reports Adequate

numbers of appropriately qualified human resources for health (HRH) are a critical component of any effective health system, being associated with positive health outcomes.1 Many regions suffer from a shortfall of health personnel. Africa represents 40 % of the global shortfall, and of the 57 countries in the entire world with a critical shortage, 36 are in sub-Saharan Africa.1 The Sub-Saharan African crisis is exacerbated by a disproportionately high rate of infectious diseases and the burden of emerging chronic, noncommunicable diseases.2–4 A major setback for the region has been the large number of highly trained doctors, educated in Sub-Saharan Africa countries, who have migrated outside the continent.3,5 For example, over the 10-year period 2002 through 2011, many Sub-Saharan African countries experienced decreases in physician densities because of increasing migration.6 In addition, until 2010, eight Sub-Saharan African countries had no medical schools of their own, which necessitated dependence on expatriates and external training.7 Although not as severely affected as most other Sub-Saharan African counterparts, Botswana has for many years experienced its own physician shortages. Botswana, a country geographically smaller than Texas, has a population of 2 million but only 700 doctors (34 physicians for every 100,000 people).4 Only 21 % of these physicians are citizens of Botswana. To help address the shortage, Botswana in the 1990s embarked on an aggressive program to train its students at foreign medical schools. This effort was facilitated by a number of arrangements wit