Botswana faces the risk of further cuts to international HIV and tuberculosis funding if it fails to demonstrate that previous government financing commitments were fulfilled. The Global Fund has also warned that it could reduce funding by twice the outstanding recoverable amount if the debt is not satisfactorily repaid.
The warning is contained in an annexture accompanying a letter addressed to government representative Thapelo Phuthego who is currently the Deputy Permanent Secretary in the Ministry of Youth and Gender Affairs. The letter was from Head of the Grant Management Division at the Global Fund to Fight AIDS, Tuberculosis and Malaria, Mark Eldon-Edington.
The document sets out conditions governing Botswana’s next funding cycle, including requirements to account for previous commitments, increase domestic spending and prepare for the eventual withdrawal of external support.
The Global Fund warns that failure to realise previous co-financing commitments under its seventh grant cycle could result in reductions to existing grants and/or Botswana’s next allocation.
‘Failure to realize previous co-financing commitments from GC7 may result in the Global Fund reducing funds from existing grants and/or the GC8 allocation,’ the annexure states.
Botswana is required to submit evidence that previous commitments were fulfilled when applying for the next funding cycle. This includes proof of expenditure on increased government health spending, disease programmes and specific programme-related activities.
The conditions place the government under pressure to demonstrate that promised domestic resources translated into actual spending as it prepares to assume greater responsibility for financing the national HIV and TB response.
The annexure also reveals that Botswana had an outstanding recoverable amount of US$297,414 (approximately P4.23 million) owed to the Global Fund as of February 15, 2026. Of that amount, US$96,882 (approximately P1.38 million) was overdue under the relevant grant agreements.
The document warns that failure to repay the money satisfactorily could trigger remedial action, including a funding reduction equivalent to twice the outstanding recoverable amount.
That could expose Botswana to a potential reduction of US$594,828 (approximately P8.46 million), if the Global Fund applies the specified measure to the full outstanding balance. The debt is separate from the new domestic investment requirements attached to the next allocation.
Under the eighth grant cycle, known as GC8, Botswana must commit at least US$4,231,381 (approximately P60.2 million) in additional domestic investment to qualify for its full allocation.
The Global Fund states that 25 percent of Botswana’s allocation is conditional on meeting co-financing requirements.
As an upper-middle-income country, Botswana must direct all its co-financing commitments towards specified sustainability and transition activities, with particular attention to key and vulnerable populations.
The funding should support essential services that will need to continue after the Global Fund’s financial support ends. These include healthcare personnel, data systems for monitoring HIV and TB, and community and civil society organisations that help vulnerable groups access services.
The annexure also calls for continued procurement reforms to improve efficiency and ensure essential health products remain affordable and accessible. The government must provide a formal co-financing commitment letter and subsequently supply evidence from appropriate authorities, including the Ministry of Finance, demonstrating that the commitments have been realised.
The document makes clear that the next allocation is intended to support Botswana’s transition towards financing its HIV and TB programmes increasingly from domestic resources.
The new grant is scheduled to begin on January 1, 2028. Botswana is being asked to use a tailored funding application approach designed for countries transitioning from external assistance.
The Global Fund requires applications for eligible disease components to be submitted together and, where feasible, integrated into a single funding request. A joint HIV and TB application is mandatory because of the high level of co-infection.
Botswana is also encouraged to have a principal recipient in place when submitting its application, with sub-recipients and implementing partners identified before the grant is signed.
The document warns that the allocation is based on announced donor pledges and that some funding may not materialise if donor contributions fall short. In that event, the Global Fund, government and implementing partners would have to adjust programme designs to accommodate the reductions.