Nosmot Gbadamosi/ Africa Brief
Botswana, which has long been at the forefront of global efforts to combat HIV/AIDS, declared a public health emergency on Aug. 25, citing financial challenges that have led to hospitals running short of essential medicines and equipment.
The shortage has come amid challenges with Botswana’s medical supply chain, a global downturn in the diamond market, and U.S. President Donald Trump’s foreign aid cuts.
Botswanan President Duma Boko blamed the state procurement agency Central Medical Stores (CMS), which in turn blamed middlemen for inflating drug prices. “The current prices often are inflated five to 10 times. And under the current economic conditions, this scenario is not sustainable,” Boko said in a televised address.
In early August, the Botswanan Health Ministry warned parliament that the system was “severely strained” and that it owed around $74 million to private health facilities and suppliers, prompting it to suspend nonurgent surgeries. Last week, Boko approved around $18.7 million in emergency funding for the military to distribute medicine.
Thabo Lucas Seleke, a lecturer in global health policy at the University of Botswana, suggested that one sustainable path forward would be to disband CMS “in its current form” and convert it to “an autonomous entity governed by an independent body.”
As Seleke told Foreign Policy, “From 2010 to 2012, Botswana in collaboration with PEPFAR [the U.S. President’s Emergency Plan for AIDS Relief] developed a CMS reform agenda because CMS was marred with a lot of controversy where there was a lot of theft.” But it’s unclear what happened to those recommendations.
For now, Seleke said that the new emergency funding should be put under “legal and institutional safeguards to prevent diversion, elite capture, or politicization.”
Meanwhile, Botswana—one of the world’s largest diamond producers—is also facing an economic slowdown, as the global diamond market has crashed this year. The diamond industry accounts for around 80 percent of the country’s exports and a quarter of its GDP.
In June, Botswanan diamond miner Debswana—a joint venture between the government and mining giant De Beers—cut production by 40 percent after its sales nearly halved last year, partly a result of more consumers turning to lab-grown diamonds. The same month, the Botswanan Finance Ministry said that the country’s monthly public wage bill was far higher than available funds.
For many years, successive governments had proposed diversification away from diamond mining, but like many African nations, Botswana has struggled to findcapital to drive the economy away from natural resources. Recently, Botswana’s government, which holds a 15 percent stake in De Beers, has been pushing for majority ownership in the corporation; currently, British multinational Anglo American owns the other 85 percent.
Also Read: Botswana receives cold chain equipment from Africa CDC
The country is now hoping that a new $12 billion Qatari investment pledge can help turn around its economic fortunes. The agreement, announced on Aug. 21, will see Qatar’s Al Mansour Holdings finance key sectors including infrastructure, energy, mining, agriculture, and tourism.
Amid the economic downturn, Botswana has also been affected by Trump’s decision to halt most foreign aid. As early as February, health experts warned that U.S. aid cuts, including to PEPFAR, would undermine the country’s health services. As of earlier this year, Botswana—which faces the third-highest rate of HIV prevalence in the world—still relied on the United States to fund around a third of its HIV response.
Less than four months ago, Botswana became the first country with a high HIV burden to achieve the World Health Organization’s “gold tier” status for eliminating mother-to-child transmission of HIV as a public health threat. Botswana has cut mother-to-child HIV infection rates down to just 1.2 percent from around 40 percent in the 1990s.
Now, there’s a serious risk of rolling back Botswana’s massive gains on tackling HIV/AIDS. Several projects researching paediatric HIV in Botswana have also been imperilled due to Trump’s termination of research funding to Harvard University.
