Botswana has a population of just over 2 million, 33% of whom are under 14. The country is divided into nine districts. The biggest cities are Gaborone and Francistown, with about 200 000 and 100 000 inhabitants respectively. Based on an incidence of 1/500 live births and a birth rate of 22.02/1000 of the population, it is estimated that over 90 babies are born with clubfoot per year in Botswana. 
Steps founder Karen Moss first became involved in clubfoot treatment in Botswana in 2009, after being contacted by Gaborone mother Tshepang Seisa for help with her son’s case. Tshepang took her son for Ponseti treatment in Johannesburg. In 2011 Karen raised funds and arranged treatment in Johannesburg for another child from Botswana, Erto. After this, Karen and Tshepang discussed the need to introduce the Ponseti method to Botswana so that all children could access treatment in their own country. Tshepang identified a delegate to attend the May 2012 SAPOS Ponseti Instructional Course in Cape Town. After training, they had several meetings with government to motivate for the introduction of Ponseti.
In November 2012, Karen attended a meeting organised by Tshepang with the head of Paediatric Orthopaedics at Princess Marina Hospital, Dr Yash Gureja.
Two further meetings were held at the Ministry of Health (MoH) in November 2012 and January 2013 and Steps was requested by the Botswana government to help establish a National Clubfoot Programme. Steps organised the first Botswana Ponseti training in June 2013 at Princess Marina Hospital, Gaborone. Three South African Ponseti faculty trainers trained twenty-three delegates attended from 12 hospitals/clinics, and seven towns/districts.
In July 2013, the Ponseti clubfoot clinic in Princess Marina Hospital started. By October 2013, the Princess Marina Hospital clubfoot clinic had already treated 34 patients. In November 2013 the STEPS Botswana Trust was registered as a non-profit trust in Gaborone. In July 2013, a week after the training, the first Ponseti clubfoot clinic in Princess Marina Hospital started, supported by Steps. By October 2013, the Princess Marina Hospital clubfoot clinic had already treated 34 patients.
In November 2013 the STEPS Botswana Trust was registered as a non-profit trust in Gaborone. In November 2014 STEPS organised the 2nd Botswana Ponseti training at Mahalapye Hospital with support from the Botswana Ministry of Health, with South African and local faculty trainers. A Ponseti trained Botswana team set up a new clubfoot clinic at Mahalapye Hospital with support from Steps, Steps Botswana Trust, the PMH team and the Botswana Ministry of Health.
In May 2015, Steps Botswana signed a Memorandum of Understanding with the Botswana Ministry of Health and Social Services to collaborate on the development of a national clubfoot programme and to raise awareness in the community that clubfoot can be treated. In November 2014 STEPS organised the 2nd Botswana Ponseti training at Mahalapye Hospital with support from the Botswana Ministry of Health. A Ponseti trained team set up a new clubfoot clinic at Mahalapye Hospital with support from Steps Botswana Trust, the PMH team and the Botswana Ministry of Health.
Pamella and Lunzulu, Maun
The 3rd Botswana Ponseti training was held in Maun in July 2015 at Letsholathebe II Memorial Hospital in partnership with Thuso Rehabilitation Centre. As a result of the training, a new clubfoot clinic was established at Letsholathebe Hospital with local support resources from Thuso Rehabilitation Centre. A follow up training was held in Maun in April 2016 to educate nurses and community workers on recognising clubfoot, as there are a high number of neglected cases in outlying areas due to late referral.
Steps’ MOU with the Botswana Ministry of Health expired in May 2017 and is under discussion. Over 290 patients have been treated in the programme from July 2013 to June 2017. Steps Botswana has provided training workshops and materials, clubfoot braces, parent education, data capture, and supported outreach visits and clubfoot awareness events.
1. Mkandawire N.C., Kaunda E, Incidence and Patterns of Congenital Talipes Equinovarus (Clubfoot) Deformity At Queen Elizabeth Central Hospital, Malawi