In late 2023, Boitumelo Mosege fell sick. Her neck swelled up, her whole body itched and she fainted frequently. She was diagnosed with hyperthyroidism and had to give up her work as a farmer on the outskirts of Molepolole, a town about 30 miles north-west of Botswana’s capital, Gaborone.
In Botswana, public healthcare is supposed to be universal and free. However, Mosege said she had only sporadically received medication since becoming ill. The 53-year-old relies on her four children’s occasional piecework (where a worker is paid a fixed rate per task or unit produced), and her mother’s 1,400 pula (£77) monthly pension, to afford 2,000 pula-worth of medication every month. In early May, she said it was three months since she had last bought medicine.
“I felt like I had lost my life right there,” Mosege said, recounting when she was told she had to buy her medication herself. “I felt suicidal.”
Nearby, Kelly Jansen cares full time for her 83-year-old father, Gerhardus Jansen, who uses a wheelchair. They spend a third of his pension on medication and supplies including a blood pressure monitor and compression stockings.
Jansen, 39, is searching for someone to donate an electric wheelchair, which would give her more freedom. “I want my life back,” she said.
Kelly Jansen has become the full-time caregiver for her 83-year-old father, Gerhardus Jansen. Photograph: Kefilwe Monosi/The Guardian
Last year, shortages of essential medicines and medical supplies led the president, Duma Boko, to declare a public health emergency, 10 months after he defeated the party that had ruled Botswana since independence from Britain in 1966.
Health procurement had long been dysfunctional. But a multi-year economic downturn caused by a collapse in demand for diamonds, which are 80% of Botswana’s exports, tipped it over the edge, Boko wrote in an opinion piece for the Guardian in February. Meanwhile, the economic malaise has pushed up unemployment in what has long been one of the most stable and wealthiest countries in Africa.
Boko blamed the Central Medical Stores (CMS), the state health procurement agency, for raising drug prices. Thabo Lucas Seleke, a University of Botswana health policy lecturer, said the agency’s problems had been known since at least 2010, when a government report said it needed wide-scale reforms.
“It is a breeding ground for corruption,” Seleke said. “It has not improved, it is getting worse.”
Botswana’s health ministry did not provide a comment, after a spokesperson requested written questions.
At independence, Botswana was one of the world’s poorest countries. The fortunes of the landlocked, semi-arid state were transformed a year later, when De Beers geologists found diamonds. For the next few decades, it was one of the world’s fastest-growing economies.
Diamonds on display in Gaborone. Photograph: Siphiwe Sibeko/Reuters
This wealth enabled Botswana to provide free primary and secondary education and become a world leader in tackling HIV/Aids. Its 2024 GDP per capita of $7,695 (£5,697) was the fourth highest in Africa, according to the World Bank.
However, other healthcare outcomes haven’t kept pace with economic growth. Maternal deaths are higher than in similarly wealthy countries, according to the World Health Organization.
Meanwhile, the crash in natural diamond prices – which have fallen 60% in four years and show no signs of recovery as consumers buy cheaper lab-grown stones – have dented Botswana’s relative prosperity. The IMF estimated that Botswana’s economy shrank 3% in 2024 and 1% last year.
The rise in fuel prices caused by the US war with Iran will hit Botswana hard, as it is an oil importer, said Marisa Lourenço, an independent political risk consultant. “It doesn’t have much other buffer,” she said. “If we look at how much the economy contracted during Covid, it never really recovered from that.”
Unemployment rose to 21% among its population of 2.5 million in the year to 31 March 2025, according to the most recent official data. Almost 29% of 15- to 35-year-olds were jobless.
Oratile Olorato Kgatle has been applying for public relations jobs for 18 months and her mental health has suffered. Photograph: Kefilwe Monosi/The Guardian
Oratile Olorato Kgatle’s eyes lit up as she spoke about wanting to work in public relations. But the 26-year-old, who lives with her aunt, has not had a single job interview in 18 months of applying.
“I could feel that light just dimming with each day, until January when I went to [a psychiatric hospital] to seek help,” said Kgatle, who is limited to office work by Erb’s palsy, a condition that affects her strength and mobility.
Botswana’s ailing economy has also affected middle-class families. Phenyo Tanka said her family stopped eating out and fired their domestic worker, after her husband was made redundant from his job as a mining engineer in December.
Phenyo Tanka has not found a job since graduating in agriculture in 2011, despite applying for numerous positions in the sector. Photograph: Kefilwe Monosi/The Guardian
Tanka, a 39-year-old mother of four, is also an example of Botswana’s failure to diversify its economy away from diamonds. She graduated with a degree in agriculture in 2011, but has never been able to find a job.
Tanka hasn’t given up, though. She now sells homemade cakes and wants to set up a toilet paper factory. “I have two girls and I want them to know that they can also be independent, as ladies,” she said.
