Gaborone, Botswana, 29 October 2026 (ECA) – The United Nations Economic Commission for Africa (ECA) and the Government of Botswana have agreed on a framework to advance sustainable health financing reforms, including the establishment of a Joint Technical Working Group and an initial 100-day action plan aimed at improving the efficiency of health expenditure and translating public investment into better healthcare outcomes.
The agreement follows a high-level engagement and scoping mission to Gaborone, led by ECA Chief of Staff Aboubakri Diaw, which brought together government institutions and development partners to examine how Botswana can strengthen health financing while supporting its broader economic transformation agenda.
Botswana has made significant progress in expanding access to publicly financed healthcare and protecting households from high out-of-pocket health expenditure. However, increasing fiscal pressures, rising healthcare costs and changing health needs are placing greater demands on the sustainability of its financing model.
Against this backdrop, the mission focused on how Botswana can preserve these achievements while improving the efficiency, resilience and long-term sustainability of health financing.
A key outcome was the endorsement of a Joint Technical Working Group, chaired by the Minister of Finance and co-chaired by the Minister of Health, to coordinate reforms across government institutions and development partners. An initial 100-day action plan will guide priority measures on fiscal sustainability, outcome-based budgeting, data coordination and institutional capacity for implementation.
The discussions underscored the importance of moving beyond increasing health expenditure towards ensuring that available resources deliver measurable improvements in healthcare services and outcomes.
Priority areas include strengthening public financial management, procurement and expenditure tracking, addressing medicine shortages and service disruptions, and leveraging digitalisation and decentralisation to improve service delivery.
The proposed National Health Insurance (NHI) was also central to the discussions, with participants highlighting the importance of clearly defined financing arrangements, credible costing and careful assessment of its medium- and long-term fiscal implications.
During an engagement with the Speaker of the National Assembly, Hon. Dithapelo L. Keorapetse, MP, ECA and Parliament explored opportunities to strengthen legislative oversight of health financing reforms.
Discussions focused on parliamentary scrutiny of health budgets, public expenditure and policy implementation, as well as opportunities for capacity-building and a possible joint work plan to reinforce accountability.
The engagement highlighted the importance of ensuring that public resources are not only allocated to healthcare but also translated into improved services and measurable results for citizens.
In a separate meeting with the Bank of Botswana, discussions examined how health financing reforms, particularly the proposed NHI, can be aligned with the country's fiscal and macroeconomic priorities.
Participants considered the implications of financing options for government borrowing, domestic financial markets and long-term public expenditure, alongside opportunities to strengthen macroeconomic analysis and data coordination.
These engagements reinforced the need for a coordinated approach to health financing that brings together fiscal policy, financial stability, public expenditure management and service delivery.
Beyond the immediate reform priorities, the mission highlighted the importance of positioning health investment as a contributor to Botswana's long-term economic development.
A healthier population supports human capital development, labour productivity and economic resilience. Strengthening health financing is therefore not only about sustaining healthcare services, but also about ensuring that public investment in health contributes to broader national development objectives.
As fiscal pressures intensify and external development financing becomes less predictable, Botswana's reform agenda will require a combination of stronger domestic financing, more efficient resource allocation and measures to protect households from financial hardship.
ECA will support these efforts through economic analysis, public financial management expertise, data coordination and assessments of financing options to help inform evidence-based reforms.
ECA and government technical teams will refine the 100-day action plan, consolidate the initial health financing diagnostic, clarify institutional responsibilities and strengthen data-sharing arrangements.
Regular progress reviews will help monitor implementation, address emerging challenges and ensure alignment with Botswana's national development priorities.
The mission forms part of ECA's Africa-wide Investing in Health initiative, which supports member States in strengthening sustainable health financing and positioning health investment as a driver of productivity, resilience and economic transformation.
Through this partnership, ECA and Botswana aim to demonstrate how country-led, evidence-based reforms can strengthen health systems while supporting inclusive and sustainable economic development.
Issued by:
Communications Section
Economic Commission for Africa
PO Box 3001
Addis Ababa
Ethiopia
Tel: +251 11 551 5826
E-mail: eca-info@un.org
