Pensions for Botswana’s elderly are growing, but care services are lacking – study tracks 20 years

“Botswana’s economy is projected to contract by 0.4% in 2026, driven largely by a slowdown in the diamond sector. Diamonds account for a third of fiscal revenues and a quarter of GDP. This means the government has less money to spend, even before making any policy choices. At the same time, the government has set about reducing debt as a share of GDP by cutting expenditure to stabilise the economy. This combination is forcing difficult decisions about public spending. A key one is investment in social protection for older people. Over the past two decades, the number of older persons aged 60+ has doubled to about 279,111 people (roughly 8% of the population). In coming decades, that number is set to rise even more sharply . While this reflects important gains in life expectancy, it also presents a policy challenge: how to support an ageing population in a context of tightening public finances. We have between us expertise in long term care systems, public financing and budget analysis. Our recent study sought to tackle this question by examining how the Botswana government has funded elder care over the last 20 years. We also obtained government data to examine how state spending on older people has evolved over time under various social protection measures. These included the old age pension, destitute programme, disability allowance and war veteran’s allowance, as well as care provision through the home-based care programme. Read more: Botswana’s hike of old age pensions hasn’t fixed the problem of who cares for the elderly – new study Our final report looks at how spending in 2005 compares to spending in 2024-2025, adjusted for inflation to reflect real changes in today’s value, and how these trends correspond with the growth of the older person population. The key insight of the new report is that while Botswana has significantly expanded its old age pension system, investment in care services for older people has not kept pace. Read more: Botswana’s hike of old age pensions hasn’t fixed the problem of who cares for the elderly – new study The result is a system that provides income support but leaves many without the care they need and an underinvestment in the care economy in Botswana. A pension success story: at a cost? Botswana’s old age pension has long been one of the country’s most important social protection programmes. It is universal, meaning all citizens above a certain age qualify, and it has achieved broad reach across both urban and rural areas. In 2025, the government made two major changes: it lowered the eligibility age from 65 to 60 and increased the monthly benefit. These reforms have been widely welcomed. For many older people, the pension provides a crucial lifeline, helping to cover food, transport and other basic needs. In a country without unemployment benefits, it often supports entire households, not just individuals. But this success comes with trade-offs. The rapid expansion of the pension has absorbed a growing share of the broader social protection budget. This has left less room for other forms of public support, particularly those related to care. A hidden crisis of care Ageing is not just about income, it is also about health, disability and the need for care. As people live longer, they are more likely to experience chronic illnesses and multiple health conditions at once. This often leads to increased levels of disability and dependence. Yet Botswana’s spending patterns suggest that these realities are not being fully addressed. Pension coverage has expanded. But access to other support programmes has stagnated or even declined. The proportion of older persons receiving the destitute allowance has fallen significantly over the past decade, and disability support reaches only a small fraction of those who need it. While there has been an increase in total spending, there has not been an increase in total spending in real terms per person. At the same time, spending on community home-based care, a key service that supports older persons in their homes, has decreased in real terms. This is happening despite clear evidence that demand for such services is rising. Families under pressure Care for older people in Botswana has traditionally been provided by families. This model is under increasing strain. A previous report on caregiving indicated how the long-term impact of HIV/Aids, combined with migration and rising female employment, has reduced the availability of family caregivers. Moreover, between 2012 and 2023, female labour force participation increased from 54.9% to 63.4%, meaning fewer women are available to provide full-time care at home. At the same time, many households face significant economic and infrastructural challenges. Older-people households are often large and multigenerational, yet resources are limited. Nearly half report experiencing food insecurity, and many lack access to basic services such as piped water and sanitation. In a few isolated cases there are “voluntary” carers supporting older persons. But serious questions remain about their long-term sustainability. In rural areas, where most older persons live, these challenges are even more pronounced. Poverty persists despite pensions Poverty among older people remains a serious concern. Around 11.9% live in extreme poverty, and they are more likely to be poor than any other age group. One reason is that the pension is often stretched across entire households. At the same time, access to additional assistance is limited. Programmes such as the destitute allowance and disability grant often rely on discretionary assessments by social workers. Many older persons report that these programmes are difficult to access or simply unavailable. This points to a broader issue: Botswana’s social protection system for older people is becoming increasingly narrow, centred on a single programme while other forms of support fall away. These challenges are unfolding in a context of fiscal austerity. As the government seeks to reduce deficits and stabilise the economy, public spending is under pressure. But cuts to social services come with risks. Botswana is already one of the most unequal countries in the world. Reductions in social protection and care services are likely to exacerbate these inequalities. Public services are also under strain. The country faces shortages of healthcare workers and infrastructure. In this context, reducing investment in care could have long-term consequences for both social and economic development. Rethinking social protection The current moment calls for a shift in how social protection is understood. Rather than focusing narrowly on pensions, policymakers need to take a broader view, one that includes care as a central component. Investing in care services is not just about meeting immediate needs. It can also create jobs, support households, and contribute to economic growth. Community-based care programmes, disability support, and partnerships with local organisations all offer pathways to strengthen the system. Across Botswana, community initiatives are already stepping in to fill the gaps. But without stronger public support, these efforts cannot meet the scale of need. What’s needed is a more balanced approach to spending priorities, one that protects income security while also investing in the public services that enable people to age with dignity. Elena Moore receives funding from Welcome Trust 225910/Z/22/Z and the International Development Research Centre, Grant No. 110536 - 001 Thokozile Madonko does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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