An investigation by the Office of the Ombudsman has found that the high cost of medical referrals from government to private health facilities is a result of corruption intended to benefit private specialists.
In some instances, the probe revealed, hospital machines were allegedly tempered with to force or justify patient referrals to private hospitals.
During the 2025/26 financial year, a total of 809 patients were referred to six private health facilities across the country. Intensive Care Unit (ICU) referrals accounted for up to 46% of the referrals and the rest being non-ICU referrals (52%).
In August 2025 the Ministry of Health (MoH) revealed that the government owed P433 million in medical expenses in medical fees and found that many of the referrals were surgical referrals in Neurosurgery followed by Cardiothoracic and general surgery. Government currently spends roughly P300 million per year outsourcing patients to private facilities, which is equivalent to P6 million per week.
The Ombudsman also found that the MoH revenue collection was inadequate, only gathering P15.7 million in 2024/25 financial year whilst the potential stands at an estimated P20 million.
“The figure would be even higher if there was generalised but modest increase in the admission fee which has remained at P5.00 for decades as well as other fees. The non collection of such fees was further attributable to the high cost of collection, as the expenses associated with employing revenue collectors and securing collection facilities would outweigh the prospective annual revenue,” observed the Ombudsman.
Laboratory services have also been found to be inefficient and many of them have not been accredited whilst those in operation can’t be maintained due to persistent shortages of laboratory reagents, dysfunction, lack of diagnostic equipment among others. The machines cannot perform imaging, sterilization, and laboratory analysis systems.
“As a result, the reliability of diagnostic testing and clinical decision making has been undermined. Only five medical government laboratories are accredited, being Athlone Primary Hospital, Botswana National Tuberculosis Reference Laboratory, Nyangabwe referral Hospital Laboratory, Bamalete Luhteran Hospital, and Sekgoma Memorial Hospital. Scottish Livingston Hospital accreditation was suspended in November 2025 together with other private health facilities,” observed Ombudsman Advocate Steven Tiroyakgosi.
The government has also spent P283.2 million from 2021 to 2025 on in-service specialised training in order to decongest referral hospitals, but many personnel left the public service due to burnout from impossible workloads, distress, lack of support, and no access to tools of trade. This exodus or departure of staff from government facilities has resulted in a total of 250 lawsuits since 2021 collectively seeking more than P6.6 billion in damages for negligence and other faults attributed to systematic failures and poor processes.
The Ombudsman recommended that there is an urgent need for another referral hospital in the Greater Gaborone area to decongest Princess Marina Hospital. The ministry was also advised to fill all vacancies in MoH and its facilities, prioritize and re-direct the funds currently spent on referring patients to private healthcare facilities towards employing specialist medical personnel within the public health system.
“Investing in in-house expertise will reduce the costly external referrals, improve timely access to specialized care and build sustainable capacity in the public sector,” he advised.
