Doctors say Botswana’s deepening health care crisis stems from poor leadership within the Ministry of Health.
Speaking at a press conference hosted by the 5+1 Cooperating Trade Unions on the 2025/2026 salary negotiations, Botswana Doctors Union (BDU) president Dr. Kefilwe Selema said deteriorating working conditions are driving professionals out of the public sector. Many, he said, are leaving for better opportunities abroad or in private practice, widening gaps in public health care delivery.
Dr. Selema pointed to several disputes, including government’s back-and-forth with unions over emergency call allowances, the unilateral introduction of a shift system and the cessation of doctors’ allowances. These measures, he argued, have deepened frustration and pushed many to exit the public system.
He also criticised government for investing heavily in training health care workers, only for them to migrate to the private sector because of poor conditions. As a result, the state has been forced to outsource patients to private facilities, generating debts exceeding P1 billion. According to Dr. Selema, those obligations have severely undermined the ministry’s ability to procure essential medicines and supplies.
Recently, Minister of Health Dr. Stephen Modise admitted before Parliament that the system faces acute shortages of drugs and medical equipment. He revealed that government owes private hospitals P433 million for critical services such as intensive care, operations and dialysis.
The shortages are most severe in medicines for chronic and life-threatening conditions, including hypertension, diabetes, asthma, cancers, HIV, tuberculosis, eye diseases, sexual and reproductive health and mental health. In a bid to curb costs, the ministry recently suspended referrals for non-urgent procedures to private hospitals — a decision Dr. Selema warned could endanger citizens’ health.
The BDU condemned government’s handling of the crisis, citing lack of meaningful engagement with health professionals. Dr. Selema stressed that the ministry has yet to present a clear timeline for resolving the crisis, adding that continued delays are fueling anger and frustration among workers. He urged leaders to engage directly with frontline staff rather than relying on distant bureaucratic structures.
Adding to the strain, government has suspended training programs for health care workers, a move that has sparked alarm. The union warned that halting specialist training will have devastating long-term effects, leaving a small pool of existing specialists to shoulder an already overstretched system.
At the Workplace Wellbeing and Productivity Summit, Assistant Minister Lawrence Ookeditse struck a more optimistic tone, presenting the National Health Insurance (NHI) scheme as the long-term solution.
He noted that only 17 percent of Batswana are covered by private health insurance, while 83 percent rely solely on an under-resourced public system with high doctor-to-patient ratios. “This imbalance amounts to a rigged game that entrenches inequality,” Ookeditse said.
He explained that the NHI is designed not only to expand hospital and clinic capacity but also to address structural weaknesses, such as uneven distribution of workers and disparities in service quality across regions. For the first time, he added, mental health services will be included, reflecting the growing toll of stress, anxiety and depression on individuals and workplaces.
Ookeditse acknowledged the challenges, noting that only 67 percent of essential services are currently available in public facilities and medicine shortages persist. But he said government is committing to reforms, including a revamped procurement system to secure fair pricing and reduce waste.
He called for broad public participation to ensure success. “This is your scheme. It is an investment in a healthier workforce, a more productive economy and a more compassionate society,” he said.
