The Ombudsman has issued an ultimatum to government by directing the Ministry of Health (MoH) to urgently implement far-reaching reforms to address the health crisis
GAZETTE REPORTER
The Ombudsman has ordered the Ministry of Health (MoH) to submit a detailed, evidence-based action plan by 30 January 2026 outlining how it will implement remedial measures to restore efficiency, accountability and patient safety across Botswana’s public health facilities.
In a final investigation report released recently, the Ombudsman further directed the Ministry to submit progress reports one month, three months, six months, nine months and twelve months after the issuance of the report. Each update must detail actions taken, challenges encountered and measurable outcomes achieved.
“The current state of the public health system reflects structural, operational and policy gaps that require immediate and coordinated intervention,” the Ombudsman said, warning that failure to comply could amount to a breach of statutory obligations under the Ombudsman Act of 2021.
The report follows an extensive probe into service delivery failures that have left public hospitals struggling to meet basic standards of care.
RECOMMENDATIONS
Among the most urgent recommendations is the development of a National Emergency Referral Policy to be implemented in collaboration with the Botswana Police Service, Emergency Medical Services and public health facilities. The policy is intended to improve communication, triage and referral processes during road accidents, mass-casualty incidents and inter-facility transfers, which currently place severe pressure on individual hospitals.
The Ombudsman also noted weak inter-agency communication which has undermined planning and service delivery.
On human resources, the report directed the Ministry to urgently fill critical vacancies, including intensive care nurses, radiologists, pharmacists, cleaners, healthcare assistants and revenue collectors. Particular attention must be given to remote areas experiencing chronic understaffing.
AUDIT
The Ombudsman further ordered an audit of transfer policies for health professionals, and the introduction of a fast-tracked system for renewing contracts of essential and foreign health workers within a maximum of 30 days.
The report also addressed confusion surrounding Botswana’s free healthcare policy. Government has been instructed to issue a public clarification, stating that while no citizen should be denied essential healthcare, basic user fees must be applied — especially to non-citizens and private companies — to help sustain service quality.
OUTDATED SYSTEMS
Hospitals have been directed to modernise revenue collection through mobile payment platforms and digital billing systems, introduce secure cash-handling procedures, and hold hospital administrators accountable for meeting monthly revenue targets.
Persistent equipment breakdowns and heavy reliance on private referrals came under sharp criticism. The Ombudsman ordered a nationwide audit of medical equipment, stricter enforcement of maintenance contracts and increased funding for the Biomedical Engineering Service Unit. Funds currently spent outsourcing patients to private facilities should instead be redirected toward employing in-house specialists to build long-term capacity and reduce costs.
To ease congestion at Princess Marina Hospital, the Ombudsman recommended the development of an additional primary or district hospital within Greater Gaborone, as well as expanded wards in overcrowded facilities across the country.