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The recent economic downturn in Botswana, primarily driven by a significant drop in diamond prices, has unveiled pressing challenges in the nation’s healthcare system and increased unemployment rates. As citizens grapple with diminished access to essential medications and rising living costs, personal stories reflect a broader national crisis that threatens the well-being of many.
The Human Cost of Healthcare Shortages
In late 2023, Boitumelo Mosege, a 53-year-old resident of Molepolole, faced a health crisis that forced her to abandon her work as a farmer. Diagnosed with hyperthyroidism, she experienced debilitating symptoms, including a swollen neck and frequent fainting spells. Although Botswana’s public healthcare system is designed to provide universal access, Mosege’s experience tells a different story. She has struggled with inconsistent access to prescribed medications, relying on her family’s meagre resources to cover the costs.
Mosege’s monthly medication expenses amount to 2,000 pula (£107), a sum she can only partially meet through her mother’s pension of 1,400 pula (£75) and the sporadic earnings of her four children. “I felt like I had lost my life right there,” she lamented, recalling the moment she was informed that she would need to procure her own medication. The emotional toll of her situation is evident: “I felt suicidal.”
Similarly, Kelly Jansen, who cares for her elderly father, has seen her financial stability erode. The 39-year-old dedicates a third of her father’s pension to cover medical supplies, including a blood pressure monitor. She is currently seeking donations for an electric wheelchair, which would enhance her mobility and independence. “I want my life back,” Jansen expressed, highlighting the profound impact of their healthcare struggles.
Economic Factors Behind Healthcare Crises
The ongoing healthcare shortages can be traced back to systemic failings within Botswana’s health procurement system. President Duma Boko declared a public health emergency in 2025, a response to a previous ten-month period of dwindling access to vital medications. The crisis emerged not only from long-standing inefficiencies within the Central Medical Stores (CMS), the state health procurement agency, but also from a broader economic downturn precipitated by declining diamond demand—a commodity that constitutes 80% of Botswana’s exports.
Boko’s observations in a February opinion piece suggested that the CMS has been a “breeding ground for corruption,” a sentiment echoed by Thabo Lucas Seleke, a health policy lecturer at the University of Botswana. Seleke highlighted that the agency’s shortcomings have been acknowledged for over a decade, necessitating urgent reforms to restore trust and efficacy in the healthcare system.
Botswana’s economic landscape has shifted dramatically since its independence in 1966, when it was one of the poorest nations globally. The discovery of diamonds transformed the country into one of Africa’s wealthiest states, enabling significant investments in healthcare and education. However, the recent collapse in diamond prices—reportedly down 60% in four years—has stunted economic growth, leading to a contraction of 3% in 2024, as estimated by the International Monetary Fund.
Rising Unemployment and Economic Despair
The repercussions of economic decline are manifesting in rising unemployment rates, which reached 21% among Botswana’s 2.5 million citizens by March 2025. Notably, youth unemployment is particularly alarming, with nearly 29% of individuals aged 15 to 35 unable to secure jobs. This demographic crisis presents a daunting challenge for the nation, as the aspirations of young people like 26-year-old Oratile Olorato Kgatle are increasingly thwarted by a lack of opportunities. Kgatle, who has been job-hunting for 18 months in the public relations field, has experienced a sharp decline in her mental health due to persistent rejections.
Families across the economic spectrum are feeling the strain. Phenyo Tanka, a mother of four, epitomises the plight of many middle-class households forced to make difficult financial decisions. After her husband lost his job as a mining engineer, the family curtailed discretionary spending, including dining out and letting go of their domestic worker. Despite her agricultural degree, Tanka has struggled to find stable employment since graduating in 2011. Yet, she remains resilient, selling homemade cakes and aspiring to establish a toilet paper factory, motivated by a desire to instil independence in her daughters.
The Way Forward
Botswana’s economic and healthcare challenges are interlinked, with systemic failures in governance and procurement exacerbating the plight of its citizens. The nation must confront these issues with urgency, focusing on diversifying its economy beyond diamonds and reforming the healthcare system to ensure equitable access to medications and services.
Why it Matters
The situation in Botswana underscores how economic downturns can have dire consequences for public health and social stability. As citizens face increased healthcare costs and joblessness, the government must prioritise comprehensive reforms to restore confidence in its institutions. Without significant intervention, the current trajectory threatens not only individual lives but also the broader socio-economic fabric of this once-thriving nation.