A model global health academic partnership flourishes in Botswana

A quarter of a century ago, Botswana was in the throes of the AIDS/HIV crisis. At its peak, 25 percent of the southern African country’s population was infected. Between 1986 and 2002, life expectancy in Botswana dropped precipitously, from 61 years to 50. The country’s leaders at the time viewed the epidemic as an existential danger, with then-President Festus Mogae saying in 2001, “We are threatened with extinction.”

But in the past 25 years, Botswana’s AIDS-related death rate has fallen by more than 75 percent. Today, the AIDS/HIV crisis has stabilized to be just one of many chronic health issues the country is managing, supported by a powerful health infrastructure and academic enterprise that are looking beyond treating infectious diseases to enhancing optimal health.

Along with strategic investments in health infrastructure and public health initiatives, international partnerships were a key ingredient in this remarkable success. Since 2001, Penn has served as one of the country’s primary partners through the Botswana-UPenn Partnership, an office of Penn located in Gaborone, Botswana, that supports Botswana clinicians and leaders through collaborative research, clinical service, and training for local practitioners. The program has successfully marshalled Penn’s resources and supported Penn Medicine clinicians and faculty to promote both individuals’ health and the health and educational foundation of the entire country.

The Botswana-UPenn Partnership “represents the potential for international academic partnerships to transcend crisis and build in-country expertise for a sustainable win-win for academic and medical institutions across the globe,” said Glen Gaulton, PhD, a professor of Pathology and Laboratory Medicine, vice dean, and director of the Center for Global Health at Penn Medicine.

The collaboration, still ongoing, continues to shape an expansive vision of better health far beyond its original AIDS-crisis mission for Botswana and as a model for broader global health impact.

In 2001, after Mogae’s urgent plea for assistance to the United Nations, Penn was invited to offer clinical training support as the country became the first in Africa to offer free HIV care that same year.

At first, the organization focused on AIDS/HIV treatment with Penn personnel serving as consultants. As the partnership grew, it necessitated a fully staffed research and operational office in Gaborone to administer and support the various clinical, research, and educational endeavors. By the second year, the Botswana-UPenn Partnership had a full-time in-country director, and at its peak the program had a workforce of 140 (currently, there are 67 employees).

When millions of dollars in AIDS/HIV research funding became available through the National Institutes of Health, the partnership began to proliferate, with Penn faculty working alongside colleagues in Botswana.

In 2004, Penn medical students began optional six-week rotations at Botswana’s Princess Marina Hospital; later, they were joined by residents from nearly a dozen different specialties.

The country’s success in addressing the HIV crisis progressed on multiple fronts, including reducing mother-to-child transmission. Today, in the population aged 15 to 64 years, the country has exceeded the UNAIDS’ “95-95-95” targets: 95 percent of HIV-positive individuals know their status, 98 percent of those are receiving treatment, and 98 percent of people being treated have an undetectable viral load.

The Botswana-UPenn Partnership supported this progress in treating AIDS/HIV and, eventually, other infectious diseases like tuberculosis, through direct clinical care and research contributions by Penn faculty. It also helped expand the country’s health infrastructure to sustain these and other health gains. In 2009, Penn assisted the University of Botswana in launching the country’s first medical school, to address the shortage of doctors and reduce reliance on training medical students abroad.

Over more than two decades, the Botswana-UPenn Partnership has transformed from a response to the AIDS crisis into an organization with a broader mission and impact spanning patient care, advocacy for access to care, research, and education. That work includes raising awareness of the link between HIV and substance abuse, collaborating on the rollout of a national eye-care program, and training clinicians in fields as varied as dermatology, oncology, pediatrics, gynecology, and mental health.

“We have people growing whole departments, trying to grow the complexity of care,” said Merrian J. Brooks, DO, MS, assistant director of the Botswana-UPenn Partnership and director of Research and Pediatrics, who recently coauthored a paper in BMJ Global Health surveying the BUP’s program’s research and funding impact. She is also an assistant professor of Pediatrics in the Perelman School of Medicine and assistant program director of the David M. Pincus Pediatric Global Health Fellowship at Children’s Hospital of Philadelphia (CHOP).

“That’s something different from the global health model we’re used to, which is we come and do the basics,” Brooks said. “We’re moving into an expanded view of health.”

More recent developments include:

• A rehabilitation robotics lab at Sir Ketumile Masire Teaching Hospital
• The Physical Medicine and Rehabilitation global program in Botswana, including prosthesis fittings, joint research, and clinical initiatives
• The Global Nursing Fellowship between CHOP and Princess Marina Hospital in Gaborone
• A nursing clinic for high-risk infants
• Adolescent mental health research

The program’s growth reflects that of the University of Botswana and of the country’s health system more broadly, Brooks said. Many of the program’s former staff and trainees now play prominent leadership roles in the University of Botswana and in the nation’s government, and the program has also trained thousands of people in a wide range of health care careers.

“One of the things that’s not talked about enough is what we have done for the workforce in general,” said the program’s new director, Farouk Dako, MD, MPH, an associate professor of Radiology at Penn Medicine and the founding director of Penn’s Center for Global and Population Health in Radiology. “Our presence here has not only been for training Penn students and residents who rotate here, but also we’ve contributed to local workforce development, including through training of clinicians, nurses, and researchers and providing formal educational opportunities for local staff through employee benefits.”

In the program’s second quarter century, Dako seeks to put that wealth of local health care expertise in Botswana to greater use—both to reach more patients in Botswana, and to promote collaboration throughout Africa, with Botswana as a regional center of excellence.

“Not every single country can be excellent in every single thing,” he said. “There are unique challenges to Botswana that, perhaps, Ghana can learn from, and so forth.”

The program will celebrate its 25th anniversary with a large academic conference to be held November 12-13, 2026, in Gaborone to promote both this type of regional academic collaboration and global health partnership.

Dako explained, “I’m interested in essentially helping build a transnational group of organizations that have similar issues and concerns and shared history as well as shared destiny.”

These global health organizations can learn from shared challenges, as well. As just one example, take Dako’s specialty, radiology. In Botswana, the wait to receive results from an MRI scan could be several months or longer, due to capacity hurdles in both equipment and personnel. Additionally, most health care is concentrated in Gaborone and other major population centers, leaving many rural areas without easy and timely access to high-quality care.

“How do you innovate and come up with cost-effective solutions that are tailor-made to solve the particular problem in that particular context?” Dako asks. He is confident that investments in technology can help solve these thorny questions, along with what he calls a “frugal innovation” mindset.

Dako is excited about a new project using artificial intelligence to help automate the interpretation of medical imaging as well as to summarize medical text. He also foresees using telehealth and digital health to reach patients in sparsely populated areas, whether via direct patient appointments via cell phone video call, or via consultations between rural practitioners and specialists in cities.

Looking ahead to the future of the partnership, the program has several things working in its favor. Botswana has reached what Dako and Brooks term “middle-income” status, enabling the country to devote funding to building out a robust health infrastructure, which prioritizes technology. Because it is structured as an office of the University of Pennsylvania in Botswana, funding for the Botswana-UPenn Partnership remains within the institution, buffering it from disruptions that have affected other African health initiatives in the wake of U.S. federal funding cuts. Dako added that as a result, the program has been able to attract more grants, as well as funding from industry and foundations.

With this wellspring of support, he envisions making the program a “completely multidisciplinary effort,” involving not only relationships with the Perelman School of Medicine and CHOP, but also with Penn’s schools of business, veterinary medicine, dentistry, and even the arts.

“The goal is to really redefine what health looks like—not just individual health, but societal well-being,” Dako said. “It’s not just about, ‘OK, how do we make sure people are not sick?’ We want people to achieve their truest potential.”