The government of Botswana in southern Africa dramatically increased the universal old age pension for all citizens aged 65 and above from P830 (about US$63) to P1,400 (about US$106) per month in 2025. Headlines celebrated the near 70% rise in value. For many older citizens struggling with rising food and transport costs, it appeared to signal a new era of state recognition of elder care.
But if you look closer, the story is less straightforward.
A cash increase is something you can measure, and you can see who gets it. But it does not address the deeper question confronting ageing in Botswana: who provides care and under what conditions?
To answer this question, The Wellcome Trust funded The Family Caregiving Programme’s latest research report. It draws on interviews with 78 caregivers and 80 older people across 80 family units in four locations in the Greater Gaborone region, spanning two rural areas, one peri-urban settlement and one urban site. Approximately 20% of older people in Botswana live in these four areas.
The Family Caregiving Programme is the first major research programme dedicated to understanding family care of older persons in southern Africa. As part of this programme, the research team examines how family care operates in practice and how it can be more effectively supported. The five-year programme seeks to deepen understanding of the lived experiences of family care across South Africa, Malawi, Namibia and Botswana.
Our central finding is stark. Family care for older persons in Botswana is increasingly fragile. Caregivers, mainly adult daughters, face rising responsibilities amid resource scarcity (water, food, employment), shrinking support networks shaped by the long shadow of the HIV/Aids epidemic, and limited state assistance beyond pensions. In essence, caregivers are being asked to do more with fewer resources.
Botswana continues to face a very high burden of human immunodeficiency virus (HIV). In 2021, adult prevalence was 21%, with implications for long-term care needs, household vulnerability, and pressure on health and care systems.
As a dryland country, Botswana is highly exposed to climate change. The country’s heavy reliance on rainfall for water supply and agricultural production intensifies drought risk, placing growing pressure on elder-care systems as households and communities face rising care needs alongside constrained resources.
In the aftermath of HIV/Aids, care responsibilities are often concentrated among one or two relatives. This concentration underscores both the fragility of family-based systems and the absence of formal long-term care alternatives. Alternative long-term care support structures could include expanding existing home-based care services, which are already in operation but remain limited in reach. They could also involve increasing financial support for community programmes and organisations that provide care and related assistance to older persons and their families.
A higher cash transfer does not build community-based services, expand home-based care, fund respite support, or strengthen health and long-term care systems. Nor does it reduce the unpaid care that sustains frail older people.
Botswana is ageing
Botswana’s population aged 60 and over now stands at approximately 279,111 (Census 2022). Approximately 8% of people in Botswana are 60 years or older. Sixty percent of older people are women. Around one older person in three is visually impaired, and one in five lives with leg impairments.
Despite rising longevity, Botswana has no stand-alone national policy for older people or their family carers. Responsibility remains fragmented across ministries, and at the time of writing, the long-awaited Older Persons Policy was awaiting approval by cabinet.
A pension increase is popular, necessary and politically powerful. However, it can also be used to signal progress while postponing the more complex and costly work of building care infrastructure. What our research reveals is the absence of a broader care strategy.
Consider the disability allowance. Of the 80 older people in our sample, 32 had mobility limitations; seven were bedbound or used a wheelchair; 22 relied on walking aids and could not walk long distances. Thirty participants had poor vision and could not walk unassisted. Yet not a single person in our sample received the disability allowance. The findings reveal significant assessment challenges and complex application procedures related to the disability cash allowance.
Nationally, only about 8% of older people access this allowance. Given that more than one-third of our sample could not perform at least one vital activity of daily living, the near absence of disability allowance receipt signals systemic failure, from assessment practices to administrative processes and frontline support.
Water shortage
Care needs extend well beyond clinical health. They include access to water, food, transport and medical services. Where infrastructure fails, care demands intensify.
Building on our earlier report, Older Persons and Community Care in Botswana, which found that over 20% of older people rely on public taps or rivers for water and 18% have no toilet facilities, we documented how daily life is shaped by the relentless effort to secure water. Water scarcity increases not only health risks, but also the workload, financial pressure and emotional strain on caregivers.
Households reported chronic shortages, frequent disconnections and unaffordable bills. Some spent as much as P800 (about US$60.50) per month buying water, between 5% and 13% of household budgets, particularly high in homes caring for frail or disabled people. Hygiene, hydration and additional washing are non-negotiable in care. As one participant told us: “Without water, everything becomes difficult.”
Infrastructure, then, is not peripheral, it is in fact care policy. Water shortages are linked to ageing infrastructure, insufficient supply and environmental pressures. While upgrades are underway, they have yet to ease the daily load.
The findings are clear: family care requires far more than income. Cash transfers matter. But they do not bathe a frail body, queue at a clinic, fetch water or sit through the night with someone in pain.
The way forward
If Botswana is serious about building a long-term care system, the starting points are practical:
simpler access to the disability allowance, putting people who need high care first
targeted food support programmes
affordable, subsidised and reliable water supply
community-based or subsidised transport to healthcare and essential services.
Caregivers themselves require recognition: stipends, psychosocial support and respite care would reduce the financial, physical and emotional load that’s invisible in policy. Home-based care services and day centres must be expanded to relieve pressure on households.
Most importantly, ageing policy cannot sit in isolation. Health, social protection, water, housing and transport must be aligned.
Otherwise families, and particularly women, will continue to subsidise the state through unpaid labour. Income is necessary. But care requires systems.
