Botswana’s health crisis: The silent fracture in the nation’s promise
Dr Teedzani Thapelo | Tuesday August 19, 2025 08:33
The statement, stripped of bureaucratic gloss, read with chilling directness. For most Batswana, these words were not mere policy adjustments. They heard the sound of the floor giving way beneath their feet. In a country where the public health sector remains the primary source of care for the vast majority of citizens, this was the equivalent of an emergency siren — signalling that even the once-assumed basics of medical treatment were now in question. At first glance, “prioritising emergency and urgent operations” may sound reasonable. In conditions of scarcity, any functioning health system must triage: emergencies first, deferrable procedures later. But the devil lies in the details — and in the implications of what is being deferred. Elective and non-urgent surgeries are not frivolous luxuries. They include cataract removals that restore sight, hernia repairs that prevent dangerous complications, and orthopaedic surgeries that keep people mobile and economically productive.
Postponing them does not simply mean postponing discomfort; it often means allowing a manageable condition to deteriorate into a life-threatening one. The Ministry’s announcement is therefore more than a technical resource-allocation decision. It is an admission that Botswana’s health system can no longer simultaneously provide the full spectrum of medically necessary care — even at a basic level — to all who need it. This is not merely a “medicine shortage.” It is a systemic collapse in the capacity to deliver the constitutional promise of health as a public good. To understand the depth of the problem, it is necessary to see the crisis as both material and structural. On the material side, the government’s statement acknowledges that medicines and medical commodities — from antibiotics to surgical gloves, anaesthetic agents, cancer drugs, and dialysis supplies — are in short supply. In the language of public health, this is not a gap; it is a critical supply-chain failure. Hospitals cannot operate theatres without anaesthesia. Nurses cannot manage chronic illness without a consistent drug supply. Even emergency care becomes compromised when the very tools of life-saving interventions are absent. The root cause is fiscal. “Financial challenges facing the country” is the shorthand the Ministry has used, but in reality, it points to a deeper malaise in the national economy. The treasury is strained, foreign reserves are tight, and the prioritisation of other urgent economic commitments has squeezed the health budget. In such an environment, procurement of essential medical commodities suffers first — because suppliers demand payment guarantees and the state cannot keep up.
The structural dimension is even more troubling. The present crisis did not appear overnight. Years of underinvestment, slow procurement cycles, dependence on a limited set of suppliers, and weak enforcement of accountability in supply-chain management created a fragile system. The COVID-19 pandemic worsened it. Inflation in pharmaceutical imports, coupled with exchange-rate volatility, has now tipped it over the edge. This is a crisis that touches every citizen. It is tempting to think of it as a problem for the poor alone, those dependent on public hospitals. But the shortage radiates outward. Private sector facilities rely on the same national import pipelines, and when public sector demand surges for limited stock, private costs rise. Eventually, even the well-off find themselves affected. The implications for daily life are severe. Postponement of surgeries is not a neutral delay; it can mean the difference between a routine operation and an emergency crisis later, with higher risk and cost. In prioritizing only emergencies, routine screenings, immunizations, and chronic disease management may quietly fall by the wayside.
The country will pay for this neglect years from now in higher rates of late-stage cancers, diabetic complications, and preventable infectious diseases. Knowing that the health system is stretched to the limit erodes public confidence. People delay seeking care until it is too late, fearing either the cost or the futility of entering a dysfunctional system. Those with means will seek care abroad in South Africa or private facilities, while the majority are left to queue in a deteriorating system. This deepens the social fracture between economic classes. There is also a hidden human cost: moral distress among the health workforce. Doctors, nurses, and allied health workers are now forced into impossible choices about who gets care and who waits. This is a recipe for burnout, demoralisation, and an exodus of skilled professionals at the very moment the country needs them most. For the UDC government, the crisis presents a direct challenge to the social contract it promised to renew. The party came to power on a vision of governance grounded in transparency, equity, and a multidimensional human rights approach. Health was not to be a privilege but a right. The social contract is not an abstract concept; it is the lived belief that the state will safeguard citizens in times of need. In Botswana, the public health system is one of the most visible and tangible expressions of that contract. When the state declares it can no longer guarantee access to non-urgent care, it sends a signal — however unintended — that the safety net has holes. This risks corroding the legitimacy of the government, even when the underlying cause is inherited fiscal fragility rather than policy neglect. Furthermore, a multidisciplinary human rights governance approach obliges the state to view health not only as a medical matter but as an interlinked ecosystem of rights — the right to dignity, equality, participation, and life itself.
Suspending services without a communicated recovery plan risks undermining these obligations in practice, even if not in law. Addressing this crisis requires urgent action. The government cannot resolve its fiscal constraints overnight, but it can declare a national health emergency to mobilise the highest level of political attention and open pathways for special procurement measures, donor engagement, and emergency budget reallocation. Such a declaration would also send a powerful signal to citizens and partners that the state recognises the gravity of the crisis. A rapid health commodities task force should be established, bringing together the Ministry of Health, the Ministry of Finance, trade regulators, and supply-chain experts with a short, fixed mandate to secure emergency procurement of critical commodities. This must be complemented by aggressive engagement with regional and international partners. Botswana’s high-middle-income classification has historically limited access to concessional health aid, but emergencies open exceptional channels. Partnering with SADC neighbours, the African Union, and the WHO to replenish stocks quickly would help stabilise the situation. Public communication is vital. The August 4 memo, while clear, was reactive. Going forward, the public must be regularly updated on which commodities are scarce, what is being done to address shortages, and how long relief measures will take. It is also essential to protect preventive and primary care. Even amid shortages, it is cheaper — and ethically essential — to keep services like vaccinations, antenatal care, and management of high-risk chronic diseases intact. These services form the backbone of population health, and neglecting them now will multiply the crisis in the years ahead. Fiscal re-prioritisation is unavoidable. The Ministry of Finance, in consultation with the Presidency, must urgently reassess budget allocations. In times of crisis, the opportunity cost of cutting health is too high.
Some capital projects can be delayed; health cannot. Botswana’s health crisis is not an isolated misfortune. It is a mirror reflecting the broader vulnerabilities of the state: the fragility of fiscal planning, the limits of middle-income status in shielding against shocks, and the long shadow of underinvestment in public goods. The August 4 memo will be remembered not for its bureaucratic phrasing but for its unintentional honesty: that saving lives had to be prioritised over everything else — as if the two were ever separable. The hard truth is that in a healthy society, saving lives is everything else. It is the foundation on which all other development rests. For the UDC government, this moment is both a peril and an opportunity. Peril, because nothing corrodes political credibility faster than citizens feeling abandoned in their hour of need. Opportunity, because a decisive, transparent, and inclusive response can redefine the state-citizen relationship in ways that make the social contract more resilient.
The crisis has stripped away illusions. It has revealed that in the end, governance is judged not by grand policy blueprints, but by whether a citizen, in pain or fear, can walk into a public hospital and be treated without delay or despair. If Botswana learns this lesson now — and acts with urgency — then the August 4 health crisis, for all its human cost, may yet be remembered as the moment the nation confronted the fragility of its promise and chose to make that promise real again. Dr Teedzani Thapelo* is the author of two new books: New Perspectives On Gender-Based Violence in Botswana: Conversations With Philosophers, and Combating GBV in Botswana Society: A Five-Year Programme To Combat GBV.