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In an alarming reflection of Botswana’s deteriorating economic landscape, citizens are grappling with severe shortages of essential medications, a situation exacerbated by a significant downturn in the diamond industry, which accounts for 80% of the nation’s exports. The plight of individuals like Boitumelo Mosege, who has been forced to forgo necessary treatments, underscores the broader systemic failures within the healthcare system, prompting urgent calls for reform.
Healthcare Shortages: A Personal Struggle
Boitumelo Mosege’s life took a harrowing turn in late 2023 when she was diagnosed with hyperthyroidism, leading to debilitating symptoms that forced her to abandon her work as a farmer in Molepolole, a town situated approximately 30 miles northwest of Gaborone. Despite the promise of universal healthcare in Botswana, Mosege has faced significant obstacles in accessing her prescribed medication. The 53-year-old relies on the meagre earnings from her children’s piecework and a modest pension from her mother, which totals 1,400 pula (£77) monthly. With her monthly medication costs reaching 2,000 pula, she finds herself in a precarious position, having gone three months without her necessary treatments.
“I felt like I had lost my life right there,” she recounted, expressing her despair upon learning she would have to purchase her medication out of pocket. “I felt suicidal.”
Nearby, Kelly Jansen faces her own challenges as the primary caregiver for her 83-year-old father, who relies on a wheelchair. Spending a third of his pension on medical supplies has forced her to seek donations for an electric wheelchair, which she believes would restore some independence to her life. “I want my life back,” she lamented, highlighting the emotional toll of their financial burden.
The Economic Context
In 2022, President Duma Boko declared a public health emergency following a prolonged period of medicine shortages, a decision that came nearly ten months after he took office, ousting the party that had dominated Botswana’s political landscape since its independence in 1966. The president attributed the crisis to longstanding dysfunction within the Central Medical Stores (CMS), the agency responsible for health procurement, which has been plagued by inefficiency and corruption for over a decade.
Thabo Lucas Seleke, a health policy academic at the University of Botswana, has stated that the CMS has become increasingly problematic, with a government report from as far back as 2010 calling for extensive reforms. “It is a breeding ground for corruption,” Seleke asserted. The health ministry has not commented on the ongoing issues, further exacerbating concerns about accountability.
Economic Downturn and Its Implications
Botswana’s economic fortunes have drastically shifted since its diamond discovery in the early 1970s propelled it from one of the world’s poorest nations to a model of growth, boasting the fourth highest GDP per capita in Africa at $7,695 (£5,697) in 2024. Yet, the nation is now grappling with the repercussions of a 60% drop in diamond prices over four years, alongside rising unemployment rates that have reached 21% as of March 2025.
The International Monetary Fund (IMF) reported a contraction in Botswana’s economy by 3% in 2024, followed by a further decline of 1% in 2025, signalling a troubling trend. The economic malaise has been compounded by rising fuel prices, primarily due to geopolitical tensions, leaving Botswana vulnerable as an oil importer. Political risk consultant Marisa Lourenço noted, “It doesn’t have much other buffer,” emphasising the fragile state of the economy post-COVID.
The Unemployment Crisis
The impact of this economic downturn is palpable, particularly among the youth. Oratile Olorato Kgatle, a 26-year-old aspiring public relations professional, has not received a single interview after 18 months of job applications. Her struggles have led to a decline in her mental health, highlighting the broader issue of unemployment among young people, where nearly 29% of those aged 15 to 35 are jobless.
Phenyo Tanka, a mother of four, embodies the challenges faced by families attempting to navigate this harsh economic landscape. After her husband’s redundancy as a mining engineer, the family has curtailed their spending, even letting go of their domestic worker. Despite holding a degree in agriculture, Tanka has found it impossible to secure a job in her field since her graduation in 2011. Undeterred, she has turned to baking and aspires to launch a toilet paper factory, hoping to inspire her daughters to pursue their own independence.
Why it Matters
The intertwining crises of healthcare shortages and economic decline in Botswana expose the vulnerabilities of a nation that once thrived on its diamond wealth. The stories of individuals struggling to access basic medical care underscore the urgent need for systemic reform within the healthcare system. As the country faces increasing unemployment and the spectre of poverty looms larger, the call for diversification of the economy becomes more critical. The situation serves as a stark reminder of the fragility of prosperity in the face of global economic shifts and highlights the essential role of government accountability and effective health governance in safeguarding the wellbeing of its citizens.
