Botswana’s president has declared a public health emergency following severe shortages of essential medicines and equipment, as a prolonged slump in the diamond market and cuts to US aid strain the country’s finances.
The announcement came after the Ministry of Health suspended non-urgent surgeries on 4 August, citing shortages of drugs for hypertension, diabetes, cancer, asthma and eye conditions, as well as a lack of bandages, sutures and supplies for sexual and reproductive health.
In a televised address on Monday, President Duma Boko said the country’s medical supply chain had “failed” and announced 250m pula (£13.8m) in emergency funding for medicines, to be distributed under military supervision.
Boko blamed the Central Medical Stores (CMS), the state procurement agency, for inflated costs, saying it in turn had pointed the finger at intermediaries. “The current prices often are inflated five to 10 times. And under the current economic conditions, this scenario is not sustainable,” he said.
The president, who ended six decades of one-party dominance with his election victory last October, revealed that CMS had quoted 705m pula for a year’s worth of medicines, compared with a new emergency taskforce’s quote of less than 80m pula.
Thabo Seleke, a lecturer at the University of Botswana, said CMS was riddled with dysfunction, inertia, broken reform promises and corruption allegations. “There have been yearly reports from the auditor general, which … flagged incomplete procurement records, missing contracts and recurrent delivery delays,” he said.
The crisis is compounded by Botswana’s worsening economic position. The global diamond downturn, now in its third year, has dragged down the country’s growth, with the economy shrinking an estimated 3% in 2024. Diamonds account for a quarter of GDP, one-third of government revenues and 80% of exports, according to the International Monetary Fund.
“The diamond downturn has been a lot more sustained than diamond mining companies and the state itself had initially predicted. As a result, the state was not as prepared for this as it could have been,” said Zoë McCathie of the consultancy Signal Risk.
In its earlier statement, the health ministry said it owed 1bn pula to private health facilities and suppliers.
Botswana has long been regarded as a global leader in tackling HIV/Aids, with mother-to-child transmission falling from one in eight children in 2000 to fewer than 100 cases in 2023. This year, it became the first country with a high HIV prevalence to be awarded the World Health Organization’s gold-tier status for eliminating vertical transmission as a public health threat.
But the sector has been dealt a further blow by US aid cuts. Until January, the US funded about a third of Botswana’s HIV response, with $55m (£41m) annually from the President’s Emergency Plan for Aids Relief (Pepfar) and $12m via the Global Fund to Fight Aids, Tuberculosis and Malaria. Some, but not all, Pepfar funding has since been restored.
