Category: Sunday Standard

Botswana has only 52 labour inspectors to oversee a rapidly expanding workforce, exposing a critical enforcement gap as the country prepares to implement sweeping labour law reforms.

Labour Commissioner Veronica Moloko said the inspectorate is severely understaffed and lacks the specialist skills needed to effectively enforce the new Employment and Labour Relations Act, warning that the country’s labour inspection system has not kept pace with growth in the private sector.

‘Currently we have only 52 labour inspectors,’ Moloko said during the ILES 5th Labour Conference in Gaborone. ‘We do agree and acknowledge that this is not enough, and we cannot operate like that.’

Her remarks came during a panel discussion titled ‘Can Botswana Enforce What is Legislates? Re-imagining Labour Inspection, Compliance and Accountability in the New Labour Regime.’ Moloko said Botswana’s labour market has expanded significantly over the years, placing increasing pressure on an inspection workforce that has seen little corresponding growth.

‘As we speak, the labour market has expanded rapidly. Businesses are opening everywhere,’ she said. ‘Once a business opens, the business does employ some workers.’ She said many inspectors were recruited years ago and now face an increasingly complex workplace environment without adequate specialised training.

‘During these years, a lot of things have happened in the employment space, and they do lack some of the skills,’ Moloko said, noting that modern inspections increasingly require sector-specific expertise. The commissioner said Botswana has already begun upgrading inspectors’ capabilities with support from the International Labour Organisation (ILO), which helped train a number of officers about two-and-a-half years ago.

‘There’s no course or degree course that is done on inspection. We only gain experience through capacitation and on-the-job training.’ Her comments underscore the operational challenge facing government as it seeks to translate newly enacted labour protections into workplace compliance. While the legislation strengthens workers’ rights, its success will depend heavily on the state’s ability to monitor employers, investigate violations and enforce the law consistently.

The shortage of inspectors comes at a time when policymakers are seeking stronger compliance with labour standards across sectors, placing renewed focus on staffing levels, technical expertise and institutional capacity within the Department of Labour.

The Umbrella for Democratic Change (UDC) government faces its biggest test yet – turning promises into delivery. Already under pressure over unfulfilled election pledges, it must now overcome Botswana’s long-standing implementation problem as it seeks billions of Pula from African Development Bank, money that will only flow when the government proves it can deliver results.

Documents seen by Sunday Standard reveal that Botswana is quietly negotiating a multi-billion Pula loan from the African Development Bank (AfDB) to bankroll an ambitious jobs programme that promises to tackle the country’s unemployment crisis through skills development entrepreneurship and enterprise financing.

While the programe is being sold as a transformative intervention capable of unlocking at least P16.08 billion worth of National Development Plan 12 (NDP12)-aligned economic activities, many of the critical details such as the total value of the loan, performance targets and disbursement conditions remain under negotiation.

Before Botswana can draw down a single Pula from the proposed multi-billion Pula AfDB loan, the government must first overcome a problem that has plagued the country for decades, implementation. Confidential Ministry of Finance documents reveal that unlike traditional development financing, the proposed facility will only release funds after Botswana proves it has delivered agreed results, turning the country’s chronic inability to execute projects on time and within budget from a governance weakness into a potential barrier to accessing desperately needed financing.

The documents also show that the initiative comes at a time when Botswana is battling persistently high youth unemployment, slowing private sector job creation and growing public pressure on President Duma Boko’s administration to deliver employment opportunities promised during the election campaign.

One of the documents gleaned from the Ministry of Finance explains that; ‘Once approved (loan) by the Bank and Government of Botswana (through Parliament), the Bank will provide financing, implementation support and monitoring for the Project.’

The document further states that for projects comprising multiple subprojects developed and implemented during the programme, the government must demonstrate to the Bank before project appraisal that it has the capacity to conduct appropriate environmental and social assessments and to prepare and implement the subprojects in compliance with both Botswana’s national laws and the AfDB’s Operational Safeguards (OS).

Unlike traditional development loans where money is released upfront, the proposed financing adopts AfDB’s Results-Based Financing model, meaning Botswana will have to demonstrate measurable progress before portions of the loan are disbursed.

According to AfDB documents, the programme’s expected results include ‘an estimated total of at least P16.08 billion of NDP12-related activities that could be considered broadly aligned to job creation in general.’

The documents also states that the programme seeks to ‘accelerate sustainable job creation in Botswana by strengthening demand-driven skills development, enterprise acceleration, sustainable access to finance, and institutional delivery capacity.’ The Bank says the programme is expected to contribute directly to reducing youth unemployment and the number of young people not in employment, education or training (NEET), while increasing enterprise survival, productivity and institutional capacity. The financing model also suggests that there will be a shift in how international lenders are engaging Botswana. Rather than establishing parallel implementation structures, AfDB intends to rely almost entirely on Botswana’s existing government systems. ‘The Bank’s role will be to provide financing, technical dialogue, and oversight that reinforce national systems and incentivise performance, rather than creating parallel delivery structures,’ the assessment states.

However, the programme’s success will depend heavily on whether government ministries can deliver complex projects efficiently-an area where previous government programmes have struggled. While the Ministry of Finance has experience managing projects financed by multilateral development banks, the Bank notes that Botswana continues to rely significantly on external consultants to manage environmental and social safeguards because of limited internal expertise.

The assessment report further reveals that several ministries expected to implement key components of the programme including the Ministries of Gender and Youth Affairs, Sport and Arts, Labour and Home Affairs, and Lands and Agriculture have no internal environmental and social safeguards capacity. To address these weaknesses, the Bank proposes creating a dedicated Programme Management Unit comprising a Programme Manager, Procurement Specialist, Financial Management Specialist, Monitoring and Evaluation Specialist, and an Environmental and Social Safeguards Specialist.

The unit would coordinate multiple ministries, parastatals, universities, commercial banks and private sector partners. Even then, AfDB acknowledges that institutional arrangements, verification systems and implementation mechanisms are still being refined. Rather than focusing on a single employment initiative, the programme attempts to build an entire employment ecosystem.

Annexures accompanying the AfDB documents list the stakeholders consulted by the Bank during a series of meetings held this year. They include the Ministry of Higher Education, the Ministry of Sports and Arts, the Ministry of Trade and Entrepreneurship, the Ministry of Communications and Innovation, the Local Enterprise Authority (LEA), and the Ministry of Agriculture and Lands, among others.

Documents indicate investments will span five major result areas: skills alignment, enterprise development, access to finance, digital transformation and institutional reforms. Among the flagship initiatives are: Construction and refurbishment of Youth Resource Centres across Botswana, Expansion of Rapid Skills Centres, Transformation of Technical and Vocational Education and Training (TVET) institutions, Capacity building programmes at the University of Botswana, BIUST and BUAN, Digital innovation hubs, Refurbishment of village centres into creative industry workspaces, Creation of Enterprise and Skills Development Centres, Establishment of MSME incubation and technology transfer centres, Recapitalisation of the Youth Development Fund, Development of intellectual property commercialisation programmes, Strengthening export promotion initiatives and a proposed internship programme expected to absorb 6,000 interns over four years.

The programme also proposes digital reforms including new labour market information systems, online internship management platforms and digitisation of business registration services.

Beyond training, the project includes significant infrastructure spending. The AfDB identifies Francistown, Palapye, Mahalapye and Pilane as major implementation hubs, while activities will extend across the country. Infrastructure projects include: New Youth Resource Centres in Lerala, Serowe, Maun, Francistown, Mochudi and other towns and refurbishment of centres in Gaborone, Mahalapye, Bobonong, Tutume and Mosojane. They also include upgrading Village Centres in Mochudi, Molepolole, Serowe, Maun, Kanye and Gantsi into creative workspaces, expansion of incubation facilities, development of digital content hubs, TVET Centres of Excellence and Public Employment Centres.

AfDB classifies the programme as Category 2, meaning projects are expected to pose moderate environmental and social risks. Site inspections found anticipated impacts would generally be ‘reversible and manageable.’ The Bank also says no involuntary resettlement is anticipated because government has indicated adequate land has already been allocated. However, it requested proof of land ownership and transfer documentation before implementation.

Perhaps the most striking omission from both the Ministry of Finance and AfDB documents is the value of the loan itself. Neither document discloses how much Botswana intends to borrow despite detailing an extensive national programme expected to unlock more than P16 billion in economic activities.

The proposed programme suggests that government recognises that unemployment cannot be solved through public sector recruitment alone. Instead, it seeks to stimulate private enterprise, entrepreneurship, skills development and innovation simultaneously. The programme argues that sustainable employment requires progress in four interconnected areas skills alignment, enterprise development, access to finance and digital transformation supported by institutional reforms. The Ministry of Finance and AfDB had not responded to Sunday Standard queries by press time.

Cabinet has been petitioned to reject a proposed increase in annual subscription, licensing and penalty fees by the Nursing and Midwifery Council of Botswana (NMCB) as nurses warn that the new charges could force many professionals out of practice.

In a petition dated August 4 and addressed to the Secretary to the Cabinet through the Office of the President, citizens, nurses, midwives, students and healthcare supporters urged Cabinet to reject the proposed fee structure, arguing that it would place an unfair financial burden on the profession.

The petition which bears the stamp of the Office of the President and was copied to the Permanent Secretary to the President is backed by signatures collected through the Change.org platform.

‘We, the undersigned citizens, nurses, midwives, students, and supporters of Botswana’s healthcare system, respectfully submit this petition requesting the Cabinet of the Republic of Botswana to reject the proposed increase in the annual subscription, licensing and penalty fees proposed by the Nursing and Midwifery Council of Botswana,’ the petition states.

Petitioners argue that many nurses already struggle to pay the current annual subscription fee of P50, particularly unemployed and underemployed practitioners who must maintain their registration while searching for work.

‘For many years, nurses have struggled to meet the current annual subscription fee of P50. This challenge has been even greater for unemployed and underemployed nurses, who continue to seek employment while maintaining their professional registration. Increasing these fees substantially will make it even more difficult for many professionals to remain registered and legally practice,’ the petition says.

The group also raises concerns over proposed penalties for late payment, describing them as excessive and likely to have the opposite of their intended effect.

‘We are also deeply concerned by the proposed penalties for late payment, which are disproportionate and high. Rather than encouraging compliance, such penalties risk forcing many nurses and midwives out of the profession because they simply cannot afford the financial burden,’ the petition reads.

Beyond the financial implications, the petition questions the process followed before the proposal reached Cabinet, alleging that frontline healthcare professionals were not meaningfully consulted.

‘Equally concerning is the apparent lack of meaningful consultation with the primary stakeholders before the proposal was submitted to Cabinet. Nurses and midwives are directly affected by these changes, yet many report that they were neither adequately informed nor given a genuine opportunity to participate,’ the petition states.

The petitioners argue that professional regulatory fees should be fair, transparent and developed through broad consultation with those expected to pay them. They are now calling on Cabinet to reject the proposed fee increases and direct the NMCB to undertake wider stakeholder engagement before introducing any changes.

It is understood that the petition adds to growing opposition from nurses and their representative bodies, who have maintained that the proposed fee increases are unaffordable and could worsen staffing challenges by making it more difficult for qualified practitioners to maintain their licences.

Over the recent past too many wrong people have gotten appointed as High Commissioners and Ambassadors. Such misplaced appointments have been going on for a very long time – with despicable consequences.

The appointments are a result of subordinating strategic foreign policy interests to partisan and political patronage by those in charge.

Quite predictably, these wrongful appointments have weakened the foreign service and over time rendered it unfit for purpose.

Membership of the party in power has often mattered more than appropriate qualifications and experience in diplomacy.

The result on Botswana’s foreign service has been a long arc of descent and decline into mediocrity.

For a few years now the foreign service has been too leaden. Experienced cadres have left as their positions have been filled by political appointees who lack depth, intellectual dexterity and have no institutional memory.

However way one looks at it, the foreign service is today hollowed and depleted.

Diplomacy is not an easy job. Yet our leadership has often found nothing wrong appointing their political associates to fill what should be specialized jobs of national strategic importance to the country abroad.

At the moment Botswana’s diplomats abroad are generally unable to play a significant role to service the country’s vital economic interests. This has been the status quo for a while by the way.

They are unable to assist the country in bringing investors here. Additionally, they are generally unable to secure markets for Botswana produced goods.

That is so because a good number of them do not even understand the country’s foreign policy much less the country’s agenda on such key issues like trade.

Botswana’s place on a fast changing world is evolving. Yet many of our diplomats cannot would struggle to even identify Botswana’s station in this world.

To successfully position itself, the country needs a sharp diplomatic service.

Many of these diplomats consider themselves on a long state sponsored holiday abroad.

The global stage is getting not only smaller but also much more complex and sophisticated.

It is a world that needs diplomats who are well versed and well-heeled on international affairs.

Foreign policy should never be regarded as an add-on to Botswana’s overall policy.

It is fundamental. What happens abroad affects government policy at home as we saw on how the tariff regime imposed by the United States had a big impact on Botswana diamonds sales.

The president needs a team he can rely on to guide and brief him – at home and abroad when he tackles international issues.

Working for the Ministry of Foreign Affairs used to be the dream of every young graduate.

As a result the ministry was able to recruit some of the country’s finest and brightest.

That created a very strong ecosystem that was also resilient – at home and abroad – to undertake and see through the country’s foreign policy.

And then a change for the worse started. A big number of political appointees began to find their way into the foreign service as ambassadors and High Commissioners.

Previous BDP governments had created an impression that the slow and somewhat fatalist descent of foreign service into the farce it has become was always inevitable.

The situation took a turn for worse when government saw nothing wrong appointing someone as Ambassador so that they could go and get better medical attention abroad.

Because people were appointed purely as part of patronage, the result was that a tour could last for up to 20 years or longer.

On and on down the slope the quality went.

The current UDC government have inherited a poisoned chalice.

But there is a way out.

They should rollback the dice and get out of the abyss.

A starting point for them is to not buy into the rubbish that our foreign service cannot be brought back to what it used to be – where it served the country’s true strategic interests rather than the leader’s whims.

The current chaos on the foreign policy scene ultimately has a negative impact including on the country’s security ecosystem.

It is time for radical change.

Government should rethink the utility of political appointees as Ambassadors and High Commissioners – especially in key capitals like Pretoria, Washinton, London, Beijing, Geneva, New York, Harare, Windhoek, Lusaka and Brussels.

In the main, political appointees are unavoidable. But they should be always be used sparingly.

A UDC government can still reverse the ongoing decline of the foreign service. And get the diplomatic service back on track.

The underlying paradox is unmistakable. The appetite for political appointments, especially among the political class continues unabated, but across the wider public the demand is for career diplomats to be given a chance.

The public is fed up with political appointments, not least because there is very little to show in value for money in them.

Restoring quality will not be easy, not least because the temptation and now political pressure to appoint party men and woman into foreign service is higher than ever before.

It has not escaped the public imagination that too often, those appointed would be failed politicians, or those that were no longer wanted in their own fields like for example a military general who had fallen out of favour or who the commander in chief wanted to get rid of as a way of making space for their preferred guy.

Botswana has been placed among countries requiring updated malaria prevention advice for travellers from the United Kingdom. This follows a review by British health authorities amid continued concerns over malaria infections among overseas visitors.

The United Kingdom Health Security Agency (UKHSA) Malaria Expert Advisory Group (UKMEAG) published revised malaria prevention guidelines for 2026 on 17 June, updating country-specific risk assessments and recommendations for travellers visiting malaria-prone destinations.

Botswana was among 13 countries whose malaria descriptions were revised as part of the latest review, alongside neighbouring Namibia, South Africa and Eswatini, as well as countries including India, Myanmar, Sudan and Papua New Guinea.

The updated guidance provides advice to UK healthcare professionals and travellers on malaria risks, available antimalarial medicines and precautions for vulnerable groups, including pregnant women and individuals with special health risks.

The UKHSA warned that malaria continues to pose a serious threat to travellers, with several UK residents dying from the disease each year after visiting malaria-risk countries.

‘Each year several UK travellers die from malaria after visiting malaria risk countries, with most travellers who catch malaria reporting travel to Africa,’ the agency said.

The updated guidance includes revised malaria descriptions and new risk maps for several countries, reflecting changes in malaria transmission patterns and the need for travellers to seek appropriate medical advice before departure.

Malaria is transmitted through the bite of infected mosquitoes and remains a major public health concern in parts of sub-Saharan Africa. Travellers who are not immune to the disease are considered at higher risk of severe illness if infected.

Health authorities advise travellers visiting malaria-risk areas to consult medical professionals before travel, take recommended preventive medication where necessary, use insect repellents, sleep under mosquito nets where appropriate and seek urgent medical attention if they develop symptoms such as fever after returning from affected regions.

The UK’s updated advisory comes as Botswana continues efforts to strengthen malaria control measures, particularly in northern parts of the country where transmission risk is historically higher.

Reports show that Botswana has made significant progress in reducing malaria cases over the years through surveillance, mosquito control programmes and improved access to treatment. However, periodic outbreaks and seasonal transmission continue to require sustained prevention measures.

It is understood the revised UK guidelines are expected to influence travel health advice for thousands of British visitors to Botswana which is one of the United Kingdom’s key tourism markets.

The Court of Appeal has dismissed a bid by construction company Black Cad Investments to revive a long-running government infrastructure tender. The Court ruled that procurement authorities acted lawfully when they cancelled the project after years of disputes, investigations and repeated evaluations.

In a judgment delivered on 31 July, the appeal court upheld an earlier High Court ruling that rejected Black Cad’s challenge to the cancellation of a tender for water and sanitation infrastructure in Morwa West, Kgatleng.

The project, first advertised in 2017, was intended to deliver a water pipeline, reservoir, outfall sewer line and related services. But what began as a routine public procurement exercise spiralled into a four-year dispute involving complaints from bidders, police investigations, litigation and multiple reviews of the evaluation process.

Writing for a unanimous bench, Justice of Appeal Isaac Lesetedi described the procurement process as a ‘long drawn out four-year nightmare beset with controversy and challenges’, noting that the project had effectively become ‘a mirage’ that might never be realised.

The case centred on a decision by the Public Procurement and Asset Disposal Board (PPADB) in September 2021 to cancel the tender. The board cited two reasons: the age of the procurement process and a finding that none of the bidders ultimately complied with the tender requirements.

Black Cad argued that once the originally preferred bidder, Dambeko Construction, was disqualified for submitting false information, it should have been awarded the contract. The company also contended that the PPADB had no authority to cancel a tender simply because it had become old.

The Court of Appeal declined to determine whether age alone could justify cancellation, finding that the case could be resolved on other grounds. Instead, it focused on the board’s finding that Black Cad itself had failed to meet a mandatory tender requirement by not submitting the curriculum vitae of its proposed project manager.

The judges held that procurement authorities were entitled to revisit earlier evaluations and conduct fresh scrutiny of bids. Even if an earlier assessment had found Black Cad compliant, the PPADB retained broad statutory powers to review the procurement process and reach its own conclusions.

The court also rejected allegations that the board had acted irrationally or in bad faith. It found that procurement officials repeatedly called for records, reviewed documentation and examined complaints before making decisions.

‘From the record, the Board acted fairly, rationally and in good faith,’ Lesetedi wrote, adding that its conduct was ‘beyond reproach’.

The judgment highlights a recurring problem in Botswana’s procurement system: infrastructure projects delayed for years by disputes and litigation. By the time the PPADB revisited the Morwa West tender in 2021, four years had passed since bids were submitted, raising concerns that contractors could no longer reasonably be expected to deliver the works at 2017 prices.

The board concluded that inflation, changing project conditions and the passage of time had fundamentally altered the tender environment.

The Court of Appeal also found a procedural weakness in Black Cad’s case. While the company sought to overturn the PPADB decision, it did not directly seek to set aside the underlying decision of the Ministerial Tender Committee, which had found all bidders non-compliant.

As a result, even if Black Cad had succeeded against the board, the ministerial committee’s decision would have remained legally effective.

The appeal was dismissed with costs, bringing to an end nearly nine years of disputes over a project that has yet to break ground. Attorney Tshiamo Rantao,Maswabi, and Kgakgwe represented the PPADB while Atang Kgaodi represented the Attorney General.

Last month, I argued that patients experience one health system rather than separate government ministries. A decision on taxation affects access to care. Medicine procurement influences public confidence. Health financing shapes treatment choices. Patients do not experience these issues separately. They experience them together.

That discussion leads naturally to another question. How should governments recognise harm during a health-system crisis?

Recent public statements concerning medicine shortages and mortality have raised an important scientific and policy question. The question is not whether evidence matters. It does. Nor is it whether governments should rely on facts rather than speculation. They should. The real question is what counts as evidence when a health system is under pressure.

Health Policy and Systems Research has long recognised that health-system failure is rarely revealed by a single statistic. Harm often begins quietly. Treatments are interrupted. Medicines become unavailable. Patients postpone care. Health workers improvise. Families spend more out of pocket. Trust begins to erode. By the time mortality statistics begin to change, the health system may already have been signalling distress for months.

This distinction lies at the heart of the current debate. It is also where science has the greatest contribution to make.

The Minister’s Statement

Against this background, the Assistant Minister of Health recently stated that government had found no evidence linking medicine shortages directly to patient deaths. The statement reflects an important principle of scientific reasoning. Governments should not attribute deaths to medicine shortages without credible evidence. Public confidence depends on decisions grounded in careful investigation rather than assumption.

The statement, however, also raises an important methodological question. Does the absence of evidence demonstrating a direct causal relationship between medicine shortages and recorded mortality necessarily mean that medicine shortages have caused no harm?

Health Policy and Systems Research suggests that the answer is more nuanced. Health systems are complex adaptive systems in which outcomes rarely arise from a single cause acting in isolation. A patient’s health is shaped by a chain of interconnected events involving diagnosis, medicine availability, health-worker capacity, referral systems, financing and continuity of care. Weakness in any one part of that chain can influence the eventual outcome.

Researchers therefore distinguish between absence of evidence and evidence of absence. As Altman and Bland (1995) observed, failing to demonstrate a relationship is not the same as demonstrating that no relationship exists. That distinction provides the starting point for understanding what the international evidence shows.

What the International Evidence Shows

International research has consistently shown that medicine shortages are far more than pharmaceutical supply problems. They are recognised as health-system risks that affect the quality, continuity and safety of patient care. While shortages may contribute to increased mortality in some circumstances, the evidence demonstrates that their consequences are usually broader, more gradual and more complex than a single mortality statistic can capture.

The World Health Organization identifies uninterrupted access to essential medicines as one of the six core building blocks of a functioning health system because medicines underpin effective service delivery, clinical decision-making and public confidence (WHO, 2007). Building on this, de Savigny and Adam (2009) argue that health systems should be understood as interconnected systems in which disruption in one component inevitably affects others. A medicine shortage is therefore not simply a procurement problem; it is a signal of wider system stress.

The Lancet Commission on High-Quality Health Systems reaches a similar conclusion. Kruk and colleagues (2018) argue that health-system performance should be judged not only by access to services but by whether patients receive timely, safe, effective and trusted care. Continuity of treatment is therefore as important as the availability of treatment.

Evidence specific to medicine shortages reinforces this broader perspective. Systematic reviews by Fox and McLaughlin (2018) and Acosta and colleagues (2019) consistently associate medicine shortages with treatment interruption, medication substitution, avoidable complications, increased out-of-pocket expenditure, greater pressure on health professionals and poorer patient experiences. Although studies vary in their findings on direct effects on mortality, they overwhelmingly conclude that shortages generate measurable clinical, economic and humanistic harm.

This conclusion is also reflected in patient safety research. The Institute of Medicine argued that high-quality health systems should identify risks before they result in avoidable harm rather than simply record adverse outcomes after they occur (Institute of Medicine, 2001). Collectively, this body of evidence suggests that medicine shortages should be understood not merely as supply-chain failures, but as indicators of health-system vulnerability requiring timely stewardship and policy action.

Looking Beyond Mortality: What Counts as Evidence?

The international evidence raises an important question. If medicine shortages can cause harm without immediately affecting mortality, what should governments regard as evidence?

Health Policy and Systems Research offers a broader answer than mortality statistics alone. Health Policy and Systems Research is different to clinical research, that often aims to find direct cause-effect relationships. Health Policy and Systems Research looks at how institutions, policies and governance arrangements affect health outcomes. It asks how health systems function in practice and how the interactions between different elements of the system shape the care that patients receive (Gilson, 2012; Sheikh et al., 2011).

From this perspective, mortality is a lagging indicator. It records an outcome after a chain of events has already unfolded. By contrast, medicine availability, treatment continuity, delayed care, patient experience and financial hardship are leading indicators. They provide early evidence that a health system is under strain and allow governments to intervene before adverse outcomes become irreversible.

This distinction is familiar across many sectors. Repeated equipment failures are investigated by aviation authorities before an aircraft crashes. Before a bridge falls down , engineers fix weaknesses in a structure . Disease surveillance response by public health officials before hospitals are overwhelmed. Effective governance depends on recognising risk early rather than waiting for catastrophe.

The same principle applies to health systems. Governments may not yet be able to demonstrate that a particular medicine shortage directly caused a particular death. That level of proof often requires detailed clinical investigation and robust epidemiological analysis. However, they do not need to wait for such evidence before responding to credible indications that medicines are unavailable, treatment is being interrupted or patients are struggling to access care. The purpose of evidence is not simply to confirm failure. It is to prevent it.

Measuring Harm Before It Becomes Catastrophe

If mortality is only one indicator of health-system performance, the next question is straightforward: what should governments measure during medicine shortages?

Health Policy and Systems Research encourages governments to monitor the conditions that increase the likelihood of harm rather than waiting for harm to become visible. The objective is not simply to document failure, but to detect emerging risks early enough for corrective action to be taken. This is core to stewardship and resilience of health systems (WHO, 2021).

Several indicators are particularly important. The first is the frequency and duration of medicine stock-outs, which provide an early measure of the reliability of procurement and supply systems. The second is treatment continuity. For patients living with chronic conditions such as hypertension, diabetes, HIV infection, epilepsy and cancer, interruptions in treatment may not produce immediate mortality, but they can accelerate disease progression, increase complications and reduce quality of life (Fox and McLaughlin, 2018; Acosta et al., 2019).

Governments should also monitor medicine substitution, delayed appointments, household out-of-pocket expenditure and patient experience. Together, these indicators reveal how shortages affect clinical practice, financial protection and public confidence in the health system. As Gilson has argued, trust is not merely a desirable outcome of effective governance; it is one of the conditions that enables health systems to function effectively.

Viewed together, these measures provide a far richer understanding of health-system performance than mortality statistics alone. They allow governments to recognise vulnerability, strengthen system resilience and intervene before service disruption develops into avoidable harm.

A Better Question for Botswana

The recent public discussion on medicine shortages presents Botswana with an opportunity to strengthen, rather than polarise, evidence-informed health policymaking. The issue is not whether governments should rely on evidence they must. Nor is it whether claims linking medicine shortages to mortality require careful scientific investigation they do. The broader challenge is ensuring that the evidence collected is sufficiently comprehensive to recognise risks before they become irreversible harm.

As Botswana continues to strengthen primary healthcare, improve medicines governance and advance universal health coverage, this debate should encourage investment in stronger medicines surveillance, routine monitoring of treatment continuity, patient safety, stock-out reporting and health-system intelligence. These are not simply technical functions. They are essential components of stewardship because they enable governments to detect emerging risks, respond proportionately and learn from experience before patients suffer avoidable harm.

Ultimately, the strongest health systems are distinguished not by how well they explain tragedy after it has occurred, but by how effectively they recognise risk and prevent it. That is the enduring contribution of Health Policy and Systems Research-and perhaps the most important lesson this debate offers Botswana.

Millions of Pulas given to Botswana Football Association (BFA) for projects under the FIFA Forward 1.0 and 2.0 initiatives are yet to be accounted for.

FIFA Forward, which was first launched in 2016, is the football world governing’s initiative to develop football across its more than 211 members. Under this program, football associations, including BFA, make tailor made requests to FIFA to finance certain football projects within its jurisdiction.

These projects are designed to support areas of need such as ‘infrastructure development, football development, competitions, capacity building, administration or other institutional priorities.’

This support however comes under strict auditing expectations. FIFA demands detailed reports to show the monies were used for projects as required. If these strict auditing requirements are met, the association is then able to request for more support to undertake similar projects.

A failure to adhere to the strict auditing requirements however means no further monies can be released towards similar projects. And this is where the BFA finds itself. Since inception of the FIFA Forward initiative, the BFA has more often successfully tapped into this source.

However, reports show that the association has failed to account for millions of pulas acquired from FIFA. These accounting failures date back to the year 2017, when the BFA was given its first grants under the initiative.

BFA project management consultant Molefi Obenne has revealed that from the eighteen (18) projects financed under the initiative, only six (6) have been accounted for.

During the initial roll-out of the initiative, the FIFA Forward 1.0 between 2016 and 2018, BFA were granted assistance for at least 13 projects. From these, only six projects were completed or accounted for and closed. Seven are yet to be accounted for. In the FIFA Forward 2.0 initiative, five projects were financed. As of now, none has been accounted for or closed.

Presenting at the inaugural BFA Football Pitso, Obenne said all the unfinished projects were those under the direct purview of the association. The closed projects on the other hand are those which had been awarded to external service providers.

Among the projects which are unaccounted for are the Grassroots and Youth Football Competition (financed at US$750 000 or +/- P10 122 000), Botswana Football League project (US$107,803.32 in FIFA Forward 1.0 and US$371,556.68 in FIFA Forward 2.0 respectively), the Regional Football League Project (US$297,579.66) as well as several capacity building workshops.

In the absence of necessary reports required by FIFA, the BFA finds itself in an untenable situation. It cannot request for some of the remaining unused funds from the projects which are still with FIFA. The association can also not apply for funds to continue projects related to Botswana Football League, Grassroots and Youth Football Competitions or Regional Football League.

The BFA is said to have realized the extent of the challenge when some of its requests for project financing were not approved. Upon request for clarity, it was informed no funds could be released until FIFA has been given reports on projects of similar nature which had been financed prior.

Obenne said they have since engaged with the football world governing body seeking guidance on the matter. The BFA is now working around the clock to collate all reports and account to FIFA on how the funds were used.

Going forward, the BFA says it will have to implement tight controls on finances as well as establish close monitoring on all projects. This comes as preliminary investigations ‘indicate that the main reason the projects were not formally closed was a weakness in project monitoring, reporting and financial control.’

‘Historically, most project funding was disbursed in full at the beginning of the project, while comprehensive reporting was expected only upon completion. There were no consistent monthly or quarterly monitoring requirements to track expenditure, implementation progress, deliverables, risks and emerging variances.’

‘At this preliminary stage, there is insufficient evidence to conclude that project funds were deliberately redirected to other activities. This can only be established through a project-by-project reconciliation of approved budgets, bank transactions, payment records, procurement documents, invoices, progress reports and completed deliverables,’ the BFA says.

With uncertainty mounting on whether the BFA can get financing on similar projects to the ones it has not closed or accounted for, it now has to undertake a tedious task to audit all projects ‘to determine their status and use of funds for each of them.’

There is an old paradox about the Okavango Delta. It is one of the most photographed landscapes on Earth, yet the people who have shaped its history remain largely invisible.

For decades, filmmakers have returned to Botswana’s UNESCO World Heritage Site to capture sweeping aerial shots of papyrus channels, elephant herds and spectacular sunsets. The Delta has become shorthand for wilderness – beautiful, pristine and seemingly untouched.

Batho ba Metsi (People of the Water), the latest documentary from the Nkashi Trust, quietly dismantles that familiar narrative.

Premiered on Tuesday 4 August before an invited audience at the Btv Auditorium, including President Duma Boko, the film asks audiences to stop admiring the landscape long enough to notice the people living within it. It is less interested in the Delta as a destination than as a homeland, less fascinated by wildlife than by those who have coexisted with it for centuries.

The result is one of the most important Botswana documentaries in recent years – not because it uncovers an unknown place, but because it reveals familiar territory through unfamiliar eyes.

Produced by one of Botswana’s finest filmmakers Moabi Mogorosi as a follow-up to the acclaimed Nkashi: Race for the Okavango (2023), the documentary also marks an important milestone behind the camera. For the first time in the series, the entire production – from cinematography to sound and editing – was entrusted to a wholly Batswana crew. That decision is more than symbolic. It lends the film an authenticity that is difficult to manufacture, allowing local voices to shape not only the story but also the way it is told.

Former Miss Botswana Palesa Molefe serves as the audience’s guide. Travelling from Gaborone into the Delta, she functions less as a television presenter than as an attentive listener. Her restrained narration avoids becoming the centre of attention, allowing interviewees to carry the emotional weight of the film. It is a wise editorial choice. Rather than explaining the Delta to viewers, the documentary lets the Delta explain itself.

The film never loses sight of its central question.

Who owns the Delta?

It is a deceptively simple question with no easy answer.

The documentary refuses to reduce the issue to slogans. Instead, it presents a mosaic of perspectives from the Basarwa, WaYeyi and HaMbukushu communities alongside scientists, conservationists and tourism stakeholders. Rather than portraying indigenous knowledge and modern science as opposing worldviews, Batho ba Metsi presents them as complementary systems of understanding. Traditional ecological knowledge, accumulated over centuries of observation, is given equal weight alongside academic research.

This intellectual generosity becomes one of the documentary’s defining achievements.

Instead of asking viewers to choose between science and tradition, it demonstrates that each enriches the other.

Perhaps the documentary’s greatest emotional strength lies in its exploration of identity and belonging.

Throughout the film, ‘home’ emerges not merely as a geographical location but as an enduring emotional and spiritual attachment. That idea finds its most moving expression through Professor Lydia Nyati-Ramahobo Saleshando, the renowned WaYeyi scholar and cultural activist whose interview became one of her final recorded public reflections before her passing.

Speaking from her home in Gaborone, she recalls Ikoga, the tiny Delta village of her birth that scarcely appears on maps but occupies an immense place in her memory. Her words transcend the politics of cultural recognition to become something profoundly universal. They speak to anyone who has ever left home in search of opportunity while discovering that physical distance can never sever emotional roots.

Her testimony gives the documentary extraordinary emotional resonance.

It also transforms the film into an important historical record.

Professor Nyati-Ramahobo Saleshando is not the only voice preserved for posterity. Community elder Monnaaphuthego Oja, another respected advocate for conservation and local development who died before the film’s release, appears with equal dignity. His hope that young people should share more meaningfully in the economic benefits generated by the Delta resonates long after the credits roll.

The film’s treatment of economic inequality is refreshingly honest.

Behind the international image of luxury safari camps lies another reality: communities confronting unemployment, limited opportunities and the persistent feeling that the wealth generated by the Delta seldom reaches those who have lived there the longest.

Equally compelling is the documentary’s treatment of human-wildlife conflict.

For international audiences, the Okavango often represents an untouched Eden. For residents, however, coexistence with elephants, lions and other wildlife carries daily risks. The documentary avoids romanticising either conservation or development. Instead, it captures the difficult compromises required when protecting biodiversity also means protecting human lives and livelihoods.

Mogorosi’s direction is characterised by unusual humility.

Many documentaries position the filmmaker as interpreter or authority. Here, he deliberately steps back. As he explains, the production team approached the project as students rather than experts, recognising that the communities themselves were the true custodians of the story. That philosophy is evident throughout the film. The documentary never speaks for its subjects; it creates space for them to speak for themselves.

In doing so, Batho ba Metsi accomplishes something increasingly rare in documentary filmmaking. It trusts its audience.

It does not manufacture heroes and villains. It does not force simplistic conclusions. It acknowledges that questions of conservation, cultural identity, historical injustice and economic development rarely yield comfortable answers.

Instead, it invites viewers into a conversation.

That restraint may ultimately prove to be the film’s greatest strength.

Under the leadership of Dr Steve Boyes, the Nkashi Trust has consistently championed the integration of indigenous knowledge into conservation science. Batho ba Metsi represents the clearest cinematic expression of that philosophy to date. It argues, quietly but persuasively, that conservation cannot succeed if it excludes the very communities whose knowledge has sustained these ecosystems for generations.

In the end, Batho ba Metsi is about far more than the Okavango Delta.

It is about memory, belonging, as well as the uneasy relationship between heritage and development.

Most importantly, it restores human beings to a landscape from which they have too often been edited out.

Beautifully photographed, thoughtfully edited and emotionally resonant, the documentary challenges audiences to look beyond Botswana’s most celebrated landscape and recognise the generations of people whose stories flow through its waters.

The Delta has always had a voice. Batho ba Metsi simply allows us to hear it.

Botswana’s blood transfusion services are facing significant operational and structural challenges that require urgent reforms. This is according to the World Health Organization (WHO) Botswana Country Office Biennial Report 2024-2025.

The report highlights weaknesses ranging from fragmented coordination and outdated equipment to shortages of essential supplies, limited data systems and gaps in quality assurance – issues that could affect the country’s ability to provide safe and timely blood products to patients.

The WHO assessment found that Botswana’s National Blood Policy, introduced in 2018, remains in draft form and lacks a supporting strategic implementation plan.

It also noted the absence of a national advisory body responsible for providing oversight and guiding the development of the blood transfusion system.

‘Blood transfusion services coordination remains fragmented,’ the report states. It warns that many blood centres operate with ageing equipment, inadequate cold-chain systems and manual processes for preparing blood components.

The WHO said procurement challenges have contributed to periodic shortages of reagents and other essential consumables needed for blood processing and testing.

‘Critical shortages exist across donor recruitment, laboratory operations, quality management and data systems,’ the report said.

The global health agency warned that staff capacity also requires strengthening, with healthcare workers needing additional training in quality assurance, automation, regulatory compliance and international standards.

The report further raised concerns about Botswana’s blood information management systems noting that although the Integrated Patient Management System (IPMS) is expanding, the country still lacks a unified national blood information system.

According to WHO, inconsistent transmission of hospital data to the National Blood Transfusion Services (NBTS) limits real-time monitoring and weakens evidence-based decision-making.

The organisation also highlighted weaknesses in clinical transfusion practices, saying existing guidelines require updating to align with modern Patient Blood Management (PBM) principles.

‘Haemovigilance systems are weak, and most hospitals do not have functioning transfusion committees,’ the report stated, warning that this contributes to under-reporting of transfusion reactions and gaps in quality oversight.

To address the challenges, WHO has recommended a comprehensive reform programme covering governance, regulation, infrastructure, human resources and information systems.

The organisation called on Botswana to finalise and implement its revised National Blood Policy, establish a National Blood Advisory Group and strengthen the organisational structure of the NBTS.

It also recommended accelerating the enactment of the Medicines and Related Substances Bill and supporting accreditation of blood establishments through recognised bodies such as the Africa Society for Blood Transfusion (AfSBT).

On infrastructure, WHO called for investment in automated blood component production technologies, modern cold-chain systems and improved procurement mechanisms to prevent stockouts.

The report also recommends developing a national plasma strategy and recruiting specialised personnel to strengthen technical and managerial capacity.

WHO noted that despite significant government investment in health, the country continues to face financing inefficiencies, with 80-90 percent of the health budget allocated towards curative services, leaving prevention and health promotion underfunded.

‘Primary healthcare remains underfunded, despite being essential for achieving universal health coverage,’ the report noted.

The organisation also highlighted medicine shortages, supply chain weaknesses and disruptions affecting HIV/AIDS services following reductions in external funding.

Botswana’s maternal, newborn, child and adolescent health programmes also face persistent challenges, including shortages of health workers, vaccine stockouts, limited outreach services and gaps in reporting systems.

WHO further warned that Botswana’s ability to respond to public health emergencies remains constrained by regulatory and operational gaps.

The report noted that several emergency preparedness plans and standard operating procedures remain in draft form awaiting approval, while the absence of a fully operational Public Health Emergency Operations Centre (PHEOC) weakens coordination during outbreaks.

WHO said stronger multisectoral coordination, improved logistics systems and increased surge capacity in laboratories and healthcare staffing are needed to strengthen national emergency response.