The Botswana Pharmacy Union (BPU) has sharply criticised the government’s decision to declare a state of health emergency to address the ongoing shortage of medicines in public health facilities, arguing that the crisis was self-inflicted and could have been avoided with better financial management and consultation.
According to BPU secretary general Archie Kgosiyang, the core issue lies in the government’s delayed payments to suppliers—not inefficiencies at the Central Medical Stores (CMS).
“Initially, the issue was financial; suppliers were not being paid their arrears,” Kgosiyang said. “Instead of addressing that, the government shifted the blame to CMS, claiming there were procurement delays, when in fact CMS had long-standing procurement systems that worked.”
He explained that CMS operates through planned, contractual purchasing agreements with regional suppliers, relying on batch production—a manufacturing model dependent on large-volume orders to remain cost-effective.
“Starting production in Botswana without sufficient quantities is extremely costly. That’s why CMS coordinated regional procurement to ensure sustainability and affordability,” Kgosiyang said.
However, he noted that the government’s task force disrupted this system by cancelling existing contracts and attempting to negotiate new ones under the emergency declaration. “They basically started from scratch,” he said. “This has delayed medicine deliveries by three to four months. Had they simply paid the existing suppliers, medicines would already be available.”
The union also dismissed government claims that the emergency measures were part of a cost-saving initiative through new manufacturing contracts. “That’s what they said, but there was never any evidence to support such claims,” Kgosiyang said. “To my knowledge, the previous government had already entered into direct procurement agreements with a manufacturer immediately after COVID-19, aimed at stabilising medicine availability and reducing costs.”
He further clarified that CMS is not responsible for distribution delays, as that function is handled by the Botswana Defence Force (BDF).
The Ministry of Health (MoH), however, has defended its actions, saying the state of emergency and CMS reforms were necessary to correct years of inefficiency, inflated pricing, and inconsistent supply.
Speaking at a press conference last week, Minister of Health Dr. Stephen Modise said the emergency declaration allowed for more efficient procurement during the crisis. Without it, he argued, Botswana would have been forced to purchase medicines locally at inflated prices—spending nearly P250 million compared to about P30 million when buying directly from manufacturers abroad.
He said medicine availability in public facilities improved from 17 percent in August to 36 percent by early October, with a goal of reaching 97 percent by December.
Modise acknowledged the multiple challenges facing Botswana’s public health sector, particularly financial constraints that have led suppliers to demand upfront payments before shipping medicines. He said these payment terms, combined with global disruptions caused by geopolitical conflicts and trade barriers, have severely affected international supply chains, delaying the delivery of essential medical products.
While clinics have reported improvements—particularly in medicines for chronic conditions such as diabetes, hypertension, and pain management—stock levels remain below optimal.
Modise identified hospitals as the most affected facilities, particularly in specialised supplies for theatre, laboratory, and emergency care. He said engaging directly with producers had achieved major cost savings, allowing funds to be redirected to critical needs such as reagents and additional medicines.
He reiterated that the state of emergency was not merely a crisis response but also a mechanism to maximise limited financial resources. The president’s directive, he said, allowed flexibility in sourcing funds and adjusting budgets to ensure procurement continued despite fiscal pressures.
Despite these assurances, the BPU remains sceptical that the reforms will succeed without genuine consultation and technical inclusion. For now, hospitals and clinics continue to feel the effects of the shortage—even as the government insists that the worst is over. Whether the CMS overhaul restores confidence or deepens mistrust will depend on how quickly medicines reach patients.
