The health crisis in Botswana is intensifying, with patients increasingly unable to access essential medications due to severe shortages exacerbated by an economic downturn linked to plummeting diamond prices. As the nation grapples with the implications of these shortages, the plight of individuals such as Boitumelo Mosege and Kelly Jansen highlights the human cost of systemic failures within the healthcare system and the broader economy.
Healthcare System Strained by Economic Challenges
In late 2023, Boitumelo Mosege, a 53-year-old farmer from Molepolole, was diagnosed with hyperthyroidism, a condition that has severely impacted her quality of life. The swelling in her neck and frequent fainting spells forced her to abandon her livelihood. Despite Botswana’s commitment to providing free public healthcare, Mosege struggled to obtain her prescribed medication consistently. Her financial situation is dire; depending primarily on her mother’s modest pension of 1,400 pula (£77) and her children’s irregular income from piecework, she is tasked with covering the 2,000 pula monthly cost of her medicines.
“I felt like I had lost my life right there,” Mosege stated, reflecting on her experience of being instructed to purchase her own medication. “I felt suicidal.”
Nearby, Kelly Jansen is navigating a similar struggle. As a full-time caregiver for her elderly father, she dedicates a significant portion of his pension to medical expenses, including medication and vital supplies. Jansen, 39, is on the lookout for an electric wheelchair for her father, which she believes would restore some semblance of independence to their lives. “I want my life back,” she lamented.
Economic Downturn and Public Health Emergency
In 2025, President Duma Boko declared a public health emergency in response to these widespread shortages, a situation that has been years in the making. Botswana’s economy, once buoyed by diamond exports comprising 80% of its trade, has faced dire straits due to a significant collapse in diamond prices—down 60% over the past four years. This downturn has contributed to rising unemployment rates and heightened economic instability.
Boko has attributed the crisis to a dysfunctional health procurement process overseen by the Central Medical Stores (CMS), which has historically struggled with inefficiencies and corruption. “It is a breeding ground for corruption,” commented Thabo Lucas Seleke, a health policy lecturer at the University of Botswana, noting that issues with CMS have persisted since at least 2010, when a government report advocated for substantial reforms.
Despite Botswana’s impressive GDP per capita of $7,695 (£5,697) in 2024—the fourth highest in Africa—other health indicators have not kept pace with economic growth. The country faces higher maternal mortality rates compared to similarly affluent nations, demonstrating a troubling disconnect between wealth and health outcomes.
The Ripple Effects of Economic Instability
The economic challenges are not limited to the healthcare sector. Rising fuel prices, exacerbated by geopolitical tensions such as the US-Iran conflict, are set to place further strain on Botswana’s economy, which is already grappling with the repercussions of the COVID-19 pandemic. The International Monetary Fund reported a 3% contraction in Botswana’s economy in 2024, with unemployment soaring to 21% in early 2025. Alarmingly, youth unemployment among those aged 15 to 35 reached nearly 29%, signalling a growing crisis for the nation’s future.
Individuals like Oratile Olorato Kgatle, a 26-year-old aspiring public relations professional, are emblematic of this struggle. After 18 months of job applications without a single interview, Kgatle sought psychiatric help as her mental health deteriorated.
Similarly, Phenyo Tanka, a mother of four, has seen her family’s financial situation deteriorate after her husband lost his job as a mining engineer. Despite holding a degree in agriculture, Tanka has been unable to secure employment since her graduation in 2011. In response to the economic climate, she now sells homemade cakes and dreams of establishing a toilet paper factory to ensure her daughters are empowered and independent.
Why it Matters
The unfolding crisis in Botswana serves as a stark reminder of the vulnerabilities inherent in economies heavily reliant on a single resource. As the nation grapples with healthcare shortages and economic instability, the impact on individuals and families is profound. The situation underscores the urgent need for comprehensive reforms in both the healthcare system and the broader economy to ensure resilience against future shocks. Without these changes, the promise of Botswana’s economic growth may falter, leaving countless citizens to navigate the devastating consequences of a collapsing system.
