Primary health care (PHC) is the foundation of a strong and equitable health system. Yet across many settings, PHC delivery still reflects institutional priorities over the lived realities of the people it is meant to serve. At Jhpiego, we have seen numerous examples of health care designed around institutions rather than individuals, creating gaps in trust, access, and continuity of care. When care becomes too centralized or overly technical, it risks losing its most essential ingredient: the human connection.

In Botswana, people-centered, community-driven PHC has transformed health outcomes. So much so that last May, the World Health Organization awarded Botswana Gold Tier Status for its work eliminating mother-to-child transmission of HIV. This marked the first time any country received this status (Botswana also became the first nation to meet the criteria for silver tier status in 2021 due to significant reductions in pediatric HIV infections).

This recognition highlights a health system in Botswana that combines decentralized care, strong antenatal programs, accessible treatment, and meaningful community engagement to deliver high-quality results at scale. The Botswana approach is rooted in local leadership, community participation, and service delivery that responds to real-world needs. When communities, health workers, and partners work together, PHC can deliver excellence, equity, and progress for generations.

Here are key lessons that Botswana has learned in its commitment to PHC and the reduction of mother-to-child transmission of HIV:

1. Innovation starts at the community level
   Innovation is not only about new technology; it often begins with doing things differently. Rethinking structures, strengthening communication, and giving local health workers the skills and tools they need to transform care are essential. In Botswana, reviving village health committees and giving them decision-making roles has helped communities tackle challenges early and seek care sooner. Communities understand their realities best; our responsibility is to listen, support, and amplify their voices. When innovation begins at the community level, solutions are more sustainable, trusted, and effective.
2. Partnerships must be rooted in empowerment
   Sustainable PHC requires partnerships rooted in empowerment rather than dependency. Approaches such as embedding technical mentors within district health teams strengthen leadership, transfer skills, and align priorities across the system. When governments, technical partners like Jhpiego, and communities co-design solutions, they create systems that are stronger, more adaptable, and self-sustaining. This aligns with Botswana’s broader health vision that local ownership and community engagement drive national progress.
3. Focus on action, not just dialogue
   Achieving universal health coverage and strong PHC requires more than policy commitment; it requires action. Progress is accelerated when communities are actively engaged, traditional silos are bridged, and leadership at every level is strengthened. Across Botswana, coordinated efforts have shown that consistent investment in people, systems, and partnerships creates measurable and lasting impacts. A people-centered PHC vision demands courage, collaboration, and continuous innovation.

Botswana as Proof

Botswana’s WHO Gold Tier Certification is not the result of isolated HIV programming. It is evidence of a robust PHC approach that integrates HIV prevention and treatment into routine facility and community services. This achievement demonstrates that when PHC systems are designed around people, not institutions or funding cycles, they produce transformative, long-term results. Botswana’s success shows that meaningful partnerships, empowered communities, and investment in health workers can create health outcomes that improve lives for generations.

These ideas are not new, but their sustained implementation requires renewed commitment and creativity. The true strength of a PHC system is not measured solely by the facilities built or the policies drafted, but by the trust nurtured, the partnerships strengthened, and the communities empowered. Let’s continue building systems that work with the people, for the people.

William Bapathi is a technical director in Jhpiego’s Botswana office. Clinton Warona Mogapaesi, Visual Communication Specialist in Jhpiego’s Botswana office, contributed to this blog post.

Chantelle Allen is a Senior Principal Technical Advisor for Jhpiego.