Six months after the nation declared a public health emergency due to low supplies, a watchdog report paints a bleak picture
Botswana’s health system, which was once regarded as one of the best in Africa, has plunged into crisis as a downturn in the diamond trade drains the nation’s finances.
A broken procurement system and funding woes have led to severe medicine shortages, long waits for treatment and overwhelmed hospitals.
Six months after the nation declared a public health crisis due to low supplies, an ombudsman’s investigation has painted a bleak picture.
The watchdog report, published late last month, found hospital staff had even been forced to spend their own money to keep patients alive, and alleged ministers were oblivious to the true extent of the problems.
In several public hospitals, administrators and frontline medics reportedly chipped in to buy basic items including swabs, sutures, and infant feeding tubes.
“Without the efforts of medical personnel on the ground, many patients would have gone untreated,” the report released late last month found.
Lengthy queues for medicines are commonplace, with patients waiting only to be told stocks have run out. Medicines for non-communicable diseases like diabetes and blood pressure have been particularly hard hit.
The Princess Marina hospital in the capital, Gaborone, has been described as the epicentre of the crisis, and running “effectively at a breaking point”.
The ombudsman found management likened the country’s biggest referral hospital to “an old, heavily worn vehicle, overloaded with passengers and packages, yet still expected to transport the entire population of Botswana safely to its destination.”
President Duma Boko last month admitted he had been “deeply saddened and disturbed” by a visit to the hospital.
“I witnessed first-hand the difficult environment in which patients are treated, the severe shortage of critical resources, and the strain placed on our dedicated health workers.”
Patients complain they are increasingly being told to buy their own drugs, in a country which once prided itself on free treatment.
The World Bank last month injected $43m into the ailing system, aimed at “helping to prevent shortages and ensure uninterrupted access to essential medicines”.
The crisis is a sharp turnaround for a health system which has been held up as an example on the continent.
In 2001, Botswana was the first African country to offer free antiretroviral drugs to HIV patients, and as recently as last year was praised as reaching the gold standard for stopping mothers passing on the virus to children.
However experts say the crisis has been brewing for a long time. Mismanagement of procurement means the problem has been worsening for years, but tipped into crisis last year amid budget problems because of falling prices for Botswana’s diamonds.
The country’s vast diamond reserves had until recently made up about a third of revenue and the bulk of foreign exchange earnings.
Yet international markets have seen several years of falling prices driven in part by the rising popularity of lab-grown synthetic stones.
Mr Boko in August 2025 declared an emergency, saying the medical supply chain had failed and he would bring in army lorries to ensure medicine stocks got through.
Dr Stephen Modise, the health minister, acknowledged that the ombudsman’s report “was painful reading”.
He told the Telegraph: “The challenges are deep and systemic – and this government will fix them.
“I can only apologise to anyone who had to use their own money to treat patients. That should not have happened.”
Donald Trump’s recent aid cuts were not the cause of the crisis he said, but decades of mismanagement.
He said: “The fall in diamond revenues has hurt. But reliance on them also bred weaknesses. Easy money went on quick fixes, not deep structural reform – procurement weaknesses, inflated drug prices, and excessive outsourcing.
“When revenues were strong, the system absorbed the costs. When they fell, the weaknesses were exposed. Mismanagement across the system drove endless private referrals – unsustainable in today’s leaner times.”
‘Botswana cannot remain dependent on diamonds’
Among measures to turn the health system around, Dr Modise said the capital’s largest private hospital was being fast-tracked into public ownership to cut waiting times.
Medicine stock levels had risen from barely 17 per cent when the emergency was declared last summer, to 60 per cent now, with more shipments due from the United Arab Emirates and Zambia.
“This stockpile buys time while structural reform takes hold. We are re-engineering the health system to make it fit for purpose and sustainable,” he said.
A newly established National Health Intelligence Centre will forecast medicine demand and prevent shortages, while the national drug procurement agency is being made autonomous to cut bureaucracy, he said.
The government also hopes to bring in a new health insurance scheme to protect health spending.
Yet analysts warn such reforms take time. Forecasts for the diamond market are still weak, even if Botswanan executives at Cape Town’s annual mining investment jamboree were last week insisting that prices would soon bottom out.
Dr Thabo Lucas Seleke, a health policy and systems research expert at the University of Botswana, also warned that fixing the funding woes had to go hand in hand with reform.
He said: “Financing reform does not automatically correct procurement bottlenecks or human resource distribution. If national health insurance is implemented, it must be sequenced alongside governance strengthening. Otherwise, it risks amplifying existing weaknesses.”
Brendon Verster, a senior economist at Oxford Economics Africa, said the crisis was starting to put political pressure on Mr Boko.
He said: “Boko has also stated that the government is moving swiftly to stabilise supplies and reshape the sector’s long-term systems in a bid to ensure that essential medicines are consistently available.
“Although this might sound good, I think there is still a cause for concern given Botswana’s fiscal position. It’s also worth emphasising that reshaping/restructuring the health system does not happen overnight.”
Botswana has in the past vowed to diversify and not bet everything on diamonds. However the gems still dominate the economy.
The government has plans to raise corporate and personal income taxes to cushion the impact of falling revenues.
Dr Modise said: “Botswana cannot remain dependent on diamonds – that dependence helped create this crisis.
“Diversification is often talked about but rarely delivered. Today, there is no alternative.
“There are real opportunities across the economy that were neglected during the boom. They remain to be seized.
“National health insurance is central to funding the future.”
Source: www.telegraph.co.uk
