Dr. Matlhogonolo Mongwa-Mouwane, a prominent advocate for healthcare reform, has called for urgent and comprehensive changes to Botswana’s private practice policy framework. According to Dr. Mongwa-Mouwane, these reforms are essential for improving primary healthcare in the country and reducing the nation’s dependence on expensive tertiary-level treatments.
Botswana has long envisioned a healthcare system that prioritizes primary care, aiming to lessen its reliance on hospital-based services. Dr. Mongwa-Mouwane points out that early interventions, preventive measures, and community-based services not only contribute to healthier populations but also help alleviate the financial strain of tertiary care, ultimately reducing healthcare costs.
“From an economic perspective, preventive care offers the highest return on investment. It allows resources to be used more efficiently while also promoting a more inclusive, community-centric healthcare model,” Dr. Mongwa-Mouwane explains.
Despite these good intentions, Botswana’s current healthcare policies often clash with the goal of fostering private-sector engagement, especially in primary care. Dr. Mongwa-Mouwane argues that current regulations inadvertently discourage private investment where it is most needed—at the grassroots level of healthcare. Instead, the existing policy framework often directs capital toward tertiary services.
“Data from Harvard research underscores that well-framed incentives and clear regulatory pathways are crucial for attracting private capital,” she says. “Unfortunately, many of our current policies neither reflect global best practices nor address local contexts in a way that encourages private-sector innovation and expansion in primary healthcare.”
One area that Dr. Mongwa-Mouwane highlights as particularly problematic is Botswana’s pharmacy licensing policy. Unlike in many international healthcare systems, where pharmacies are largely operated by corporate entities, Botswana’s current regulations grant pharmacy licenses exclusively to individual practitioners. This, she argues, is detrimental to the development of accessible and affordable frontline services in the country.
“Our emphasis is that corporate ownership—when properly regulated—can significantly boost investment in local healthcare infrastructure,” Dr. Mongwa-Mouwane notes. “It makes it easier to scale services, maintain consistent quality, and direct capital to underserved regions.”
Under Botswana’s current model, where licenses are granted only to individual practitioners, investors face several challenges that undermine their ability to expand and sustain their businesses. These include higher risks, business continuity concerns, and restrictions on the number of pharmacies a single practitioner can operate.
Dr. Mongwa-Mouwane and a team of healthcare experts have outlined five specific ways in which Botswana’s individual-ownership licensing model hinders the country’s primary healthcare objectives:
- Licensing Tied to an Individual, Not a Legal Entity: The reliance on individual ownership makes healthcare ventures vulnerable. If a practitioner retires, encounters legal issues, or leaves for personal reasons, the entire business is at risk.
“A top venture capitalist from a leading global firm explained that stable, corporate-held licenses are crucial for attracting and retaining long-term investors. It’s about continuity and ensuring patient services aren’t at risk when personal factors change,” Dr. Mongwa-Mouwane adds.
- Expansion Limits: The current licensing framework caps the number of pharmacies an individual can operate, stifling expansion efforts. This directly conflicts with Botswana’s objective of extending healthcare services, particularly to rural and underserved areas.
“Entrepreneurial drive is hamstrung when practitioners cannot scale operations. A single individual can run only so many facilities,” Dr. Mongwa-Mouwane explains.
- Emphasis on Nationality and Experience, Not Managerial or Entrepreneurial Skills: The current criteria for licensing place significant focus on a practitioner’s nationality and years of professional experience, rather than on their managerial or entrepreneurial capabilities.
“A Harvard researcher in the policy space highlights that while local empowerment is commendable, it must align with demonstrated capacity. Otherwise, it becomes professional gatekeeping rather than a genuine step toward healthcare inclusion,” Dr. Mongwa-Mouwane notes.
- Capital Flow to Tertiary Care: While individual practitioners face significant barriers, companies operating at the tertiary level, such as large hospitals or specialized centers, can secure multiple licenses. This results in capital flowing away from primary care and toward high-return tertiary services, undermining efforts to reduce hospital admissions through preventive care.
“This contradiction weakens the very emphasis on prevention and early intervention. Capital naturally flows to areas with fewer obstacles and clearer returns,” Dr. Mongwa-Mouwane observes.
- Policy Misalignment: Many of the current licensing rules are grounded in professional exclusivity and citizenship requirements, rather than data-driven insights or global best practices. This misalignment obstructs efforts to enhance local, accessible primary care and reduce the demand for expensive tertiary services.
“This misalignment undermines efforts to reduce hospital admissions by enhancing local, accessible primary care,” Dr. Mongwa-Mouwane stresses.
In conclusion, Dr. Mongwa-Mouwane’s call for reforms is grounded in the belief that a more dynamic, inclusive, and well-regulated private sector in primary healthcare can significantly improve the accessibility and efficiency of the country’s health services. By revisiting policies surrounding pharmacy ownership and corporate involvement, Botswana can better align its healthcare system with global best practices, attract the necessary investment, and work toward its long-term goal of reducing reliance on costly tertiary care.
