A system that provides income but leaves many without the care they need
In Botswana, a nation navigating the twin pressures of economic contraction and an aging population, the expansion of old-age pensions has offered a measure of security to hundreds of thousands — yet income alone cannot substitute for the broader architecture of care that dignified aging requires. Over two decades, the elderly population has doubled to nearly 280,000, while the services meant to support their health, mobility, and daily lives have quietly eroded. The story unfolding here is one familiar to many societies: the tendency to measure social progress by what is visible and countable, while the quieter, harder work of care goes underfunded and unseen.
- Botswana's diamond-dependent economy is contracting, and austerity measures are tightening the very budget that aging citizens depend on for survival.
- Pension expansion — though genuinely life-sustaining for many — has crowded out disability grants, destitute allowances, and home-based care programs that older people urgently need.
- Traditional family caregiving networks are fracturing under the weight of HIV's legacy, rural-to-urban migration, and rising female workforce participation, leaving many elderly without anyone to turn to.
- Nearly half of older-person households report food insecurity, and rural communities face compounding deprivations — limited water, sanitation, and healthcare access — with no adequate public response.
- Community organizations are attempting to fill the widening gaps, but without scaled public investment, their reach remains far too small for the magnitude of need.
Botswana's economy is under strain. The diamond sector, which anchors both government revenue and national output, is slowing, and the country is expected to contract this year. Against this backdrop, the government is cutting spending — a collision of forces that is exposing a quiet crisis in how the country cares for its oldest citizens.
Over the past two decades, the population aged 60 and older has doubled to roughly 279,000 people. In 2025, the government responded by lowering the pension eligibility age and raising monthly benefits — popular moves that have become lifelines for many households. But the rapid growth of pension spending has consumed an ever-larger share of the social protection budget, leaving less for everything else. The destitute allowance reaches fewer older people than it did a decade ago. Disability support covers only a fraction of those who need it. Spending on community home-based care has actually declined in real terms, even as demand rises.
The gap this creates is significant, because aging is not only an income problem. It is a question of chronic illness, disability, and the need for daily, hands-on support. Families have historically provided this care, but that system is under pressure. The long-term toll of HIV and AIDS, combined with migration and growing female workforce participation — which rose from 54.9 to 63.4 percent between 2012 and 2023 — has reduced the pool of available family caregivers. Meanwhile, nearly half of older-person households report food insecurity, and rural communities, where most elderly Botswanans live, face the sharpest deprivations.
Poverty among the elderly remains the most acute of any age group, at around 11.9 percent in extreme poverty. Pensions, stretched across multigenerational households, rarely go far enough. Additional programs are difficult to access, dependent on discretionary assessments that many older people find opaque or simply out of reach.
What policymakers face now is a choice about what social protection is actually for. Investing in care services — home-based support, disability assistance, community health infrastructure — is not a luxury alongside pensions but a necessary complement to them. Without this rebalancing, Botswana risks deepening inequality at precisely the moment its most vulnerable citizens need the state most.
Botswana's economy is shrinking. The diamond sector, which supplies roughly a third of the government's tax revenue and a quarter of the nation's entire economic output, is slowing down. This year the economy is expected to contract by 0.4 percent. At the same time, the government is cutting spending to reduce debt and stabilize finances. These two forces—less money coming in, deliberate choices to spend less—are colliding in ways that expose a deepening contradiction in how the country cares for its oldest citizens.
Over the past twenty years, the number of Botswanans aged 60 and older has doubled to roughly 279,000 people, now representing about 8 percent of the population. This is, in one sense, a success story. People are living longer. But it is also a policy crisis that the government has not yet solved. In 2025, Botswana made two significant moves: it lowered the eligibility age for the old age pension from 65 to 60 and increased the monthly benefit. These changes were popular. For many older people, the pension is a lifeline—money for food, transport, basic survival. In a country without unemployment benefits, it often supports entire households, not just individuals. But the rapid expansion of the pension has consumed an ever-larger share of the social protection budget, leaving less money for everything else.
The result is a system that looks successful on paper but is failing in practice. Pension coverage has expanded. Access to other critical support has stagnated or shrunk. The proportion of older people receiving the destitute allowance has fallen significantly over the past decade. Disability support reaches only a small fraction of those who need it. Spending on community home-based care—the service that allows older people to remain in their homes with professional support—has actually decreased in real terms, even as demand for it rises. The government is spending more money on pensions per capita, but not more money overall on care.
This matters because aging is not only about income. It is about chronic illness, disability, and the need for hands-on care. As people live longer, they are more likely to experience multiple health conditions at once. They need help with daily tasks. They need someone to check on them. Botswana's spending patterns suggest the government is not addressing these realities. Traditionally, families have provided this care. But that system is breaking down. The long-term impact of HIV and AIDS, combined with migration and rising female employment, has reduced the pool of family caregivers. Between 2012 and 2023, female labor force participation increased from 54.9 percent to 63.4 percent. Fewer women are available to provide full-time care at home. Many older-person households are large and multigenerational, yet resources are limited. Nearly half report experiencing food insecurity. Many lack access to piped water and sanitation. In rural areas, where most older Botswanans live, these challenges are even more severe.
Poverty among older people remains acute. Around 11.9 percent live in extreme poverty—a higher rate than any other age group. One reason is that the pension is often stretched across entire households. Another is that access to additional assistance is difficult. Programs like the destitute allowance and disability grant rely on discretionary assessments by social workers. Many older people report that these programs are hard to access or simply unavailable. What emerges is a portrait of a social protection system becoming narrower, more dependent on a single program, while other forms of support fade away.
All of this is unfolding in a context of fiscal austerity. As the government seeks to reduce deficits and stabilize the economy, public spending is under pressure. But cuts to social services carry risks. Botswana is already one of the most unequal countries in the world. Reductions in social protection and care services are likely to deepen those inequalities. The country also faces shortages of healthcare workers and infrastructure. Reducing investment in care could have long-term consequences for both social and economic development. Some community initiatives are stepping in to fill gaps, but without stronger public support, they cannot meet the scale of need. What policymakers need now is a shift in thinking—a move away from focusing narrowly on pensions toward a broader view that includes care as a central component. Investing in care services is not just about meeting immediate needs. It can create jobs, support households, and contribute to economic growth. The current moment demands a more balanced approach to spending priorities, one that protects income security while also investing in the public services that allow people to age with dignity.
Notable Quotes
The rapid expansion of the pension has absorbed a growing share of the broader social protection budget, leaving less room for other forms of public support, particularly those related to care.— Analysis of government spending data
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, Professor of Sociology, University of Cape Town
The Hearth Conversation Another angle on the story
Why does it matter that the pension expanded if older people still don't have the care they need?
Because a pension without care is like giving someone money but no way to spend it. If you're frail and alone, money for food doesn't help if you can't get to the market. The pension looks like success—and it is, for income. But it's masked a deeper failure.
So the government is choosing pensions over care?
Not consciously, maybe. But yes, functionally. When you expand one program rapidly, it crowds out others. The budget is finite. Every pula spent on pensions is a pula not spent on home-based care workers or disability support. The government is optimizing for one metric—income coverage—and ignoring another—actual wellbeing.
What happens to an older person in a rural area right now?
They might get the pension. That's real money. But they might also live in a household without piped water, experience food insecurity despite the payment, and have no one to help them bathe or take medication because their daughter moved to the city for work. The pension doesn't solve that.
Is this a problem that money alone can fix?
Not entirely. But it's a problem that the absence of money definitely worsens. You need both—income security and actual care infrastructure. Right now Botswana is betting everything on the first and neglecting the second.
What would a better system look like?
One that treats care as essential, not optional. Community-based care programs, disability support, partnerships with local organizations. These create jobs, support households, and allow people to age in place with dignity. It's not more expensive than the current approach—it's a different allocation of the same resources.