Burundi's healthcare system

Burundi’s health care system is organized in a pyramid structure with four levels: central, intermediate, local and community. There is a hierarchical operational relationship between the four levels. The central level also includes the coordinating bodies of the country’s malaria control partners. 

Organizational and institutional level 

The National Malaria Control Programme is part of the central level and reports directly to the Directorate of Health Projects and Programs. The intermediate level comprises 18 provincial health offices, which coordinate the implementation of health interventions for all disease control programs, including malaria, tuberculosis (TB) and HIV. 

Organization of care 

The 47 health districts are responsible for coordinating and supervising health care facilities (109 hospitals and 1,120 health centres). A malaria focal point has been designated within the district management team. 

Challenges 

The health system is facing several challenges across the board:  

• controlling malaria to reduce malaria morbidity and mortality;  
• ending the AIDS epidemic with zero new HIV infections;  
• zero discrimination;  
• zero AIDS-related deaths;  
• eradicating TB to reduce morbidity and mortality;  
• controlling maternal, newborn and infant and child mortality;  
• reducing malnutrition to WHO thresholds;  
• ensuring the existence of an adequately strengthened national health system;  
• which is dynamic and resilient in the event of external shocks;  
• providing access for young people aged 20– 24 years to sexual and reproductive health information and services; and  
• ensuring protection for young people from sexual and other forms of gender-based violence, among others. 

Obstacles relating to the provision and optimal use of health care services, such as the quality of technical facilities and the availability of qualified personnel, equipment and high-quality drugs, mean that the major challenge lies in the quality of service delivery, which remains inadequate at all levels of the health care pyramid.  

Another bottleneck is the uncertainty of funding, its management and execution, all of which determine the current ability of health care facilities to function satisfactorily. 

The gaps in the coverage of health care services are greater for human resources, with 1 nurse for every 1,380 inhabitants (WHO standard: 1 nurse per 3,000 inhabitants), and 0.6 doctors per 10,000 inhabitants (WHO standard: 1 doctor per 10,000 inhabitants).  

The network of health care facilities is good in relation to WHO standards, with 1.02 health centers per 10,000 inhabitants (WHO standard: 1 per 10,000 inhabitants) and 0.79 hospitals per 100,000 inhabitants (WHO standard: 1 per 100,000 inhabitants).  

Geographic access to health services is relatively good, with more than 80 percent of the population having access to a health care facility within a radius of less than 5 km and free care for pregnant women and children under 5 years of age (Annex 23: p. 25 and 28). 

Private sector 

Public-private partnerships are limited in Burundi, although the private sector is actively involved in the provision of treatment services. In terms of malaria case management, the NMCP has authorized the health districts to provide private health care facilities with malaria control supplies in return for reporting in DHIS 2 and compliance with the policy of free malaria diagnosis and treatment.  

Since 2018, however, only 10 of the 367 private health care facilities have agreed to enter into contracts with the health districts that cover their area. Moreover, all private health care facilities are included in the various refresher training sessions provided on the malaria management guidelines and they are always targeted in the various supervision sessions conducted by the NMCP at the local level.  

Private health care facilities are mainly located in urban centers and tend to provide treatment rather than preventive or promotional services.