– In this article, Botswana’s President outlines his vision for the future of the country’s health system
– It is relevant to us because he mentions a few key policy preferences around health insurance, while also providing a pro (African) free trade position
– Botswana is an important country because it is one of Africa’s most stable and proven democracies, and it’s success or failure does have a symbolic impact on the viability of democracy on a continent where Pan-African sentiment is often tied up with authoritarian strongmen like Gadaffi or, more recently, Ibrahim Traore
**Key Policy Extract:**
> Private providers have an important role to play. Still, where care can be delivered at cost within a strong public system, it is simply more affordable – and more sustainable – than outsourcing it.
> Moreover, when healthcare is outsourced, accountability becomes blurred. But when shortages hit, it is the government that people turn to. Democratic responsibility cannot be subcontracted.
> Botswana is expanding public capacity. We are bringing our largest private hospital into public ownership to relieve pressure on overstretched facilities.
> 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.
**Context for the global poor**
– Botswana is a stable, well run, African democracy which built its wealth through well managed diamond revenues
– In 2024, Botswana achieved a major democratic milestone: the peaceful transfer of power to an opposition party for the first time since independence. This is the UDC of President Boko. It is a left leaning, social democratic party. The previous party, the BDP, were center right conservatives.
– Botswana is facing a major crisis: diamond prices have crashed because of the commercial advent of synthetic diamonds – threatening the state’s revenue model
– The new government has been scrambling to figure out a clear plan forward, including taking the very questionable step of offering to buy out De Beers, the diamond monopoly whose current owner, AngloAmerican, wants to offload
– Last year, the first signs of fiscal strain due to reduced diamond revenues hit Botswana as medical supplies ran short, triggering a state of emergency declaration
– So what Boko is trying to do here is answer the question: what will happen to Botswana’s welfare state as diamond revenues decline
– Boko also speaks quite a bit about the African Continental Free Trade Area, which is a win.
Here’s why this matters for this sub:
– First, there is a genuine healthcare policy/fiscal policy debate to be held as to whether this is the right move or a mistake. I’m not a strong policy guy, but I’m sure others can comment.
– Second, we want Botswana to succeed because Botswana is one of the best showcases for liberal democracy on the continent. The dream of a flourishing Africa must be centered in the democratic story of Botswana, not in the authoritarian delusions of the juntas taking over the Sahel.
– Third, Botswana has a unique opportunity in this crisis. The diamond price crash means they _have_ to transform their economy. The fact that this lined up with the first real handing over of power to a different party amplifies the salience of this moment: this is a Critical Juncture for Botswana. As a result, Botswana is an interesting country to study purely from a PolSci point of view right now. It is a small country, but that doesn’t matter much. If you have strong opinions about politics, development and institutions, now is the time to stake your claims, make predictions and bet for or against various actions. Botswana is not in equilibrium at all, nor is it part of the general right wing populist trend gripping the world. For me at least, that makes it one of the most interesting countries to follow. It’s not a natural experiment, but Botswana’s 21st Century transition will be a case study in future politics classes, one way or the other.
1 Comment
**Submission Statement:**
– In this article, Botswana’s President outlines his vision for the future of the country’s health system
– It is relevant to us because he mentions a few key policy preferences around health insurance, while also providing a pro (African) free trade position
– Botswana is an important country because it is one of Africa’s most stable and proven democracies, and it’s success or failure does have a symbolic impact on the viability of democracy on a continent where Pan-African sentiment is often tied up with authoritarian strongmen like Gadaffi or, more recently, Ibrahim Traore
**Key Policy Extract:**
> Private providers have an important role to play. Still, where care can be delivered at cost within a strong public system, it is simply more affordable – and more sustainable – than outsourcing it.
> Moreover, when healthcare is outsourced, accountability becomes blurred. But when shortages hit, it is the government that people turn to. Democratic responsibility cannot be subcontracted.
> Botswana is expanding public capacity. We are bringing our largest private hospital into public ownership to relieve pressure on overstretched facilities.
> 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.
**Context for the global poor**
– Botswana is a stable, well run, African democracy which built its wealth through well managed diamond revenues
– In 2024, Botswana achieved a major democratic milestone: the peaceful transfer of power to an opposition party for the first time since independence. This is the UDC of President Boko. It is a left leaning, social democratic party. The previous party, the BDP, were center right conservatives.
– Botswana is facing a major crisis: diamond prices have crashed because of the commercial advent of synthetic diamonds – threatening the state’s revenue model
– The new government has been scrambling to figure out a clear plan forward, including taking the very questionable step of offering to buy out De Beers, the diamond monopoly whose current owner, AngloAmerican, wants to offload
– Last year, the first signs of fiscal strain due to reduced diamond revenues hit Botswana as medical supplies ran short, triggering a state of emergency declaration
– So what Boko is trying to do here is answer the question: what will happen to Botswana’s welfare state as diamond revenues decline
– Boko also speaks quite a bit about the African Continental Free Trade Area, which is a win.
Here’s why this matters for this sub:
– First, there is a genuine healthcare policy/fiscal policy debate to be held as to whether this is the right move or a mistake. I’m not a strong policy guy, but I’m sure others can comment.
– Second, we want Botswana to succeed because Botswana is one of the best showcases for liberal democracy on the continent. The dream of a flourishing Africa must be centered in the democratic story of Botswana, not in the authoritarian delusions of the juntas taking over the Sahel.
– Third, Botswana has a unique opportunity in this crisis. The diamond price crash means they _have_ to transform their economy. The fact that this lined up with the first real handing over of power to a different party amplifies the salience of this moment: this is a Critical Juncture for Botswana. As a result, Botswana is an interesting country to study purely from a PolSci point of view right now. It is a small country, but that doesn’t matter much. If you have strong opinions about politics, development and institutions, now is the time to stake your claims, make predictions and bet for or against various actions. Botswana is not in equilibrium at all, nor is it part of the general right wing populist trend gripping the world. For me at least, that makes it one of the most interesting countries to follow. It’s not a natural experiment, but Botswana’s 21st Century transition will be a case study in future politics classes, one way or the other.