Health and Development in Burundi
Extract from WHO (2006). Country Cooperation Strategy at a glance. Burundi


The political crisis and violence that Burundi has experienced since 1993 has resulted in the reduction by almost 50% of its gross domestic product (GDP) and the increase of the proportion of Burundians living with less than US$ 1 per day to 67% according to 2002 estimates. Political instability, insecurity, violence, and population movements have affected national production and worsened food security, and decreased access to, and availability and use of, basic services (health, education and drinking water). All these factors have significantly aggravated the vulnerability of the population, in particular that of children, who have an acute malnutrition prevalence of 6 to17.8%. Gross mortality rate, which oscillates between 1.2 and 1.9 per 10 000 inhabitants/day among adults, and 2.2 to 4.9 per 10 000 inhabitants/day among children under five, is higher than is generally observed in complex emergency situations (2004).

Malaria is the main cause of morbidity and mortality, being responsible for 40% of consultations in health centres and 47% of in-patient deaths. Epidemics are common in the high plateaus of Burundi. Respiratory infections are the second cause of morbidity and mortality among children under five and represent 15% of deaths registered at health care facilities. Epidemic diseases such as cholera and meningitis are continuous threats in the lowlands bordering Lake Tanganyika. Despite steady improvements in early detection of and rapid response to epidemics, inadequate infrastructure and basic services leave the population vulnerable to future epidemics.

HIV/AIDS prevalence was estimated at 3.6% in 2003 and more than 6% in the 15-44 age group, with rates above 10% in urban and periurban areas. The number of persons living with HIV/AIDS (PLWHA) is estimated at 250 000, of which 66% are women and 60 000 are children. Strong national commitment and coordinated support from financial and technical partners have helped mobilize resources towards the implementation of the 2002-2006 National Strategic Plan and its action plan for universal access to antiretroviral therapy (ART), which was developed in 2004. All these efforts have yielded positive outcomes: the number of PLWHA under ART has tripled in one year and increased close to 6-fold in two years (4000 in December 2004, 6416 in December 2005).

Increased burden of maternal and neonatal morbidity and mortality is due to the low rate (20%) of deliveries assisted by qualified staff and the even lower access to emergency obstetrical care, as well as the total fertility rate (6.8%) and low contraceptive prevalence.

An essential primary health package and adequate reference care in hospitals are lacking. These constraints are more critical than the number of health facilities (health centres and hospitals) in limiting access to and use of health care services. When services are available, financial constraints limit access for the poorest section of the population. Deficiencies of the health system parallel the serious shortage of qualified staff (1 doctor per 34 744 inhabitants and almost no specialists in the hinterland): inadequate logistics, insufficient public funding (5 purchasing power parities (PPPs) per inhabitant per year in 1997 and 1998, of which 1.5 from Government funds and 3.5 from donors, out of total health expenditure estimated at 12 PPPs), high share of funding borne by households while existing social insurance mechanisms cover less than 10% of the population.