As Botswana courts global health partners in New York, medicine shortages, a missing CT scanner and depleted condom stocks expose the continuing gap between the government’s health reform ambitions and conditions confronting patients at home.
GAZETTE REPORTER
In New York this week, Botswana is selling a story of transformation.
As world leaders gather for the 81st United Nations General Assembly, the government says its programme is not confined to diplomacy. It is pursuing what International Relations Minister Dr Phenyo Butale calls “economic diplomacy,” with President Duma Boko and his delegation seeking investors and development partners in sectors that include healthcare.
It is an ambitious pitch from an administration approaching two years in office, and one that fits comfortably with Health Minister Dr Stephen Modise’s increasingly international approach to fixing Botswana’s health system: foreign procurement, strategic partnerships, digital health, genomics, pharmaceutical investment, National Health Insurance and agreements intended to secure medicines from beyond Botswana’s borders.
But more than 12 months after the government was forced to declare a State of Public Health Emergency over collapsing medicine supplies, three separate investigations by The Botswana Gazette paint a considerably less futuristic picture at home.
At Princess Marina Hospital, medicine availability is understood to be hovering around 40 percent. The country’s largest referral hospital still has no functioning CT scanner and sends patients elsewhere for scans. Across public facilities, condoms have become scarce enough for the Ministry of Health to return to emergency procurement while thousands of sexually transmitted infections continue to be recorded.
The contrast does not mean the government has done nothing. It has done plenty.
The question increasingly confronting Modise and the UDC administration is whether almost two years of policies, emergency interventions, international procurement and newly signed partnerships are translating quickly enough into the most basic measure of a health system: what happens when a patient walks through the door.
Below Half
The clearest measure is medicine availability.
When Botswana’s medical supply crisis reached breaking point in August 2025, availability of essential medicines and medical commodities had fallen to just 17 percent. President Boko declared a State of Public Health Emergency on 25 August, putting the crisis at the centre of the new administration’s health agenda.
By early October 2025, Modise reported that availability had recovered to 36 percent.
He then set a far more ambitious benchmark: 97 percent medicine availability and at least three months of stock at Central Medical Stores by December 2025.
Almost a year later, The Gazette has established that several facilities are still struggling to maintain even 50 percent availability, while Princess Marina Hospital is operating at about 40 percent.
The figures do not suggest that every category of medicine is equally depleted.
Government reported in June that availability in some priority categories was substantially stronger, with antiretroviral medicines at 93 percent, cancer medicines at 87 percent and tuberculosis medicines at 76 percent. But the broader picture gathered from facilities remains uneven, with the 97 percent national benchmark set by Modise still distant in parts of the system.
At Marina, the shortages have created their own internal survival system.
An insider told The Gazette that when scarce medicines arrive, wards frequently secure supplies for admitted patients first because those patients have less ability to leave the hospital and search private pharmacies.
The rapidly changing stock position also makes medicine registers difficult to keep current. A drug can appear available when the register is updated, only to be exhausted soon afterwards as wards draw down the new consignment.
For outpatients, that can mean arriving at the pharmacy expecting treatment only to discover that the medicine is gone and must be purchased privately.
Emergency Government
This comes despite an extraordinary range of interventions.
Since the crisis erupted, government has used emergency international procurement, micro-procurement, redistribution between facilities and increased oversight of procurement and distribution. A national logistics operation brought together the Ministry of Health, the Botswana Defence Force and presidential structures to accelerate the movement of medicines around the country.
In October last year, Modise said emergency powers had allowed Botswana to bypass expensive local intermediaries and procure directly from international manufacturers. He said a procurement that could have cost close to P250 million locally could, in one example, be obtained for about P30 million directly from a manufacturer.
By June this year, government was again announcing emergency international orders covering several months of supply.
Yet the persistence of shortages suggests that emergency purchasing alone has not solved the deeper problem of turning procurement into reliable availability at facility level.
That distinction is increasingly important.
A health system is not stabilised merely when an order is placed, an aircraft lands or a warehouse receives a consignment. For the patient, stability exists when the prescribed medicine is reliably on the shelf.
Scanner Gap
The same divide between intervention and delivery is visible in diagnostic equipment.
President Boko visited Princess Marina Hospital in January and was confronted with overcrowding, medicine shortages, ageing infrastructure and inadequate diagnostic capacity.
Priority equipment subsequently identified for procurement included an MRI scanner, an additional CT scanner and a new X-ray machine.
Eight months later, Marina remains without its own functioning CT scanner.
Patients requiring computed tomography continue to be referred to Sir Ketumile Masire Teaching Hospital, meaning that a patient who has already reached Botswana’s major referral hospital must be referred again simply to obtain a scan.
A replacement CT scanner is estimated to cost about P12 million.
The absence is particularly striking when set against Marina’s workload. The hospital has 567 beds and has reportedly accommodated more than 600 patients at times. SKMTH, which has CT capability and now absorbs Marina referrals, has about 450 beds.
CT imaging is central to the diagnosis of strokes, tumours, internal injuries, infections and other potentially life-threatening conditions.
The issue is therefore not merely whether Botswana has a CT scanner somewhere in the public system. It is whether a national referral hospital carrying hundreds of complex patients can perform one of modern medicine’s most basic diagnostic procedures where those patients are being treated.
Condom Alarm
At the other end of the health system, the pressure is also showing in one of Botswana’s most established public-health interventions.
Condom shortages have persisted long enough for the Ministry of Health to turn again to emergency procurement.
The ministry says 350,000 condoms received during the first week of August had already been distributed. In its response to The Gazette on 18 September, it said another consignment expected during the week ending 25 September should provide approximately seven months of stock, while procurement for a further 12 months was also being planned.
The shortage comes against troubling infection figures.
Gaborone recorded 11,464 STI cases in just three months between April and June 2026. Kanye recorded another 617 cases between April and July.
In Lobatse, 132 people tested HIV-positive among 8,145 people tested between April 2025 and March this year.
Those figures cannot be used to claim that the condom shortage caused the infections.
Indeed, district information available to The Gazette does not establish such a causal relationship. In Kanye, officials linked infections to inconsistent condom use or non-use, but did not establish how many cases, if any, resulted from condoms being unavailable at government facilities.
What the figures do establish is the environment in which the shortage is occurring.
Modise himself said on World AIDS Day last year that an estimated 4,120 people acquired HIV in Botswana during 2024, including 1,118 adolescent girls and young women aged 15 to 24. He also warned about declining condom use among young people.
Botswana simultaneously remains one of Africa’s strongest HIV treatment performers, with UNAIDS reporting figures above 98 percent across the treatment cascade in 2025. The risk therefore lies in allowing weaknesses in prevention and commodity supply to sit alongside achievements built over decades.
Deals Multiply
None of this has stopped the government from pursuing a considerably more ambitious future health system.
Last month, Botswana signed a 10-year strategic partnership with Abu Dhabi-based M42 covering digital health, a national genomics programme, precision medicine, capacity development and pharmaceutical and medical-equipment supply.
At the signing, Modise said the deal was intended to strengthen health security and build resilience into supply chains so that patients would not be left without medicines because of avoidable delays.
Only days ago, Botswana and Oman signed another set of agreements covering bilateral health services, medicines security, regulatory cooperation, pharmaceutical supply and investment.
Parliament has meanwhile approved the National Health Insurance policy, which government presents as a fundamental redesign of health financing and delivery rather than simply another insurance product.
On paper, the direction is expansive: AI, genomics, precision medicine, NHI, foreign pharmaceutical partnerships, digital systems and international supply corridors.
On the ground, Marina still needs a CT scan.
A patient can still leave a government pharmacy without prescribed medicine.
And Botswana is still buying condoms through emergency channels.
Time Matters
The administration inherited structural weaknesses in the health system, including procurement problems, ageing infrastructure, staff shortages and financial pressure. Modise has repeatedly made that argument, and the scale of the crisis that erupted in 2025 supports the assessment that the underlying weaknesses did not begin with the UDC.
But the UDC assumed power in November 2024.
By now, the record also includes its own targets, its own interventions and its own timelines.
The 97 percent medicine target was Modise’s.
The State of Public Health Emergency was the administration’s intervention.
The task forces, emergency procurement arrangements, international supply agreements, NHI policy, M42 partnership and Oman agreements are now part of its record.
That makes the condition of hospitals and clinics an increasingly direct test not simply of what the government inherited but of whether its chosen remedies are working.
Delivery Test
New York offers Botswana access to capital, technology, international institutions and companies capable of helping rebuild a health system that government itself accepts requires fundamental reform.
Such partnerships may prove important.
But the success of the government’s health diplomacy will ultimately be measured much further from the conference rooms of Manhattan.
It will be measured at the Marina pharmacy counter.
In whether a doctor can order a CT scan without transferring a patient across Gaborone.
In whether a clinic has condoms when a young person asks for them.
And in whether Modise’s 97 percent medicine-availability target eventually becomes something patients experience rather than a number government continues to pursue.
For nearly two years, the UDC government has been assembling the machinery of health reform.
The three snapshots from Botswana’s public health system suggest that the next phase will be judged less by how many agreements are announced than by what finally arrives, works and remains available at the bedside.