Botswana: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 50

There is evidence that Botswana has formally adopted and implemented a national Antimicrobial Resistance (AMR) plan for the surveillance, detection, and reporting of priority AMR pathogens. The 2021 Tripartite AMR Country Self-Assessment Survey (TrACSS) conducted by the World Health Organization (WHO) indicated that Botswana had developed a draft National Action Plan (NAP) addressing AMR surveillance, infection prevention and control, and antimicrobial stewardship; however, it also noted the absence of formal endorsement or implementation. ¹ The 2024 Joint External Evaluation (JEE) report conducted by the WHO reaffirms that status: while Botswana’s multi sectoral coordination on AMR was scored at the lowest level (score: 1), indicating that a formal coordination mechanism and adopted national plan are lacking, moderate progress was observed in other domains. Specifically, surveillance of AMR (score: 2), surveillance of antimicrobial use (AMU) in humans and animals (score: 2), and infection prevention and control programs (score: 2) suggest the existence of some technical capacity without an overarching national framework. ² The 2024 JEE states that the country developed a national action plan for AMR covering the period from 2018 to 2022, however this is not publicly available. ³ This aligns with earlier assessments, including the 2017 JEE report, which similarly noted that while draft planning existed, it had not been formalized or publicly disseminated. ⁴ To date, the draft NAP has not been published by the Ministry of Health, Ministry of Agriculture, or the WHO AMR NAP Library. ⁵⁶⁷, and AMR is still not listed among the Ministry of Health’s key strategic focus areas. ⁸

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 50

Botswana has a National Health Laboratory that tests for some of the priority antimicrobial resistance (AMR) pathogens. While efforts are underway to strengthen the lab's capacity, gaps remain in standardizing testing procedures and expanding testing to more facilities according to the World Health Organization's (WHO) 2024 Joint External Evaluation (JEE) report. ⁹ It specifically confirms that Botswana has "availability of relatively strong laboratory capacity and expertise to isolate and identify AMR pathogens from both humans and animals, particularly in referral and district hospital laboratories" (p. 17). The report also notes that national laboratory system is capable of conducting AMR diagnostics, with the National Health Laboratory (NHL) accredited under ISO/IEC 17043 and all clinical laboratories operating under a national licensing framework. The report further notes that AMR surveillance is integrated into routine diagnostics at major hospitals (e.g., Princess Marina Hospital in Gaborone and Nyangabgwe Hospital in Francistown) and that external quality assurance (EQA) and referral mechanisms are in place. However, testing remains concentrated in central and sentinel sites, with limited decentralization to district-level laboratories (Section P4. on Antimicrobial resistance (AMR) pp. 16-19). While the JEE indicates that Botswana performs AMR testing for several WHO-priority pathogens, it does not confirm nationwide capacity to detect all seven plus two priority AMR organisms.

Evidence from recent studies substantiates testing for at least five of these pathogens. These include Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Streptococcus pneumoniae. A 2022 outbreak investigation confirmed detection of carbapenem-resistant A. baumannii via whole-genome sequencing. ¹⁰ Environmental surveillance studies in neonatal and adult wards have identified extended-spectrum beta-lactamase (ESBL) producing Klebsiella, E. coli, Acinetobacter, Pseudomonas, and Enterobacter spp. using standard culture and phenotypic methods. ¹¹ A separate community and healthcare prevalence survey showed colonization with extended-spectrum cephalosporin-resistant and carbapenem-resistant Enterobacterales. ¹² Additionally, rising penicillin resistance in Streptococcus pneumoniae isolates was documented by researchers between 2016 and 2019. ¹³

Similarly to the 2024 JEE report, the 2021 Tripartite AMR Country Self-assessment Survey (TrACSS) specifically recommends "strengthen lab and diagnostic capacity, including quality assurance and uninterrupted supply of consumables" (p. 6) . ¹⁴ Notably, in 2023, Botswana launched a National Laboratory Strategic Plan, which was developed in collaboration with the U.S. Centers for Disease Control and Prevention (CDC). According to the World Health Organization (WHO), the plan aims to modernize and upgrade laboratory infrastructure in Botswana, enhancing disease detection, diagnosis, and management. It has a strong emphasis on improving disease surveillance, strengthening public health capabilities, and ensuring quality assurance. ¹⁵¹⁶ However, the Plan is not publicly available on the Ministry of Health or Ministry of Agriculture websites. ¹⁷¹⁸ The National Health Laboratory has no online presence. ¹⁹

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is insufficient evidence that the government conducts environmental detection or surveillance activities (e.g., in soil, waterways) for antimicrobial residues or AMR organisms.

The 2021 Tripartite AMR Country Self-Assessment Survey (TrACSS) Country Report on the Implementation of National Action Plan on Antimicrobial Resistance (AMR) conducted by the World Health Organization (WHO) stresses the need for strengthening "knowledge through surveillance and research". Specifically, it notes that Botswana has "no capacity" for a "national monitoring system for pesticide use in plant production including antimicrobial pesticides" or a "national surveillance system for AMR in food (animal and plant origin)" (GAP objective 2 – Strengthen knowledge through surveillance and research, p. 2). ²⁰ The WHO's Joint External Evaluation (JEE) report of 2024 does not mention environmental surveillance specifically for antimicrobial residues or antimicrobial-resistant organisms in soil, water, or other environmental media. The most recent assessment found no such activities described at the national level. ²¹

Previously, the Joint External Evaluation (JEE) report of December 2017 states that "Environmental monitoring of air and water and surveillance for chemicals in other media is provided by the Environment Laboratory but does not cover the whole of the country." But there is no mention of antimicrobial residues or AMR organisms. Although a national action plan for combating antimicrobial resistance has been drafted, there is no subsequent evidence that the plan is in place. ²² There is no evidence of a NAP in the WHO's Library of National Action Plans or evidence of relevant surveillance and detection activities on the websites of the Ministries of Health or Agriculture or Environment. ²³²⁴²⁵

While environmental AMR detection does not exist on governmental level, there are multiple NGO and academic-led projects in the past few years. ²⁶²⁷²⁸

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 100

Botswana has a national legislation in place requiring prescriptions for antibiotic use for humans and it is enforced.

The Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024 confirms that Botswana has comprehensive legislation in place requiring prescriptions for antibiotic use in humans. The report highlights that both the Public Health Act and the Medicines and Related Substances Act provide a sound legal basis to regulate access to antimicrobials, including the designation of restricted medicine schedules and the requirement of prescriptions issued by licensed practitioners. ²⁹ The Public Health Act of 2013 explicitly mandates that antibiotics must be sold only with a prescription issued by a recognized prescriber. ³⁰ The Medicines and Related Substances Act of 2013 reinforces this, stipulating that Schedule 1 and 2 medicines (which include most antibiotics) cannot be possessed, dispensed, or sold unless prescribed, and outlines penalties for violations. ³¹ The National Health Policy Towards a Healthier Botswana also supports these provisions, requiring adherence to norms and standards for prescribing and dispensing all medicines, under Objective 4.5.1.2. ³² A 2023 narrative review examining patterns of over-the-counter antibiotic sales across sub-Saharan Africa identified Botswana as one of the few countries with very limited non-prescription access. Researchers specifically note that "whilst the purchasing of antibiotics without a prescription may possibly occur in Botswana, this is believed to be very limited due to current regulations issued by the Botswana Medicines Regulatory Authority (BOMRA), which are enforced. Access to free healthcare, including medicines as part of Universal Health Coverage, also helps negate the need and expense of purchasing of antibiotics without a prescription in Botswana" (p.1027). The authors note that Botswana could serve as a regional model for antimicrobial stewardship at the community level. ³³

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 50

There is a national legislation or regulation in place requiring prescriptions for antibiotic use for animals in Botswana, but there is evidence of gaps in enforcement. Under the Medicines and Related Substances Act of 2013, veterinary medicinal products (VMPs), including antibiotics, are expected to be prescribed and dispensed only by licensed veterinarians or pharmacists. ³⁴
Botswana employs regular inspection and targeted enforcement to uphold its veterinary antibiotics regulations. The Botswana Medicines Regulatory Authority (BoMRA) and the Veterinary Surgeons Board use structured, risk-based inspections and formal disciplinary processes to enforce veterinary antibiotic prescription laws. ³⁵ BoMRA effectively enforces prescription-only regulation for veterinary medicines within formal supply chains. Veterinary inspectors regularly conduct inspections with authority to monitor, seize, and suspend non-compliant products. However, no structured oversight exists for informal sellers or livestock advisors; their antibiotic use remains outside regulated control.³⁶ The Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024 specifically notes that "while prescriptions from veterinarians are typically required for antimicrobial use in animals, there are instances in which specific antibiotics like doxycycline can be obtained without a prescription" (section P4.5. Optimal use of antimicrobial medicines in animal health and agriculture; p. 16). ³⁷

1.2.1a Laws/plans on zoonotic disease

Score: 100

Botswana has a national plan addressing zoonotic diseases. The Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024 confirms that Botswana maintains sustainable surveillance systems for priority zoonotic diseases and possesses a capable veterinary workforce to support monitoring. ³⁸ However, mechanisms for responding to zoonoses are not yet functional or fully operational according to the 2024 JEE report, indicating the absence of a formalized, permanent multi sectoral coordination structure. Specifically, the report states that "there was lack of evidence demonstrating how stakeholders from the public health, animal health and environment sectors work together through the One Health lens to tackle public health threats resulting from outbreak of zoonoses. Consequently, responses to outbreaks are sector specific" (p. 21). ³⁹

According to the country’s previous JEE, conducted in December 2017, the Department of Veterinary Services (DVS) maintains a national animal disease surveillance plan covering seven zoonotic diseases of public health concern: avian influenza, rabies, brucellosis, bovine tuberculosis, cysticercosis, Rift Valley fever, and anthrax. ⁴⁰ However, the full content of this plan is not publicly available online.

Botswana has robust legal authority and operational surveillance systems for multiple zoonotic diseases—covering both animal and human reporting. The Diseases of Animals Act (1977, revised 2008) grants the DVS authority to control animal diseases and empowers the Minister of Agriculture to regulate diseases that affect both animals and humans. ⁴¹ However, a formal, permanent One Health coordinating structure is not yet established, resulting in reliance on intermittent joint exercises rather than an ongoing multi sectoral mechanism. No further detailed plans were found on the websites of the Ministry of Health, Ministry of Agriculture, or in the OIE PVS Evaluation Follow-Up Mission Report of 2019. ⁴²⁴³⁴⁴

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 0

Botswana does not currently have any public national legislation, plans, or strategy documents that explicitly address risk identification or reduction measures for zoonotic spillover events (i.e., preventing transmission from animals to humans).

The 2017 Joint External Evaluation (JEE) reports that Botswana has a national animal disease surveillance plan covering seven priority zoonoses (avian flu, rabies, brucellosis, bovine tuberculosis, cysticercosis, Rift Valley fever, and anthrax; p. 7), but there’s no indication this plan focuses on upstream risk reduction for spillover events, such as monitoring wildlife interfaces or controlling environmental risk factors. ⁴⁵ The 2024 JEE report does not specifically address legislation or strategy measures targeting risk identification and reduction for zoonotic spillover events, but provides indirect evidence through certain scores. For example: P.5.3 (Sanitary animal production practices) scored 3 (developed capacity), implying that Botswana has instituted standards or controls in the animal farming sector that benefit spillover prevention—such as biosecurity protocols in livestock operations—even though these are not explicitly framed as spillover-risk measures (p.21). Among challenges, the report specifically notes that "The Botswana Animal Identification and Traceability System is exclusively applicable to cattle" and that "there is currently no identification system for tracking the movement of other animals" (p. 22). ⁴⁶

The Diseases of Animals Act (1977, revised 2008) empowers authorities to manage animal diseases but does not include provisions specifically targeting spillover risk identification or intervention. ⁴⁷ Neither the Ministry of Health nor Ministry of Agriculture websites host such documents, and no national framework addressing spillover prevention is found in the 2019 OIE PVS Follow-Up Report. ⁴⁸⁴⁹⁵⁰

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

Botswana does have national legislation, plans, and guidelines covering the surveillance and control of multiple zoonotic pathogens. Botswana’s surveillance system under the Ministry of Health and Wellness includes weekly reporting of four zoonotic diseases via its Integrated Disease Surveillance and Response (IDSR) mechanism. The Diseases of Animals Act of 1977 gives the Department of Veterinary Services of the Ministry of Agricultural Development and Food Security the authority to manage the control of animal diseases, which include anthrax, brucellosis, rabies and Rift Valley fever. ⁵¹
According to the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in December 2017, the following zoonoses are reported weekly: human rabies (including rabies exposure), acute haemorrhagic fever syndrome, yellow fever, plague. The report also states that the "Department of Veterinary Services [DVS] has a national animal disease surveillance plan that includes seven zoonotic diseases" which are avian influenza, rabies, brucellosis, bovine tuberculosis, cysticercosis, Rift Valley fever, and anthrax. (p. 11). ⁵² Additionally, the JEE gives Botswana a score of 4 for "Surveillance systems in place for priority zoonotic diseases/pathogens", the score meaning that there are "zoonotic surveillance systems in place for five or more zoonotic diseases/ pathogens of greatest public health concern" (p.3). ⁵³
Notably, the more recent 2024 JEE report downscores Botswana's "Surveillance of zoonotic diseases" as well as "Response to zoonotic diseases" to 1, due to "insufficient evidence indicating that a standardized process involving all stakeholders (such as the Ministry of Agricultural Development and Food Security, the Ministry of Environment, Wildlife and Tourism, and the Ministry of Health and Welfare) was utilized to establish a list of priority zoonotic diseases" (p.20). ⁵⁴ The report further stresses that while there is some collaboration and information sharing between sectors, it appears to rely primarily on informal relationships and individual goodwill rather than formalized structures. Surveillance coordination and reporting of suspected or confirmed zoonotic disease cases are carried out in an informal and ad hoc fashion. Data sharing between stakeholders occurs only upon request or in response to a suspected outbreak. Moreover, comprehensive multi sectoral surveillance reports and joint risk assessments are not routinely undertaken. ⁵⁵

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 0

There is no publicly available evidence that Botswana has a permanently established department or agency solely dedicated to zoonotic disease that operates across ministries.

According to the Joint External Evaluation (JEE) conducted by the World Health Organization in March 2024, no formal multi sectoral coordinating mechanism, such as a One Health agency or unit, with dedicated authority or structure across ministries for zoonotic disease surveillance and response.
According to the Joint External Evaluation (JEE) conducted by the World Health Organization in December 2017, a One Health approach, linking the Department of Veterinary Services with the Ministry of Health & Wellness, had not yet been implemented, and no formal inter-ministerial unit existed for zoonotic management. ⁵⁶⁵⁷ While multi sectoral taskforces and technical working groups are convened during outbreaks, drawing in Health, Agriculture, Environment & Tourism, Disaster Management, Defence, and others, these remain issue-specific and temporary, not ongoing institutionalized bodies based on the principles of the Libreville Declaration (2008). ⁵⁸⁵⁹
The 2024 JEE reinforces this status: Botswana scored a low 1 for P.4.3 ("mechanisms for responding to zoonotic events", p. 2), indicating non-functional or weak coordination mechanisms for zoonotic response. The report mentions "the absence of coordination between the animal health, public health and environmental sectors during responses to zoonotic diseases" (p.21). Although the 2024 evaluation acknowledges the presence of multi sectoral coordination tools under development, such as the One Health Coordination Mechanism Operational Tool and One Health Surveillance & Information Sharing Tool, these remain "forthcoming", with no evidence of a standing cross-ministerial agency in operation. Outbreak responses tend to occur in silos and are led by individual sectors. For example, the veterinary services led the response to a recent outbreak of highly pathogenic avian influenza, while the 2019 anthrax outbreak was managed solely by the Department of Wildlife (p. 21). ⁶⁰

1.2.1e Presence of One Health strategic plan

Score: 0

Botswana does not have a One Health strategy. ⁶¹⁶² Although there is no official OH platform to coordinate OH in Botswana, there is a technical working group that involves all ministries that are concerned with OH. Through the review of the situational analysis and needs assessment (SANA) workshop for the Libreville Declaration held in September 2023, the Country Coordinating Committee (CCC) was introduced to the OH approach. During the review, it became clear that there was no mechanism that linked issues of animal, plant, human and environmental health. The new SANA document was amended to include priority issues from agriculture, land and water management including pollution control and wildlife/human conflicts to strengthen the animal, health and environment linkages.⁶³

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 100

Botswana has a national mechanism for owners of livestock to conduct and report on disease surveillance to a central government agency.
The Diseases of Animals Act (Cap. 37:01, 1977) legally requires livestock owners, or their veterinarians, to report suspected or confirmed occurrences of listed animal diseases to the nearest veterinary official. This framework obliges owners to isolate affected animals, comply with movement restrictions, and notify the District Officer when outbreaks occur. ⁶⁴
In addition, Botswana operates the Botswana Animal Identification and Traceability System (BAITS), a digital platform launched in 2018, where registered cattle owners must record animal movements, treatments, deaths, and new arrivals. These data are centrally stored and used for surveillance and traceability. ⁶⁵⁶⁶ BAITS strengthens disease control in the cattle sector and contributes to compliance with international sanitary standards. However, as the 2024 Joint External Evaluation (JEE) confirms, BAITS is exclusively applicable to cattle, and there is currently no identification or traceability system for other livestock species (e.g., poultry, goats, sheep, swine). ⁶⁷

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is no comprehensive legislation or regulation in Botswana that safeguards the confidentiality of information generated through animal disease surveillance for all livestock owners. The Diseases of Animals (Stock Identification and Traceability System) Regulations (Statutory Instrument No. 7 of 2018) include strong confidentiality provisions tied to the national traceability system. Section 19(1) requires the Director of Veterinary Services to “maintain the confidentiality of any information obtained through the stock identification traceability system.” Section 19(2) further specifies that disclosure of such information is permitted only under narrowly defined circumstances, including “for public health and safety, national security, planning, public welfare, or for purposes of disease or pest control,” or upon written request from law enforcement agencies or the Director of Public Prosecutions. Section 20 makes it an offense for any person with access to such information to disclose it without authorization. ⁶⁸⁶⁹
However, these protections are linked specifically to the Botswana Animal Identification and Traceability System (BAITS). As confirmed by the 2024 Joint External Evaluation (JEE), BAITS is “exclusively applicable to cattle; there is currently no identification system for tracking the movement of other animals.” ⁷⁰ This means that while confidentiality of cattle surveillance data is well protected, there is no equivalent framework for poultry, goats, sheep, swine, or other livestock.
Although Botswana has general privacy frameworks, such as the Data Protection Act 2018 and provisions under the Public Health Act (Cap. 63:01), these laws do not explicitly address data generated through animal disease surveillance. ⁷¹⁷² Therefore, in the absence of a comprehensive system covering all species, Botswana does not have a national mechanism that consistently safeguards the confidentiality of information generated through animal disease surveillance. There is no evidence of such a law on the websites of the Ministry of Health or Ministry of Agriculture. ⁷³⁷⁴

1.2.2c Wildlife zoonotic disease surveillance

Score: 100

Botswana conducts surveillance of zoonotic diseases in wildlife, poultry, and livestock, although coverage and consistency vary across sectors.
The Joint External Evaluation (JEE) conducted by the World Health Organization (WHO) in March 2024, confirms that surveillance mechanisms exist for multiple zoonotic pathogens across animal populations, but notes that biosecurity measures and routine disease monitoring are not consistently applied across farms, particularly within informal or small-scale poultry and livestock production systems.⁷⁵ Furthermore, the JEE explicitly notes that "Botswana Animal Identification and Traceability System is exclusively applicable to cattle;
there is currently no identification system for tracking the movement of other animals" (p.22).
Botswana has a legal framework that provides the authority to conduct wildlife disease surveillance: under the Diseases of Animals Act (Cap. 37:01), Section 3(1) empowers the Minister of Agriculture to declare any disease affecting wild animals as “notifiable,” thereby mandating its reporting and surveillance. Additionally, Section 11 authorizes the Director of Veterinary Services to inspect, test, and implement quarantine or destruction measures for any animal, including wildlife, suspected of being infected. ⁷⁶ These provisions have been operationalized during anthrax and avian influenza outbreaks, where wildlife populations such as buffalo and wild birds were tested and monitored. However, the 2024 JEE underscores the absence of a formal, multi sectoral mechanism for wildlife disease surveillance, noting that responses to zoonotic outbreaks involving wildlife tend to occur in isolation within individual sectors. For example, during the 2019 anthrax outbreak, the response was led solely by the Department of Wildlife, without involvement from other relevant sectors (p. 21). ⁷⁷
Botswana maintains zoonotic disease surveillance in poultry, particularly targeting avian influenza and Newcastle disease, though coverage varies by production system. The 2024 JEE recognizes the existence of routine surveillance in poultry, especially in commercial operations and at points of entry, but notes that implementation in backyard and smallholder settings is inconsistent and under-resourced (p. 22). ⁷⁸ Surveillance is supported by the Diseases of Animals Act (Cap. 37:01), which empowers the Minister of Agriculture under Section 3(1) to declare poultry diseases as notifiable, thereby triggering mandatory reporting and control measures. ⁷⁹ National preparedness has included targeted avian influenza surveillance in domestic and wild birds, often in response to regional outbreaks, and is aligned with guidance from the Southern African Development Community (SADC) and the World Organisation for Animal Health (WOAH). ⁸⁰ However, as the JEE notes, disease detection and reporting from informal poultry producers remain limited, and a comprehensive, nationwide poultry surveillance strategy has not been institutionalized. ⁸¹
Botswana has an established system for surveillance of zoonotic diseases in livestock, particularly cattle, goats, and sheep, supported by legislative authority and internationally recognized traceability systems. The Diseases of Animals Act (Cap. 37:01) mandates disease notification, grants inspection and quarantine powers to the Director of Veterinary Services (Sections 3 and 11), and provides a legal basis for routine surveillance in livestock populations. ⁸². These provisions are reinforced by the Stock Identification and Traceability System (SITS) Regulations, which facilitate animal movement tracking and outbreak response. ⁸³ The 2024 JEE notes that Botswana conducts active and passive surveillance for several priority zoonoses in livestock—such as anthrax, brucellosis, and Rift Valley fever—particularly within commercial herds (p. 22). ⁸⁴ A 2024 study confirmed the detection of Brucella spp. and Coxiella burnetii in abortion cases among livestock, indicating both the presence of zoonotic threats and Botswana’s laboratory capacity to detect them. ⁸⁵

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

There publicly available evidence of a mechanism for reporting notifiable diseases to The World Organisation for Animal Health (WOAH). Botswana is an active participant in the WOAH animal disease reporting system, showing clear evidence of a national mechanism for reporting notifiable diseases. Botswana submits “immediate notifications” and disease event reports through WOAH’s WAHIS system. For example, on 13 May 2025, Botswana reported an outbreak of bluetongue via WOAH’s Immediate Notifications platform, confirming timely cross-border animal health communication. ⁸⁶ Similarly, on 29 August 2022, the country notified WOAH of foot-and-mouth disease (serotype pending) in its northeastern cattle zone, reflecting detection of a high-priority livestock disease.

1.2.4a Number of veterinarians per 100,000 people

Score: 13.57

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 28.86

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

There is insufficient evidence evidence that Botswana’s national plans, legislation, or regulations explicitly include structured mechanisms for working with the private sector in controlling or responding to zoonotic diseases. While Botswana's National Health Policy, adopted by the Ministry of Health in December 2011, implemented via the Integrated Health Sector Plan, mandates data collection from all health stakeholders, including the private sector, under Policy Initiative 4.6.3, this provision is general and not specific to zoonoses. ⁸⁷ Similarly, the Department of Veterinary Services (DVS) within the Ministry of Agriculture has operational capabilities for surveillance and disease control, but no documented frameworks were found outlining public-private collaboration specific to zoonotic response. The World Organisation for Animal Health (WOAH) Performance of Veterinary Services (PVS) Evaluation Follow-Up Mission Report of 2019 states clearly: “Involvement of the private sector in disease prevention and control is not presently backed by a clear policy/law”. ⁸⁸ This remains consistent with the World Health Organization's 2024 Joint External Evaluation (JEE) findings, which noted a score of 1 out of 5 in P5.2 “Mechanisms for responding to zoonotic events”, indicating that Botswana lacks a formal multi sectoral coordination mechanism for zoonotic threats, including engagement with private sector actors. The report specifically calls for "Fast-tracking the establishment and institutionalization (within a legal framework) of the National One Health platform to strengthen multi sectoral collaboration, coordination and communication, at the national and subnational levels" (p.2). ⁸⁹ There is also no publicly available evidence from the Public Health Act (2007), or from the websites of the Ministry of Health or Ministry of Agriculture, that suggests otherwise ⁹⁰⁹¹⁹²

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 50

Botswana has a limited record of the facilities in which dangerous pathogens are stored, and there is no evidence the record
has been updated within the past five years.
According to the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024 Botswana lacks a comprehensive, government‑wide system to identify, secure, and monitor facilities storing high-consequence biological agents. The JEE report specifically notes that "the absence of an updated inventory of facilities housing high-consequence agents nationally poses a significant challenge" (p. 26). The JEE report notes that the absence of such updated inventory is one of the reasons why the country scored lowest on the 'Biosafety and biosecurity' indicator (specifically, 'Whole-of-government biosafety and biosecurity system is in place for human, animal and agriculture facilities'; p. 2). The JEE report lists conducting "comprehensive survey to identify all facilities handling high-consequence agents and establish a central database of agents to be monitored through a national monitoring system" as one of the main priorities (p. 2). ⁹³
Priorly, the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in December 2017 stressed that "Botswana is still undergoing initial development" in terms of biosecurity, specifically noting that "while there are well-documented repositories for HIV and suspected poliomyelitis specimens, there is no collation of other pathogens stored throughout the country" (p.15). Among the recommendations for priority actions, the 2017 JEE report lists establishing "a national inventory of stored pathogens and consolidate holdings where appropriate" (p. 16). The 2017 JEE report does not mention other pathogens. It notes that there are "few protocols for the use and management of isolates for research purposes". ⁹⁴
There is no public evidence to indicate that records have been updated in the past 5 years on the websites of the Ministries of Health, Agriculture, Research or the Botswana Defence Force or the VERTIC Biological Weapons Convention (BWC) Legislation Database. ^9596979899 Neither the Botswana Public Health Institute nor the National Public Health Laboratory have an online presence. Although Botswana is party to the Biological Weapons Convention there is no public evidence that it has submitted Confidence-Building Measures reports. ¹⁰⁰

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 0

There is no publicly available evidence that Botswana has in place legislation related to biosecurity which address requirements such as physical containment, operation practices, failure reporting systems and/or cybersecurity of facilities in which especially dangerous pathogens and toxins are stored or processed.
According to the 2024 Joint External Evaluation (JEE) report, Botswana scored 1 (no capacity) under Indicator P7.1 'Whole-of-government biosafety and biosecurity system', indicating the absence of a functioning national framework to identify, monitor, or regulate facilities that store or process high-consequence biological agents (p. 2). The report notes the lack of a multi sectoral legal or regulatory framework for biosafety and biosecurity and confirms that Botswana has not implemented standard operating procedures for laboratory biosafety, incident reporting, risk assessment, or biosecurity protocols. Additionally, there is no oversight mechanism or formal plan to address potential containment failures or security breaches. These findings highlight that Botswana is at a foundational stage in developing a comprehensive biosafety and biosecurity system, and substantial work remains to align with international standards. Among key priority actions the report stressed the need for developing "a national biosafety and biosecurity strategy and a comprehensive framework to be implemented from national to subnational levels across One Health sectors, including the private sector" (p.2). ¹⁰¹
Priorly, the Joint External Evaluation Report, conducted in December 2017, also noted that biosecurity was still in early stages of development. ¹⁰² There was no public evidence of biosecurity legislation and/or regulations which address requirements such as physical containment, operation practices, failure reporting systems and/or cybersecurity of facilities in which especially dangerous pathogens and toxins are stored or processed, via the National Security Act, the Public Health Act or the Biological and Toxin Weapons Act. ^103104105 No information was found via the following websites: Ministries of Health, Agriculture or Research or the Botswana Defence Force. ^106107108109 The VERTIC biological weapons and materials legislative database does not include any biosecurity-specific entries for Botswana. ¹¹⁰ Neither the Botswana Public Health Institute nor the National Public Health Laboratory have an online presence. Although Botswana is party to the Biological Weapons Convention there is no public evidence that it has submitted Confidence-Building Measures reports. ¹¹¹

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There insufficient evidence that Botswana has established agency or agencies responsible for the enforcement of biosecurity legislation and regulations. The Joint External Evaluation, conducted in December 2017, or the 2024 JEE found no evidence of biosecurity legislation or a designated enforcement agency on the websites of Botswana’s Ministries of Health, Agriculture, Research, or the Defence Force. ^{112113114115116} Similarly, the VERTIC biological weapons and materials legislative database contains no biosecurity-specific entries for Botswana, and the National Security Act does not reference biosecurity. ¹¹⁷ Neither the Botswana Public Health Institute nor the National Public Health Laboratory maintain an online presence. Although Botswana is a party to the Biological Weapons Convention, there is no public evidence of Confidence-Building Measures reports having been submitted. ¹¹⁸ While Botswana does have legal frameworks and a functional Chemical, Biological, Radiological & Nuclear Weapons Management Authority (CBRNWMA) overseeing biosecurity and dual-use issues, there is no single, established agency specifically mandated to enforce biosafety and biosecurity within laboratories, agriculture, or public health. Enforcement roles are dispersed across the CBRNWMA and sectoral regulators, with no centralized mechanism. Agencies such as the Department of Veterinary Services (under the Diseases of Animals Act), the National Plant Protection Organisation (NPPO) (under the Plant Protection Act), and the CBRNWMA (under the Biological and Toxin Weapons (Prohibition) Act) handle specific aspects of biosecurity, but there is no overarching body with comprehensive cross-sector enforcement authority. ^119120121

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is no public evidence that shows that the country has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities, other than HIV and suspected poliomyelitis specimen repositories.
The Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024 (Indicator P7.1) confirms that Botswana lacks a national, multi sectoral biosafety and biosecurity system. Specifically, the evaluators noted that “the country lacks an updated inventory of facilities housing high-consequence agents nationally and their contents” (p. 26), and that consolidation into secure facilities had not been achieved. The report recommends creating and maintaining a comprehensive nationwide inventory of facilities handling dangerous pathogens and toxins. ¹²²
Priorly, Botswana's Joint External Evaluation, conducted in December 2017, also specifically recommended that the country "establish a national inventory of stored pathogens and consolidate holdings where appropriate." ¹²³ There is no relevant evidence of such actions in the National Health Policy (2011) or on the websites of the Ministries of Health, Agriculture or Research, the Botswana Defence Force or the VERTIC biological weapons and materials legislative database. ^{124125126127128129} The Ministry of Tertiary Education, Research, Science and Technology does not have a web presence as of November 2018. Neither the Botswana Public Health Institute nor the National Public Health Laboratory have an online presence. Although Botswana is party to the Biological Weapons Convention there is no public evidence that it has submitted Confidence-Building Measures reports. ¹³⁰

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 0

There is no publicly available evidence that Botswana has an in-country capacity to conduct Polymerase Chain Reaction (PCR)-based diagnostic testing for anthrax or Ebola.
While Botswana has demonstrated capabilities in PCR-based diagnostics for other diseases, such as HIV and tuberculosis ¹³¹, no specific public evidence confirming the existence of PCR-based diagnostic testing for anthrax or Ebola can be found in the 2024, or the 2017 Joint External Evaluation, conducted by the World Health Organization (WHO) in March 2024 and December 2017 respectively. There is no further information on the websites of the Ministries of Health, Agriculture or Research, the Botswana National Veterinary Laboratory, or Botswana Defence Force. ^{132133134135136137138139}
However, the 2022–2023 WHO Africa Biennial Report notes that Botswana has moderate preparedness across a range of outbreak categories, including both anthrax and Ebola, implying that testing systems for these pathogens may be under development or in preliminary stages. ¹⁴⁰

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no publicly available evidence on biosecurity training for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential.
According to the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024 Botswana has scored 1 on the P7.2 Indicator on 'Biosafety and biosecurity training and practices in all relevant sectors (including human, animal and agriculture)' meaning the country has basic capacity. The report specifically notes that Botswana implemented some basic biosecurity training practices, particularly within laboratories handling human, animal, and agricultural samples. However, these efforts are not standardized or mandatory, and there is no nationally endorsed curriculum or certification system. Training varies between institutions and lacks oversight by a central authority, resulting in inconsistent adherence to biosafety protocols across sectors. ¹⁴¹ Priorly, the Joint External Evaluation report, conducted in December 2017, also stated that biosafety and biosecurity training and practices had not been fully harmonised, while also noting that most laboratory staff have received biosafety training. ¹⁴² There is no evidence of a training requirement on the websites of the Ministries of Defence, Infrastructure, Science and Technology (MIST), Health, Agriculture, or Research. ^{143144145146147} Neither the Botswana Public Health Institute nor the National Public Health Laboratory have an online presence. The VERTIC biological weapons and materials legislative database does not include any biosecurity-specific entries for Botswana. ¹⁴⁸ Although Botswana is party to the Biological Weapons Convention there is no public evidence that it has submitted Confidence-Building Measures reports. ¹⁴⁹

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no publicly available evidence that security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential are subject to drug testing, background checks, and psychological or mental fitness checks. There is no evidence of such checks in Botswana's Joint External Evaluation Report, conducted in December 2017 and in May 2024, or the Ministry of Health's National Health Policy of 2011. ^150151152 There is no evidence on the websites of the Ministries of Health, Agriculture, Research or the Botswana Defence Force. ^153154155156 The VERTIC Biological Weapons Convention legislative database does not include any biosecurity-specific entries for Botswana. ¹⁵⁷ Although Botswana is party to the United Nations Biological Weapons Convention there is no public evidence that it has submitted Confidence-Building Measures reports. ¹⁵⁸ While the Intelligence and Security Service Act defines terms such as “security clearance” and “security vetting investigation”, these provisions appear limited to intelligence services personnel and do not extend to public health, agriculture, or scientific research sectors handling high-risk biological materials. ¹⁵⁹

1.3.4a National transport regulations for Category A and B infectious substances

Score: 0

There are no publicly available national regulations in Botswana that specifically address the safe and secure transport of infectious substances classified as Category A (UN2814, UN2900) or Category B (UN3373). Transport of hazardous goods in Botswana is generally governed by the Road Traffic (Transportation of Hazardous Goods) Regulations of 2013, which outline packaging, marking, driver training, and documentation requirements, but do not specifically mention infectious substances or medically dangerous pathogens. ¹⁶⁰ In the absence of national regulations for infectious substances, Botswana relies on adherence to international guidelines such as those of the International Air Transport Association (IATA) and International Civil Aviation Organization (ICAO), which provide detailed packaging instructions for these substances. ¹⁶¹ Botswana is also a member of the Universal Postal Union (UPU), which allows the dispatch of infectious materials through postal services provided international packaging standards are followed. Article 16 of UPU, on admissible radioactive and biological materials, includes Category A and B infectious substances. ¹⁶² Regionally, the Southern African Development Community (SADC) has issued standards for the transport of dangerous goods, though these do not specifically address Category A and B infectious substances. ¹⁶³
The Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024 found a difference in performance between specimen referral and transport systems for both human and veterinary laboratories. Specifically, human health laboratories scored a 4, while veterinary laboratories received a 3. The higher score for the human health sector reflects the existence of a formal contract between reference laboratories and a courier service, which facilitates efficient sample transportation. In contrast, the veterinary sector relies on the collection and delivery of specimens to a single national veterinary laboratory, and the availability of transport vehicles is sometimes limited, leading to inconsistencies in the system. The report specifically highlighted that "during field visits, the National Health Laboratory showcased evidence of a contract with a private courier company for transporting samples, particularly for acute flaccid aralysis/polio and proficiency testing, to the National Institute of Communicable Diseases, and National Health Sciences Laboratory, both in South Africa, which has functioned without issues" (p. 34). Nonetheless, several challenges were identified in the 2024 JEE report, especially regarding delays in collecting and transporting samples from lower-tier facilities to district-level centers. These delays stem from the dependence on ambulances and other vehicles, which are often reassigned to address other urgent needs. Likewise, the transport of animal samples relies on district-level ministry vehicles, which are not always accessible, leading to similar disruptions. ¹⁶⁴
There is no evidence of national regulatory information on the websites of the Ministries of Transport, Health, Agriculture, Research or the Botswana Defence Force or the VERTIC Biological Weapons and Materials – BWC Legislation Database. ^{165166167168169170} Neither the Botswana Public Health Institute nor the National Public Health Laboratory have an online presence. Although Botswana is party to the Biological Weapons Convention there is no public evidence that it has submitted Confidence-Building Measures reports. ¹⁷¹

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

There is no publicly available evidence of national legislation/regulation in place to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins and pathogens with pandemic potential. While Article 46 of the Public Health Act references compliance with “relevant international guidelines” for transport, entry/exit, processing, and disposal of biological materials, it does not specifically regulate the cross-border movement or end-user verification of especially dangerous pathogens. ¹⁷²
In 2022, Botswana adopted a voluntary national implementation action plan on United Nations Security Council resolution 1540 (2004) that calls for strengthened export and border controls, mandatory licensing, end-user certifications, and enforcement measures through the Chemical, Biological, Radiological and Nuclear Weapons Management Authority (CBRNWMA) under the Biological and Toxin Weapons (Prohibition) Act 2018. This national action plan improves alignment with UNSCR 1540 by integrating a dual-use control list and mapping institutional responsibilities—but it remains a voluntary instrument, not yet codified into statutory law. ^173174175

1.4.1a Biosafety laws/regulations

Score: 0

Botswana does not currently have national biosafety legislation or regulations in place. While the country adopted a National Policy on Access to Human Biological Material and Equitable Benefit‑Sharing in 2024, which includes provisions on biosafety risk assessments and safe handling in the context of material transfers, this policy is neither legally binding legislation nor a biosafety regulation and does not cover core elements such as laboratory biosafety standards, licensing, containment levels, or emergency response. ¹⁷⁶ Earlier initiatives, such as the 2008 National Biotechnology and Biosafety Policy and a draft Biosafety Bill (2013), were never enacted into law. ¹⁷⁷¹⁷⁸ The 2017 or the 2024 Joint External Evaluation confirms the absence of formal biosafety legislation in Botswana. ¹⁷⁹ The 2024 JEE report specifically lists developing "a national biosafety and biosecurity strategy and a comprehensive framework, to be implemented from national to subnational levels across One Health sectors, including the private sector" among the among the country's priority actions (p. 28). ¹⁸⁰

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 0

There is no publicly available evidence of an established agency responsible for the enforcement of biosafety legislation and regulations. Such an agency is not referred to in any of the following sources: World Organisation for Animal Health (OIE) PVS evaluation follow-up mission report (2019), World Health Organizations Joint External Evaluation reports (JEE) (2017 and 2024), the National Health Policy (2011), National Security Act (2008), Public Health Act (2007) or the National Biosafety framework report (2006). ^{181182183184185186187} There is also no relevant information on the websites of the Ministries of Health, Agriculture or Research. ^188189190 Neither the Botswana Public Health Institute nor the National Public Health Laboratory have an online presence. Although Botswana is party to the Biological Weapons Convention there is no public evidence that it has submitted Confidence-Building Measures reports. ¹⁹¹

1.4.2a Biosafety training using a standardised, required approach

Score: 0

There is no publicly available evidence on biosafety and biosecurity training for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential.
According to the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024 Botswana has scored 1 on the P7.2 Indicator on 'Biosafety and biosecurity training and practices in all relevant sectors (including human, animal and agriculture)' meaning the country has basic capacity. The report specifically notes that Botswana implemented some basic biosecurity training practices, particularly within laboratories handling human, animal, and agricultural samples. However, these efforts are not standardized or mandatory, and there is no nationally endorsed curriculum or certification system. Training varies between institutions and lacks oversight by a central authority, resulting in inconsistent adherence to biosafety protocols across sectors. ¹⁹² Priorly, the Joint External Evaluation report, conducted in December 2017, also stated that biosafety and biosecurity training and practices had not been fully harmonised, while also noting that most laboratory staff have received biosafety training. ¹⁹³ There is no evidence of a training requirement on the websites of the Ministries of Defence, Infrastructure, Science and Technology (MIST), Health, Agriculture, or Research. ^{194195196197198} Neither the Botswana Public Health Institute nor the National Public Health Laboratory have an online presence. The VERTIC biological weapons and materials legislative database does not include any biosecurity-specific entries for Botswana. ¹⁹⁹ Although Botswana is party to the Biological Weapons Convention there is no public evidence that it has submitted Confidence-Building Measures reports. ²⁰⁰

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no public evidence that Botswana has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential, and/or other dual use research. There is no evidence of such an assessment in Botswana's Joint External Evaluation Report conducted by the World Health Organization in December 2017 and March 2024 respectively. ²⁰¹²⁰² The 2024 JEE report specifically states regarding the initial proposed score of 1 indicating that research and development activities on public health emergencies (operational and implementation) including approvals of research "are conducted on an ad hoc basis" (p. 48). It further states that "Botswana lacks a research agenda for public health emergencies and risk assessment", that "the research pillar is still underdeveloped at the BPHI [Botswana Public Health Institute]", as well as that "a public health emergency research action plan specifically tailored for research purposes during emergencies is absent" (p. 48). ²⁰³
There is no evidence of such an assessment in Botswana's World Organisation for Animal Health (OIE) PVS Evaluation follow up mission report (2019); the National Health Policy (2011); the National Security Act (2005); or the Public Health Act (2007). ^204205206207 There is no relevant information on the websites of the Ministries of Health, Defence, Agriculture or Research. ^208209210211 Neither the Botswana Public Health Institute nor the National Public Health Laboratory have an online presence. Although Botswana is party to the Biological Weapons Convention there is no public evidence that it has submitted Confidence-Building Measures reports. ²¹²

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no public evidence of a national policy requiring oversight of dual use materials research. There is no evidence of such a policy in Botswana's Joint External Evaluation Reports (2017 or 2024) conducted by the World Health Organization (WHO). ²¹³²¹⁴ The 2024 JEE report specifically states regarding the initial proposed score of 1 indicating that research and development activities on public health emergencies (operational and implementation) including approvals of research "are conducted on an ad hoc basis" (p. 48). It further states that "Botswana lacks a research agenda for public health emergencies and risk assessment", that "the research pillar is still underdeveloped at the BPHI [Botswana Public Health Institute]", as well as that "a public health emergency research action plan specifically tailored for research purposes during emergencies is absent" (p. 48). ²¹⁵
There is no evidence of a national policy requiring oversight of dual use materials research in Botswana's World Organisation for Animal Health (OIE) PVS Evaluation follow up mission report (2019); the National Health Policy (2011); the National Security Act (2008); the Public Health Act (2007); or the Department of Agricultural Research "National Biosafety framework, Republic of Botswana" report (2006). ^{216217218219220221} There is no relevant information on the websites of the Ministries of Health, Defence, Agriculture or Research. ^222223224225 Neither the Botswana Public Health Institute nor the National Public Health Laboratory have an online presence. Although Botswana is party to the Biological Weapons Convention there is no public evidence that it has submitted Confidence-Building Measures reports. ²²⁶

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 0

Botswana does not have a designated national agency for overseeing research involving especially dangerous pathogens, toxins, agents with pandemic potential, or dual-use life sciences research. There is no public evidence in Botswana's Joint External Evaluation Reports (2017 and 2024) conducted by the World Health Organization (WHO). ²²⁷²²⁸ The 2024 JEE report specifically states regarding the initial proposed score of 1 indicating that research and development activities on public health emergencies (operational and implementation) including approvals of research "are conducted on an ad hoc basis" (p. 48). It further states that "Botswana lacks a research agenda for public health emergencies and risk assessment", that "the research pillar is still underdeveloped at the BPHI [Botswana Public Health Institute]", as well as that "a public health emergency research action plan specifically tailored for research purposes during emergencies is absent" (p. 48). ²²⁹ Botswana's World Organisation for Animal Health (OIE) PVS Evaluation follow up mission report (2019); the National Health Policy (2011); the National Security Act (2008); the Public Health Act (2007); or the Department of Agricultural Research "National Biosafety framework, Republic of Botswana" report (2006). ^{230231232233234235236237} There is no relevant information on the websites of the Ministries of Health, Defence, Agriculture or Research. ^238239240241 Neither the Botswana Public Health Institute nor the National Public Health Laboratory have an online presence. Although Botswana is party to the Biological Weapons Convention there is no public evidence that it has submitted Confidence-Building Measures reports. ²⁴² The Biological Weapons Convention implementation database confirms the absence of publicly accessible information on any body responsible for this oversight. ²⁴³
Although in 2022 Botswana entered a partnership with Ginkgo Bioworks to enhance biosecurity capabilities—including pathogen monitoring at entry points—this remains a capacity-building initiative rather than a formal regulatory or oversight mechanism. ²⁴⁴

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no publicly available evidence that Botswana has national legislation, regulation, policy, or other guidance requiring the screening of synthesised DNA before it is sold. A National Center for Biotechnology Information (NCBI) article from July 2017 states that a national Laboratory policy and strategic plan was under development, which evaluated gaps in national laboratory policies and plans in 39 sub-Saharan countries. Botswana was listed as 'Started', but a national laboratory policy and strategic plan for the country cannot be found online. ²⁴⁵ The National Biosafety Framework, published in 2006, does not refer to DNA screening, and does not appear to have been updated in the past 14 years. ²⁴⁶ There is no relevant information on the websites of the Ministries of Defence, Health, Agriculture, Research or the VERTIC Biological Weapons and Materials – BWC Legislation Database. ^{247248249250251} Neither the Botswana Public Health Institute nor the National Public Health Laboratory have an online presence. Although Botswana is party to the Biological Weapons Convention there is no public evidence that it has submitted Confidence-Building Measures reports. ²⁵²

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 0

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 100

Yes, official foot-and-mouth disease (FMD) vaccination figures for livestock publicly available through the OIE WAHIS database since 2020. ²⁵³

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

Botswana has a national immunization strategy, which reportedly covers equitable distribution and includes equity strategies.
Botswana has developed its National Immunization Strategy (NIS) for 2025–2030, led by the Ministry of Health’s Child Health Division through its Expanded Program on Immunization (EPI), with support from WHO, UNICEF, and other key partners. The strategy is designed to provide strong protection against vaccine-preventable diseases throughout all stages of life, in line with global and regional goals such as the Immunization Agenda 2030. ²⁵⁴²⁵⁵ It builds on achievements under the previous Comprehensive Multi-Year Plan (CMYP) 2018–2022, which included the introduction of new vaccines into the national schedule, while also addressing past challenges such as "funding constraints, low immunization coverages and data management limitations" ²⁵⁶²⁵⁷. The NIS responds to ongoing difficulties in “reaching zero-dose and under-immunized populations, particularly in remote and marginalized communities” ²⁵⁸²⁵⁹, with vaccination coverage remaining below the 90% target over the past three years. To address these gaps, the strategy outlines the expansion of mobile outreach services to underserved areas and the launch of public awareness campaigns aimed at increasing uptake across all age groups. ²⁶⁰ Developed through national consultations that involved stakeholders from various sectors and community representatives, the strategy reflects a wide range of perspectives to ensure contextual relevance. ²⁶¹ Community leaders also helped shape communication efforts to counter misinformation and cultural hesitancy around vaccines. ²⁶² The NIS identifies eight key pillars, including Governance and Accountability, Service Delivery, Human Resource Management, Data Quality and Monitoring, Vaccine Management, Community Engagement and Demand Generation, Disease Surveillance, and New Vaccine Introduction. ²⁶³ It highlights Botswana’s goal of delivering “equitable, high-quality immunization services” and underscores that the strategy “embodies Botswana's dedication to health equity and disease prevention”. ²⁶⁴

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 0

While Botswana has a national immunization strategy, which reportedly includes measures to address vaccine hesitancy and build public trust in vaccines, the document is not yet publicly available.
Botswana has developed its National Immunization Strategy (NIS) for 2025–2030, led by the Ministry of Health’s Child Health Division through its Expanded Program on Immunization (EPI), with support from WHO, UNICEF, and other key partners. While the current NIS is publicly not available yet, it reportedly includes provisions on public trust building. The WHO Africa Regional Office reported that “community representatives highlighted the importance of involving local leaders in promoting immunization, providing insights instrumental in shaping communication strategies to address cultural beliefs and misconceptions about vaccines.” It also stated that “community awareness campaigns will be rolled out to inform communities about the new strategy and promote immunization across all age groups.” ²⁶⁵
Similarly, the WHO Botswana Country Office’s Q4 2024 Newsletter confirmed that the strategy was developed through a broad consultation process that included stakeholders at both national and subnational levels, as well as community representatives. These consultations helped inform the strategy’s approach to expanding immunization access and improving communication with under-immunized populations, particularly in remote and marginalized communities. ²⁶⁶ However, it is not possible to verify whether these measures are formally and explicitly included in the strategy.

1.6.1e National advisory group for immunization strategy/plan

Score: 100

Botswana has a national advisory group that provides technical guidance and advice on the immunization strategy/plan to government.
Botswana operates a national immunization advisory body known as the Botswana National Immunization Technical Advisory Group (BOTSNITAG). This is a domestic, national-level committee composed of multidisciplinary local experts, established to provide independent, evidence-based advice on vaccine policies to the Botswana government and the Expanded Programme on Immunization (EPI). For instance, in July 2024, BOTSNITAG reviewed global evidence and recommended the introduction of a second dose of inactivated poliovirus vaccine (IPV) into the national immunization schedule—a policy decision that was subsequently implemented across all districts, demonstrating actionable influence. ²⁶⁷²⁶⁸

1.6.1f Presence of an immunization programme for influenza

Score: 0

Botswana does not have a formal immunization program for influenza.
According to the World Health Organization (WHO) Immunization Data portals, as of the latest update, Botswana does not appear have a formal national influenza vaccination plan or policy. ²⁶⁹²⁷⁰ Despite the absence of such a policy, the WHO Country Office in Botswana has actively supported the Ministry of Health in advancing pandemic influenza preparedness. Recognizing the recurring global threat posed by respiratory viruses, including influenza, Botswana has taken steps to align with the WHO Pandemic Influenza Preparedness (PIP) Framework, which is grounded in the International Health Regulations (IHR, 2005). As part of these efforts, Botswana is operationalizing the High-Level Implementation Plan (HLIP) to contribute to WHO’s Global Influenza Surveillance and Response System (GISRS), aiming to improve the detection and sharing of influenza viruses with pandemic potential. In July 2023, the WHO Country Office, in collaboration with WHO Africa Regional Office (AFRO), the Ministry of Health, and the Botswana Public Health Institute (BPHI), convened a multi-sectoral pandemic preparedness workshop. The event brought together stakeholders from health, local government, agriculture, environment, and regulatory sectors, as well as the U.S. Centers for Disease Control and Prevention (CDC), to strengthen Botswana’s pandemic response capacity. While a national influenza vaccination programme is not currently in place, these planning and coordination efforts reflect Botswana’s commitment to improving readiness for future pandemics through equitable access to medical countermeasures, community engagement, and cross-sectoral collaboration. ²⁷¹

1.7.1a Strategy/plan for resilience of health system

Score: 100

Botswana has a National Climate Change Strategy and Action Plan which includes considerations that specifically address evolving threat of infectious diseases, changing weather patterns and acute events following extreme weather.
Botswana is actively advancing the development of a health system that is resilient to the impacts of climate change and shifting seasonal weather patterns, particularly with regard to infectious disease threats. In December 2024, the World Health Organization (WHO) Country Office, with support from the Wellcome Trust, facilitated a Climate Change Health Vulnerability and Adaptation Assessment in selected districts. The assessment evaluated the health risks posed by climate-sensitive disease pathways—such as vector-borne, waterborne, nutritional, and environmental illnesses—and mapped both at-risk populations and health system vulnerabilities. Findings from the assessment are reportedly being used to develop Botswana’s first National Health Adaptation Plan (H-NAP), under the Ministry of Health, with the aim of strengthening policies, surveillance, emergency preparedness, and integrated planning for climate-related health risks. ²⁷²²⁷³ The climate-health assessment and planned H-NAP prioritize expanding integrated disease surveillance, early warning systems, and multi sectoral coordination—engaging stakeholders from the Ministries of Health, Agriculture, Environment, and Meteorology, as well as academic and local actors. ²⁷⁴
The H-NAP development aligns with Botswana’s existing climate adaptation framework, including its National Climate Change Strategy and Action Plan (2018) and Third National Communication (2019) to the United Nations Framework Convention on Climate Change (UNFCCC), both of which emphasize integration of health into climate resilience efforts. Specifically, the 2018 Action plan emphasizes that climate change—through rising temperatures, increased droughts, floods, and other extreme weather—poses both direct and indirect threats to human health. It notes that these events exacerbate heat-related illness, contribute to food and water insecurity, amplify vector-borne (e.g., malaria) and waterborne (e.g., diarrheal) diseases, and worsen mental health and non-communicable conditions. The strategy highlights that vulnerable populations—particularly low-income, rural, and marginalized groups—are most at risk. It stresses the need for a resilient health system capable of anticipating and coping with additional disease burdens, including implementing early-warning systems and integrating climate considerations into public health responses. It further recommends education and training for primary health care and community-level providers to recognize and manage climate-sensitive diseases, drawing on international commitments like the Alma Ata Declaration and the Ottawa Charter for Health Promotion (pp. 33-36). ²⁷⁵

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 100

There is public evidence that Botswana’s national laboratory system can conduct all ten WHO core diagnostic tests. The 2017 and the 2024 Joint External Evaluation (JEE) conducted by the World Health Organization (WHO) confirmed capacity for at least five core tests. Specifically, the 2024 JEE report states that "Botswana has the capacity to conduct most tests for priority diseases; in cases where facilities lack testing capabilities, there exists a well-established laboratory referral network for sending samples" (p. 34). ²⁷⁶ The 2017 JEE report notes that "point-of-care testing is done for tuberculosis (TB), HIV and malaria"
Malaria RDT and microscopy, HIV serology, tuberculosis microscopy (via the National TB Reference Laboratory in Gaborone), and bacterial culture for salmonella are regularly performed across the laboratory network. ^277278279 Influenza PCR testing is centralized. ²⁸⁰ Subsequent evidence confirms capacity for the remaining core tests: Botswana’s WHO-accredited national measles and rubella laboratory performs RT-PCR and serology ²⁸¹; cholera testing capacity is confirmed by Botswana’s classification as a Category 1 cholera laboratory by WHO ²⁸²; large-scale COVID-19 PCR testing and sequencing is performed by the Botswana-Harvard AIDS Institute Partnership lab ²⁸³; Hepatitis B serology and viral DNA testing are routinely conducted ²⁸⁴; and HIV viral load PCR testing is a standard service ²⁸⁵. While the Ministry of Health reports that hospital laboratories perform microbiology, cytopathology, histopathology, clinical chemistry, haematology, serology, blood banking, viral load and CD4 count testing, specific core tests are not always explicitly listed ²⁸⁶. There is no additional supporting evidence from Botswana’s World Organisation for Animal Health (OIE) PVS Evaluation Follow-Up Mission Report (2019), the National Health Policy (2011), or the Integrated Health Service Plan 2010–2020. ^287288289 No further updates were found on the websites of the Ministry of Health, Ministry of Agriculture, or from the Botswana Public Health Institute or National Public Health Laboratory, which do not maintain an online presence. ^290291292

2.1.1b Plan to conduct testing during a public health emergency

Score: 50

There is evidence of a national plan, but there is insufficient evidence that it includes considerations for testing for novel pathogens, scaling capacity, and defining goals for testing.
In August 2024, a new National Health Emergency Response Operations Plan (NHEROP) was reportedly drafted aiming to integrate preparedness, detection, response, and recovery functions. However, it is not yet publicly available for review and its provisions on laboratory testing, including provisions for novel pathogens and capacity scale-up, cannot be confirmed. ²⁹³
Botswana also reportedly adopted National Laboratory Strategic Plan (2024–2028), which outlines goals to modernize infrastructure, strengthen diagnostic and surveillance capacity, enhance workforce training, and establish quality assurance systems—aligned with WHO’s Regional Strategy on Diagnostic and Laboratory Services and Systems (2023–2032). However, the full text of the plan is not publicly available either; only summary descriptions are accessible via WHO communication channels. For instance, the WHO African Region reports that the "strategic plan also focuses on enhancing disease surveillance and monitoring capabilities, essential for tracking public health trends and emerging outbreaks". ²⁹⁴
Notably, in June 2025, Botswana Medicines Regulatory Authority launched a 'Health Emergency Preparedness, Response and Resilience Project' with the aim to "strengthen health system resilience and multi sectoral preparedness and response to health emergencies in Botswana". The project lists four components, two of them of interests are: "Strengthening the preparedness and resilience of the health system to manage health emergencies; and Improving early detection and response to health emergencies through a multi sectoral approach". The second component focuses on enhancing the country’s ability to detect and respond to health emergencies by reinforcing a multi sectoral approach. This part of the project aims to build capacity and operational readiness across essential systems critical for emergency response. One of the two main areas of intervention is "strengthening integrated surveillance systems and laboratory diagnostic capabilities across sectors".
During the COVID-19 pandemic, Botswana implemented ad-hoc measures, such as a National Emergency Operations Centre and interim testing and quarantine guidelines, but these were operational responses rather than components of an existing strategic testing plan. ²⁹⁵²⁹⁶
There is no mention of any of these three capabilities in; the Joint External Evaluation (JEE) conducted in 2017 and in 2024, or on the websites of the ministries of Health or Agriculture. ^297298299300 Neither the Botswana Public Health Institute nor the National Public Health Laboratory have an online presence.

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 100

There is publicly available evidence that Botswana has national laboratories serving as reference facilities accredited to international standards. The Botswana National HIV Reference Laboratory is ISO 15189-accredited and designated as a WHO Collaborating Centre for HIV drug resistance. ³⁰¹ The Botswana Harvard AIDS Institute Partnership Laboratory is also ISO 15189-accredited via SADCAS and certified through the African Society for Laboratory Medicine’s COVID-19 Laboratory Testing Certification Program (CoLTeP). ³⁰² The National Tuberculosis Reference Laboratory has confirmed ISO 15189:2012 accreditation. ³⁰³ The WHO-accredited national measles and rubella laboratory also remains active. ³⁰⁴
The 2024 Joint External Evaluation (JEE) report for Botswana includes a section assessing "Laboratory Quality System" (Indicator D1.2). Within this assessment, the report explicitly states that "the National Health Laboratory is accredited by South African National Accreditation System
in accordance with the requirements ISO: 15189:2012" (p. 35). ³⁰⁵ According to the previous JEE report conducted in December 2017, there were at least five ISO-accredited laboratories in the country at that time, though not all were clearly specified as reference labs. ³⁰⁶ The Botswana Institute for Clinical Laboratory Professionals (BICLP) previously listed five reference hospital laboratories — including the HIV Reference Laboratory, the Botswana National Quality Assurance Laboratory (BNQAL), the National Blood Transfusion Service (NBTS), the National Tuberculosis Reference Laboratory, and the Nyangabgwe HIV Reference Laboratory — though public confirmation of current accreditation status beyond the three mentioned labs is unavailable. ³⁰⁷ The Schroeder and Amukele 2014 study reported six accredited labs in Botswana, though it did not clarify which were reference facilities. ³⁰⁸ No further evidence was found on the ISO website or through the Ministry of Health & Wellness. ³⁰⁹

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

There is evidence that Botswana’s national reference laboratory system is subject to external quality assurance (EQA) review. The 2017 Joint External Evaluation (JEE) conducted by the World Health Organization in December 2017, confirms that “external quality assurance programmes are in place in most laboratories” (p. 21). ³¹⁰ Specifically, the Botswana Harvard HIV Reference Laboratory (BHHRL), accredited to ISO 15189, participates in external proficiency testing and quality assessment programs, in line with ISO standards and WHO ResNet requirements. ³¹¹ The National Tuberculosis Reference Laboratory (NTRL) has operated EQA schemes—including proficiency testing for mycobacterial culture and smear microscopy—since at least 2007. ³¹² Botswana’s broader laboratory network, including reference centers, also engages in regional EQA initiatives through the WHO Regional Office for Africa (WHO-AFRO) and the African Society for Laboratory Medicine (ASLM), ensuring ongoing external validation of testing. ³¹³

2.2.1a Nationwide specimen transport system

Score: 100

There is evidence of a nationwide specimen transport system for both animal and human specimens in Botswana. The 2017 Joint External Evaluation (JEE) conducted by the World Health Organization reported that Botswana’s national laboratory system had an effective referral network, using ministry vehicles, couriers, and district-level teams; it earned a score of 4 out of 5, indicating over 80% of districts have access to specimen transport to national labs. ³¹⁴³¹⁵
According to the 2024 Joint External Evaluation (JEE), Botswana’s specimen referral and transport system for human health laboratories is well-established and was scored 4 in the internal assessment, while the system for veterinary laboratories received a score of 3 due to operational constraints. The high human health score reflects an effective contract between reference laboratories and a private courier service that ensures reliable sample transport—especially for acute flaccid paralysis/polio and proficiency testing samples sent to South African reference labs. The National Health Laboratory has structured protocols and a functional referral system from all districts, supported by guidelines and standard operating procedures (SOPs). In contrast, veterinary specimen transport is more limited. Animal samples are collected by field officers and must be delivered to a single national veterinary laboratory. Transport relies on ministry vehicles, which are often unavailable, causing delays. Similarly, human sample transport from lower-level facilities to district labs can face delays due to reliance on ambulances, which may be diverted for other uses. The external assessors confirmed the scores, recognizing both the strengths of the human system and the logistical challenges facing veterinary specimen transport. (p. 34) ³¹⁶
The State Party Annual Reporting (SPAR) data collected by the World Health Organization, also confirms that capacity remains robust, assigning Botswana a 60% score for C.5.1 Specimen referral and transport system, equating to operational coverage in at least 80% of districts. ³¹⁷ However, no detailed operational protocols or manuals are publicly available via the Ministry of Health or Ministry of Agriculture websites. ³¹⁸³¹⁹

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 0

There is insufficient evidence to suggest there is a plan in place to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak. Botswana’s National Health Emergency Response Operations Plan (NHEROP) and the National Laboratory Strategic Plan (NLSP) improve overall preparedness—but neither currently includes a mechanism to rapidly authorize or license additional laboratories during a crisis.
The NHEROP, launched in August 2024, establishes a multi-sectoral coordination framework to prepare for, detect, respond to, and recover from health emergencies. It emphasizes activating entire government systems—from the Ministries of Health and Agriculture to local government and the US CDC—to ensure functional operational response during crises. However, the NHEROP does not specify expedited lab licensing or approval protocols as part of its emergency operations toolkit. ³²⁰
The NLSP, released in October 2023 with support from WHO and CDC, focuses on strengthening lab infrastructure, expanding diagnostic capacity, improving surveillance, training staff, and ensuring quality assurance. It lacks explicit provisions for surge response, such as redirecting non-governmental or private labs into the public health system during outbreaks. ³²¹
There is no mention of rapid authorisation or licensing during outbreaks in a World Health Organization (WHO) article, dated 4 February 2020, on support for Botswana's preparedness and response efforts for coronavirus, the Joint External Evaluation (JEE) reports (2017 and 2024), Botswana's World Organisation for Animal Health (OIE) PVS Evaluation follow up mission report (2019) or on the website of the Ministry of Health. ^{322323324325326} Neither the Botswana Public Health Institute nor the National Public Health Laboratory have an online presence.

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

Botswana is actively conducting both indicator-based and event-based surveillance for notifiable and emerging infectious diseases but there is no evidence that the data are being analyzed on a daily basis.
According to the 2017 Joint External Evaluation report conducted by the World Health Organization, the country maintains a comprehensive Integrated Disease Surveillance and Response (IDSR) system under the Ministry of Health, which facilitates routine data collection, reporting, and analysis for notifiable diseases through established channels. ³²⁷
According to the 2024 JEE report, Botswana demonstrates strong preparedness to manage public health threats through its well-established surveillance systems. The 2024 JEE report specifically notes that the IDSR incorporates a One Health approach, promoting coordinated efforts among the human, animal, and environmental health sectors in activities related to the prevention, detection, and response to public health events. The report further adds that Botswana has successfully adapted the third edition of the IDSR guidelines and conducted training at both national and district levels. However, the implementation of event-based or community-based surveillance systems—which would strengthen early warning and alert mechanisms—has not yet been achieved. The capacity to analyze surveillance data exists at both the national and district levels, and the country has established systems and guidelines for verifying and investigating suspected disease outbreaks. Despite these strengths, challenges remain regarding the interoperability of surveillance systems across sectors, which hinders the timely exchange of information and data according to the 2024 JEE. ³²⁸
In addition to indicator-based surveillance, Botswana has taken concrete steps to enhance its event-based surveillance (EBS) capabilities. In September 2023, public health specialists from the Ministry of Health received training on the Epidemic Intelligence from Open Sources (EIOS) platform. This World Health Organization (WHO) system enables early detection of public health threats through real-time monitoring of digital media and other open sources. ³²⁹ Furthermore, according to the Africa Centres for Disease Control and Prevention (Africa CDC), Botswana launched its national Event-Based Surveillance Guidelines on 24 June 2025. While these guidelines are not yet publicly available on the Ministry of Health’s website, their development indicates continued progress toward operationalizing EBS nationally. ³³⁰

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 100

There is publicly available evidence of a mechanism for reporting notifiable diseases to the WHO within the set timeline.
Botswana has a designated National International Health Regulations (IHR) Focal Point, established under the Public Health Act of 2013, which serves as the official mechanism for reporting notifiable diseases to the World Health Organization (WHO) within the required timelines. The Act mandates that “all reports of urgent events” must be assessed within 48 hours, and those that meet the notification criteria under IHR must be reported to the WHO “within 24 hours of assessment” through the National IHR Focal Point (NFP). This mechanism ensures that the country maintains a continuous line of communication with WHO and fulfills its international obligations for timely disease notification and verification. ³³¹
According to the 2024 Joint External Evaluation (JEE) report, Botswana has taken steps to establish its NFP by appointing a full-time IHR Coordinator and six part-time officers. Relevant sectors—including veterinary, agriculture, and environment—have also designated IHR contact officers. However, several structural and operational deficiencies hinder the functionality of the NFP. Notably, there is no designated NFP centre or office equipped with the necessary infrastructure to support continuous operations. The IHR Coordination Team has not received formal induction or training, and only the IHR Coordinator has defined terms of reference. Although the contact details of the team are updated annually and the State Party Annual Report is submitted on time, the lack of standard operating procedures (SOPs), a formal multi sectoral coordination forum, and continuous (24/7) accessibility undermines effectiveness. Coordination meetings occur mainly on an ad hoc basis during emergencies. Moreover, the existing temporary Public Health Emergency Operations Centre (PHEOC) at the Botswana Public Health Institute (BPHI) operates irregularly and is not fully functional. While the IHR have been incorporated into the National Public Health Act, this domestication has not translated into adequate authority, recognition, or resource allocation for the IHR Coordination Team. Many IHR-related documents lack endorsement from senior leadership, further limiting implementation. The recent establishment of the BPHI is a positive step; once relevant legislation is passed, the BPHI is expected to assume responsibility for IHR implementation and serve as the official NFP. However, due to current limitations in authority, infrastructure, and resources, Botswana's capacity was rated at Score 1—the lowest level—by both the external assessors and the national self-assessment (pp. 13-14). ³³²

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

The government operates an electronic reporting surveillance system at both the national and the sub-national level in Botswana.
An electronic Integrated Disease Surveillance and Response (eIDSR) system is embedded within the District Health Information Software 2 (DHIS2) platform. This system is implemented at both national and sub-national levels to support timely disease monitoring and response through weekly reporting of notifiable diseases. ³³³ The platform enables case-based surveillance for vaccine-preventable diseases and integrates data from health facilities and districts across the country. ³³⁴
The 2024 Joint External Evaluation (JEE) report confirms that Botswana has a functional indicator-based surveillance system aligned with the WHO’s Integrated Disease Surveillance and Response (IDSR) strategy, with data collected, analyzed, and reported from both national and district levels. ³³⁵ However, the JEE notes challenges related to interoperability across systems and sectors, which affects real-time data sharing. ³³⁶
According to Measure Evaluation, by 2019 Botswana had implemented e-health strategies for disease reporting and rolled out DHIS2 across all 27 health districts, enhancing reporting timeliness and completeness. ³³⁷ The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) also acknowledge that Botswana was part of the WHO African Region’s migration from Epi Info to DHIS2, with system improvements ongoing between 2019 and 2023. ³³⁸

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 50

Botswana operates a real-time electronic reporting surveillance system, but there is insufficient evidence to suggest collected data can be disaggragated and analysed by different variables (as age, ethnicity, etc.) Botswana’s electronic Integrated Disease Surveillance and Response (eIDSR) system operates on the DHIS2 platform, enabling real-time reporting of notifiable diseases at national and district levels. It supports both aggregate and case-based surveillance, with laboratories sending results via DHIS2 to inform public health responses. However, there is no specific publicly available evidence confirming that Botswana’s system collects ongoing or real-time laboratory data, nor that such data can be automatically disaggregated by age, ethnicity, or similar demographic variables. While DHIS2 supports these data capabilities, and is used in Botswana's health system, it depends on the country’s system configuration and workflows to collect and analyze lab data with demographic attributes—information that is not detailed in existing sources. ^339340341

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within the country. The WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 8 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.³⁴²

The detection of cVDPV2 in environmental surveillance in 2022 and 2023 highlighted vulnerabilities in population immunity. In response, the Botswana National Immunization Technical Advisory Group, BOTSNITAG conducted a rigorous review of scientific evidence, concluding that introducing a second IPV dose would substantially increase immunity among children under two years of age.³⁴³

In 2022, Environmental Surveillance (ES) was introduced to complement case-based AFP surveillance. The first established site for ES was Gaborone, Glen Valley Wastewater Treatment Site.³⁴⁴ However, it is unclear whether that has been rolled out to a national level or if this is still ongoing.

2.4.1a Common usage of electronic health records

Score: 50

Electronic Health Records (EHRs) are in partial use in Botswana but have not yet been fully implemented nationwide. The Government of Botswana has articulated a strong commitment to digital health through its National eHealth Strategy 2020–2024, which identifies the development of electronic health information systems, including EHRs, as a national priority. ³⁴⁵ At present, some major public hospitals in Botswana use an Integrated Patient Management System (IPMS), which functions as a limited form of EHR. However, this system is not universally deployed and suffers from issues of interoperability and consistent usage. ³⁴⁶ In parallel, Botswana has implemented the District Health Information System 2 (DHIS2), which is widely used for health data reporting but does not serve as an EHR since it collects aggregate, not patient-level data. ³⁴⁷
Progress is scaling up EHRs is hindered by several systemic challenges. These include poor internet connectivity, insufficient hardware infrastructure in rural health facilities, and limited human resource capacity for system maintenance and digital literacy among health workers. ³⁴⁸ Despite these limitations, Botswana has benefited from technical support from the World Health Organization (WHO), United States Centers for Disease Control and Prevention (CDC), and other international partners in advancing its digital health infrastructure and EHR-related capacity. ³⁴⁹ The CDC, through its Global Health Program in Botswana, has supported the Ministry of Health in piloting and scaling electronic medical records in selected high-burden HIV treatment sites, helping to streamline clinical workflows, improve data quality, and support continuity of care. Additionally, the CDC has collaborated with local institutions on the development of national data standards and interoperability frameworks to enable integration of disparate digital health systems. On the other hand, WHO has provided strategic guidance on national eHealth architecture, policy formulation, and capacity building. It has also supported assessments such as the Joint External Evaluation (JEE) and the Digital Health Atlas, which help identify gaps in health information systems and prioritize interventions. UNICEF has contributed to the deployment of DHIS2 for health surveillance and reporting, and has worked alongside the Ministry of Health to digitize maternal and child health data at the primary care level. ³⁵⁰
According to the 2024 Joint External Evaluation (JEE), “fragmented usage across different facilities persists, primarily due to infrastructure gaps such as internet and computer availability, and inadequate staff training” (p. 29). While a few facilities are employing electronic monitoring systems for routine care, these systems do not directly integrate with the national District Health Information System 2 (DHIS2), which captures aggregated data on health service utilization. As a result, data must be manually transferred to DHIS2, a process that introduces delays and the risk of omissions, ultimately weakening the accuracy and timeliness of health service reporting (p. 31). Despite these challenges, there are important strengths. A functional electronic health information management system exists at multiple levels of care, and a health inspectorate body is responsible for overseeing quality standards in health services. Standards for systematic quality assurance are also available through the Council for Health Services Accreditation of Southern Africa. Nonetheless, major weaknesses persist. Chief among them is the lack of interoperability between facility-level electronic systems and the DHIS2 platform, which limits data integration and hampers effective monitoring of service utilization. In addition, Botswana does not currently have comprehensive guidance for ensuring continuity of essential health services (EHS) during public health emergencies—a gap that further undermines the utility of EHRs for real-time response and planning. Overall, the external assessment rated Botswana’s capacity for utilization of health services at a score of 2 out of 5, reflecting the need for stronger system integration, infrastructure investment, and workforce training. ³⁵¹

2.4.1b Public health system access to individual electronic health records

Score: 100

Botswana’s national public health system does have access to individual-level electronic health records (EHRs) in a growing number of facilities, but this access remains incomplete, fragmented, and lacking full interoperability across the health system. Two main electronic systems are in operation: the Patient Information Management System (PIMS), used in approximately 493 health facilities, and the Integrated Patient Management System (IPMS), deployed in 2004 in all 28 district hospitals and 18 high-volume public clinics. These systems allow clinicians to access detailed patient information—including demographics, diagnoses, laboratory results, and treatment histories—and are especially prominent in HIV/TB care and higher-tier health services ³⁵²³⁵³.
Both PIMS and IPMS feed data into the National Data Warehouse (NDW), which consolidates electronic and semi-electronic data (including abstracted paper records) to support longitudinal analysis and program planning. ³⁵⁴ However, these systems do not yet fully integrate with the national District Health Information System 2 (DHIS2), which is used for aggregate reporting at the national level. As the 2024 Joint External Evaluation (JEE) conducted by the World Health Organization notes, “fragmented usage across different facilities persists, primarily due to infrastructure gaps such as internet and computer availability, and inadequate staff training” (p. 29), and manual data transfers from EMRs to DHIS2 often result in “delays or the omission of some facility data” (p. 31). ³⁵⁵
Botswana’s 2020–2024 National eHealth Strategy and Health Data Collaborative Roadmap prioritize expanding EHR coverage, improving data quality, and achieving interoperability between systems ³⁵⁶³⁵⁷.

2.4.1c Existence of data standards for health record data comparability

Score: 100

There is evidence of data standards to ensure data is comparable. Botswana has adopted clear data standards to promote comparability and interoperability across its national health information systems.
Botswana’s National eHealth Strategy 2020–2024 explicitly calls for the adoption of interoperability standards and health information exchange protocols, including the use of standardized terminologies (e.g., ICD-10, LOINC, and SNOMED CT) and data structures compliant with international frameworks like Health Level Seven (HL7) and International Organization for Standardization (ISO). ³⁵⁸
In 2025, Jembi Health Systems – a non-profit Organization based in South Africa that specializes in digital health and health information systems (HIS) for low- and middle-income countries, particularly in sub-Saharan Africa that plays a significant role in developing, implementing, and supporting health information exchange architectures, interoperability standards, and open-source digital health tools – published the Botswana Fast Healthcare Interoperability Resources (FHIR) Implementation Guide, which defines the technical requirements for health information exchange across systems such as PIMS, IPMS, DHIS2, and the Shared Health Record (SHR). This guide is aligned with HL7 FHIR standards, which are widely recognized internationally and used to ensure data consistency and compatibility. ³⁵⁹
The 2020 Botswana Health Data Collaborative (HDC) Roadmap also emphasizes the establishment of data governance mechanisms and common data dictionaries to support system-wide data comparability. It highlights the need for harmonized indicators, unique patient identifiers, and standardized metadata to ensure that data from different digital health platforms can be integrated and compared effectively. ³⁶⁰
Despite this policy alignment, Botswana still faces significant challenges in implementing these standards uniformly. Many health facilities operate offline or use legacy systems that do not fully conform to ISO or HL7 data structures. Interoperability with private-sector platforms and mobile health tools remains limited, and manual data transfers continue to compromise data consistency and timeliness. ³⁶¹ This is in line with findings of the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024, that notes Botswana has “interoperable, interconnected, electronic real-time reporting system” capacities at a level 3, indicating moderate functionality with room for improvement. ³⁶²

2.4.2a Data sharing mechanisms

Score: 0

Botswana lacks established mechanisms at the relevant ministries responsible for animal, human, and wildlife surveillance to share data.
A 2024 study on One Health implementation in Botswana reports that ministries responsible for human, animal, and environmental health do share surveillance data across sectors, but only in an ad hoc, event-driven manner, without a formalized mechanism or legal mandate for routine exchange. Existing intersectoral structures allow data coordination for specific threats—such as zoonotic disease outbreaks or food safety hazards—but there is no institutionalized platform or Memorandum of Understanding (MoU) to standardize multi-sectoral data flows ³⁶³ This conclusion was reiterated by the 2024 Joint External Evaluation (JEE) conducted by the World Health Organization, stating that although Botswana has some mechanisms for inter ministerial collaboration on zoonotic disease surveillance—such as limited data exchange and participation in One Health meetings—these interactions are not structured by formal policies or standardized procedures. External evaluators even downgraded the score from 2 to 1 for the zoonotic disease indicator because there was "insufficient evidence indicating that a standardized process involving all stakeholders…was utilized to establish a list of priority zoonotic diseases" (p. 20) ³⁶⁴. Instead, the 2024 JEE stresses that cooperation occur based largely on informal relationships and "goodwill among individual staff" in the various ministries, rather than institutionalized agreements or operating procedures (p. 20). ³⁶⁵
The 2017 Joint External Evaluation (JEE) similarly observed that human–animal health collaboration was irregular, informal, and lacking. formal data-sharing channels. ³⁶⁶ The 2019 World Organisation for Animal Health (WOAH) Performance of Veterinary Services (PVS) follow-up report echoed these findings, noting the absence of policies, strategies, or multidisciplinary frameworks to support ongoing data exchange between public health, veterinary, or wildlife authorities. ³⁶⁷

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 0

Botswana does not make de-identified health surveillance data on infectious diseases publicly available. A 2024 One Health study confirms that while Botswana’s Ministry of Health continues to collect infectious disease surveillance data, its public availability remains limited. ³⁶⁸ Botswana previously released weekly Disease Surveillance Reports, but these were last updated in July 2019 and are no longer accessible on government websites; therefore, they do not constitute evidence of ongoing public data release for this indicator ³⁶⁹³⁷⁰. Botswana has since adopted newer systems—the national DHIS2 health information platform for infectious disease and COVID-19 surveillance, and an Event-Based Surveillance (EIOS) unit to support early outbreak detection through the WHO-led platform ³⁷¹³⁷². However, these systems are not publicly accessible; DHIS2 and EIOS data are used internally by health professionals. The main current public source is WHO Africa’s Weekly Bulletins, which provide regional updates including Botswana ³⁷³. Key national institutions—such as the Botswana Public Health Institute and National Public Health Laboratory—still lack an online presence.

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

There is a law that safeguards the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities. The Data Protection Act of 2024 (Act No. 18 of 2024) establishes a comprehensive privacy framework. It defines "sensitive personal data" to include health information and mandates strict safeguards, such as consent requirements, data minimization, secure storage, breach notifications within 72 hours, and penalties for unauthorized processing. The Act specifically stresses that "processing of sensitive personal data for health or medical purposes is allowed where the processing is done by a health professional and is necessary for preventative medicine as well as protection of public health, medical diagnosis, health care or the management of health and hospital care services." ³⁷⁴ Additionally, Article 45 of the Public Health Act requires that health information remains confidential and is processed anonymously. ³⁷⁵ According to the World Health Organisation Atlas of e-health profiles, legislation protects the privacy of individuals' health related data held in electronic format in an electronic health record. However, in practice, such protections may not extend to paper records. ³⁷⁶ The Ministry of Health's "National Health Quality Standards: Standards & Guidelines for Emergency Medical Services" (2013) report ensures, under section 5.1.2, that patient privacy is protected. ³⁷⁷

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 100

Botswana's Data Protection Act, which is safeguarding the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities, does not include explicit mention of protections from cyber attacks (e.g. ransomware).
Although Botswana’s Data Protection Act No. 18 of 2024 does not explicitly reference protections against cyberattacks or ransomware, the legislation includes several provisions that implicitly safeguard against such threats. Specifically, Section 62 requires data controllers and processors to implement “appropriate technical and Organizational measures” to ensure the security of personal data, including measures to protect against unauthorized access, accidental loss, destruction, or unlawful processing. These include pseudonymization, encryption, access controls, and regular testing of security protocols—practices widely recognized as effective against cyber threats. Additionally, the Act mandates breach notification within 72 hours and requires data protection impact assessments for high-risk processing activities, such as large-scale health surveillance. While the absence of explicit references to cybercrime may limit legal specificity, the Act’s overall framework clearly supports proactive data security and risk mitigation aligned with international standards such as the EU General Data Protection Regulation (GDPR).³⁷⁸³⁷⁹

2.4.5a Cooperative commitments or agreements within regions

Score: 0

There is no publicly available evidence of the Botswana government making a commitment—via public statements, legislation, or cooperative agreements—to share surveillance data during a public health emergency with other countries in the region for one or more diseases. While Botswana participates in regional coordination through the Southern African Development Community (SADC), including efforts to link points of entry and district surveillance, it has not established memoranda of understanding (MOUs) or other binding agreements for systematic cross-border data sharing. ³⁸⁰ Botswana’s COVID‑19 country case study by the World Health Organization (WHO) confirms that, although real-time data was shared with WHO and neighboring countries at border points during the pandemic response, this was implemented at the operational level—not through a formal legal or policy framework. ³⁸¹ There is no evidence of such a commitment on the Botswana Government COVID-19 website, in the World Organisation for Animal Health (OIE) PVS Evaluation Follow-Up Mission Report (2019), in the Ministry of Health's media pages, or in the 2017 JEE report. ^382383384 The 2024 Joint External Evaluation (JEE) conducted from 11–15 March 2024 also reviewed Botswana’s International Health Regulations (IHR) core capacities, including surveillance, coordination, and cross-border data sharing. However, it did not document any legislative or policy-level commitment to share surveillance data with other countries during health emergencies. ³⁸⁵

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 0

There is no publicly available evidence that there is a national system in place to provide support at the sub-national level (e.g. training, metrics standardization and/or financial resources) to conduct contact tracing in the event of a public health emergency. Nevertheless, Botswana has made significant progress in extending national-level support mechanisms to districts through capacity-building initiatives. The 2024 Joint External Evaluation (JEE) conducted by the World Health Organization (WHO) reports that Botswana “has already successfully adapted the 3rd edition IDSR guidelines and rolled out training at both national and district levels” (p. 38), equipping District Health Management Teams (DHMTs) with standardized procedures for disease detection, case investigation, and outbreak response. This demonstrates clear national coordination and technical support to the sub-national level. However, the JEE also notes that “training has been extended to all districts, yet not all healthcare workers have been included, failing to meet the targeted healthcare worker coverage” (p. 39), indicating that these efforts, while broad in reach, have not yet achieved full institutionalization or sustained coverage. ³⁸⁶ Similarly, the WHO COVID-19 Intra-Action Review (November 2020) found that testing and contact-tracing activities were conducted in all districts under the coordination of the National Emergency Operations Centre and the Ministry of Health, suggesting functional district-level engagement but largely in response to active emergencies rather than through a permanent, structured national system. ³⁸⁷

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 100

Botswana did provide wraparound support to enable infected individuals and their contacts to self-isolate or quarantine during the COVID‑19 pandemic. Under Regulation 6 of the Emergency Powers (COVID‑19) Amendment (No. 4) Regulations, 2020, Botswana covered 100 % of quarantine costs for local contacts in government-designated facilities unless they opted for private accommodation. Returning residents paid 50 %, while companies covered costs for employees and diplomats self-quarantined at home. ³⁸⁸ The government repurposed public facilities—such as student residences—and established modular clinics, funded in part by the U.S. Government, across decentralized areas to facilitate access to isolation services, even in remote regions. ³⁸⁹Quarantine measures and cost-sharing frameworks were regulated under emergency legislation and clarified in official public notices and legal reviews. ³⁹⁰³⁹¹ Botswana established a COVID‑19 Relief Fund with an initial BWP 2 billion (~USD 150 million) investment, which provided wage subsidies (covering 50 % of basic salaries, with a BWP 1 000–2 500 cap), prohibited retrenchment during quarantine, and offered loan guarantees and tax relief to help sustain incomes and prevent job loss. ³⁹² The Auditor-General reported BWP 2.45 billion received and BWP 1.58 billion spent between April and August 2020 from the Fund. ³⁹³ Botswana’s measures were part of a broader Southern African response, supported by donors and decentralised quarantine centres. ³⁹⁴ International monitoring bodies recognized Botswana’s financial and policy measures during the COVID‑19 response, though they noted that these were emergency-specific and not part of a formal long-term legal framework. ³⁹⁵

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is no publicly available evidence of a formal joint plan or cooperative agreement between Botswana’s public health system and border control authorities to identify suspected or potential cases among international travellers—and to trace and quarantine their contacts—in the event of a public health emergency. The 2017 Joint External Evaluation (JEE) noted that Botswana effectively engages critical stakeholders—like border control and public health—through a “one‑government” approach led by cabinet and departmental leadership. However, the report made no mention of a formal mechanism, such as memoranda of understanding (MoUs), specifically between public health and border control authorities. ³⁹⁶ During the COVID‑19 pandemic, Botswana coordinated testing and quarantine at points of entry with support from the Southern African Development Community (SADC) and the World Health Organization (WHO). These measures, however, were implemented on an ad hoc operational basis, not through a structured, long-term joint plan. ³⁹⁷ The 2024 JEE, conducted from 11–15 March 2024, reviewed technical area (Section 'Points of Entry and Border Health'; pp. 61-63) and confirmed that while Botswana maintains coordination at ports of entry and participates in regional planning, there is no established joint plan or cooperative agreement between public health and border authorities to identify and manage international travellers and their contacts in future public health emergencies. ³⁹⁸

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

Botswana has established an in-country Applied Epidemiology Training Program, modeled on the global Field Epidemiology Training Program (FETP) framework. A Frontline FETP was launched in 2022, with 161 local graduates trained to date. ³⁹⁹ The program is coordinated by the Botswana Ministry of Health with technical and financial support from the U.S. Centers for Disease Control and Prevention (CDC). ⁴⁰⁰ Botswana’s FETP is also connected to regional capacity-building through Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) and African Field Epidemiology Network (AFENET), supporting surveillance, outbreak investigation, and field response capacity at national and district levels. ⁴⁰¹ There is no publicly available evidence—including on the Ministry of Health’s website, TEPHINET, or AFENET—of government scholarships, funding, or sponsorships for applied epidemiology training programs abroad. ^402403404

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 0

There is no publicly available evidence of a field epidemiology training programme explicitly inclusive of animal health professionals. Botswana’s Field Epidemiology Training Program (FETP) is primarily focused on public health professionals and does not appear to be explicitly inclusive of animal health professionals, nor does the country currently offer a dedicated Field Epidemiology Training Program for Veterinarians (FETPV). The Frontline FETP, launched in 2022 with CDC support, is designed for Ministry of Health staff and related public health workers; no public information indicates routine participation by veterinarians or other animal health personnel ⁴⁰⁵⁴⁰⁶. Botswana is not listed among countries implementing integrated One Health FETP models or a veterinary-specific track ⁴⁰⁷. While global initiatives such as Competencies for One Health Field Epidemiology (COHFE) provide a framework for integrated training, Botswana’s program has not yet adopted this approach ⁴⁰⁸.

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 100

Botswana has at least 1 trained field epidemiologist per 200,000 people. The country has made significant progress in developing an applied epidemiology workforce through its Field Epidemiology Training Program (FETP). According to the U.S. Centers for Disease Control and Prevention (CDC), as of early 2024, approximately 200 public health professionals have graduated from FETP programs in Botswana, spanning both Frontline and Intermediate tiers. ⁴⁰⁹ Given Botswana’s estimated population of 2.76 million ⁴¹⁰, this equates to roughly one trained field epidemiologist per 13,800 people, well above the international benchmark of one per 200,000.

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 33.33

Botswana does have a formal national public health emergency response plan but it is not publicly available.
In August 2024, World Health Organization's Regional Office for Africa announced the launch of the Botswana National Health Emergency Response Operation Plan (NHEROP), a comprehensive framework designed to prepare, detect, respond to, and recover from public health emergencies using a multi-sectoral, International Health Regulations IHR-aligned approach. The plan was reportedly developed collaboratively by the Ministry of Health & Wellness, Ministry of Agriculture, Ministry of Environment & Tourism, Immigration, Civil Aviation, local government, academic institutions, Southern African Development Community (SADC), U.S. Centers for Disease Control and Prevention (CDC), United States Agency for International Development (USAID), World Health Organization (WHO), and other stakeholders. ⁴¹¹ However, the plan is not publicly available to this date.

3.1.1b National public health emergency response plan published in past 3 years

Score: 100

Botswana has an overarching national public health emergency response plan, which was reportedly adopted in 2024.
In August 2024, World Health Organization's Regional Office for Africa announced the launch of the Botswana National Health Emergency Response Operation Plan (NHEROP), a comprehensive framework designed to prepare, detect, respond to, and recover from public health emergencies using a multi-sectoral, International Health Regulations IHR-aligned approach. The plan was reportedly developed collaboratively by the Ministry of Health & Wellness, Ministry of Agriculture, Ministry of Environment & Tourism, Immigration, Civil Aviation, local government, academic institutions, Southern African Development Community (SADC), U.S. Centers for Disease Control and Prevention (CDC), United States Agency for International Development (USAID), World Health Organization (WHO), and other stakeholders. ⁴¹² However, the plan is not publicly available to this date.

3.1.1c One health principles by covering multiple threat types

Score: 0

Botswana does have a formal national public health emergency response plan but since the plan has not been released publicly, there is insufficient evidence to determine whether it covers multiple threat types.
In August 2024, World Health Organization's Regional Office for Africa announced the launch of the Botswana National Health Emergency Response Operation Plan (NHEROP), reportedly a comprehensive framework designed to prepare, detect, respond to, and recover from public health emergencies using a multi-sectoral, International Health Regulations IHR-aligned approach. The plan was developed collaboratively by the Ministry of Health & Wellness, Ministry of Agriculture, Ministry of Environment & Tourism, Immigration, Civil Aviation, local government, academic institutions, Southern African Development Community (SADC), U.S. Centers for Disease Control and Prevention (CDC), United States Agency for International Development (USAID), World Health Organization (WHO), and other stakeholders. ⁴¹³
NHEROP operationalizes response actions across key public health threat categories. However, details of NHEROP await publishing.

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 0

Botswana’s National Health Emergency Response Operation Plan (NHEROP) does not explicitly reference health equity or contain structured mechanisms for identifying and addressing the needs of vulnerable populations, such as those of lower socioeconomic status, older adults, children, or minority ethnic groups. Publicly available documentation focuses on multi sectoral coordination and an all-hazards approach but lacks formal processes for equity impact assessment or inclusion of population vulnerability mapping. ⁴¹⁴⁴¹⁵ However, Botswana has incorporated health equity considerations in other national planning efforts. A 2023 climate and health vulnerability and adaptation assessment, supported by WHO, addresses equity impacts on women, children, rural residents, and other at-risk groups.⁴¹⁶ Similarly, Botswana’s participation in Global Health Initiative (GHI) partnerships in 2023–2024 includes targeted actions to reduce health disparities and promote youth- and community-centered services. ⁴¹⁷ These equity-focused initiatives operate outside the NHEROP and are not yet embedded within Botswana’s formal emergency response framework.

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 100

Botswana does engage with the private sector to support outbreak preparedness and response. However, engagement remains largely ad hoc, rather than being formalized through specific frameworks or agreements. For example, during the COVID‑19 pandemic, the government activated public–private partnerships (PPPs)—including with private laboratories such as Botswana Harvard AIDS Institute Partnership (BHAIP)—to increase PCR testing capacity, and with private pharmacies to support Antiretroviral Therapy (ART) delivery and decentralized viral load testing. ⁴¹⁸⁴¹⁹ The African Comprehensive HIV/AIDS Partnerships (ACHAP), a long-standing PPP established in 2001, played a central role in launching Botswana’s national Antiretroviral (ARV) program, setting a precedent for outbreak-related collaboration, though not structured under emergency-specific clauses. ⁴²⁰

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 0

There is limited evidence of formal national policy or operational guidelines in Botswana for implementing non-pharmaceutical interventions (NPIs) during epidemics or pandemics. While Botswana effectively applied a range of NPIs—such as mask mandates, lockdowns, and school closures—during the COVID-19 pandemic, these measures were adopted through emergency powers and public health regulations without a standing national framework to govern their consistent use. A May 2020 analysis by the Tackling Infections to Benefit Africa (TIBA) consortium documented the country-specific NPIs applied in Botswana for COVID-19, including school closures, travel restrictions, and bans on mass gatherings. ⁴²¹ The National Emergency Operations Centre (NEOC) also issued daily situation reports through the Botswana COVID-19 Task Force website. ⁴²² However, no further evidence of NPI guidance was found in key national documents such as the 2009 National Disaster Risk Management Plan, the 2024 and the 2017 Joint External Evaluations conducted by the WHO, or the Ministry of Health’s public guidance. ^423424425426 According to the World Health Organization (WHO), Botswana adopted a new National Health Emergency Response Operation Plan (NHEROP) in August 2024 to strengthen its emergency response systems, though this document has not yet been made publicly available and it remains unclear whether it includes standardized NPI protocols. ⁴²⁷

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 0

There is no public evidence that Botswana has either conducted a national-level biological threat-focused exercise or activated its National Health Emergency Response Operation Plan (NHEROP) for an infectious disease outbreak within the past year. The country’s 2024 World Health Organization State Party Self-Assessment Annual Reporting Tool (WHO SPAR) submission contains no record of completed infectious disease simulation exercises, after-action reviews, or NHEROP activations. ⁴²⁸ While Botswana had declared a State of Public Emergency in April 2020 during the COVID‑19 pandemic, this occurred prior to the 2024 adoption of NHEROP and was not linked to the current plan. ⁴²⁹⁴³⁰ Additionally, Botswana did not participate in WHO’s 2024 Pandemic Preparedness and Response Tabletop Exercise 1 (PanPRET‑1) biological threat simulation initiative, which engaged seven other African countries. ⁴³¹

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 0

There is insufficient evidence to suggest that Botswana identified a list of gaps and best practices in response (either through an infectious disease response, after action review or a biological-threat focused exercise) and developed a plan to improve response capabilities in the past year. While Botswana conducted at least one formal national intra-action review (IAR) focused on an infectious-disease response, specifically, a Country COVID‑19 Intra‑Action Review, but it was held in November 2020. This process identified both strengths and gaps, capturing best practices such as rapid laboratory scale-up, leveraging existing surveillance systems, and strong political will. It also highlighted challenges including supply chain constraints, contact tracing shortfalls, and Information and Communication Technology (ICT) and data delays. ⁴³²⁴³³
There is no evidence of a broader biothreat-focused simulation exercise or after-action review (AAR) that was explicitly centered on biological threats or non-COVID outbreaks in the past year. While regional analyses of African IARs underscore common thematic learnings, Botswana appears not to have participated in exercises like Pandemic Preparedness and Response Tabletop Exercise 1 (PanPRET-1) or similar tabletop drills. ⁴³⁴⁴³⁵

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 0

There is no public evidence that Botswana has conducted a national-level biological threat simulation exercise in the past year that included private sector representatives. The country’s 2024 submission to the State Party Self-Assessment Annual Reporting Tool (SPAR)—the World Health Organization’s mechanism for countries to annually report their International Health Regulations (IHR 2005) capacities, shows no record of national tabletop or full-scale biological threat exercises conducted with private sector participation. ⁴³⁶ The Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024 explicitly notes that "Simulation exercises have not been conducted to assess capacities for emergency preparedness" (p.46). ⁴³⁷ However, Botswana participated in a regional Public Health Emergency Operations Center (PHEOC) Functional Simulation Exercise organized by WHO AFRO, Africa CDC, and partners in 2024, which focused on testing regional coordination for an Ebola outbreak scenario. While this demonstrates engagement in regional preparedness activities, it does not constitute a national-level biological-threat exercise, nor does it provide evidence of private-sector involvement. ⁴³⁸

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

Botswana reportedly has an operational national Emergency Operations Center (EOC) under the Office of the President, coordinated through the National Disaster Management Office (NDMO).
In 2024, the Minister for State President, Moeti Caesar Mohwasa, publicly confirmed that a National Emergency Operation Centre has been established at the Botswana Police Service Headquarters, where emergency, law enforcement, and government agencies coordinate activities guided by the National Disaster Risk Management Plan. The center also operates a toll-free emergency number (888) with 12 dedicated streams for public assistance. ⁴³⁹
However, according to the World Health Organization (WHO) Joint External Evaluation (JEE) conducted in March 2024, Botswana does not yet have a fully functional Public Health Emergency Operations Center (PHEOC); a temporary PHEOC operates on an ad hoc basis within the Botswana Public Health Institute (BPHI). The JEE recommends establishing and operationalizing a dedicated PHEOC with an integrated incident management system (IMS), tailored PHEOC handbook, and trained personnel. ⁴⁴⁰
While the National Health Emergency Response Operation Plan (NHEROP, 2024) reportedly references coordinated response mechanisms, it is not yet publicly available. ⁴⁴¹ Therefore, although a national all-hazards EOC exists, there is no evidence of a fully functional, health-sector-specific PHEOC with permanent infrastructure and defined IMS protocols.

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

Botswana has established a National Emergency Operations Center (EOC) located at the Botswana Police Service Headquarters, where emergency, law-enforcement, and government agencies coordinate response activities under the National Disaster Risk Management Plan. ⁴⁴² However, there is no publicly available evidence that this EOC is required to, or routinely does, conduct annual simulation or functional drills focused on public-health emergencies. The 2024 World Health Organization (WHO) Joint External Evaluation (JEE) reported that a temporary Public Health Emergency Operations Center (PHEOC) operates within the Botswana Public Health Institute (BPHI) on an ad-hoc basis, and that simulation exercises to assess emergency preparedness capacities have not yet been conducted (p. 46). ⁴⁴³ While the newly launched National Health Emergency Response Operation Plan (NHEROP, 2024) reportedly references coordination mechanisms for emergency response, the document is not yet publicly available, and no evidence of an institutionalized annual drill schedule has been found. ⁴⁴⁴

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no public evidence to show that the Emergency Operations Center (EOC) has conducted within the last year a coordinated emergency response or emergency response exercise activated within 120 minutes of the identification of the public health emergency/scenario. Botswana has established a National Emergency Operations Center (EOC) located at the Botswana Police Service Headquarters, where emergency, law-enforcement, and government agencies coordinate response activities under the National Disaster Risk Management Plan. ⁴⁴⁵ However, there is no indication that this EOC or the temporary Public Health Emergency Operations Center (PHEOC) within the Botswana Public Health Institute (BPHI) has been activated within the specified timeframe for a public health emergency or simulation exercise. ⁴⁴⁶ The 2024 World Health Organization (WHO) Joint External Evaluation (JEE) confirms that Botswana does not yet have a fully functional PHEOC and that simulation exercises to assess activation and response capacities have not yet been conducted (p. 13, 46). ⁴⁴⁷

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 0

There is no evidence that Botswana's public health and national security authorities have carried out an exercise to respond to a potential deliberate biological event. Neither is there evidence that there are standard operating procedures, guidelines, MOUs or other agreements between the public health and security authorities to respond to a potential deliberate biological event.
Botswana's Joint External Evaluation (JEE) Report, conducted in March 2024 by the World Health Organization (WHO) notes that the country has established a legal foundation for multi sectoral coordination through its Public Health Act, which mandates the reporting of public health threats, authorizes quarantine measures, and permits the involvement of security forces to ensure compliance. During the COVID-19 pandemic, the country demonstrated effective coordination between health and security sectors, supported by a declared state of emergency that enabled swift resource mobilization and a unified national response. Botswana also has a Chemical, Biological, Radiological and Nuclear (CBRN) management framework aligned with international standards, and a Public Health Emergency Management Committee (PHEMC) technical working group with defined responsibilities at the national level. However, several gaps remain. The 2024 JEE report specifically flags that there are "no joint SOPs or memoranda of understanding are in place to formalize connections with security forces and streamline information sharing between public health and law enforcement authorities" (p. 50). It further adds that the national all-hazards emergency plan has not yet been officially endorsed, and joint simulation exercises with defense and security authorities have not been conducted. To address these shortcomings, the report recommends the development of SOPs for intersectoral coordination, clearly outlining the roles and responsibilities of public health and security actors during both peacetime and emergency scenarios. ⁴⁴⁸
There is no evidence of such exercises in Botswana's Standards & Guidelines for Emergency Medical Services (2013), National Disaster Risk Management Plan (2006). ⁴⁴⁹⁴⁵⁰ There is no evidence on the websites of the Ministry of Health or the Government of Botswana. ⁴⁵¹

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 0

Botswana has a national strategy that is intended for use during a public health emergency and that outlines how messages will reach populations and sectors with different communication needs. However, the strategy appears to be in draft stage and is publicly unavailable.
According to the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024, Botswana has shown strong capacity to engage communities and deliver risk communication messages effectively during public health emergencies, as evidenced by its response to both the COVID-19 pandemic and the recent polio outbreak. The country has developed a Health Promotion Strategy (2018–2022) and a draft National Multi-hazard Risk Communication and Community Engagement (RCCE) Strategy (2023). However, the 2024 JEE report notes that the strategy is in draft stage claiming “once endorsed, will serve as a comprehensive guideline for coordination and communication” in response to a wide range of hazards, including biological, environmental, and human-induced events (p. 57). ⁴⁵²
A World Health Organization (WHO) article, dated 4 February 2020, on coronavirus support for Botswana states that there is a Risk Communication and Community Engagement committee of the Public Health Emergency Coordinating Committee (PHECC), a multi-sectoral national committee which advises the Minister and coordinates communication, awareness creation, social mobilization and community engagement. There is however no mention of a risk communication plan. ⁴⁵³ Under the executive summary of the audit conducted in 2013 by International Federation of Red Cross and Red Crescent Societies, on "A study on legal preparedness for facilitating and regulating international disaster assistance" for Botswana, there was no National Disaster Risk Management legislation and stated "Existing legislation is fragmentary and while it may be used to assist in disaster situations, this may take valuable time and resources and be burdensome on Government and international actors offering assistance". ⁴⁵⁴ None of the government COVID-19 website, the Ministry of Health or the Government of Botswana websites refer to a risk communication plan. ^455456457 Botswana reportedly adopted a National Health Emergency Response Operation Plan (NHEROP) in August 2024, which may include provisions detailing a risk communication specifically intended for use during a public health emergency, but it is yet to be published. ⁴⁵⁸

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 0

There is insufficient evidence suggesting that Botswana's risk communication strategy includes provisions outlining how emergency risk communication messages will be tailored to reach diverse populations (such as speakers of different languages, rural or urban residents, vulnerable groups, or communities with limited media access).
According to the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024, Botswana has developed a Health Promotion Strategy (2018–2022) and a draft National Multi-hazard Risk Communication and Community Engagement (RCCE) Strategy (2023). However, the 2024 JEE report notes that the strategy is in draft stage claiming “once endorsed, will serve as a comprehensive guideline for coordination and communication” in response to a wide range of hazards, including biological, environmental, and human-induced events (p. 57). ⁴⁵⁹
Under the executive summary of the audit conducted in 2013 by International Federation of Red Cross and Red Crescent Societies, on "A study on legal preparedness for facilitating and regulating international disaster assistance" for Botswana, there was no National Disaster Risk Management legislation and stated "Existing legislation is fragmentary and while it may be used to assist in disaster situations, this may take valuable time and resources and be burdensome on Government and international actors offering assistance". ⁴⁶⁰
Botswana reportedly adopted a National Health Emergency Response Operation Plan (NHEROP) in August 2024, which may include provisions detailing a risk communication specifically intended for use during a public health emergency, but it is yet to be published. ⁴⁶¹

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

There is no public evidence that Botswana’s risk communication plan (or other legislation, regulation or strategy document used to guide national public health response) which would designate a specific position within the government to serve as the primary spokesperson to the public during a public health emergency.
According to the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024, Botswana has developed a Health Promotion Strategy (2018–2022) and a draft National Multi-hazard Risk Communication and Community Engagement (RCCE) Strategy (2023). However, the 2024 JEE report notes that the strategy is in draft stage claiming “once endorsed, will serve as a comprehensive guideline for coordination and communication” in response to a wide range of hazards, including biological, environmental, and human-induced events (p. 57). ⁴⁶²
Botswana reportedly adopted a National Health Emergency Response Operation Plan (NHEROP) in August 2024, which may include provisions detailing a risk communication specifically intended for use during a public health emergency, but it is yet to be published. ⁴⁶³
Previous WHO-supported communication efforts during COVID‑19 in Botswana emphasized multi sectoral RCCE working groups and media briefings, but did not confirm the establishment of a single designated spokesperson at the national level. ⁴⁶⁴ Furthermore, the Public Health Act (Cap. 63:01) grants the Director of Health Services authority to issue directives under Emergency Powers, it does not establish that role as the designated public communicator or spokesperson during health crises. ⁴⁶⁵

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 100

There is evidence that the government uses media platforms to inform the public about public health emergencies, and also regularly uses them.
The Ministry of Health & Wellness, Botswana actively uses its official Facebook page to keep the public informed on a wide range of health-related topics. With over 128,000 followers, the page regularly publishes posts that include: health notices and press releases; public announcements; and public awareness initiatives, including educational campaigns or notification of upcoming programs like paediatric palliative care discussions. Notably, the Ministry also used its official Facebook page to post about diarrhoea in children. These regular updates via social media reflect the Ministry’s strategy to inform, engage, and mobilize the public and health stakeholders through digital communication platforms. ⁴⁶⁶⁴⁶⁷ This was echoed by a 2024 study on strategic planning within Botswana’s public health institutions which found that the Ministry of Health & Wellness effectively uses social media and digital channels for health education, recognizing their wide reach and capacity for real-time message dissemination. ⁴⁶⁸

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

Senior leaders of Botswana have not shared misinformation or disinformation on infectious diseases in the past two years.
As of now, there is no credible public evidence that Botswana's current Minister of Health, Dr. Stephen Modise, has shared any misleading or false information regarding infectious diseases. A search of news articles, official statements, parliamentary records, and public social media did not uncover any claims by Dr. Modise that could be classified as misinformation or disinformation. Instead, he has consistently engaged in factual, science-based communication. For instance, in May 2025, he met with the World Health Organization (WHO) Representative to prepare for the World Health Assembly and reiterated Botswana’s commitment to “balancing curative and preventive healthcare” and strengthening health system resilience. ⁴⁶⁹ He has spearheaded initiatives such as piloting a digital health ecosystem, including telemedicine and artificial intelligence–based diagnostics. ⁴⁷⁰ He has also addressed public health concerns through press briefings, including a May 2025 call to “uphold food safety standards” to help prevent disease outbreaks. ⁴⁷¹ These examples suggest that Dr. Modise’s communications are aligned with public health best practices and do not constitute the dissemination of false or misleading information.

3.6.1a Percentage of households with Internet

Score: 75.26

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 96.82

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 100

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 8.33

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

In the past year, there is insufficient evidence suggesting that Botswana has implemented restrictions on export/import of medical goods (e.g. medicines, oxygen, medical supplies, PPE) due to an infectious disease outbreak.
In the past year, Botswana experienced two notable infectious disease outbreaks: a malaria surge in early 2025, which affected both endemic and previously low-risk areas such as Gaborone and Ghanzi, and Rift Valley Fever (RVF), identified through national surveillance and reported by the World Health Organization (WHO). ⁴⁷²⁴⁷³ Despite these outbreaks, there is no public evidence that Botswana implemented any export or import restrictions on medical goods such as medicines, oxygen, personal protective equipment (PPE), or other essential health supplies in response. The country has continued to maintain open and regulated trade channels for medical goods, aligned with international best practices.
The last recorded trade restriction on medical imports occurred during the COVID-19 pandemic in 2020, when Botswana introduced a temporary licensing requirement for the importation of essential supplies under Statutory Instrument No. 61 of 2020, aimed at mitigating critical shortages. No similar measures have been enacted since. ⁴⁷⁴

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

Botswana implemented an import restriction in October 2023 on poultry products from South Africa in response to outbreaks of highly pathogenic avian influenza (HPAI). The measure was explicitly tied to biosecurity concerns and the regional risk posed by bird flu epidemics. Such restrictions align with international standards and recommendations from the World Organisation for Animal Health (WOAH) regarding the management of HPAI outbreaks. ⁴⁷⁵ Seasonal restrictions on vegetables, meat, dairy, and grains also remained in place during the period, but these were agricultural trade measures not linked to infectious disease outbreaks. ⁴⁷⁶ By April 2025, most vegetable-related restrictions were lifted, but the poultry import ban illustrates a recent example of an outbreak-driven restriction grounded in structured scientific and biosecurity considerations. ⁴⁷⁷⁴⁷⁸

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

Botswana has not implemented any new inbound or outbound travel restrictions due to infectious disease outbreaks in the past year.
In the past year, Botswana experienced two notable infectious disease outbreaks: a malaria surge in early 2025, which affected both endemic and previously low-risk areas such as Gaborone and Ghanzi, and Rift Valley Fever (RVF), identified through national surveillance and reported by the World Health Organization (WHO). ⁴⁷⁹⁴⁸⁰ Despite these outbreaks,
inbound or outbound travel restrictions have not been imposed. Current travel advisories (as of early 2025) list no restrictions specific to outbreaks such as the malaria surge or Rift Valley Fever. ⁴⁸¹
These actions align with international recommendations, which generally discourage broad travel bans and instead emphasize evidence-based screenings, surveillance, and response measures, as recommended by WHO and other global health authorities.

3.7.2b Risk-based approach to international travel-related measures

Score: 0

Botswana does not currently have a fully implemented risk-based approach to international travel-related health measures. The 2024 Joint External Evaluation (JEE) assigned a score of 1—the lowest rating—indicating that while the Ministry of Health’s Port Health Unit is developing a multi sectoral mechanism for planning such measures, it remains incomplete. Although airports have adopted border control procedures aligned with International Civil Aviation Organization (ICAO) Annex 9, the absence of clear guidelines and standard operating procedures (SOPs) limits the effective application of risk-based international travel protocols. The JEE recommends that Botswana develop and integrate a multi-hazard surveillance system at points of entry, align public health emergency contingency plans with national and district systems, establish a vector control programme, and formalize a national process for adopting risk-based international travel measures. ⁴⁸²

4.1.1a Doctors per 100,000 people

Score: 5.2

4.1.1b Nurses and midwives per 100,000 people

Score: 41.06

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 0

Botswana currently lacks a fully developed multi sectoral health workforce strategy.
The The Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024 notes that while the Ministry of Health has conducted a baseline assessment of human resources for health across the public, private, and social sectors—which will inform future planning—there is no comprehensive workforce policy, and investment needs remain unassessed. Although the country has skilled personnel across sectors and provides training through workshops and seminars on public health emergency topics according to the 2024 JEE, the existing training plan does not adequately include personnel from non-health sectors. Key challenges include limited domestic budget allocation, shortages of healthcare workers, high attrition rates, and insufficient incentives, all of which hinder Botswana’s ability to meet International Health Regulations (IHR) workforce requirements. ⁴⁸³

4.1.1d Health system capacity for essential health services

Score: 0

There is insufficient evidence that Botswana has sufficient capacity within the health system to deliver essential health services. The WHO Joint external evaluation of the International Health Regulations (17-21 September 2023) says that while there is a defined EHS package in Botswana, it hasn't been updated to address public health emergencies and lacks guidance for ensuring continuity of EHS during such emergencies.⁴⁸⁴

4.1.1e Essential health services continuity plan for public health emergencies

Score: 0

There is no publicly available evidence that Botswana has a dedicated plan to ensure continuity of essential health services (EHS) during a public health emergency. The country’s Essential Health Service Package (EHSP) identifies a minimum set of services—such as maternal and child health, HIV/TB care, nutrition, and noncommunicable disease services—that should be maintained across all levels of care. ⁴⁸⁵ However, the EHSP is a general health system planning document and is not explicitly focused on maintaining service continuity in emergency contexts.
The 2024 Joint External Evaluation (JEE) notes that Botswana has only partial capacity in this area, with some elements of continuity addressed during the COVID-19 response, but without comprehensive guidance or a monitoring framework for broader public health emergencies (p. 52). ⁴⁸⁶ These gaps indicate that while core health services are defined, there is no explicit emergency continuity plan.

4.1.2a Hospital beds per 100,000 people

Score: 57.66

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 0

Botswana does not currently have a dedicated, permanent biocontainment unit for managing highly communicable diseases. However, the country has demonstrated the capacity to rapidly establish functional isolation facilities in response to outbreaks.
During the COVID-19 pandemic, Botswana promptly adapted the World Health Organization's COVID-19 Strategic Preparedness and Response Plan (SPRP) to develop its own Country Preparedness and Response Plan (CPRP), which guided the national pandemic response. This plan led to the establishment of eleven dedicated isolation centers in addition to the country's 26 public hospitals, all of which were mobilized to deliver COVID-19 care. The CPRP emphasized four core strategies: proactive surveillance, timely case detection, clinical management of confirmed cases, and systematic contact tracing to curb transmission. ⁴⁸⁷
Additionally, modular isolation clinics were constructed in underserved areas such as Maun and Kasane with funding and support from the U.S. Department of Defense, further strengthening the country's surge capacity for isolation care. ⁴⁸⁸
Despite this progress, limitations remain. According to the 2024 Joint External Evaluation (JEE), "scarcity of isolation facilities" persists across most healthcare settings, alongside overcrowding, insufficient equipment, and inadequate staffing levels, all of which pose barriers to maintaining a safe healthcare environment during infectious disease outbreaks. ⁴⁸⁹

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 0

There is no publicly available evidence that Botswana has demonstrated capacity to expand isolation capacity in response to an infectious disease outbreak in the past two years, nor that it has developed, updated, or tested a formal plan to do so. Although the Ministry of Health has reportedly drafted a National Infection Prevention and Control (IPC) Strategic Plan 2024–2028, which is intended to guide the coordination of IPC activities and the expansion of isolation capacity across health facilities, this document is not publicly available and therefore cannot be independently verified. Botswana has also disseminated updated national IPC guidelines (2023) and designated IPC focal points at national and intermediate levels, but these materials likewise remain inaccessible through public channels. In the absence of verifiable evidence that the strategy has been finalized, implemented, or tested, the country cannot be credited with meeting the indicator criteria. ⁴⁹⁰

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 50

There is a national procurement protocol (plan) in place which can be utilised by the Ministry of Health for the acquisition of laboratory supplies and medical supplies for routine needs. There is insufficient evidence of any similar procurement plan for the Ministry of Agriculture.
Botswana’s Central Medical Stores (CMS), a government-owned enterprise responsible for the procurement, storage, and distribution of health commodities, continues to operate under the strategic framework of its Central Medical Stores Botswana 2010–2012 Strategic Plan. ⁴⁹¹ While a newer strategy may now be in effect, such as the recently launched National Supply Chain Strategy for Health Commodities (2023–2028), the absence of a publicly accessible version of this document prevents confirmation of whether it formally replaces or updates the earlier plan. Nonetheless, recent activities indicate ongoing evolution of CMS operations. For example, in 2023, CMS undertook a quantification exercise to forecast health commodity needs for 2026, illustrating active engagement in supply planning and responsiveness to national health demands. ⁴⁹² While these efforts are notable, the absence of an updated or integrated multi sectoral procurement protocol persists. The 2024 Joint External Evaluation (JEE) of Botswana highlights the need to “review and implement an effective plan for improving laboratory reagents/supplies procurement and management, and regular equipment service schedules”, underscoring that formal modernization of procurement strategies remains a priority. ⁴⁹³
In September 2023, Botswana’s Ministry of Health, in partnership with CMS, launched the National Supply Chain Strategy for Health Commodities (2023–2028) to improve the procurement and management of essential medicines and medical supplies. The strategy aims to provide clarity and prioritization in supply chain activities, particularly in response to public frustrations over medicine stockouts. USAID’s Global Health Supply Chain Programme–Procurement and Supply Management (GHSC-PSM) Country Director, Phetogo Phoi, expressed confidence that the strategy would mark a turning point in ensuring the availability of medical commodities. Though the document itself is not yet publicly accessible, its launch implies that Botswana may have also undertaken a review of its procurement protocols in line with recommendations from the 2024 JEE. At the launch event, Minister of Health Dr. Edwin Dikoloti acknowledged that multiple assessments had highlighted significant issues in the supply chain, including “unstable supply of medicines and related supplies, long procurement processes, systemic organisational bottlenecks, outdated legal and policy frameworks, inadequate ICT infrastructure, warehousing and distribution challenges, and limited supply chain skills”—factors that have historically hindered access to health commodities. ⁴⁹⁴ There is insufficient evidence that the strategy would cover procurement functions within the Ministry of Agriculture.

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 0

There is insufficient evidence that Botswana maintains a dedicated national stockpile of medical supplies—such as medical countermeasures (MCMs), medicines, vaccines, medical equipment, or personal protective equipment (PPE)—for use during a public health emergency.
According to the World Health Organization (WHO), Botswana adopted a new National Health Emergency Response Operation Plan (NHEROP) in August 2024 to strengthen its emergency response systems. However, as the document has not been made publicly available, it remains unclear whether Botswana maintains a national stockpile of medical supplies—such as medical countermeasures (MCMs), medicines, vaccines, medical equipment, and personal protective equipment (PPE)—for use during a declared public health emergency, or what the intended scope, targets, and operational goals of such a stockpile might be under the new plan. ⁴⁹⁵
Further, Botswana has reportedly launched the National Supply Chain Strategy for Health Commodities (2023–2028), which may include provisions for stockpiling medical supplies—such as medical countermeasures (MCMs), medicines, vaccines, equipment, and personal protective equipment (PPE)—for national use during public health emergencies. However, as the strategy document is not publicly available, it remains unclear whether such measures are included or how they are defined. ⁴⁹⁶
In the past two years, Botswana has experienced repeated shortages of essential medical supplies, suggesting broader challenges with both routine and emergency stockpiling systems. In June 2025, the Ministry of Health confirmed before the Public Accounts Committee that national stock availability had dropped to 70%, well below the targeted 90% needed to sustain medical supply coverage. These shortages were attributed to delayed payments to suppliers, foreign currency constraints, and inadequate infrastructure for warehousing and distribution—issues that have impacted access to medicines for chronic conditions and basic healthcare needs ⁴⁹⁷. Similar problems were reported in 2023, when widespread medicine stock outs across public facilities triggered the launch of the National Supply Chain Strategy for Health Commodities (2023–2028), aimed at overhauling procurement and logistics management ⁴⁹⁸. While this strategy may include measures for emergency stockpiling, the document remains unavailable to the public, and no specific provisions are confirmed. Collectively, these persistent shortfalls in the routine medical supply chain raise concerns about Botswana’s capacity to maintain a reliable stockpile of medical countermeasures (MCMs), vaccines, or personal protective equipment (PPE) in the event of a public health emergency. ⁴⁹⁹

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is insufficient public evidence that Botswana maintains a dedicated national stockpile of laboratory supplies—such as reagents, diagnostic media, or testing equipment—for use during a public health emergency.
The 2024 Joint External Evaluation (JEE) highlighted persistent challenges in laboratory procurement and supply chain management, recommending that the country “review and implement an effective plan for improving laboratory reagents/supplies procurement and management, and regular equipment service schedules” (pp. 36-37). ⁵⁰⁰ While Botswana reportedly launched a National Supply Chain Strategy for Health Commodities (2023–2028) to address recurring shortages and systemic inefficiencies, the document is not publicly available, and it remains unclear whether laboratory-specific emergency stockpiling is included. ⁵⁰¹

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no evidence that Botswana conducts or requires an annual review of the national stockpile to ensure the supply is sufficient for a public health emergency.
There is no publicly available evidence that Botswana’s Central Medical Stores (CMS) conducts or requires an annual review of the national stockpile specifically to ensure sufficiency for a public health emergency. While CMS engages in routine supply forecasting (e.g. the 2023 quantification exercise for 2026 needs) ⁵⁰², no official protocol for systematic annual review of emergency reserves has been identified in publicly available documents, including the 2024 Joint External Evaluation (JEE) report, the websites of the Ministry of Health, the Ministry of Defence or the Botswana Medicines Regulatory Authority (BoMRA). ^503504505

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 0

There is insufficient evidence that Botswana has a formal plan or agreement to leverage domestic or regional manufacturing capacity—whether public or private—for the production of medical supplies (e.g. medical countermeasures [MCMs], medicines, vaccines, equipment, or personal protective equipment [PPE]) for national use during a public health emergency. At present, Botswana lacks domestic pharmaceutical manufacturing for human-use medicines; local firms primarily engage in importation and packaging of bulk drugs, with full-scale manufacturing remaining aspirational and undocumented in formal policy frameworks. ⁵⁰⁶ While the Botswana Vaccine Institute (BVI) does produce vaccines for animal health (e.g. foot-and-mouth disease, anthrax), this capability does not extend to human health applications. ⁵⁰⁷
Although Botswana has launched both a National Health Emergency Response Operation Plan (NHEROP) and a National Supply Chain Strategy for Health Commodities (2023–2028), neither document is publicly available, making it unclear whether either includes provisions to mobilize or develop domestic or regional manufacturing capacity during emergencies. ⁵⁰⁸⁵⁰⁹ Notably, during the launch of the Supply Chain Strategy, Minister of Health Dr. Edwin Dikoloti stated, “Among our priorities would be to increase private sector engagement in health services delivery and local manufacturing of health commodities,” suggesting some intent to pursue local production in the future. However, this remains a policy aspiration rather than a documented operational plan. ⁵¹⁰
The Joint External Evaluation Reports, conducted in December 2017 and in March 2024 respectively, make no mention of leveraging domestic manufacturing capacity to produce medical supplies. The Report does state there is limited capacity for a system to send/receive MCMs during a public health emergency. However, the Ministry of Health & Wellness Central Medical Stores are able to rapidly acquire medical countermeasures. ⁵¹¹⁵¹² An INK (Centre for Investigative Journalism) article, dated 13 March 2020, quotes the Ministry of Health and Wellness (MoHW) Permanent Secretary, Solomon Sekwakwa, as saying there is a 'dire shortage of protective gear and equipment needed to manage the Coronavirus in the country'. He also said that of greater concern was fact that the government was unable to purchase the necessary equipment from their main Chinese suppliers because production has ceased due to of lockdown. In addition, other potential suppliers are keeping the equipment for local use. ⁵¹³ There is no further information on the websites of the Ministry of Health or Botswana Defence Force or the Government COVID-19 website or of agreements with manufacturers or distributors. ^514515516 The National Public Health Laboratory does not have an online presence.

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 0

There is no publicly available evidence of a formal plan or agreement in Botswana to leverage public or private sector domestic or regional manufacturing capacity specifically for the production of laboratory supplies (e.g. reagents, media) for national use during a public health emergency.
There is some evidence that Botswana has acknowledged the need for improved procurement mechanisms for laboratory supplies. The 2024 Joint External Evaluation (JEE) recommended that Botswana “review and implement an effective plan for improving laboratory reagents/supplies procurement and management, and regular equipment service schedules” (p. 4), suggesting that an updated procurement mechanism may still be under development or pending implementation ⁵¹⁷.
In terms of facilitating emergency procurement, no specific mechanism or contingency protocol for expediting laboratory supplies through points of entry during a public health emergency could be identified in publicly available documents. The National Health Emergency Response Operation Plan (NHEROP) adopted in August 2024 may contain relevant provisions, but this document has not yet been made publicly available, making it impossible to verify whether it includes procedures for expediting critical laboratory materials at borders or airports. ⁵¹⁸ Similarly, while the National Supply Chain Strategy for Health Commodities (2023–2028) may outline emergency stockpiling or expedited import procedures, it also remains unpublished, leaving these questions unresolved. ⁵¹⁹
Botswana reportedly launched a National Laboratory Strategic Plan in October 2023, which may include measures to leverage public and/or private sector domestic or regional manufacturing capacity to produce laboratory supplies; however, since the full document is not publicly available, it is not possible to determine whether such provisions exist. ⁵²⁰

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

Botswana has elements of a system for emergency logistics and supply chain management at both national and subnational levels, although its comprehensiveness and functionality remain unclear due to limited publicly available documentation.
The Central Medical Stores (CMS) plays a central role in coordinating health commodity logistics across the country. It is responsible for the procurement, storage, and distribution of essential medical supplies and supports health facilities nationwide. The CMS operates under strategic frameworks, including the Central Medical Stores Strategic Plan 2010–2012 and the more recent but unpublished National Supply Chain Strategy for Health Commodities (2023–2028), which was launched by the Ministry of Health and CMS to improve resilience and ensure uninterrupted supply of medicines. ⁵²¹⁵²²
According to the 2024 Joint External Evaluation (JEE) report, Botswana has established a foundational emergency logistics and supply chain management system, including legal frameworks, an emergency supply chain management playbook, and the National Supply Chain Strategy for Health Commodities (2023–2028). These are supported by the Central Medical Stores and contracted private transport services. However, the system is currently underutilized and insufficiently resourced, with notable gaps in coordination, lack of a dedicated emergency logistics unit, and limited operational capacity to fully support public health emergencies. As a result, the JEE assigned a score of 2 out of 5, indicating that while mechanisms exist, their implementation and effectiveness remain limited (p.47). ⁵²³

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 100

Botswana reportedly has a plan and guidelines in place for dispensing medical countermeasures (MCM) for national use during a public health emergency (i.e., antibiotics, vaccines, therapeutics and diagnostics).
According to the 2024 Joint External Evaluation (JEE) report, Botswana has a legal framework that supports the use of medical countermeasures (MCMs) during public health emergencies, including guidance on the stocking and distribution of medical commodities. This is supported by the operations of the Central Medical Stores (CMS) and the Botswana National Supply Chain Strategy for Health Commodities (2023–2028). The country also reportedly possesses an emergency supply chain management playbook outlining the competencies needed for effective emergency response. However, there are significant gaps. The emergency playbook is reportedly underutilized, there is no dedicated emergency logistics unit, and stakeholder coordination remains weak. Moreover, there is no specific evidence of a comprehensive, functional plan for dispensing MCMs—such as antibiotics, vaccines, therapeutics, or diagnostics—during a national public health emergency. Importantly, neither the Botswana National Supply Chain Strategy for Health Commodities (2023–2028) nor the emergency playbook is publicly available, making it impossible to verify whether dispensing protocols for MCMs are included.

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 0

Botswana does not currently have a comprehensive public plan to facilitate workforce surge during a public health emergency. While the country has conducted surge preparedness trainings and maintains a database of approximately 70 trained surge personnel, the 2024 Joint External Evaluation (JEE) noted the absence of a national surge deployment framework outlining systems for pre-deployment, deployment, and post-deployment of response teams. Although a national surge strategy is reportedly available, it is not publicly accessible, making it difficult to assess the scope or operational readiness of Botswana’s health workforce surge capacity. ⁵²⁴
In June 2022, seventy representatives from various government agencies and institutions in Botswana received training to strengthen their capacity to respond to public health emergencies. Conducted with support from the World Health Organization (WHO), Africa Centres for Disease Control and Prevention (Africa CDC), and other partners, the initiative was part of the WHO AFRO flagship programme “Strengthening and Utilizing Response Groups for Emergencies” (SURGE). The training aimed to equip a multidisciplinary team with the knowledge and skills necessary for emergency coordination, incident management, and rapid deployment using an all-hazards approach. A key outcome was the establishment of a national roster of trained personnel to be deployed within 24–48 hours during emergencies, supported by logistical resources such as an ambulance, vehicles, interoperable stock systems, and subnational warehouse hubs. A roadmap and Memorandum of Understanding between the Ministry of Health and WHO were also agreed upon, though the full national surge deployment plan is not publicly available. ⁵²⁵

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no publicly available plan in place that outlines how Botswana would receive and integrate international health personnel during a public health emergency. While Botswana has partnered with Organizations like the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (Africa CDC) on training and preparedness initiatives—including the SURGE programme, which supports regional response capacity—there is no documented or accessible national framework specifying protocols for the reception, coordination, and deployment of foreign medical teams in an emergency. ⁵²⁶

4.3.2c Plan to redeploy existing health personnel within the country

Score: 0

Botswana does not have a plan in place to redeploy existing health personnel within the country. Rather than being governed by a pre-established, enduring national plan, staff redeployment has been treated operationally within existing emergency responses. For instance, during the COVID-19 outbreak, nurses and other clinical staff were temporarily reassigned from routine service roles to COVID‑19 isolation centers, screening posts at border facilities, and community outreach activities, a practice documented in a 2022 review showing structured staff repositioning at district and national levels within existing workforce pools. ⁵²⁷ While this ad hoc redeployment reflects practical flexibility, there is no publicly accessible national policy or formal plan that systematically outlines role-based or geographic redeployment procedures for emergencies beyond COVID‑19. Further, the 2024 Joint External Evaluation (JEE) noted the absence of a national surge deployment framework outlining systems for pre-deployment, deployment, and post-deployment of response teams and called for a "comprehensive deployment framework/plan" (p. 47).

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 0

Botswana’s Constitution does not explicitly guarantee a general right to health or medical care. It outlines fundamental rights such as the right to life, and allows the state to restrict liberties for public health reasons, for instance, to prevent the spread of infectious diseases. ⁵²⁸ There is no specific constitutional provision affirming universal healthcare access or free medical treatment for all citizens. ⁵²⁹ Despite the absence of constitutional guarantees, Botswana’s public healthcare system effectively provides free services through government-run facilities. These include outpatient services, inpatient care, laboratory tests, and medications, particularly for citizens and at subsidized rates for others. ⁵³⁰⁵³¹ Access is achieved through health policies and national plans, but not established as a justiciable right. ⁵³²⁵³³

4.4.1b Access to skilled birth attendants (% of population)

Score: 100

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 93.81

4.4.1d Coverage of essential health services through universal health coverage

Score: 58.33

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 89.43

4.4.1f Rate of mortality amenable to health care

Score: 37.33

4.4.2a Guaranteed paid sick leave

Score: 66.67

In Botswana, employees are guaranteed paid sick leave, but there is insufficient publicly available evidence to confirm that Botswana’s paid sick leave provisions explicitly include mental health conditions. As per the Employment Act of 2000 (amended in 2020), employees are legally entitled to at least 14 working days of paid sick leave per year after one month of continuous employment, with the possibility of more if medically certified. If necessary, an additional 14 days of unpaid sick leave may be granted, depending on the employer's discretion. Employers must pay full basic wage during this sick leave period. ⁵³⁴ According to the Social Security Programs Throughout the World report from 2019, while the Employment Act mandates a minimum of 20 days of certified sick leave annually, there is no statutory cap on additional leave if justified by medical assessment. ⁵³⁵ The law applies to any illness or incapacity certified by a medical officer, but it does not specifically reference mental health. Public healthcare in Botswana provides medical benefits, including mental health care, via government clinics and hospitals, but there is no clear evidence that such care is formally integrated into the sick leave framework. ⁵³⁶

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no publicly available evidence that the government has issued legislation, a policy or a public statement committing to provide prioritised health care services to healthcare workers who become sick as a result of responding to a public health emergency.
Although general protections exist under occupational health and safety frameworks—such as the Workers’ Compensation Act, which covers injuries and illnesses arising from employment—there is no dedicated provision ensuring priority treatment or support for frontline health workers in emergency contexts. Similarly, while the Public Health Act (2013) empowers authorities to manage and control public health risks, it does not include clauses granting healthcare workers preferential access to care or benefits during outbreaks. As a result, Botswana currently lacks a formal mechanism guaranteeing prioritization of health services for healthcare personnel exposed during epidemic or pandemic response. ⁵³⁷⁵³⁸ The government COVID-19 website has no details of such a commitment. ⁵³⁹ Prioritized healthcare services for healthcare workers who become ill on duty is not mentioned in any of: the Joint External Evaluation (2017 and 2024), the Ministry of Health's "National Health Quality Standards: Standards & Guidelines for Emergency Medical Services" (2013), the Public
Health Act (2013), the National Health Policy (2011) or the National Disaster Risk Management Plan (2009). ^{540541542543544}

4.5.1a Existence of system for communication during a public health emergency

Score: 100

Botswana has a system in place for public health officials and healthcare workers to communicate during a public health emergency.
Based on the 2024 Joint External Evaluation (JEE) report, Botswana does have mechanisms in place for communication among public health officials and with healthcare workers during public health emergencies, particularly at the district level. These mechanisms were demonstrated during the COVID-19 pandemic and polio outbreak response, reflecting the country’s ability to disseminate risk communication messages effectively. Botswana has developed a Health Promotion Strategy (2018–2022) and a draft National Multi-hazard Risk Communication and Community Engagement (RCCE) Strategy (2023). Once formally endorsed, this strategy is intended to guide coordination and communication during a range of emergencies, including biological, geographical, meteorological, and human-induced hazards. The country has a professional RCCE workforce at both national and district levels, supported by a technical RCCE committee. Partnerships with WHO, UNICEF, and the Botswana Red Cross have further strengthened RCCE capacity. Training programs have been conducted to prepare hospital staff, education officers, and other personnel to manage epidemics and engage effectively with communities. However, the RCCE system is not yet implemented in a systematic manner. Delays in the formal endorsement of the national RCCE strategy, limited resources, inadequate community consultation, and the absence of two-way feedback mechanisms limit its overall effectiveness. Additionally, there is no dedicated team of trained spokespersons for emergency situations, which weakens coordinated communication efforts during crises. Despite these limitations, Botswana’s internal communication channels—such as toll-free hotlines and digital media—provide some infrastructure for information dissemination during health emergencies. ⁵⁴⁵

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

There is insufficient evidence to suggest Botswana's system for public health officials and healthcare workers to communicate during an emergency encompasses healthcare workers in both the public and private sector.
Based on the 2024 Joint External Evaluation (JEE) report, Botswana does have mechanisms in place for communication among public health officials and with healthcare workers during public health emergencies, particularly at the district level. These mechanisms were demonstrated during the COVID-19 pandemic and polio outbreak response, reflecting the country’s ability to disseminate risk communication messages effectively. Botswana has developed a Health Promotion Strategy (2018–2022) and a draft National Multi-hazard Risk Communication and Community Engagement (RCCE) Strategy (2023). Once formally endorsed, this strategy is intended to guide coordination and communication during a range of emergencies, including biological, geographical, meteorological, and human-induced hazards. However, there is no evidence that this system includes private sector health workers. ⁵⁴⁶

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

Botswana has no national public health system monitoring and tracking the number of healthcare associated infections (HCAI) that take place in healthcare facilities. However, the country has taken initial steps toward monitoring healthcare-associated infections (HCAIs) at the facility level.
There is partial evidence of national efforts to monitor healthcare-associated infections (HCAIs) in Botswana, but capacity remains limited. While certain private and mine hospitals in Botswana are engaged in healthcare-associated infection (HCAI) surveillance, these efforts lack nationwide standardization and coordination. The 2024 Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) specifically notes that "The absence of a national HCAI surveillance plan hampers the guidance and coordination of HCAI
surveillance at various levels across all pertinent sectors" (p.55). ⁵⁴⁷
A 2019 study at Nyangabgwe Hospital (a tertiary referral centre in Botswana), which conducted a point prevalence survey and found that 13.5% of inpatients had healthcare‑associated infections (HAIs), also echoed similar notions as the 2024 JEE report, claiming that "the prevalence of HAIs in Botswana hospitals is currently unknown" (p. 2). The study also highlighted that some hospitals have started monitoring HAIs "due to the requirements of the health-care accreditation process, this is currently not standardized" (p.2). ⁵⁴⁸

4.6.1b Infection prevention and control programme

Score: 100

Botswana has an infection prevention and control programme in place nationally.

The Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024 confirms that “Botswana has demonstrated some capacity in implementing the IPC programme,” (p. 54) with a designated national IPC focal person, national guidelines disseminated to healthcare providers, and a draft IPC Strategic Plan (2024–2028) developed—though not yet finalized. Over 80% of healthcare workers and IPC focal persons have received IPC training, and “IPC committees have been established at the intermediate level to oversee the implementation of the eight core components of IPC.” However, challenges remain, including limited funding, no designated IPC positions in the health workforce structure, and no monitoring and evaluation system in place to assess compliance. ⁵⁴⁹

Botswana has an established Infection Prevention and Control (IPC) programme in place, as evidenced by the official document "Botswana Hospital Standards SE 9 – Prevention and Control of Infection" published by the Ministry of Health and Wellness in 2014. This hospital standard prescribes in Section 9.1 the systematic requirements for IPC, including the development and implementation of a hospital-wide IPC programme, allocation of necessary resources, and assignment of staff responsibilities for infection control. The document requires each hospital to maintain a functional IPC committee and deliver training for personnel. ⁵⁵⁰

4.6.1c National plan to ensure a safe environment in health facilities

Score: 100

Botswana has established a policy framework to ensure safe environments in health facilities, primarily through the development and implementation of national quality standards for hospitals and clinics. These standards include specific requirements for infection prevention and control (IPC), such as the presence of functional IPC committees, appropriate waste management, availability of personal protective equipment (PPE), and ongoing staff training in IPC practices. ⁵⁵¹ The Botswana National Health Quality Standards for Hospitals and Clinics both explicitly mandate risk assessment procedures, regular audits, and the implementation of IPC protocols aligned with WHO guidance ⁵⁵². Furthermore, Botswana’s Essential Health Service Package requires primary care facilities to maintain essential IPC capacities, including safe patient flows, sterilization systems, and surveillance for nosocomial infections. ⁵⁵³ In support of these efforts, the National Health Emergency Response Operations Plan (NHEROP) was reportedly launched in August 2023 to build resilience across health facilities during public health emergencies, with a multi-sectoral approach that includes IPC capacity-building and facility-level safety planning. ⁵⁵⁴ These initiatives are underpinned by legal mandates in the Public Health Act, which codifies infection control responsibilities, reporting duties, and facility requirements across the health sector. ⁵⁵⁵ The Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024, gave Botswana a score of 2 for this indicator (p. 55). This rating is supported by the existence of the Botswana Health Facility Standards Manual, which provides healthcare facilities with standardized protocols for ensuring a clean and safe environment. The country also possesses resources to support the implementation of essential water, sanitation, and hygiene (WASH) measures, which help reduce healthcare-associated infections (HCAIs) and enhance patient safety. However, Botswana faces significant challenges in ensuring safe environments in health facilities due to a shortage of isolation facilities in both clinics and hospitals, as well as overcrowded wards—particularly in clinics—which undermine effective infection control and safe care practices (p. 56). ⁵⁵⁶

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

There is a national requirement for ethical review before beginning a clinical trial.
In Botswana, all clinical trials are subject to a mandatory ethical review process prior to initiation. The Ministry of Health & Wellness outlines this process in its 2012 Guideline for Regulating the Conduct of Clinical Trials Using Medicines in Human Participants, which states under Section 4 that ethical clearance must be obtained from a recognized Research Ethics Committee (REC) at the relevant trial site. In addition, all protocols must be reviewed and approved by the Health Research and Development Committee (HRDC), which functions as the national ethics committee. Investigators are also required to secure regulatory authorization from the Drug Regulatory Unit (DRU). ⁵⁵⁷⁵⁵⁸These approvals ensure that clinical trials align with international standards, including the Declaration of Helsinki and Good Clinical Practice (GCP) guidelines. While some institutional IRBs—such as the University of Botswana IRB—can help expedite the process, national-level review by HRDC can take several months due to limited resources and administrative delays. ⁵⁵⁹

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

Botswana does not have an expedited process for approving clinical trials for unregistered medical countermeasures (MCM) or mutual recognition of clinical trial results taking place elsewhere to treat ongoing pandemics or epidemics.
Its 2012 Clinical Trial Guidelines require standard ethical review and full regulatory approval before trials can begin, without provisions for faster review or emergency pathways. They do not include pandemic-related fast-track mechanisms. ⁵⁶⁰⁵⁶¹ The ethical review process for research was the focus of a study published in 2018 ("A case study of researchers' knowledge and opinions about the ethical review process for research in Botswana"), which notes that the "majority of proposals, which often qualified for expedited review, were reviewed by the secretariat and committee members outside of the IRB meeting". However, it does not define which protocols qualify or reference any that address ongoing outbreaks. ⁵⁶²
However, Botswana is party to the Southern African Development Community (SADC) Emergency Use Authorization (EUA) framework, adopted in 2022, which enables Member States to fast-track the assessment and approval of MCMs during public health emergencies, including those already approved by trusted regulatory authorities or prequalified by the World Health Organization (WHO). ⁵⁶³ The framework provides a legal and regulatory pathway for authorizing medical products, such as vaccines or therapeutics, in response to pandemics or emerging infectious diseases. Nevertheless, as of July 2025, there is no public evidence that BOMRA has activated this mechanism or incorporated it into national policy or practice, and Botswana’s EUA capabilities remain theoretical until formally adopted through a domestic regulatory update. ⁵⁶⁴

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

Botswana has a government agency responsible for approving new medical countermeasures (MCM) for humans.
In Botswana, responsibility for approving new medical countermeasures—such as unregistered drugs, vaccines, or devices—rests with the Botswana Medicines Regulatory Authority (BoMRA), which operates under the Medicines and Related Substances Act (2013). BoMRA's mandate includes the evaluation, approval, and authorization of clinical trials and medical products for use within the country medical countermeasures. ⁵⁶⁵ Before BoMRA took over, these responsibilities were managed by the Drug Regulatory Unit (DRU) under the Ministry of Health & Wellness. The DRU continues to function within the Ministry, primarily handling operational and regulatory duties such as reviewing trial applications, but is now part of the MoH supervisory structure rather than serving as the autonomous national authority. ⁵⁶⁶
BoMRA participates in regional harmonization initiatives such as the Southern African Development Community (SADC) Medicines Regulatory Harmonization Program, which supports faster and collaborative assessments of essential medical products, particularly during public health emergencies. ⁵⁶⁷

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 0

Botswana currently does not have a publicly documented expedited national process for approving unregistered medical countermeasures (MCMs) during public health emergencies. Its existing regulatory system, overseen by the Botswana Medicines Regulatory Authority (BoMRA) and formerly the Drug Regulation Service, requires full review and approval under standard regulations, without specific accelerated pathways even during crises such as pandemics, not reflected in BoMRA’s clinical trials or licensing guidelines. ⁵⁶⁸⁵⁶⁹
However, Botswana is a party to the Southern African Development Community (SADC) Emergency Use Authorization (EUA) framework adopted in 2022. This regional framework, which aligns with WHO’s Emergency Use Listing, offers a structured pathway for SADC member states to expedite the authorization of unregistered or WHO-approved MCMs during emergencies. It includes mechanisms such as: forming expert review committees, using reliance on regulatory authorization from trusted agencies, setting post-market conditions, and enabling rapid review and issuance of EUAs by national regulatory authorities. ⁵⁷⁰

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Botswana has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁵⁷¹

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 100

In Botswana, epidemics and pandemics are included within the broader National Disaster Risk Reduction Strategy rather than addressed through a separate standalone plan. The 2013–2018 National Disaster Risk Reduction Strategy situates animal disease outbreaks (e.g., bovine pleuropneumonia) and public health emergencies under its multi-hazard approach—explicitly incorporating early warning mechanisms for infectious diseases alongside natural disasters like floods and droughts. ⁵⁷² Health emergencies like epidemics and pandemics are reportedly addressed in the Botswana National Health Emergency Response Operation Plan, which is designed to function within the broader national disaster risk governance structure. While the full plan is not yet publicly available, it is expected to outline systems for preparedness, detection, response, and recovery related to public health emergencies, including outbreaks. This complements Botswana’s overarching National Disaster Risk Reduction Strategy (2013–2018), which integrates biological threats as part of its multi-hazard approach. ⁵⁷³
There is no publicly available evidence that Botswana has replaced or updated its National Disaster Risk Reduction Strategy (2013–2018) with a revised version covering subsequent years. The Ministry responsible, historically the National Disaster Management Office (NDMO) within the Office of the President, has not released a new standalone nationwide risk reduction strategy post-2018, and the 2013–2018 strategy remains the most recent official framework. ⁵⁷⁴⁵⁷⁵

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 100

Botswana has established and actively implements cross-border and regional agreements to coordinate responses to public health emergencies.
According to the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024 Botswana participates actively in cross-border efforts with neighboring countries to exchange information and coordinate responses to public health challenges. This includes holding regular meetings at both district and national levels, and engaging in regional initiatives such as those led by the Southern African Development Community (SADC) and the Africa Centres for Disease Control and Prevention (Africa CDC), which support collaborative planning and information sharing during public health emergencies. ⁵⁷⁶
Furthermore, the US Centers for Disease Control (CDC) and Prevention’s Division of Global Migration and Quarantine, in partnership with the Health Systems Trust, jointly implemented a capacity-building project among eight Southern African countries during 2022, including Botswana. This initiative established joint protocols for communicable disease detection, isolation, and referral at points of entry covering both health and immigration services around COVID-19 and other health threats. According to a study evaluating the cooperation, the project enhanced the Botswana’s capacity to meet International Health Regulations when responding to communicable disease outbreaks and concluded that the results demonstrate that ongoing engagement, continuous improvement of standard operating procedures, and multilateral agreements that align national priorities with global health obligations are both feasible and effective. ⁵⁷⁷
Additionally, Botswana is a member of the SADC Humanitarian and Emergency Operations Centre (SHOC), which coordinates regional disaster preparedness and emergency response efforts across member states, including public health emergencies. Yet there is no clear national reporting on how this has translated into regular coordination or shared operational SOPs across borders ⁵⁷⁸

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 100

Botswana maintains active cross-border cooperation with neighboring countries to manage and respond to animal health emergencies, particularly those involving transboundary animal diseases (TADs).
In 2023, Botswana participated in a regional veterinary coordination meeting with Angola, Namibia, Zambia, and Zimbabwe. The meeting, held in Katima Mulilo, Namibia, focused on harmonizing approaches to control diseases such as foot-and-mouth disease (FMD), contagious bovine pleuropneumonia (CBPP), peste des petits ruminants (PPR), highly pathogenic avian influenza (HPAI), and rabies. Key areas of collaboration included the establishment of joint surveillance systems, coordination of vaccination campaigns, and improving infrastructure for cross-border movement control, especially in border zones within the Kavango-Zambezi Transfrontier Conservation Area (KAZA TFCA). ⁵⁷⁹
At the regional level, Botswana is an active member of the Southern African Development Community (SADC), which provides a broader institutional framework for addressing animal health threats. Through the SADC Protocol on Health and its Animal Health Sub Programme, member states coordinate disease surveillance and control strategies. These include shared early warning systems, harmonized import/export standards, and the development of regional vaccine banks. The Agricultural Information Management System (AIMS) under SADC also facilitates information sharing and the implementation of joint preparedness plans for TADs across the region. ⁵⁸⁰
Internationally, Botswana aligns with the World Organisation for Animal Health (WOAH, formerly OIE) guidelines and has achieved disease-free status for certain TADs, including CBPP and PPR. These certifications are often the result of coordinated surveillance, border quarantine measures, and animal identification systems that conform with WOAH standards. Cross-border collaboration is crucial in maintaining these statuses, as Botswana shares porous borders with countries where TADs are endemic. The government’s adherence to WOAH protocols is supported by the presence of the Botswana Vaccine Institute (BVI), which produces key vaccines for domestic and regional use, strengthening emergency preparedness throughout Southern Africa. ⁵⁸¹
Botswana is also involved in One Health regional initiatives, such as the Southern Africa Disease Surveillance and Response Strategy, which is co-financed by the Pandemic Fund. This initiative includes countries such as Lesotho, Malawi, Mozambique, Namibia, South Africa, and Zimbabwe, and aims to strengthen national and cross-border capacities to detect, monitor, and respond to zoonotic disease outbreaks. Activities include the development of interoperable surveillance systems, joint simulation exercises, and the standardization of protocols for multi sectoral response coordination at points of entry. ⁵⁸² Complementing these efforts, the Africa Centres for Disease Control and Prevention (Africa CDC) and SADC have supported the development of Standard Operating Procedures (SOPs) and memoranda of understanding (MoUs) that facilitate border health management across human and animal health sectors. ⁵⁸³

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

Botswana is a State Party to the Biological Weapons Convention (BWC), having ratified the treaty on 5 February 1992. This step carries the same legal weight as full ratification. It confirms that Botswana is bound by international obligations to prohibit, prevent, and penalize the development, acquisition, stockpiling, and use of biological weapons. Additionally, in 2018, Botswana enacted the Biological and Toxin Weapons (Prohibition) Act, further integrating these prohibitions into national law and designating enforcement responsibility to relevant domestic authorities. ^584585586

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 100

Botswana has submitted Biological Weapons Convention (BWC) Confidence-Building Measures (CBMs) in the past three years. According to the official UN database maintained by the UN Office for Disarmament Affairs (UNODA), Botswana’s profile shows 4 submissions of CBM reports, for years 2022, 2023, 2024, and 2025. ⁵⁸⁷

5.3.1c Submission of UNSCR 1540 reports

Score: 100

Botswana submitted its United Nations Security Council Resolution (UNSCR) 1540 report to the Security Council Committee established pursuant to resolution 1540 (1540 Committee) on 18 April 2008. This remains its only publicly posted submission, with no updated matrices or annual reports added to the 1540 Committee records since then. ⁵⁸⁸⁵⁸⁹

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 0

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

Botswana does not hold a membership in any of the listed Organizations.
Botswana is not a member of the Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (often simply called the “Global Partnership” or GP). However, Botswana does engage with GP-funded initiatives—particularly on capacity-building and BWC implementation workshops in Southern Africa—but this does not equate to formal membership. ⁵⁹⁰
The Australia Group currently consists of 42 countries plus the European Union, all of which are parties to both the Chemical Weapons Convention (CWC) and the Biological Weapons Convention (BWC). Botswana is not listed among these participating states. However, the AG does allow non-members to become “adherents” by notifying the Chair of their intent to align with AG guidelines—though Botswana has not indicated such adherent status. ⁵⁹¹
Botswana is not a member of the Proliferation Security Initiative (PSI). The PSI is a voluntary, action‑based framework in which countries become participants by formally endorsing the PSI Statement of Interdiction Principles—making a political commitment to interdict WMD trafficking. As of the most recent public list (19 November 2024), over 100 states have endorsed the PSI. However, Botswana is not included among the endorsing states. ⁵⁹²

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 100

Botswana completed a Joint External Evaluation (JEE) using the WHO’s third‑edition JEE tool in March 2024, and the full mission report is publicly available as of June 2025. This evaluation assessed all International Health Regulations (IHR) core capacities through on‑site visits, stakeholder interviews, and technical area scoring, identifying gaps and priorities for enhancing health security. ⁵⁹³⁵⁹⁴ Botswana also conducted a prior JEE in December 2017. ⁵⁹⁵

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

Botswana has not completed a Performance of Veterinary Services (PVS) evaluation follow-up mission within the last five years. The most recent PVS follow-up assessment by the World Organisation for Animal Health (WOAH, formerly OIE) took place in May 2019, which is now over six years ago. While the final report from that mission is publicly available, there is no evidence of a more recent PVS evaluation conducted or published since then. ⁵⁹⁶

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

Botswana has not completed a Performance of Veterinary Services (PVS) gap analysis within the last five years. According to the World Organisation for Animal Health (WOAH, formerly OIE) PVS Pathway status, Botswana’s most recent PVS gap analysis was completed in 2011, following an initial PVS evaluation mission in 2010. This was followed by a PVS evaluation follow-up mission in May 2019, but no new gap analysis missions have been conducted or published since then. While the 2019 follow-up report is available and publicly accessible, no updated gap analysis aimed at identifying veterinary service deficiencies for strategic planning or resource prioritization has been released in the past five years. ⁵⁹⁷

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 0

There is insufficient evidence to suggest that Botswana has allocated national funds to improve capacity to address pandemic or epidemic threats within the past three years.
According to the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024, Botswana lacks developed financial resource plans specifically designated for public health emergency response, resulting in funding that is mobilized and distributed on an ad hoc basis when emergencies occur. This limitation led to an external evaluation score of 1, consistent with the country’s self-assessment. Nonetheless, Botswana demonstrated the ability to mobilize funds during the COVID-19 pandemic by establishing a dedicated resource pool to support response efforts. In addition, the country has benefited from financial and technical assistance provided by external partners such as the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and the United States Centers for Disease Control and Prevention (CDC), particularly prior to January 2025. Despite these strengths, Botswana still faces significant challenges due to the absence of dedicated financial resources for emergency response and the lack of clearly documented mechanisms or guidelines for the mobilization, distribution, and monitoring of such funds. ⁵⁹⁸
The Minister of Finance introduced the 2024/2025 national budget before Parliament on 5 February 2024. During her speech, the Minister reaffirmed the Government’s strong commitment to fulfilling its promises to the people of Botswana and noted the country has successfully navigated the challenges posed by the COVID-19 pandemic. For the 2024/2025 financial year, she introduced an expansionary budget designed to stimulate the economy by fostering greater inclusivity, innovation, and knowledge-based development. However, the detailed budgetary plan is not publicly available, so it remains unclear whether specific national funds have been allocated to improve capacity to address pandemic or epidemic threats. ⁵⁹⁹

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 0

There is insufficient evidence that Botswana allocates or describes specific funding from the national budget covering a time-period either in the future or within the past five years to address the identified gaps.
According to the Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024, the Government of Botswana prioritizes healthcare, having allocated 14% of the national budget to the Ministry of Health in 2019 as per the National Health Accounts 2023 report. ⁶⁰⁰ However, the JEE 2024 does not provide information on future or planned health security expenditures. While Botswana has successfully developed its National Action Plan for Health Security (NAPHS), the document is not publicly available. As a result, although it may contain specific funding allocations for priority actions, there is no way to verify whether national resources have been earmarked for improving epidemic and pandemic preparedness. ⁶⁰¹
Budget documents such as the Budget-in-Brief 2024–2025 and Committee of Supply speeches detail allocations for routine health services (e.g. drugs, vaccines, infrastructure) but do not link to NAPHS objectives. ⁶⁰²⁶⁰³ A review of publicly available appropriations, including analyses by development partners and audit firms, confirms this lack of direct allocation or ring-fenced funding. ⁶⁰⁴⁶⁰⁵

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

Botswana's Performance of Veterinary Services (PVS) gap analysis does not allocate or describe specific funding from the national budget to address the identified gaps. The country's 2019 PVS follow-up report acknowledges government support through a sustainable and sizeable recurrent budget for veterinary services, including the ability to reallocate funds for emergency responses, such as foot-and-mouth outbreaks. ⁶⁰⁶ However, the report makes no mention of dedicated, costed funding in the national budget aimed specifically at addressing gaps identified by the PVS gap analysis process. Instead, it describes case-by-case funding mechanisms that rely on contingency reallocations rather than ring-fenced resources aligned with strategic PVS priorities. The gap analysis specifically notes that the "emerging animal disease threats and arising challenges warrant consideration of an increase to emergency funding under the National Development Plan" (p.3). ⁶⁰⁷

5.5.3a Emergency public financing during a public health emergency

Score: 0

Botswana has no special emergency public financing mechanism which the country can access in the face of a public health emergency.
The Joint External Evaluation (JEE) report conducted by the World Health Organization (WHO) in March 2024 specifically notes that "Botswana lacks developed financial resource plans specifically designated to support response efforts during public health emergencies" and further adds that "funds are allocated and distributed in an ad hoc manner when such emergencies arise" (p. 12). ⁶⁰⁸
However, Botswana has demonstrated its ability to rapidly mobilize public financing through emergency decrees, sectoral appropriations, and access to regional multilateral funds. For example, during the COVID‑19 pandemic, the government rapidly established a COVID‑19 Relief Fund with 2 billion Botswana pula (~USD 170 million) in seed funds to support response activities suggesting the use of ad hoc public financing in emergencies. ⁶⁰⁹ Moreover, legal authority for public health emergencies comes from the Emergency Powers Act (1966) and Public Health (Declaration of a Public Health Emergency) Order 2020 created under it, both providing a legal basis to mobilize emergency resources, though no permanent health-dedicated fund exists within this framework. ⁶¹⁰ Moreover, Botswana participates in the African Public Health Emergency Fund (APHEF), a regional financing mechanism under the Southern African Development Community (SADC), supported by the World Health Organization Regional Office for Africa. APHEF is designed to provide “ready cash” to member countries to respond rapidly to public health emergencies, with a recommitted annual target of US $50 million, including a US $30 million revolving fund managed by WHO AFRO in Brazzaville. ⁶¹¹⁶¹²

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 100

Botswana's leadership has made both regional and domestic commitments over the past three years to bolster epidemic and pandemic preparedness.
During his speech at the UN General Assembly, President Mokgweetsi Masisi stated that “Botswana is building capacity to manufacture vaccines for humans and animals.” He also highlighted the designation of Botswana’s National HIV Reference Laboratory as a WHO Collaborating Centre, underscoring a direct government effort to boost domestic public health infrastructure and preparedness.
In the 2024/2025 budget presentation to Parliament on 5 February 2024, the Finance Minister explicitly reflected on lessons from COVID-19, stating that “the COVID-19 pandemic has underscored the need for us to be prepared for future pandemics, as well as build resilience to withstand any shocks to our economy.” She emphasized the importance of the government’s ability to reallocate financial resources strategically in response to crises
At the 77th World Health Assembly in May 2022, Health Minister Dr. Edwin Dikoloti publicly committed to “capacitate the World Health Organization country offices and enable them to support countries with normative and technical guidance,” signaling Botswana’s support for strengthening regional and global health capacity. ⁶¹³
During the COVID‑19 pandemic, President Mokgweetsi E.K. Masisi, chaired the national task force and declared the response a “number one governmental project,” demonstrating high-level domestic political commitment to bolster national COVID‑19 response capacity. ⁶¹⁴ He also emphasized Botswana’s commitment to regional health security by reaffirming the Abuja Declaration pledge to allocate at least 15% of national budget to health, strengthening domestic financing for health systems and emergency preparedness. ⁶¹⁵

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

Botswana has actively received technical support and financing through regional pandemic preparedness mechanisms in the past three years. Specifically, in a Pandemic Fund–financed project launched in 2023, Botswana joined seven other Southern African countries—including Lesotho, Malawi, Mozambique, Namibia, South Africa, Zimbabwe, and Madagascar in receiving USD $36 million (plus USD $12 million in co-financing) to strengthen One Health disease surveillance, laboratory capacity, workforce development, and early warning systems. ⁶¹⁶⁶¹⁷ Botswana has also received technical support from international partners, such as the World Health Organization (WHO) Regional Office for Africa and the Africa Centres for Disease Control and Prevention (Africa CDC) to coordinate pandemic and epidemic preparedness initiatives, including joint proposal development and integrated surveillance efforts with regional laboratories and health institutes. ⁶¹⁸⁶¹⁹ However, there is no public evidence that Botswana has provided financing or technical support to other countries for addressing epidemic or pandemic threats during the past three years.

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 100

Botswana has partially fulfilled its assessed contributions to the World Health Organization (WHO) within the past two years. According to the WHO Assessed Contributions Overview for All Member States (as at 31 December 2023), Botswana had no outstanding balance for 2023, indicating that it met its financial obligations in full for that period. ⁶²⁰ However, the Seventy-eighth World Health Assembly (WHA 78) Status of Collection of Assessed Contributions report (May 2024) shows an outstanding balance for Botswana’s 2024 assessment, suggesting that the most recent payment cycle had not yet been completed at the time of reporting. ⁶²¹ Consequently, while Botswana has demonstrated timely contribution for 2023, it cannot be confirmed that the country fulfilled its full assessed contribution for 2024.

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

Botswana has no a publicly available plan for sharing genetic data, clinical specimens, and isolated specimens (biological materials) along with the associated epidemiological data with international Organizations and other countries that goes beyond influenza. While, the 2024 Joint External Evaluation (JEE) confirms that Botswana has a draft National Policy on Access to Human Biological Material and Equitable Benefit-Sharing as of 2024, the policy remains officially in progress indicating that it has not yet been enacted or officially adopted as national law or formal government policy. The draft plan, once adopted, will clearly indicate a publicly available mechanism for sharing genetic data, clinical specimens, isolated biological materials, and associated epidemiological data beyond influenza. Developed in collaboration between the Ministry of Health and the World Health Organization Botswana Country Office, the policy incorporates material transfer agreements, rights protections for both providers and recipients, and governance systems.⁶²²⁶²³

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

There is no public evidence that Botswana has failed to share influenza virus samples in accordance with the World Health Organization’s (WHO) Pandemic Influenza Preparedness (PIP) Framework in the past two years. The WHO PIP Framework portal provides global information on virus sharing and benefit-sharing arrangements but does not include country-specific implementation data. ⁶²⁴ Nevertheless, Botswana participates actively in influenza surveillance through the Global Influenza Surveillance and Response System (GISRS), which facilitates the timely sharing of influenza virus samples and related data. The WHO Regional Office for Africa has also reported that Botswana’s High-Level Implementation Plan (HLIP) supports GISRS operations and strengthens national capacity to identify and share influenza viruses with pandemic potential. ⁶²⁵⁶²⁶

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

There is no public evidence that suggests Botswana has not shared pandemic pathogen samples during an outbreak in the past two years.
On the contrary, Botswana has publicly shared pathogen samples—notably SARS‑CoV‑2 genome sequences—during outbreaks in the past two years, indicating compliance with global sharing expectations. ⁶²⁷ Furthermore, during the emergence of the Omicron variant, high-throughput sequencing in Botswana, in collaboration with regional partners, produced complete viral genomes—some included alongside data from Benin and South Africa—demonstrating active participation in outbreak-sample sharing. ⁶²⁸ Botswana’s sequencing data also played a key role in regional surveillance efforts, contributing information that helped flag Omicron through networks like the Africa CDC and South Africa’s genomic surveillance platforms. ⁶²⁹

6.1.1a Policy formation

Score: 75

6.1.1b Quality of bureaucracy

Score: 50

6.1.1c Excessive bureaucracy/red tape

Score: 50

6.1.1d Vested interests/cronyism

Score: 50

6.1.1e Corruption

Score: 57

6.1.1f Accountability of public officials

Score: 50

6.1.1g Human rights risk

Score: 75

6.1.2a Orderly transfers of power

Score: 100

6.1.3a Risk of social unrest

Score: 75

6.1.4a Risk of terrorism

Score: 100

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 75

6.1.5a Presence or risk of armed conflict

Score: 100

6.1.6a Government territorial control

Score: 100

6.1.7a International tensions

Score: 75

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 86.03

6.2.2a UNDP Gender Inequality Index score

Score: 42.6

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 76.63

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 33.33

6.2.4a Public confidence in government

Score: 100

6.2.5a Robust, open, diverse local media and reporting

Score: 100

6.2.6a Gini coefficient

Score: 45.1

6.3.1a Adequacy of road network

Score: 50

6.3.2a Adequacy of airports

Score: 75

6.3.3a Adequacy of power network

Score: 0

6.4.1a Urban population (% of total population)

Score: 23.4

6.4.2a Change in forest area (percentage points)

Score: 51.66

6.4.3a Natural disaster risk

Score: 75

6.5.1a Total life expectancy (years)

Score: 66.68

6.5.1b NCD mortality rate

Score: 88.71

6.5.1c Population aged 65+

Score: 81.96

6.5.1d Tobacco use (% of adults)

Score: 30.31

6.5.1e Level of adult obesity (%)

Score: 31.77

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 65.86

6.5.2a Access to potable water

Score: 91.99

6.5.2b Access to at least basic sanitation facilities

Score: 71.96

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 72.92

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 73.64

6.5.4a Trust medical and health advice from the government

Score: 50

6.5.4b Trust medical and health advice from medical workers

Score: 50