The Botswana Government has been operating out of touch with the realities facing public health facilities across the country. In its newly released report, the Ombudsman has exposed what it describes as a profound disconnect between government policy-making and the grim realities inside Botswana’s public health facilities revealing that the Ministry of Health was largely unaware of the depth and scale of the crisis unfolding on the ground.
According to the Ombudsman’s investigation, there are ‘significant deficiencies in the Ministry’s awareness of, and effective oversight over, conditions prevailing within public health facilities,’ exposing what the report also describes as a ‘marked disconnection between policy-level governance and operational realities on the ground.’
Information reaching Sunday Standard suggesting that President Duma Boko and the Minister of Health Stephen Modise’s recent nationwide tour of some public hospitals was triggered by the release of the damning investigation. Sources within the government enclave say the report’s findings jolted the leadership into action after it became clear that senior decision-makers had been operating in the dark while conditions in hospitals deteriorated.
The report paints a bleak picture of systemic dysfunction. Among the most alarming findings was the operation of an X-ray machine at Hukuntsi Primary Hospital that was emitting unsafe radiation levels, exposing patients and staff to serious health risks. In other facilities, laboratory analysers acquired outside formal procurement processes were abruptly withdrawn following ministry directives, in the absence of any policy governing donations. This left hospitals routinely referring patients to distant facilities for basic laboratory tests due to chronic shortages of equipment and reagents.
Infection control has also been severely compromised. The Ombudsman found a ‘widespread absence of functional autoclaves’, forcing hospitals to transport surgical instruments over long distances for sterilisation. The report notes that this practice not only undermined efficiency but also heightened the risk of infection. Compounding these failures, medical personnel frequently advised patients especially in urgent cases to purchase essential medicines and non-medical supplies out of their own pockets.
‘These realities highlight a stark disconnect between the Ministry’s oversight responsibilities, the duty to provide medicines, and the lived realities of service delivery within public healthcare facilities,’ the report states.
The investigation found that through a series of administrative actions and omissions, Botswana has ‘to a certain extent failed in her obligations regarding the right to health, particularly the duty to respect this right.’ This failure is linked to inadequate ambulance services, limited hospital bed space, shortages of demoralised staff, weak patient complaints mechanisms, chronic medicine stockouts, and budgetary mismanagement.
Across the country, investigators encountered overcrowded wards, lack of privacy, inadequate bedding, and delayed emergency responses conditions described as ‘incompatible with human dignity’. The Ombudsman warns that these shortcomings disproportionately affect low-income and rural populations who depend exclusively on public healthcare, thereby undermining the constitutional principles of equality and non-discrimination.
Princess Marina Hospital (PMH) emerged as the epicentre of the crisis. Allegations previously reported in the media were substantiated with the report stating that the hospital is operating beyond its functional limits and is ‘effectively at a breaking point’. the report says hospital management likened PMH to ‘an old, heavily worn vehicle, overloaded with passengers and packages, yet still expected to transport the entire population of Botswana safely to its destination.’
Emergency medical services were found to be equally fragile. At the time of the report, the Ministry of Health was operating 101 active ambulances alongside 87 inactive ones. Many of the active vehicles are over five years old and fail to meet roadworthiness standards, forcing government to spend heavily on repairs. The Ministry also lacked any policy framework to determine the optimal number of ambulances needed nationally, resulting in ad hoc procurement and escalating inefficiencies.
The report says the government spends an estimated P12 million annually on private emergency medical services, a move the Ombudsman describes as ‘reactive’ and lacking long-term sustainability. Matters were worsened by the Government Purchase Office moratorium, which restricted fuel procurement for ambulances, directly delaying patient transfers and, in some cases, leading to adverse outcomes.
Laboratory services have also been crippled. Persistent reagent shortages and obsolete equipment have left most public laboratories without accreditation. Only five government laboratories currently meet accreditation standards, while Scottish Livingstone Hospital’s accreditation was suspended in November 2025.
The Ombudsman warns that these systemic failures not only endanger patients but also significantly increase government exposure to legal liability. ‘Each failure undermines patient well-being and places the state at risk through breaches of non-delegable duties and vicarious liability,’ the report notes.
The investigation says that unless these barriers are urgently addressed, Botswana’s public health system will continue to erode public trust, deepen inequality, and fall short of safeguarding the fundamental right to health and life.