The healthcare system in Botswana is facing a profound crisis, as economic downturns linked to the diamond industry have led to severe shortages of essential medicines. Patients like Boitumelo Mosege and Kelly Jansen are experiencing dire consequences as they struggle to access necessary treatments, revealing the stark realities of a nation grappling with an economic collapse. The ongoing challenges highlight the fragility of Botswana’s public healthcare system, previously lauded for its achievements.
A Personal Struggle for Health
Boitumelo Mosege, a 53-year-old former farmer, has been battling severe health issues since late 2023. Diagnosed with hyperthyroidism, her condition worsened as she faced significant challenges in obtaining her prescribed medication. Despite Botswana’s commitment to providing universal healthcare, Mosege reported that she has only sporadically received her treatment, relying heavily on the limited income from her children’s part-time jobs and her mother’s modest pension.
“I felt like I had lost my life right there,” Mosege shared, reflecting on the moment she was informed that she would need to purchase her medication independently. “I felt suicidal.” This sentiment echoes throughout the community, as many patients are now forced to navigate a broken healthcare system where the expectation of free public health services is increasingly out of reach.
Widespread Medication Shortages
The healthcare crisis escalated when President Duma Boko declared a public health emergency in 2025, citing a critical shortage of medication and medical supplies. This declaration came nearly a year after he assumed office, following the defeat of a long-standing ruling party. The economic downturn, largely precipitated by a significant decline in diamond demand—accounting for 80% of Botswana’s exports—has severely strained the country’s health procurement processes.
Boko has pointed fingers at the Central Medical Stores (CMS), the agency responsible for health procurement, accusing it of inefficiencies and inflated drug prices. Thabo Lucas Seleke, a health policy lecturer at the University of Botswana, corroborated this assessment, noting that the CMS has long been in need of reform. He stated, “It is a breeding ground for corruption. It has not improved; it is getting worse.” The ministry of health did not respond to requests for comment.
The Economic Context
Historically, Botswana emerged from poverty following the discovery of diamonds in the early 1970s. The subsequent economic boom allowed for significant public investment in education and healthcare. With a GDP per capita of $7,695 in 2024, Botswana ranks among the wealthiest nations in Africa. However, despite these achievements, many health indicators, such as maternal mortality rates, have not kept pace with economic growth, raising concerns about the efficacy of the healthcare system.
The recent plunge in diamond prices—down by 60% over the past four years—has exacerbated the country’s economic woes. As consumer preferences shift towards more affordable lab-grown alternatives, Botswana’s economy has contracted, with the International Monetary Fund estimating a shrinkage of 3% in 2024 and an additional 1% in 2025. This economic decline has led to rising unemployment rates, now at 21%, with youth unemployment soaring to nearly 29%.
The Human Cost of Economic Decline
The ramifications of this economic downturn extend beyond the healthcare system, affecting families across Botswana. Phenyo Tanka, a 39-year-old mother of four, exemplifies this struggle. After her husband lost his job in December 2025, Tanka’s family was forced to cut back on expenses, including dining out and employing