BACKGROUND: The increasing burden of non-communicable diseases (NCDs) in sub-Saharan Africa is causing a further burden on healthcare systems that are least equipped to deal with the challenge. In Botswana, NCDs accounted for 38% of deaths in 2021. Despite this high economic, social, and human burden of NCDs, interrogation of the problem and policy responses in Botswana and sub-Saharan Africa more generally have been limited. Much of the literature from Botswana focuses on developing a successful HIV/AIDS policy, but this has not been used to inform the examination of NCD policy development. This thesis describes the NCD policy development process in Botswana. It examines the experiences of translating the 2011 UNGASS political declaration to national policies for the prevention and control of NCDs, the extent to which WHO "best buy" interventions for NCD prevention have been implemented, and the role of actors in shaping and constraining NCD policy development and implementation. METHODS: The study employed a qualitative case study design. A policy framework developed by Shiffman and Smith, which considers actor power, ideas framing the problem, political contexts, and issue characteristics, guided data collection and analysis. First, a review of literature and policy documents relevant to NCD responses in sub=Saharan Africa and Botswana was undertaken to determine the mandated policies, the agenda-setting, and planning, as stated in key documents. Twenty-eight semi-structured interviews were conducted with key national-level informants who were decision makers in various sectors, including the government authorities, civil society, industry (private sector), and UN agencies. The key informants’ narratives revealed the processes of formulating government-led NCD policies and their knowledge, insights, and experiences regarding the current state of policy development and implementation. Data were coded and analysed thematically, guided by, but not limited to, the Shiffman and Smith analysis framework. RESULTS: The NCDs prevention policy development process in the country is influenced by both global and local factors. The overarching issues emerging from the study are that while political will is considered to be important for NCD programme implementation, there are divergent views among the stakeholders interviewed on the extent to which political will is actually exercised in the response to NCDs and NCD risk factors, compared to the response to HIV/AIDS. Although the National Strategic Framework was developed to integrate NCD responses into health service delivery, it has not led to adequate resources and capacity to enable its implementation. There are also a lack of incentives and interest by the actors involved, both at the national and sub-national levels, to implement an effective NCD response. The study findings also indicate that there is fragmented leadership and a lack of coordination by guiding institutions to translate policy into action. The study also found parallel activities by non-government actors and fragmentation between national bodies, which in turn lead to disconnection between national and sub-national implementing structures. These fragmented responsibilities led to structural problems hampering the NCD response. The study also finds that the alcohol industry and medical aid insurance schemes are mostly profit-oriented, and their commitment to addressing NCDs is often tokenistic. Similarly, the youth and their organisations do not think NCDs relate to them. Civil society is also ineffective because civil society organizations are merely implementing agencies who rely on donor funding, but no such funding is forthcoming for NCD activities. Moreover, they are not driven by their own goals or vision on NCDs and do not have a strong presence or power to influence policy development or implementation processes. CONCLUSION: The findings of this thesis illustrate various challenges in bringing sectors together to develop and implement the National Strategic Framework on NCDs to address the increasing NCD burden and risk factors. Unlike the response to HIV/AIDS in Botswana, which had a lot of political support and funding, the situation with the NCD response is markedly different. Stronger coordination mechanisms with clear guidelines for sector engagement are required for the effective implementation of NCD policies and programmes, drawing on the lessons from the HIV/AIDS strategies and programming. The health sector alone cannot achieve successful prevention and control of NCD epidemics. A wide range of organizations from multiple sectors and across government must be involved in implementing the necessary action on NCDs. The legacy of reliance on external funds and dependency culture created by the response to HIV/AIDS needs to be overcome, with leading institutions ensuring that NCD policies become an integral part of the health system of Botswana. KEY WORDS: Non-communicable diseases, policy, health systems, Botswana, Africa.