Sir Ketumile Masire Hospital: The transition matrices

The transition of Sir Ketumile Masire Teaching Hospital (SKMTH) from a private entity to a public hospital has ignited a storm of challenges that expose critical gaps in Botswana’s specialist healthcare services. This shift, heralded by government officials as a move toward expanded and improved care, has instead revealed a troubling reality of service disruptions, staff dissatisfaction, and growing patient backlogs. At the heart of the turmoil are low proposed salaries for doctors, contractual uncertainties, and the strain of relocating specialist services, all converging to threaten the fragile balance of care delivery for some of the country’s most vulnerable patients.

The government insists the transition is being carefully phased to avoid overwhelming either SKMTH or Princess Marina Hospital (PMH), the country’s leading public hospital. According to Dr. Seeletso Nchingane, a paediatric endocrinologist at PMH, this phased approach allows time to expand critical resources such as ICU beds gradually, preventing burnout among staff and easing the patient load.

Yet, despite these reassurances, the lived experience of patients paints a bleaker picture. Long waits, denied care, and confusion about where to receive urgent specialist treatment have become common complaints. One of the most alarming reports has come from cardiology patients at SKMTH, who say they were turned away and advised that paying for care was pointless given the absence of specialists.

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This situation appears to stem from unresolved contractual issues after the abrupt announcement of the hospital’s public transition by the Minister of Health. Many specialists have halted their services while demanding clarity on their terms of employment, leaving patients stranded and uncertain where to turn for life-saving care. The core of the problem lies in the proposed salary structures for SKMTH’s new public doctors.

Specialists reportedly find the pay insufficient compared to private sector roles or opportunities abroad, prompting many to reject the transition and seek employment elsewhere. This exodus risks a brain drain in a healthcare system already stretched thin, compounding existing challenges in service availability and quality. The loss of experienced specialists threatens to widen waiting times and deepen backlogs in critical care.

Indeed, long-standing capacity issues at PMH have been exacerbated by the transition. Nchingane describes an emergency department overwhelmed by demand, with patients sometimes waiting days for a proper specialist consultation. His own specialty clinics operate at three times the recommended patient volume, underscoring the severe congestion and strain on the system.

The relocation of specialist clinics from PMH to SKMTH, while intended to ease pressure, has so far contributed to growing backlogs and patient frustration. Patients and their families have expressed deep anxiety about the continuity of care and accountability during this turbulent shift. The risk of burnout among overworked public health specialists is real and well-documented globally, with chronic stress, emotional exhaustion, and moral injury leading to high turnover and diminished care quality.

Botswana’s healthcare workforce now faces the same pressures amid this uncertain transition, threatening to erode the gains made in specialist services. Christopher Nyanga, acknowledges the slowness of the process but insists tangible progress has been made. Over 300 patients have already been served at SKMTH since its reclassification, and several specialist clinics have been successfully relocated.

Officials emphasize that misinformation is fueling public anxiety and that the phased approach is designed to build sustainable capacity and improve service delivery in the long term. For Botswana’s public health sector, the stakes could not be higher. Effective specialist care is critical for managing complex and chronic conditions that require timely intervention.

The ongoing uncertainty about staffing and contracts risks creating a dangerous vacuum in service availability. Meanwhile, the pressure on remaining specialists grows, increasing the risk of burnout and further attrition, a cycle that could take years to reverse. As the government pushes forward with the SKMTH transition, the path ahead demands more than phased planning and official reassurances.

It requires transparent communication with both healthcare workers and the public, fair and competitive compensation to retain talent, and urgent investment in infrastructure to handle the increased patient load. Without these, the promise of improved care risks becoming a distant hope while patients suffer in the present. For the thousands of Batswana relying on these services, the cost of disruption is measured not just in inconvenience but in lives. The coming months must be a test of whether Botswana’s health authorities can bridge these gaps swiftly and decisively, or whether the cracks laid bare by this transition will widen into a crisis.

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