In my last column I talked about the dividing line between Botswana’s National Health Insurance (NHI) policy and the institutions which have to fund it. At first glance, the emphasis shifts. The structural basis of NHI is already primary health care with a costed benefit package, strategic purchasing, a payment model and phased pilots proposed (Parliament of Botswana, 2025; Government of Botswana, 2026). The question is not whether policymakers have considered primary care, but how these commitments will operate across the institutions that deliver it.
Government Notice No. 742 of 2024 transferred clinics and public health functions to the ministry responsible for local government, while primary hospitals stayed outside; NHI design remains with the Ministry of Health (Government of Botswana, 2026). Who funds a clinic’s transport and medicines while a claim is pending? Who supervises a referral to a hospital under another line? Which accounting officer answers when a transfer arrives late? These need published operating rules before they become disagreements at a patient’s expense.
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