Botswana is expected to finance its HIV and tuberculosis (TB) programmes entirely from domestic resources by the end of 2030. This is after the Global Fund to Fight AIDS, Tuberculosis and Malaria designated its latest grant cycle as the country’s final allocation for the two diseases.
The decision is accompanied by a reduction in funding for HIV with Botswana’s allocation falling from US$22.88 million (about P305.45 million) under Grant Cycle 7 (GC7) to US$13.12 million (about P175.15 million) under Grant Cycle 8 (GC8). This is a decline of 42.6% or approximately US$9.75 million (about P130.16 million).
The tuberculosis allocation has also been reduced from US$1.15 million (about P15.35 million) to US$979,998 (about P13.08 million). This represents a 14.4% decrease.
The funding decision places pressure on the government to develop a credible financing plan to sustain HIV prevention, treatment and community-based services, while maintaining TB diagnosis and treatment as the country prepares for the withdrawal of the Global Fund’s financial support.
In an allocation letter dated 13 March 2026 addressed to Botswana government representative, Thapelo Phuthego and currently the deputy permanent secretary in the Ministry of Youth and Gender Affairs, Head of the Global Fund’s Grant Management Division,Mark Eldon-Edington states that the latest funding cycle will be the last for both HIV and TB.
‘In line with the Global Fund’s Sustainability, Transition, and Co-Financing Policy (STC policy), the Global Fund has determined that GC8 will be the final allocation for Botswana for HIV and TB, so investment priorities should reflect the need to transition to domestic funding at the end of this grant cycle,’ Eldon-Edington states.
The grants are scheduled to cover the period from 1 January 2028 to 31 December 2030 giving Botswana a defined window to prepare for the transition.
The Global Fund has allocated Botswana up to US$14.10 million (about P188.30 million) for HIV, TB and resilient and sustainable health systems during GC8. Of this amount, US$13.12 million (about P175.15 million) is earmarked for HIV and US$979,998 (about P13.08 million) for TB.
The allocation letter makes clear that the challenge extends beyond replacing donor money. Botswana is expected to reform procurement, strengthen public financial management and integrate HIV and TB services into the broader healthcare system to ensure that programmes remain sustainable after external financing ends.
Eldon-Edington warns that the decision comes at a time when external health financing is constrained and the global health environment is changing rapidly.
Eldon-Edington adds that; ‘Together, the Global Fund partnership has made remarkable progress in the fight against HIV, tuberculosis (TB) and malaria over the past two decades.’
‘Now, with significant constraints in external financing for health and a rapidly evolving global health ecosystem, we must adapt and intensify our focus on delivering sustainable health outcomes in this new context,’ he says.
He says the new funding framework is intended to accelerate countries’ transition towards self-reliance, sharpen spending priorities and improve value for money.
‘For GC8, Botswana has been allocated up to US$14,104,603 (about P188.30 million) for HIV, TB and building resilient and sustainable systems for health (RSSH). This allocation has been determined according to a methodology primarily based on disease burden and income level,’ the letter states.
The Global Fund has urged Botswana to develop a robust transition plan aimed at fully domestically funded HIV and TB responses. It warns that investment decisions under the final grant cycle must take account of the impending withdrawal of its support.
‘Botswana is encouraged to focus on implementing a robust transition plan to enable fully domestically-funded HIV and TB responses,’ Eldon-Edington says.
He adds that the country should prioritise sustainable financing for community health systems, cost-effective procurement, integrating disease programmes into the wider health system and streamlining management structures.
The letter also urges Botswana to strengthen government-led financing for civil society organisations that provide HIV and TB services including expanding social contracting arrangements that allow such organisations to deliver essential services.
On HIV prevention, the Global Fund recommends prioritising integrated pre-exposure prophylaxis (PrEP), sexual and reproductive health services, and hepatitis services, particularly for vulnerable populations.
For TB, it recommends more efficient screening, integrated service delivery and near point-of-care molecular testing to improve diagnosis and increase case notifications.
The transition will also require the government to assume responsibility for health infrastructure and operating costs previously supported by the fund.
Eldon-Edington recommends further that; ‘Transitioning health systems investments financed by the Global Fund to domestic financing including support for PSA plants, GeneXpert maintenance and operational costs, and critical human resources supporting HIV and TB service delivery.’