Botswana's Health Crisis Exposes Country's Fragile Political, Economic Systems

Kim Heller

Once celebrated as a stronghold of democracy and stability in Africa, Botswana is now displaying worrying signs of deterioration, as the nation grapples with economic and health challenges.

Botswana's future well-being and prosperity are under threat. The country's over-reliance on the diamond industry has resulted in a highly fragile economy. The lack of economic diversification and development of other key sectors is placing Botswana in a precarious situation.

Over-dependence on diamonds restricts the nation's capacity to weather global fluctuations in the demand for diamonds. The export of diamonds makes up 80% of the country's exports and one-third of government revenue. This dependency makes it highly exposed to economic fluctuation.

The inadequate investment in key industries such as agriculture, technology, and manufacturing has meant that the Botswana economy is not sufficiently geared for stable and sustainable development. The lack of diversification has significantly strained the economy, hindering its overall stability, trading power, and economic prowess.

Botswana is facing a crucial resilience test. Just last week, the President of Botswana, Duma Boko, announced a national public health crisis. With the country's medical supply chain in ruins, hospitals overrun by patients, medical supplies in short supply, and surgeries postponed, the country's health care system is in a state of collapse.

Overcrowded hospitals and medicine shortages have become increasingly common, especially in rural settings where non-essential procedures have been suspended and treatment for chronic conditions remains limited.

Mortality rates are rising, as is the resurgence of preventive diseases. Glaring shortfalls in healthcare access and provision in rural communities are increasingly difficult to ignore. Botswana is heading towards a widespread health emergency. Deficits to medical suppliers surpass seventy million dollars. An $18 million emergency funding has been leveraged to deal with the situation, and the military has been placed on standby to deliver essential medical supplies.

Botswana's HIV response, once a global success, is faltering. In 2022, on the back of PEPFAR funding, Botswana achieved the UNAIDS' 95-95-95 targets (95% of people living with HIV diagnosed, 95% of those on treatment, and 95% virally suppressed).

However, the withdrawal of U.S. AID is causing severe damage to health initiatives, including the treatment and management of HIV. Botswana's admirable record of dealing effectively with HIV is now in ruins. Opposition party leader, Dr. Alfred Madigele, has criticized the government for its poor planning in the fight against HIV-AIDS.

The current health crisis does not occur in a void. It is symptomatic of the structural fragility of Botswana's political and economic systems. The highly majestic diamond industry, which was once at the heart of the nation's prosperity, now threatens its economic well-being.

The country is now experiencing the downside of overdependency on this precious mineral. There has been a significant decline in global demand for diamonds over recent years. In 2024, there was a 27% decline in diamond production by government-owned De Beers Debswana, and further production cuts are forecast for 2025.

With the development of synthetic diamonds and the global slowdown in key markets, Botswana's diamonds are losing their shine. With the diamond industry becoming more of a burden than an asset, Botswana needs to revitalise its economic model.

The Botswana economy shrank by 3% in 2024. Public debt stands at just over 27%. Austerity measures have, in the face of economic decline, eroded investment in healthcare, placing pressure on supply and services. 

Botswana's lack of economic resilience is a warning for the region as a whole. Overreliance on a single resource is a factor in many economies in Africa. In Angola, it is oil. In Zambia, it is copper, and in the DRC, it is cobalt.

Over-reliance on these valuable resources has seen these economies see-saw from booming times to rock bottom. It is not a sustainable economic strategy. Resource-dependent economies are not eternal wells of prosperity. Countries that have diversified have fared better, such as Mauritius and Rwanda.

President Boko has begun to spearhead a more resilient economy. A transformation plan, announced in July 2025, outlines a more significant investment in tourism, as well as renewable energy and technology. This is an important step in reducing the country's reliance on imports, even if it is rather late.

The African Continental Free Trade Area (AfCFTA) offers a whole new trading world and a universe of opportunities for value chain development. This has yet to be fully leveraged. Regional collaboration is a key driver of greater trade diversification.

As income from the diamond mining sector continues to drop, the structural defect of Botswana's economy is bare and exposed. The challenge for Botswana is to reconfigure its economy, with a reduced dependency on diamonds and a greater emphasis on development and diversification. Local innovation and self-sufficiency require urgent attention and amplification in a new, more resilient economic matrix.

Without investment in key infrastructure and core services, such as healthcare, the nation will remain in an ever-vulnerable and unstable state. A massive injection of investment in infrastructure is the right prescription for resilience in the worst of days. The health emergency in Botswana has severely impacted its reputation.

The health sector must be given an injection of investment. The best prescription would be an investment in local pharmaceutical production and more robust, resilient supply chains and management. As Botswana plans for recovery, there are hard lessons for the region in avoiding a similar crisis.

The future of Botswana and the region will be born on diversification and development. The era of over-dependency on resources is over. Resilience is essential to the prescription of a new economic model for Africa.

* Kim Heller is a political analyst and author of No White Lies: Black Politics and White Power in South Africa.

** The views expressed do not necessarily reflect the views of IOL, Independent Media or The African.