Behind the clean white coats of Botswana’s public service hospitals lies a little-known deal in which Cuban doctors who are keeping the country’s overstretched healthcare system afloat, are allegedly trapped in a lucrative network of state -sponsored ‘modern day slavery.’
Under the confidential bilateral agreement, obtained by the Sunday Standard, the Cuban government takes control of the doctors’ wages, with one international watchdog alleging that as much as 75% of their true earnings is siphoned off by the Cuban state.
While Botswana pays about P56,000 per every specialist every month, sources cited by international watchdog Prisoners Defenders say the Cuban professionals receive about P14,000. The watchdog has denounced the arrangement between the governments of Botswana and Cuba as ‘modern day slave trade.’
The confidential 21-page Memorandum of Agreement between the Government of Botswana and the Government of Cuba, represented respectively by the two countries’ Ministries of Health, provides the contractual framework for the deployment of Cuban specialized health professionals to Botswana. The then Minister of Health Edwin Dikoloti signed on behalf of Botswana on 22 August 2024 while Cuba’s ambassador to Botswana Orlando Alvarez signed on behalf of his country.
The document betrays Botswana’s human rights paradox. While the country is trying to plug critical staffing shortages in its public health system, the structure of the bilateral deal means the country is knowingly financing and institutionalizing an exploitative system that violates Botswana’s own constitutional prohibitions against forced labour.
The document says Botswana has an ‘acute shortage’ of specialized health professionals and records the two governments’ agreement to continue their cooperation in supplying such personnel.
Under Article 10, Botswana agrees to pay the Cuban government not more than pound 2,469,600 per annum, inclusive of withholding tax, for the provision of the services. The agreement further provides that Cuba will issue a monthly invoice to Botswana showing both the amount to be paid to Cuban health professionals in Botswana and the amount to be transferred to Cuba. The agreement places responsibility for paying the Cuban health professionals on the Government of Cuba rather than directly on the Government of Botswana.
The document states that payment to the professionals ‘shall be the responsibility’ of the Cuban government. It identifies an account in Botswana under the name ‘CUBAN MEDICAL TEAM IN BOTSWANA ‘for payments to the health professionals while the balance due to Cuba is to be transferred to a Cuban bank account in Havana.
That arrangement creates a fundamental question: how much of the money paid by Botswana actually reaches the doctors and other Cuban professionals working in Botswana, and how much is retained or transferred to the Cuban state?
The agreement itself does not answer that question. What it does reveal is the official rate attached to the personnel. Appendix B lists pound 3,500 per month for specialist physicians, including the coordinator while allied professionals, including pharmacists and biomedical engineers, are listed at pound 2,800 per month.
The financial architecture therefore places Botswana on one side of the transaction, the Cuban government on the other, and the individual medical professionals within a system in which their remuneration is administered by Cuba.
It is this structure that fuel claims that Botswana is effectively financing a system in which Cuban doctors do not directly control the full value generated by their work.
However, the agreement itself does not establish that Cuban doctors are victims of slavery nor does it disclose what proportion of their remuneration Cuba retains. The agreement nevertheless gives Cuba substantial control over the personnel arrangement.
Botswana selects personnel from a pool provided by Cuba, while Cuba undertakes to provide specialized professionals and ensure that they possess the required training and experience. The professionals normally serve for two years with the possibility of extending their assignments by another two years.
Botswana, meanwhile, assumes a wide range of costs. These include economy-class air travel between Cuba and Botswana, repatriation costs in the event of death, accommodation and certain household costs. Botswana must also provide housing and basic furniture, while covering security or alarm-system costs and up to P1,900 per household per month for basic amenities.
The agreement also gives Botswana the right to request the replacement of a Cuban professional deemed not to be performing duties satisfactorily or who has committed an act of indiscipline.
At the same time, Cuba undertakes to ensure that participation by the selected health professionals is voluntary. The document expressly states that the selected Cuban professionals must have ‘voluntarily expressed’ their intention to participate in the arrangement.
The agreement was signed in Gaborone in 2024 and provides for an initial five-year term, renewable for subsequent five-year periods unless terminated earlier. Article 8 requires both governments to keep confidential information received from the other party during implementation of the agreement and prohibits disclosure without prior written approval, subject to exceptions including court orders, applicable laws and international obligations. The secrecy provision is likely to intensify demands for transparency over the financial relationship. The agreement covers a broad range of specialties, including surgery, pediatrics, nephrology, neonatology, neurosurgery, emergency and intensive care, obstetrics and gynecology, cardiology, oncology and gastroenterology.
Commenting on the confidential document, international watchdog, Prisoners Defenders said; ‘the current Duma Boko government materially and knowingly supports the economic architecture that allows for a modern slavery scheme.’
‘ Princess Marina Hospital’s official administrative documents record stipends, such as the one dated March 9, 2020 and later, of up to $800 for 18 specialist or coordination positions and which are forwarded to financial administration with a copy to the government’s Ministry of Finance; The State’s connivance cannot therefore be attributed to a lack of knowledge of the payment mechanism, ‘the organisation argues.
It says ‘The gross contractual fee paid by Botswana, under the Agreement, amounts to $4,094.65 per month per specialist. However, direct sources from Prisoners Defenders confirm that Cuban professionals receive only $1,000 a month: 24.42% of the fee paid for their work. The gross difference is 75.58%.’
Prisoners Defenders notes that ‘In August 2026, several direct first-hand sources in the country placed the current salary of Cuban medical specialists at $1,000 per month, presenting a slight increase.’
It says ‘Although this is a nominal improvement of $200 compared to 2020, the price paid by Botswana for each doctor has also risen markedly and has reached the equivalent of $4,094.65 per month. so the structure of extracting wages from Cuban workers for the benefit of the regime has even been aggravated.’
‘The Cuban specialist, receiving only $1,000 a month, receives less than a quarter of what Botswana pays Cuba for his work and only 20 to 23 percent of the documented remuneration for a local specialist, ‘says Prisoners Defenders.
Responding to Sunday Standard queries, The Ministry of Health spokesperson Malepa Dibonwa said; ‘The Government Of Botswana pays an agreed fee for the services rendered by the specialists to the Government of Cuba. Cuban specialists remain employees of the Government of Cuba.’ He added that; ‘Accordingly, the remuneration arrangement between the Government Of Cuba and its personnel are matters governed by the arrangement applicable to the Cuban health professionals and the Government Of Cuba. .Government Of Botswana does not determine or negotiate the individual remuneration payable by the Government of Cuba and its personnel.’
According to Prisoners Defenders, the alleged financial exploitation of the Cuban doctors is only the first layer of the system. According to a recent exposé by Prisoners Defenders, the bilateral contract is sustained by an aggressive legal framework of surveillance and severe civil restrictions engineered directly by the Cuban Medical Mission leadership in Gaborone.
The human rights watchdog revealed that on 3rd July 2026, Mission Head Dr. Pablo Ricardo Betancourt Álvarez issued an official Resolution mandating nine restrictive control measures explicitly designed to prevent Cuban doctors from integrating into Botswana society or attempting to escape the program.
· The Curfew and Isolation: Under the mandate, specialists face strict, mandatory nightly curfews. They are completely prohibited from staying overnight anywhere outside their designated official residences. Furthermore, they are banned from visiting or socializing with any Cuban nationals residing in Botswana who are not part of the active Brigade.
· Asset and Travel Bans: To eliminate any possibility of unauthorized long-distance transit or local independence, the resolution strictly prohibits the medical professionals from purchasing or driving private vehicles. Their movement is tightly boundaried, with a blanket ban on traveling outside their specifically assigned working districts without explicit, written permission from mission handlers.
· Passport Seizure and Digital Surveillance: Testimonies collected from the ground reveal that a staggering 84% of doctors report being subjected to continuous surveillance. Central to this control is the immediate seizure of their passports upon arrival. By physically withholding their official travel documents, handlers leave the doctors legally trapped inside Botswana’s borders, unable to apply for local asylum, leave through Sir Seretse Khama International Airport, or return home voluntarily.
The report by Prisoners Defenders says the testimonies of professionals stationed in Botswana reproduce the pattern of slavery documented in all Cuban medical missions:
All stated that they did not voluntarily participate in the mission.
None received a copy of their contract; In 60% of the cases there was a contract, but it was never delivered, and for the rest no contract was even formalized.
All of them suffered the withdrawal of their passports by the Cuban authorities, restrictions on movement and control of relations with the local population.
Prisoners Defenders requested that the government of President Duma Boko should include among others;
The publication of the complete agreement, all its addenda, budgetary authorizations, monthly invoices and payments executed, protecting only legitimate personal data.
The direct payment to each Cuban professional for the full amount that corresponds to their work, subject only to ordinary and transparent taxes, prohibiting forced salary transfers to third parties.
Interview all aid workers individually, without the presence of Cuban coordinators, with interpreters and independent legal assistance.
Ensure that each worker retains his or her passport, contract, credentials, freedom of movement, accommodation, association, communication, and the right to complete the mission without retaliation. Immediate comment from the Cuban embassy was not available. Claims by Prisoners Defenders have been backed by independent sources. The 2025 US Trafficking in Persons Report specifically warned that the Cuban regime ‘may have forced approximately 80 Cuban regime-affiliated medical professionals in Botswana to work’ and recommended that Botswana systematically screen Cuban medical workers for trafficking indicators. That warning did not emerge in isolation. Previous US trafficking reports have repeatedly identified Cuban medical personnel in Botswana as a potentially vulnerable group. The 2024 report recommended that Botswana proactively identify trafficking victims among Cuban government-affiliated medical professionals.