Across Botswana, patients are growing used to a sentence that lands like a warning. “Ga gona molemo.” Your medication is out of stock. For mothers at clinics, elderly patients and people living with chronic illness, the phrase signals more than inconvenience. It means interrupted treatment, rising anxiety and, in some cases, worsening health.
Health experts and former officials say the shortages are not random. They are the visible sign of long-standing structural weaknesses in the public system. Botswana medicine shortages, they argue, have been building for years.
Botswana Medicine Shortages Rooted in Procurement Bottlenecks
Former Ministry of Health Permanent Secretary Ruth Maphorisa says the current crisis did not arrive overnight. She served in the role from April 2018 to December 2019. Maphorisa recalls that shortages were less severe then, but the foundations of today’s disruption were already present.
She points to persistent procurement inefficiencies, weak supply chain systems and the lack of real-time health data. Procurement, she says, sits at the centre of the problem. The process is lengthy and complex. Rigid tender rules and heavy reliance on imported medicines shape it.
Botswana’s small market size also weakens its buying power. Suppliers want volume, and the country struggles to compete for attention in a volatile global pharmaceutical environment. Problems escalate when tenders are challenged in court. Legal disputes can halt procurement entirely.
When that happens, the ministry often turns to emergency procurement. It is faster but costly. Maphorisa warns it can lead to inflated prices. She recalls periods when unresolved legal battles risked incurring close to P10 million in costs within a short period.
Botswana Medicine Shortages Highlight a Data and Supply Chain Gap
Reforms have been introduced. The Ministry of Health worked with the Public Procurement Regulatory Authority and international partners to improve flexibility and reduce legal bottlenecks. These changes may appear helpful on paper, but Maphorisa says they do not address the core weakness.
Without real-time data, stock levels cannot be monitored effectively to prevent shortages. Supplies run out before decision-makers can intervene. That creates a cycle of reactive purchasing and rushed distribution.
Maphorisa also urges the government to rethink its approach to working with the private sector. She believes strategic partnerships could improve blood services, equipment leasing and laboratory operations. She warns that building facilities without proper equipment leads to underutilised infrastructure and wasted investment.
Frontline Staff And Civil Society Warn of Patient Harm
For healthcare workers, the crisis is familiar but more severe than before. Retired midwife Esther Mogakolodi, who worked for 48 years, says medicine shortages have followed her entire career. But she has not seen shortages at this scale.
She is especially worried about people with diabetes and hypertension. Many rely on uninterrupted medication to stay stable. When medicines are missing, some patients skip doses, self-medicate or abandon treatment. The health risks are serious.
Civil society groups have raised similar concerns. BONELA reported widespread stock-outs across districts in 2022. The shortages included everyday medicines such as paracetamol, as well as drugs used for chronic conditions. A particular concern was raised about Methyldopa, used to manage high blood pressure during pregnancy. BONELA linked its absence to premature births following the use of less effective substitutes.
Research echoes the warnings. Studies cited in the report highlight poor governance, limited management autonomy and inefficient supply chain management. An Ombudsman report on Princess Marina Hospital described overcrowding, staff shortages and service breakdowns as symptoms of deeper governance problems. Another 2023 study pointed to low manufacturing capacity, inefficient logistics and administrative delays, noting that Botswana’s small market increases vulnerability.
For many patients, Botswana’s medicine shortages now mean travelling from clinic to clinic or turning to private pharmacies, where prices are unaffordable. The human cost is mounting, and confidence in the public system is under strain.