Devpro Resource Centre
Government’s commitment to maternal and child health care in Burundi
|© UNICEF Burundi/2007/Marie-Andrée Robert|
|A mother and her daughter at the Therapeutic Nutritional Centre in Ruyigi.|
Context and challenge: Reeling from the aftermath of conflict and a health plan that placed the burden of costs on the patient
Burundi, a landlocked country sharing borders with Tanzania, Rwanda and the Democratic Republic of the Congo, is one of the world’s least developed countries. Protracted civil war and halting political restructuring have stymied economic and social progress there. Poverty rates are soaring, with nearly 88 per cent of Burundians living on just US$2 a day. Undernutrition affects 66 per cent of the population, and more than half of the country’s children under age five suffer from moderate or severe stunting. According to the latest international estimates, the neonatal mortality rate was 41 per 1,000 live births, and women faced a lifetime maternal death risk of 1 in 16.
Grappling with the fact that only a small part of the national budget is allocated to health care, the Government implemented a cost-recovery programme in February of 2002 that required patients to pay for medical consultations, tests and drugs. The initiative aimed to generate resources for a nascent health-care system and was implemented in 12 of 17 rural provinces, covering 5 million of the country’s 8.5 million inhabitants. The result was dismal given that the population was already suffering the aftermath of conflict; the programme’s introduction led to an increase in the number of patients who were unable to pay for the medical services they received in public hospitals, and many of them were subject to detention in the facilities. Women who had delivered by Caesarean section accounted for an estimated 35 per cent of indigent hospital patients according to a 2006 Human Rights Watch report on patient detentions; 10 per cent of the indigent patients in the study were children. In addition to the burdensome expenses, health-care services for women and children were often of poor quality.
|© UNICEF Burundi/2008/Marie Andrée Robert|
|A young mother receives a dose of vitamin A at Buyenzi Community Health Centre in Bujumbura.|
Action: Prioritizing free health care for pregnant women and children
The Burundi experiment of funding the health system by increasing the burden of costs to the patient was unsuccessful. This is not surprising given the burden that the populace in a post-conflict country already has to bear. The current Government, led by President Nkurunziza, has begun to take a new approach in tackling the country’s health-care dilemma, which is aimed at protecting the health of poor women and children.
In 2005, when Burundi joined the Heavily Indebted Poor Countries Initiative of the International Monetary Fund-World Bank, it received an interim debt relief in 2005 and its health budget was tripled. In 2006, the Government took the critical step of announcing free health care for pregnant women and children. A new policy, Road Map for the Reduction of Neonatal and Maternal Mortality, was drawn up and launched that same year with the assistance of the United Nations Population Fund, the World Health Organization, the World Food Programme and UNICEF.
Another important step was taken in 2007, when Burundi became one of eight countries to join the International Health Partnership, a country-led and outcome-driven collaboration among governments, international organizations and non-governmental organizations. A major objective of this partnership is to identify a set of key goals, which include raising the number of institutional deliveries and increasing services to prevent mother-to-child transmission of HIV. Burundi’s National Reproductive Health Policy now includes newborn care as a critical strategy in reducing child mortality together with scaling up services to prevent mother-to-child transmission of HIV. The median HIV-infection prevalence rate for young pregnant women aged 15–24 in Bujumbura, the capital city, stands at 8.6 per cent. The country has also embarked on providing much-needed basic health care that will positively affect women and children. Immunization programmes have provided tetanus toxoid vaccines to nearly three quarters of the women in seven high-risk districts.
|© UNICEF Burundi/2008/Marie-Andrée Robert|
|A woman, five months pregnant, undergoes voluntary testing for HIV.|
Impact: A step towards progressively realizing the right to health for mothers and children in Burundi
While it is still early to gauge the impact of the Road Map for the Reduction of Neonatal and Maternal Mortality and the International Health Partnership initiative, it is certain that these efforts have galvanized stakeholders at national and local levels. Also, the Government’s decision to remove health-care costs for pregnant women and children marks a progressive step in realizing the right to health.
Opportunities: Sustainability of Roadmap for the Reduction of Neonatal and Maternal Mortality will be a key concern
Sustained governmental prioritization of health care for the poor will be necessary to ensure the continued support of international and grass-roots actors in building Burundi’s health infrastructure. Future programmes may focus on the prevention of HIV transmission and securing greater male support for prevention of mother-to-child transmission strategies.
To learn more
Human Rights Watch, ‘A High Price to Pay: Detention of poor patients in hospitals’, Human Rights Watch, vol. 18, no. 8(A), September 2006. | access report
International Health Partnership, ‘Scaling-Up for Better Health (IHP+) Update’, November 2007. | PDF English
Philips, Mit et al., ‘Burundi: A population deprived of basic health care’, British Journal of General Practice, vol. 54, no. 505, August 2004.
UNICEF Burundi | website