On a Thursday evening, Minister of Health Dr Stephen Modise walked into the BTV studio to address the nation. He appeared composed, almost Zen-like. This was striking for a man widely known within political circles as The Hurricane: restless, kinetic, always in motion.
On this night, however, the storm had slowed. The posture was calm. The language measured.
The reassurance deliberate. For a long time, Botswana’s health system survived on trust. Trust that the clinic would be there.
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Trust that the referral hospital would function. Trust that illness, though frightening, would not automatically become punishment. That trust did not disappear suddenly.
It was worn down through repeated exposure to institutional harm, one missing drug at a time, one broken machine left unrepaired, one referral that felt less like care and more like abandonment. What citizens experienced was not a single failure, but a pattern of injury, repeated, predictable, and largely uncorrected.A Crisis with a Political LineageFrom the late 1990s through to the end of BDP rule, Botswana’s health system was shaped under successive presidencies, those of Festus Mogae, Ian Khama, and Mokgweetsi Masisi. It was during this period that key features of the current crisis hardened: Procurement systems that tolerated fragmentation and opacity, Maintenance regimes that allowed public infrastructure to decay, Referral pathways that quietly redirected patients into private care.
Policy choices that insulated commercial intermediaries from competition and consequence. These were not momentary lapses. They were governance choices sustained over time.What the Record ShowsOver successive years, Botswana’s own oversight institutions raised alarms.
The Auditor General repeatedly documented weaknesses in health-sector procurement and contract management,delays, irregularities, poor value for money, and the normalisation of emergency purchasing that bypassed safeguards. These reports were produced, tabled, and debated during the BDP’s long tenure in government. The evidence was available.
The patterns were visible. The corrective action was partial at best. Individually, these findings read like technical shortcomings. Taken together, they reveal something more serious: a system that absorbed damage without resisting it, because the damage did not threaten those with the power to change it.From Failure to Capture
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