Category: Sunday Standard

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.

Botswana Meat Commission (BMC) has again failed to fully utilise the country’s annual Norway beef quota after recurring foot-and-mouth disease outbreaks disrupted cattle movements and slaughter operations, allowing neighbouring Namibia to secure additional export volumes in one of the region’s most lucrative beef markets.

Botswana and Namibia each have access to about 1,600 tonnes of duty-free beef exports to Norway under a preferential quota arrangement. Norway remains a premium market because imports outside the quota attract steep tariffs.

Namibia’s state-owned meat processor, Meatco, said it had secured additional quota volumes released by Botswana and had exported 45.2% of its Norway allocation by mid-April, compared with 29.2% at the same stage in 2024.

The Norway market contributes 18% of Meatco’s international revenue and helped drive the company’s return to profitability. In the 2024/25 financial year, Meatco earned N$1.514 billion (about P1.16 billion) from direct beef sales, with Norway accounting for roughly N$227 million (about P174 million) of revenue.

The latest shortfall extends Botswana’s struggle to consistently utilise the Norway quota since 2021, despite reforms aimed at reviving BMC. Government ended live cattle exports for slaughter in 2023 to increase supplies to domestic abattoirs after BMC struggled to secure enough cattle for export markets.

Bank of Botswana data show exports of meat and meat products recovered from P137.2 million in 2022 to P311.9 million in 2023, P403.6 million in 2024 and P441.5 million in 2025, but remain about 62% below the P1.15 billion recorded in 2016, before the prolonged decline in Botswana’s beef exports.

The debate on Batswana’s lips over whether President Duma Boko is taking Botswana in the right direction or the wrong one will, for the first time, be grounded in hard evidence when the Mo ibrahim Foundation releases the 2026 Inbrahim Index of African Governance.

On social media, homes and social gatherings across the country, opinions are shaped by perceptions, political loyalty and lived experience. The upcoming 2026 Ibrahim Index is expected to cut through the noise, offering a data driven assessment of Botswana is performing under President Boko’s leadership.

The Ibrahim Index measures governance broadly. Its methodology covers political participation, rights, rule of law, security, public administration, economic opportunity, human development and other dimensions of state performance.

The 2026 edition will draw on hundreds of variables from dozens of international data sources. Crucially, the index will be released on October 31st, the second anniversary of Boko’s presidency, giving it added political and symbolic weight as a mid-term benchmark of his administration’s early performance.

The forthcoming index should not be treated as a verdict on Boko’s presidency. Its data will only cove through the end of 2025, meaning that that the index captures only the early part of the Unvrella For Democratic Change (UDC) administration. It will take several more editions befoe a clear trend under Boko can be established. But the 2026 index will nevertheless be significant. It will provide the first independent, continent-wide statistical benchmark against which the new government’s governance record can be measured.

Anti-corruption performance wil be particularly important. The Mo Ibrahim Foundation’s preliminary findings for the forthcoming index show that corruption remains one of the continent’s major governance challenges, with African countries divided between those improving and those experiencing deterioration.

Although Botswana remains ranked sixth in Africa with an Anti-Corruption score of 57.8, the index classifies the country among only six African nations experiencing ‘Increasing Deterioration’-a category reserved for countries whose anti-corruption performance has not only declined but where the pace of decline has accelerated since 2021.

The report shows Botswana’s score has fallen by 8.6 points over the past decade, causing the country to drop three places in continental rankings.

Botswana is listed among the five countries recording the worst anti-corruption deterioration since 2016, alongside Comoros, Liberia, South Africa and Niger.

The Mo Ibrahim Foundation’s preliminary 2026 Anti-corruption assessment provides a decade-long measure of Botswana’s anti-corruption trajectory through 2025, including the first year of the Boko administration. The report is expected to reveal details on whether the the country’s anti-corruption deterioration continues under Boko’s presidency or is being reversed.

Another crucial measure will be whether President Boko’s recent sweeping changes in the leadership in Botswana’s civil service has made the state better or worse off.

Botswana’s public administration has traditionally been regarded as one of the country’s institutional strengths. The Ibrahim Index preliminary report has recorded a decline in the effectiveness of the state. The preliminary index however captured a decade-long trend and does not have specific findings for the period under the UDC government. Those figures are expected in the detailed final report.

The economic test will also be increasingly important because the new government has inherited a much less comfortable fiscal environment than previous administrations enjoyed. The global diamond market has experienced a prolonged downturn and for Boko, fiscal discipline could be a governance issue as much as an economic one.

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.

The current state of the economy has left many businesses across Botswana grappling with declining sales, delayed customer payments, rising operating costs, and increasing pressure from creditors. For most directors, the first instinct is to ride out the storm with the hope that the financial turbulence will eventually subside. What many directors fail to appreciate is that this is often the point at which the risk of reckless trading starts to emerge.

Financial distress often places directors in the difficult position of deciding whether to continue trading in the hope of recovery or to take steps to protect creditors from incurring losses.

Where directors continue to incur obligations despite clear evidence that the company is unlikely to meet them, they risk crossing the line from prudent commercial decision-making into reckless trading. In such circumstances, the law empowers the courts to hold directors civilly liable where they have knowingly allowed the company to incur debts despite there being no reasonable prospect of those debts being paid as they fell due.

In practice, this means that where directors fail to exercise oversight over the affairs of the company or ignore financial warning signs, and those failures result in loss or prejudice to the company or its stakeholders, they may be required to compensate the company, creditors, or other affected stakeholders for the resulting losses.

In many cases, reckless trading does not arise from deliberate misconduct or wilful negligence. Instead, directors and management fall into it by continuing with familiar ways of managing financial challenges, believing that strategies which worked in the past will carry the company through another difficult period.

One of the most common mistakes made by company executives is failing to distinguish between temporary cash-flow pressure and actual insolvency. It is common for companies to experience short-term liquidity challenges caused by delayed customer payments, seasonal fluctuations or broader economic conditions. These challenges do not necessarily mean that a business is likely to fail. However, directors should be cautious of assuming that short-term liquidity pressures will resolve themselves without a clear assessment of the company’s financial position and a realistic plan for recovery.

Reckless trading may also occur when a company starts relying on new debt to service existing obligations. While obtaining short-term finance or negotiating extended credit terms may form part of a legitimate turnaround strategy, directors should be cautious of relying on new debt to meet existing obligations and incurring liabilities that cannot realistically be honoured.

One of the defining characteristics of companies that ultimately fail is delayed intervention. Directors frequently seek legal, financial or restructuring advice only after creditors have commenced legal proceedings or the company’s financial position has deteriorated beyond repair. At this point, many of the restructuring options that were previously available may no longer be viable. Boards that recognise financial distress early on and seek professional advice place themselves in a far better position to consider business rescue solutions such as judicial management before liquidation becomes unavoidable.

Too often, boards regard judicial management and liquidation as measures of last resort, only to discover that they have acted when it is already too late. In reality, both are statutory mechanisms intended to protect companies, creditors and directors alike.

Once a company is placed under judicial management, a court appointed judicial manager takes over the control of the company and its affairs. The judicial manager is then tasked with ensuring that measures aimed at restoring the company to financial viability are implemented.

A key advantage of judicial management is that it provides the company with relief from creditor action while a recovery plan is developed and implemented. During this period, legal action against the company is put on hold, giving the judicial manager time to understand the company’s challenges, develop a recovery plan and negotiate with creditors without the immediate pressure of enforcement action.

Where the company has been successfully rehabilitated and is able to meet its obligations going forward, the court may terminate the judicial management order and control of the company’s affairs may return to the directors. However, where the company cannot be rescued and there is no reasonable prospect of recovery, the judicial manager may recommend that the company be placed into liquidation.

The decision to move from preservation to liquidation is one that requires careful consideration by the board. Directors must recognise that their duty is not to preserve the company at all costs, particularly where continued trading is likely to increase losses and prejudice creditors. It is the directors’ fiduciary duty to initiate or support liquidation of the company where there is no reasonable prospect of rehabilitation.

Liquidation provides a structured and orderly process for winding up the affairs of a company. An independent liquidator is appointed to take control of the company’s assets, realise them for the benefit of creditors, investigate the company’s financial affairs where necessary, and distribute the proceeds in accordance with the priorities prescribed by law. By bringing trading to an end, liquidation also prevents further debts from being incurred and protects creditors from additional losses that may result from continued trading.

In carrying out their duties, liquidators are required to investigate the circumstances that led to the company’s failure and determine whether there is evidence of misconduct, reckless trading, fraudulent trading or breaches of directors’ duties. Where appropriate, they may institute proceedings to recover losses on behalf of the company or its creditors or seek orders holding directors and other responsible parties personally liable.

Ultimately, the hallmark of good corporate governance is not keeping a financially distressed company alive at all costs but recognising when the company requires a different course of action. In today’s challenging economic environment, the most effective boards are not those that avoid judicial management or liquidation, but those that have the courage and foresight to implement the right process at the right time.