Prioritise remote areas staffing – Ombudsman report
Pini Bothoko | Monday January 26, 2026 06:00
This follows an investigation into whether the government of Botswana fulfilled its obligations on appropriate governance and resource allocation in the public health sector. The investigation found that persistent shortages, service delays, inhumane conditions, and systemic breakdowns long highlighted in media reports could longer be dismissed as isolated incidents.
In the recommendations, the Ombudsman urged the Ministry to intensify accelerated recruitment drives and introduce strong retention incentives, with particular focus on remote districts where communities remain most affected by limited access to quality health care.
The report noted that conditions in district and primary hospitals are further compounded by inadequate accommodation in rural areas, a challenge described as widespread across the public service. Housing shortages, coupled with high rental costs, have made it difficult for transferred medical personnel to take up postings in remote locations.
“Accommodation in these areas is often scarce, or local landlords opt to rent to private companies that can afford higher rentals. As a result, even where doctors are transferred to remote primary and district hospitals, they often fail to secure accommodation,” reads the report.
According to the Ombudsman, remote postings deter experienced and seasoned doctors and nurses from accepting or remaining in such posts, depriving rural communities of access to quality health care. This has left many facilities dependent on newly graduated doctors, a situation that has negatively affected service delivery.
“In Chobe and Okavango districts, hospital staff reported that most doctors posted to the areas are on their first appointments. At Letsholathebe II Memorial Hospital, management expressed concern that the hospital’s staff complement consists largely of medical interns. To maintain continuity of services, the Ministry has increasingly employed foreign medical doctors on short-term contracts and transferred them to remote areas. However, the Ombudsman found that language barriers during patient consultations often hinders effective communication, sometimes requiring nurses to interpret,” reads the report.
The report warned that such barriers can compromise the quality of care by affecting accurate diagnosis, treatment and patient understanding.
It further revealed serious shortcomings in the Ministry’s transfer and posting practices, stating that transfers are governed by the MoH Transfer Guidelines of June 2012, in line with the Public Service Act of 2008 and the 1996 Consolidated Botswana Public Service General Orders, which require officers to serve a minimum of five years at district level and at least two years within a facility.
Contrary to these provisions, some officers reported having spent up to 10 years at the same institution, particularly in Tsabong, Hukuntsi and Ghanzi.
“The Ministry has stated that overstaying is common in remote areas such as Okavango, Ngami, Kgalagadi and Ghanzi, where limited access to basic services discourages staff movement,” the report reads.
The Ombudsman noted that poor posting and transfer practices have created an environment where employees decline lawful transfers or promotions. Studies cited in the report link dissatisfaction with postings and inadequate support to absenteeism, low morale and declining quality of health services.
“Health workers interviewed cited job dissatisfaction, feelings of being undervalued and trapped, mental health challenges including depression and anxiety, and increased susceptibility to alcohol and substance abuse. Despite senior MoH officials being aware of these challenges and having received repeated reports from hospital administrators and unions, the investigation found that the government has taken little action to resolve them,” states the report.
However, the report revealed that the government spent P283,107,373.67 between 2021 and 2025 on in-service specialised training to strengthen staffing at primary and district hospitals and reduce pressure on referral hospitals.
The Ombudsman concluded that while such investment was commendable, it must, however, be complemented by deliberate prioritisation of staffing for remote areas, improved accommodation solutions and fair transfer practices to ensure equitable access to quality health care across the country.