20 Aug 2026

Minister of Health Dr Stephen Modise says the proposed National Health Insurance policy is a historic protective framework aimed at improving transparency, minimising waste, and securing medical supply chains for future generations.

 Speaking this week, Dr Modise described NHI as a potential ‘defining social investment of the generation’ and a paradigm shift for Botswana’s health ecosystem. “For too long, health systems around the world had been designed around the hospital where health officers waited for people to become sick, then we treat them, wait for complications, then we intervene, wait for emergencies, then mobilise resources,” he said.

The minister said the future must focus on ‘prevention before treatment, early intervention before complications and primary healthcare before hospitalisation.’ Dr Modise noted that NHI would help government better manage and stabilise the rising costs of outsourced medical services that were currently straining the public budget.

 “For many years, the state has absorbed heavily inflated costs to outsource complex diagnostics, specialised surgeries and long-term care due to a lack of centralised, coordinated purchasing power,” he said. Citing World Health Organisation data, he said government accounted for approximately 74.7 per cent of current health expenditure in 2020. 

Yet Botswana’s Universal Health Coverage service coverage index stood at approximately 55 out of 100 in 2021, compared to a global average of about 67 and an average of 77 among upper-middle-income countries. “This is the paradox we must confront. 

We are investing substantially, but the return in health outcomes is not yet commensurate with the investment,” Dr Modise said. He identified administrative and financial fragmentation in the dual-tier health system as the core challenge.  

Families across constituencies, he said, still faced unexpected out-of-pocket spending during medical emergencies. Meanwhile, systemic inefficiencies, billing discrepancies and duplicate procurement structures absorb resources that could otherwise go to patient care. 

If left unaddressed, national health spending is projected to rise from P10 billion to over P15 billion within five years without delivering the full improvements in clinical care and facility modernisation that citizens deserve, he warned. Dr Modise stressed that NHI did not mean government was withdrawing from financing healthcare. “Rather, it seeks to broaden the financing base, increase predictability, improve efficiencies and sustainability,” he said.

The policy envisages a mixed financing model. Potential revenue sources include general taxation as the core source, earmarked health-related or sin taxes, progressive formal-sector payroll contributions, and mechanisms for informal sector participation.

Mandatory employer and employee participation is also envisaged, but implementation will be phased according to system readiness, enrolment capacity, provider accreditation and institutional preparedness.

“This is not an experiment that Botswana is undertaking in isolation. Countries across the world have travelled this road. Some have succeeded spectacularly, others have encountered difficulties. From both experiences, we can learn,” Dr Modise said. Dr Modise said implementation of the  policy would be in three phases. Phase 1 include the legal, policy and institutional development. 

This includes NHI legislation, establishment of NHI structures, governance arrangements, system preparation, and finalisation and costing of the Essential Health Services Package.   Phase two comprise the system development and pilots, covering provider accreditation, digital systems, provider contracting, payment mechanisms and initial enrolment while Phase three will address progressive national expansion, subject to readiness and evidence. “It is an invitation to reform and to build something better,” the minister concluded. ENDS