Financial access to health care in Karuzi, Burundi: a household-survey based performance evaluation

Abstract

Background: In 2003, Médecins Sans Frontières, the provincial government, and the provincial health authority began a community project to guarantee financial access to primary health care in Karuzi province, Burundi. The project used a community-based assessment to provide exemption cards for indigent households and a reduced flat fee for consultations for all other households.

Joint effect of water and sanitation practices on childhood diarrhoea in sub-Saharan Africa

“…Scholars [ 15 , 16 ] contend that the lack of access to clean and safe water, limited access to health care, poor sanitation facilities, and undernutrition account for the high incidence of diarrhoea among under-five children. Even though access to health facilities seems to be adequate in Burundi, about 61% of the population cannot afford health care costs [ 17 ]. According to OConnell et al [ 15 ], an increased risk of diarrhoea among children under five is associated with unimproved sanitation, younger mothers, and mothers with sub-tertiary education levels.…”

Joint effect of water and sanitation practices on childhood diarrhoea in sub-Saharan Africa

“…Scholars [ 15 , 16 ] contend that the lack of access to clean and safe water, limited access to health care, poor sanitation facilities, and undernutrition account for the high incidence of diarrhoea among under-five children. Even though access to health facilities seems to be adequate in Burundi, about 61% of the population cannot afford health care costs [ 17 ]. According to OConnell et al [ 15 ], an increased risk of diarrhoea among children under five is associated with unimproved sanitation, younger mothers, and mothers with sub-tertiary education levels.…”

Economic burden of childhood diarrhea in Burundi

“…In addition, there is unequal distribution of health professionals; most qualified health professionals are found in urban areas, while most Burundians stay in rural areas [ 7 ]. Furthermore, around 61% of Burundians are unable to pay health care fees with their usual income; they require additional sources of funding, such as working additional jobs or selling a part of their properties, or they could go into debt [ 46 ]. These factors could inhibit the promptness of treatment of diarrhea, which is a key factor to reduce cost.…”

A Comparison of Health Achievements in Rwanda and Burundi

“…32 Furthermore, a lack of coordination among programs possibly led to reduced gains in health-system performance due to conflicting priorities of the various actors. In conclusion, while the Rwandan government acted in a stewardship role, set policy, and directed international part- 33 Nurse mentorship and supervision program (2012) 34 Community health worker training and implementation to improve access to care (2007) 35 Launch of Burundi Health Workforce Observatory (2012) 36 Health service delivery Nationwide distribution of insecticide-treated bed nets to prevent malaria transmission (2005-2006) 37 Decentralization of health care decision making (2009) 38 Renovations of facilities through nonprofit and international partners (2009-2012) 39 Increased coverage of HIV and prevention of motherto-child transmission services nationwide (2009-2012) 40 Decentralization of health care decision making (2009) 41 Increased coverage of HIV and prevention of motherto-child services nationwide (2015) 42 Ambulance referral network (2011) 43 Health information systems Implementation of nationwide health information system (2005) Trainings for data managers and data officers (2006) 44 Routine reporting and data quality assessments (2008-2012) 45 Emphasis on research training for health professionals (2012) 46 Rapid mobile messaging for community health workers to report vital events (2010) 47 Early infant diagnosis via mobile phone (2008) 48 Implementation of health management information systems (2008) 49 Global Alliance for Vaccines and Immunization (GAVI) strengthens vaccine delivery and monitoring (2009) 50 Health financing Mutuelles de Santé community-based insurance (1999) 51 Performance-based financing incentives for health professionals (2005) 52 Abolition of user fees for delivery services and underfive care (2006) 53 Performance-based financing incentives for health professionals (2010) 54 Flat-fee program to decrease poverty (2003) 55 Increased public funding for reproductive health (2010) 56…”

Joint effect of water and sanitation practices on childhood diarrhoea in sub-Saharan Africa

“…Scholars [ 15 , 16 ] contend that the lack of access to clean and safe water, limited access to health care, poor sanitation facilities, and undernutrition account for the high incidence of diarrhoea among under-five children. Even though access to health facilities seems to be adequate in Burundi, about 61% of the population cannot afford health care costs [ 17 ]. According to OConnell et al [ 15 ], an increased risk of diarrhoea among children under five is associated with unimproved sanitation, younger mothers, and mothers with sub-tertiary education levels.…”

Economic burden of childhood diarrhea in Burundi

“…In addition, there is unequal distribution of health professionals; most qualified health professionals are found in urban areas, while most Burundians stay in rural areas [ 7 ]. Furthermore, around 61% of Burundians are unable to pay health care fees with their usual income; they require additional sources of funding, such as working additional jobs or selling a part of their properties, or they could go into debt [ 46 ]. These factors could inhibit the promptness of treatment of diarrhea, which is a key factor to reduce cost.…”

A Comparison of Health Achievements in Rwanda and Burundi

“…32 Furthermore, a lack of coordination among programs possibly led to reduced gains in health-system performance due to conflicting priorities of the various actors. In conclusion, while the Rwandan government acted in a stewardship role, set policy, and directed international part- 33 Nurse mentorship and supervision program (2012) 34 Community health worker training and implementation to improve access to care (2007) 35 Launch of Burundi Health Workforce Observatory (2012) 36 Health service delivery Nationwide distribution of insecticide-treated bed nets to prevent malaria transmission (2005-2006) 37 Decentralization of health care decision making (2009) 38 Renovations of facilities through nonprofit and international partners (2009-2012) 39 Increased coverage of HIV and prevention of motherto-child transmission services nationwide (2009-2012) 40 Decentralization of health care decision making (2009) 41 Increased coverage of HIV and prevention of motherto-child services nationwide (2015) 42 Ambulance referral network (2011) 43 Health information systems Implementation of nationwide health information system (2005) Trainings for data managers and data officers (2006) 44 Routine reporting and data quality assessments (2008-2012) 45 Emphasis on research training for health professionals (2012) 46 Rapid mobile messaging for community health workers to report vital events (2010) 47 Early infant diagnosis via mobile phone (2008) 48 Implementation of health management information systems (2008) 49 Global Alliance for Vaccines and Immunization (GAVI) strengthens vaccine delivery and monitoring (2009) 50 Health financing Mutuelles de Santé community-based insurance (1999) 51 Performance-based financing incentives for health professionals (2005) 52 Abolition of user fees for delivery services and underfive care (2006) 53 Performance-based financing incentives for health professionals (2010) 54 Flat-fee program to decrease poverty (2003) 55 Increased public funding for reproductive health (2010) 56…”

Joint effect of water and sanitation practices on childhood diarrhoea in sub-Saharan Africa

“…Scholars [ 15 , 16 ] contend that the lack of access to clean and safe water, limited access to health care, poor sanitation facilities, and undernutrition account for the high incidence of diarrhoea among under-five children. Even though access to health facilities seems to be adequate in Burundi, about 61% of the population cannot afford health care costs [ 17 ]. According to OConnell et al [ 15 ], an increased risk of diarrhoea among children under five is associated with unimproved sanitation, younger mothers, and mothers with sub-tertiary education levels.…”

Economic burden of childhood diarrhea in Burundi

“…In addition, there is unequal distribution of health professionals; most qualified health professionals are found in urban areas, while most Burundians stay in rural areas [ 7 ]. Furthermore, around 61% of Burundians are unable to pay health care fees with their usual income; they require additional sources of funding, such as working additional jobs or selling a part of their properties, or they could go into debt [ 46 ]. These factors could inhibit the promptness of treatment of diarrhea, which is a key factor to reduce cost.…”

A Comparison of Health Achievements in Rwanda and Burundi

“…32 Furthermore, a lack of coordination among programs possibly led to reduced gains in health-system performance due to conflicting priorities of the various actors. In conclusion, while the Rwandan government acted in a stewardship role, set policy, and directed international part- 33 Nurse mentorship and supervision program (2012) 34 Community health worker training and implementation to improve access to care (2007) 35 Launch of Burundi Health Workforce Observatory (2012) 36 Health service delivery Nationwide distribution of insecticide-treated bed nets to prevent malaria transmission (2005-2006) 37 Decentralization of health care decision making (2009) 38 Renovations of facilities through nonprofit and international partners (2009-2012) 39 Increased coverage of HIV and prevention of motherto-child transmission services nationwide (2009-2012) 40 Decentralization of health care decision making (2009) 41 Increased coverage of HIV and prevention of motherto-child services nationwide (2015) 42 Ambulance referral network (2011) 43 Health information systems Implementation of nationwide health information system (2005) Trainings for data managers and data officers (2006) 44 Routine reporting and data quality assessments (2008-2012) 45 Emphasis on research training for health professionals (2012) 46 Rapid mobile messaging for community health workers to report vital events (2010) 47 Early infant diagnosis via mobile phone (2008) 48 Implementation of health management information systems (2008) 49 Global Alliance for Vaccines and Immunization (GAVI) strengthens vaccine delivery and monitoring (2009) 50 Health financing Mutuelles de Santé community-based insurance (1999) 51 Performance-based financing incentives for health professionals (2005) 52 Abolition of user fees for delivery services and underfive care (2006) 53 Performance-based financing incentives for health professionals (2010) 54 Flat-fee program to decrease poverty (2003) 55 Increased public funding for reproductive health (2010) 56…”