Botswana's diamond-funded health system has failed: it needs to be reformed and rebuilt | Duma Gideon Boko

"Shortages of medicine in Botswana forced me to declare a public health emergency last year. Patients went without treatment not because health workers failed them, but because the system did. For a nation committed to universal healthcare, free at the point of use, it was a moment of hard truth. Even outwardly strong public health systems can be fragile. As donor assistance bites across the continent, governments cannot afford to delay building resilience."

"Diamond revenues enabled Botswana to build a universal public health system. Even in one of the world's most sparsely populated countries, most people in Botswana are rarely more than five kilometres away from a clinic. Yet the same diamond revenues that built our system also masked its weaknesses. Problems were paid away rather than fixed. Drug prices were inflated many times over. Supply chains were inefficient. Public capacity was hollowed out through outsourcing."

"These failures did not suddenly appear but accumulated over the years. When shortages hit, it is the government that people turn to. Democratic responsibility cannot be subcontracted Falling revenues simply made them impossible to ignore. When healthcare systems face a moment of reckoning, the same prescription is reliably offered: inject more private-sector rigour into inefficient public health delivery. But greater reliance on private provision fragments care, raises costs and diverts scarce health budgets into profit margins."

Medicine shortages in Botswana forced a public health emergency and left patients untreated due to systemic failures rather than frontline staff. Diamond revenues funded a universal, free-at-point-of-use public health system and enabled wide clinic access. Those revenues also concealed structural problems: inflated drug prices, inefficient supply chains, outsourced public capacity, and patchwork solutions paid for rather than fixed. Fiscal shocks from falling diamond income exposed these accumulated weaknesses. Greater reliance on private providers fragments care, raises costs, and diverts scarce budgets into profits. Delivering care at cost within a strong public system is more affordable and sustainable.

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