Botswana’s health system remains beset by medicine shortages, critical shortages of health professionals, fragmented blood transfusion services and weak emergency preparedness despite sustained government investment in healthcare, according to a new World Health Organization (WHO) assessment.
The findings are contained in the WHO Botswana Country Office Biennial Report 2024-2025, which concludes that structural weaknesses continue to slow the country’s progress towards Universal Health Coverage (UHC), with governance failures, inefficient financing and operational bottlenecks limiting access to quality healthcare.
‘Botswana’s progress toward UHC is hindered by persistent health system challenges. Despite strong government spending on health, the financing structure is inequitable, inefficient and fragmented,’ the report states.
WHO notes that between 80 and 90 percent of Botswana’s health budget is spent on curative services, leaving primary healthcare, disease prevention and health promotion significantly underfunded. The organization says recent disruptions in external funding for HIV/AIDS programmes, coupled with financial constraints, exposed serious weaknesses in the country’s medicine supply chain.
‘Severe medicine shortages highlight inefficiencies in supply chain management and disrupt continuity of care,’ the report says. The assessment identifies widespread shortages of healthcare workers-including midwives, neonatal specialists, vaccinators and adolescent health providers-as another major obstacle affecting service delivery, particularly in rural and underserved communities.
According to WHO, geographical barriers, inadequate outreach services and persistent vaccine stockouts continue to limit access to essential maternal and child healthcare.
The report also raises concern over Botswana’s national blood transfusion system, describing it as fragmented and in urgent need of reform.
WHO found that the country’s National Blood Policy, first drafted in 2018, has yet to be finalized, while there is no national advisory body overseeing blood services.
Many blood centres continue operating with ageing equipment, inadequate cold-chain infrastructure and manual blood component preparation systems. Procurement delays frequently result in shortages of essential reagents and laboratory consumables.
The report further points to critical shortages of skilled personnel responsible for donor recruitment, laboratory services, quality management and health information systems.
‘While progress has been substantial, the path forward requires deliberate reforms, sustained investment and strengthened partnerships,’ WHO says.
Among its recommendations, the agency urges Botswana to urgently finalize the National Blood Policy, establish a National Blood Advisory Group, modernize blood-processing infrastructure, recruit specialized personnel and implement a national blood information management system.
Beyond routine healthcare, WHO warns that Botswana remains vulnerable to future disease outbreaks and public health emergencies.
The report says key legislation needed to operationalize the Botswana Public Health Institute remains pending, while many emergency preparedness plans have not received final ministerial approval. The absence of an operational Public Health Emergency Operations Centre continues to undermine national coordination and real-time decision-making during outbreaks, WHO says.
The organization also highlights weaknesses in emergency logistics, laboratory surge capacity and multisectoral coordination, warning that these shortcomings could hamper responses to future health crises. WHO says that achieving universal, equitable and affordable healthcare will require comprehensive reforms across governance, financing, procurement, workforce development, digital health systems and emergency preparedness.
‘Governance gaps, resource constraints and structural inefficiencies continue to slow Botswana’s path toward achieving comprehensive, affordable and equitable health services for all,’ the report says.