Botswana fails ‘right to health’ test
Tsaone Basimanebotlhe | Monday January 26, 2026 06:00
When unveiling the investigation report before the media on Tuesday this week, Tiroyakgosi disclosed that this is due to an inadequate supply of ambulances, limited space for hospital beds, shortage and demoralised staff, deficiencies in patient complaints handling and follow-up mechanisms (weak policy framework). Tiroyakgosi said this is also due to a shortage of medicines and medical commodities, and budget and resource inadequacy and mismanagement and that the failure is clear.
He said, “The investigation found country-wide structural realities of overcrowded wards, lack of privacy, inadequate bedding, and delayed emergency response reflecting conditions incompatible with human dignity.”
He, however, said these shortcomings were found to innately undermine the principle of equality and non-discrimination, as they placed disproportionate burdens on low-income and rural populations who rely exclusively on the public health system, thus diminishing their right to fair and non-discriminatory treatment in the receipt of public health services.
At Princess Marina Hospital (PMH), the investigation found that the hospital is operating beyond its functional limits and is effectively at a breaking point. In illustrating the severity of the situation, he said hospital management likened PMH to an old, heavily worn vehicle, overloaded with passengers, packages, and mechanical strain, yet still expected to transport the entire population of Botswana safely to its destination.
“This analogy underscores the unsustainable burden placed on the facility,” he said. The investigation revealed that the Ministry of Health currently operates (that is, at the time of this report) a fleet comprising 101 active ambulances and 87 inactive ambulances. In addition, he said a high proportion of these active vehicles are over five years old and do not meet roadworthiness standards as prescribed under the Transport Orders and Procedures Policy.
“As a result, the Government continues to incur substantial expenditure on servicing and repairs in an attempt to keep an ageing and unreliable fleet operational. The Ministry operated without a policy or planning framework to determine the optimal number of ambulances required to meet national demand, leading to the procurement of an insufficient number of ambulances and utility vehicles,” he said.
Moreover, he said ambulances and hospital utility vehicles are repaired or replaced on an hoc basis, subject to the availability of funds. Ombudsman said this absence of strategic planning has contributed to inefficiencies, service gaps, and escalating costs. He said PMH is the busiest tertiary/referral hospital in Botswana, serving as a critical national healthcare hub in the country.
“It’s Emergency Department manages a high and complex patient load with 60-70 patient visits every 24 hours, functioning with only three resuscitation bays, nine main treatment bays and four triage bays with a staff complement of 75 medical staff: The Emergency Department currently has 16 medical officers, half of whom are on six month temporary contracts,” the report states. Additionally, he said the department is supported by 10 emergency medicine residents (with 4–5 full-time), 36 nurses with only five nurses working per shift), and eight healthcare auxiliaries.
He said in light of these constraints, it is evident that the Emergency Department is severely overstretched. “Patients at Princess Marina Hospital reportedly experience waiting periods ranging from approximately 36 to 120 hours (three to five days) before being triaged, examined by a medical practitioner, and admitted to the appropriate ward. Scottish Livingstone Hospital reportedly accommodates referred patients who are awaiting review or admission at PMH,” he said.
Furthermore, he indicated that Primary and district hospitals further indicated that these prolonged waiting times result in extended patient stays, attracting subsistence allowances for nurses and drivers accompanying patients, as well as ambulances away from the site for the period the patient is waiting for admission at PMH.
“These excessive waiting times were found to be peculiar to PMH and not common to NRH. As a result, the Government expends an estimated amount of P12million annually on private Emergency Medical Services (EMS) contracts to supplement the inadequacies of the public ambulance system,” he said. He said this pattern reflects a reactive approach to emergency medical transport, characterised by high recurrent expenditure without corresponding long-term sustainability or assured value for money.
He said service delivery has been further severely compromised by the Government Purchase Office (GPO) moratorium, under which no dispensation has been granted to the Ministry of Health for the fueling of ambulances. He said the moratorium directly affected the timely referral and transfer of patients between facilities, resulting in delayed care and, in some instances, adverse patient outcomes.
He also stated that the Ministry of Health (MoH) did not deny the challenges they are facing. “It acknowledged that deficiencies in competency, capacity, and governance significantly contributed to the deterioration of health service delivery over the years and ultimately the violation of the right to health,” he said. He said a district-level sampling methodology was applied, focusing on 17 public hospitals selected due to their central role in the health system, accounting for more than 60% of hospital beds and public expenditure.
While the investigation did not fully apply the World Health Organisation’s Health, he said System Performance Assessment Framework, its principles, particularly those relating to access, equity, efficiency, and quality, shaped the methodology. Moreover, he said internationally, Botswana has ratified several human rights instruments including the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), the Convention on the Rights of the Child (CRC), the Convention on the Rights of Persons with Disabilities (CRPD), the African Charter on Human and Peoples’ Rights (ACHPR) and the African Charter on the Rights and Welfare of the Child (ACRWC), and has committed to the Sustainable Development Goals, particularly Goal three.
Further pointing out that the absence of ratification of the International Covenant on Economic, Social and Cultural Rights (ICESCR), the key convention explicitly recognising the right to the highest attainable standard of health, limits enforceability despite Botswana being bound by evolving customary international law in this regard, as well as under the Universal Declaration of Human Rights.
“It is within this context that this report would propose that the right to health is essential to human dignity and aligned with the global understanding articulated since the 1946 Constitution of the World Health Organisation and further elaborated in General Comment No. 14 of the Committee on Economic, Social and Cultural Rights (August 11, 2000),” he said.