In Botswana, the intersection of economic challenges and healthcare inadequacies has become painfully clear, as citizens grapple with dire drug shortages that have forced many to seek private solutions for their medical needs. The crisis highlights the repercussions of a significant downturn in the diamond market, which has long been the backbone of the nation’s economy.
The Human Cost of Healthcare Shortages
Boitumelo Mosege, a 53-year-old resident of Molepolole, has faced life-altering challenges due to a lack of access to her prescribed medication. Diagnosed with hyperthyroidism in late 2023, Mosege’s health deteriorated as her condition went untreated for months. The swelling in her neck and persistent symptoms have left her unable to work on her farm, pushing her into financial distress.
Mosege, reliant on a modest pension from her mother and occasional earnings from her children, has been unable to afford the necessary medication, which costs approximately 2,000 pula (£106) monthly. “I felt like I had lost my life right there,” she lamented, reflecting on the moment she realised she would have to purchase her medicine out of pocket.
Her plight is echoed by Kelly Jansen, a 39-year-old caregiver for her elderly father, whose medical needs consume a significant portion of their limited resources. “I want my life back,” Jansen expressed, highlighting the emotional toll of their circumstances. The burden of healthcare costs is forcing families to make impossible choices, further exacerbating the strain on their mental and physical well-being.
Economic Downturn and Healthcare Challenges
The root of Botswana’s healthcare crisis can be traced back to a public health emergency declared by President Duma Boko in 2025, following a series of shortages in essential medicines. The economic downturn, largely attributed to a decline in global demand for diamonds—which constitute about 80% of the country’s exports—has dramatically affected public health procurement processes.
In an opinion piece, President Boko pointed to the Central Medical Stores (CMS) as a primary culprit, accusing the agency of mismanagement and inflated drug prices. Thabo Lucas Seleke, a health policy expert at the University of Botswana, reinforced this sentiment, stating that the agency has been plagued by corruption and inefficiency since at least 2010. “It has not improved; it is getting worse,” he stated, underscoring the urgent need for reform in the healthcare system.
The Economic Landscape
Historically, Botswana transformed from one of the world’s poorest nations at independence in 1966 to one of Africa’s wealthiest, thanks to diamond discoveries. Its GDP per capita reached $7,695 (£5,697) in 2024, ranking fourth in Africa. However, this economic growth has not translated into improved health outcomes, with maternal mortality rates lagging behind those of similarly affluent nations.
The recent downturn has been stark; diamond prices have plummeted by 60% over the past four years, and the economy contracted by 3% in 2024 and 1% in 2025, according to the International Monetary Fund. Compounding this issue, rising fuel prices, driven by geopolitical tensions, threaten to further destabilise the fragile economy. With unemployment soaring to 21% and nearly 29% among youth aged 15 to 35, the social fabric of Botswana is under severe strain.
Oratile Olorato Kgatle, a 26-year-old with aspirations in public relations, has faced her own struggles amid the economic turmoil. After 18 months of job applications without a single interview, her mental health has suffered. “I could feel that light just dimming with each day,” she recounted, illustrating the personal toll of the nation’s economic woes.
A Call for Diversification and Resilience
The case of Phenyo Tanka, a 39-year-old mother of four, further exemplifies the struggle for economic diversification within Botswana. After her husband lost his job as a mining engineer, the family had to cut back on expenses and let go of their domestic worker. Despite graduating with a degree in agriculture, Tanka has been unable to secure employment in her field. Yet, she remains determined, selling homemade cakes and dreaming of starting a toilet paper factory to support her daughters’ independence.
The current situation reveals a pressing need for Botswana to expand its economic base beyond diamonds, which have historically dominated its exports. The failure to diversify has left the economy vulnerable to fluctuations in global demand and prices, jeopardising the livelihoods of many.
Why it Matters
The healthcare crisis in Botswana serves as a stark reminder of the profound impact that economic conditions can have on public health. As citizens like Mosege and Jansen navigate the challenges of securing necessary medical care, it becomes evident that the health of a nation is intricately linked to its economic stability. The urgent call for reform within the healthcare system, alongside a strategic shift towards economic diversification, is not merely a policy recommendation—it is a necessity for the future well-being of Botswana’s citizens. Without immediate action, the consequences of inaction may echo for generations to come.
