February 26, 2026
Botswana’s President Slams Diamond-Funded Healthcare Failures
Duma Gideon Boko outlined his plans to rebuild and repair the country’s broken diamond-funded healthcare system.
Botswana’s President, Duma Gideon Boko, has issued an open letter outlining his push for the country to rebuild and repair the country’s broken diamond-funded healthcare system.
After announcing Botswana’s plans to secure a majority stake in De Beers, the UK-based diamond giant whose wealth is rooted in the African nation, Boko laid out his broader vision for a stronger Africa, including rebuilding the country’s strained healthcare system.
In a Feb. 21 open letter for The Guardian, Boko, who assumed office in November 2024, detailed why he declared a public health emergency last year.
“Shortages of medicine in Botswana forced me to declare a public health emergency last year,” Boko wrote. “Patients went without treatment–not because health workers failed them, but because the system did. For a nation committed to universal healthcare, free at the point of use, it was a moment of hard truth.”
Last August, Boko declared a public health emergency in Botswana after a severe shortage of medicine and medical equipment exposed deep cracks in the healthcare system. The crisis was fueled by a collapse in state funding tied to a global diamond market downturn, the nation’s primary revenue source, alongside U.S. aid cuts under Donald Trump, more than 1 billion pula in supplier debt, and a strained procurement system that worsened the situation.
Pointing to the ongoing health crisis, Boko has doubled down on calls for stronger government action across Africa as he works to chart a new course for Botswana.
“Even outwardly strong public health systems can be fragile. As donor assistance bites across the continent, governments cannot afford to delay building resilience,” he wrote. “As a stable, middle-income country, Botswana was only ever a peripheral recipient of aid. Yet when diamond revenues—the country’s primary export—fell amid a market downturn, the fiscal shock was no different in effect.”
The crisis has been fueled by a shrinking national budget tied to the global diamond market downturn. Diamonds account for about 80% of Botswana’s foreign earnings, but falling sales have forced spending cuts. Reduced U.S. aid, once a major source of HIV, malaria, and tuberculosis funding, has deepened economic strain. UNICEF warns urgent action is needed as the health emergency worsens, with rising child malnutrition in some regions.
“Yet the same diamond revenues that built our system also masked its weaknesses,” Boko explained. “Problems were paid away rather than fixed. Drug prices were inflated many times over. Supply chains were inefficient. Public capacity was hollowed out through outsourcing. These failures did not suddenly appear but accumulated over the years.”
He continued. “Falling revenues simply made them impossible to ignore. When healthcare systems face a moment of reckoning, the same prescription is reliably offered: inject more ‘private-sector rigor’ into inefficient public health delivery. But greater reliance on private provision fragments care, raises costs, and diverts scarce health budgets into profit margins.”
To address the country’s strained healthcare system, Boko laid out a plan that includes shifting away from private providers and strengthening publicly owned medical facilities, along with other reforms.
“Botswana is expanding public capacity. We are bringing our largest private hospital into public ownership to relieve pressure on overstretched facilities,” he wrote. “We are restructuring the national medicines procurement body, making it autonomous to cut bureaucratic delays. A national health intelligence centre will soon be operational, using real-time data to forecast medicine demand and prevent shortages. And once the health insurance bill passes parliament, health funding will be ringfenced—ending our exposure to swings in commodity markets.”
“Together, these reforms will determine whether a mother can find antibiotics for her child, or whether a patient needing dialysis must travel huge distances for care,” Boko added.
Boko’s open letter follows his November 2024 announcement about Botswana’s push to secure a majority stake in De Beers amid a competing bid from Angola. Botswana, which owns 15% of the diamond giant and produces about 70% of its rough diamonds, views the company as a key national asset despite falling global prices.
Talks between the two nations came as Anglo American, the London-based mining giant that holds 85% of De Beers, moves to sell its stake as part of a shift toward copper and other clean-energy metals, valuing the company at about $4.9 billion.
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