Botswana government likes to pride itself on the fact that public healthcare in the country is free as is education.
But upon scrutiny, it immediately becomes apparent that much of the breast beating cannot pass.
The system is free, but it is also creaking.
Much of the breast beating is nostalgia, a result of the country’s past economic glory.
As in many other aspects, that glory, sadly has become a hindrance for progress.
The truth is Botswana’s public health sector is limping.
It is a catastrophe waiting to happen.
And it will need a lot of money to fix.
There are just too many things wrong with it.
These include dilapidated hospitals, demoralized staff and empty shelves.
The number of hospital beds has not grown with the needed and or population.
Sickness levels have grown exponentially, mainly on account of lifestyle diseases.
Technology has moved ahead at great speed.
The health sector here has not kept abreast.
To be blunt, the state of the health sector is not in any way reflective of the proportion of budget expenditure apportioned to the sector.
There are too many cracks, much of them due to corruption.
In many instances, hospitals do not even have the most basic of supplies.
Patients are always implored to buy things for themselves and bring those when they come to hospital.
To say the system is not coping would be an understatement. The system is itself on a deathbed.
No matter how much we try to tweak it and drive it, it cannot go on and on.
Soon it will just fall down and die.
The capacity that used to be there too has become history. Especially on the front of trained people.
Of course corruption has had its share in the contribution to the crisis as has management, including the systems of Central Medical stores. Inefficiencies have played a big part in the decay. Too much of expensive medication has had to be sent to be destroyed either because too much was bought or because owing to corruption, unnecessary medication was purchased at the expense of needed supplies.
To be fair, the pandemic has wrought a lot of damage to the health sector. And since the pandemic, the sector has not recovered.
To make matters worse, there has not been any significant investment into it.
We preface all the above to point out that the economy of Botswana cannot forever carry the load of free healthcare.
Of course a sizeable portion of the population still uses private sector healthcare.
To save the public health sector, Government has to significantly increase contribution by patients.
It would be harder and much more expensive to get the system back to life were we to allow it to die.
It is much better to prevent its death.
But because of its limitations, especially costs, the public health sector remains by far the most used in the county.
It might be high time Botswana government undertook a root and branch reform.
The same really applies to education.
There will no doubt be resistance to the reforms.
But Government has to be honest to the public and also to itself.
Public finances It can no longer do the heavy lifting.