The health sector is largely financed by international organizations. But the Burundian state wants to try to take matters into its own hands by mobilizing domestic financing.
The ideal is that 15% of the general state budget should be channeled towards the health sector.
The high-level dialogue on health financing in Burundi was organized from February 12 to 14, 2024 in Bujumbura. This initiative was set up by the government of Burundi (through various institutions including the ministry in charge of health) in collaboration with several international and regional organizations including the East African Community (EAC). This process is part of Agenda 2063 which highlights Africa’s 50-year development plan and gives priority to the mobilization of domestic resources as the main sources of financing for the structural transformation of the continent.
The overall objective of the said dialogue is to mobilize national and international stakeholders to evaluate and review health financing strategies in Burundi. It is also necessary to assess progress, challenges and reach consensus on technically viable and politically feasible health financing reform priorities or actions.
“More money for health”, where is Burundi?
“More money for health” is one of the four themes around which the dialogue revolved. Various speakers showed that the state budget has increased over the years, but that the proportion allocated to health has not followed the same trend. The ideal is that 15% of the general state budget should be channeled towards the health sector. Unfortunately, it is not the case. As an illustration, for the 2021-2022 budget year, the sum injected into health was 228.8 billion FBu out of a national budget of 1.71 thousand billion FBu, or 13.35%. For the 2022-2023 budget year, the national budget amounted to 2.39 trillion FBu, but the share reserved for health was only 228.7 billion FBu. For the current budget year (2023-2024), the envelope allocated to health is 337.4 billion FBu compared to 3.39 thousand billion FBu of the national budget, or 9.94%.
On the one hand, this is explained by the fact that advocacy (not very sustained) fails to show the importance of substantial funding for the health sector as a growth-producing sector. On the other hand, there is a pretext based on the availability of external financing for health through development partners. For example, here is the rate at which certain health programs are financed externally. The program around the fight against malaria is financed to the tune of 77.8%; HIV-AIDS and STIs (92%), tuberculosis (85%), vaccination (90%), diarrhea (57.37%) and malnutrition (93.14%).
“More health for the money available”
This is the second of the four themes developed. Although the envelope allocated to the health sector is not sufficient, the little available is not managed effectively. Inequity characterizes the allocation of funds without forgetting the duplication of interventions. Failure to respect the patient’s circuit was also mentioned. Added to this is the poor quality of care. Another problem to take seriously is the instability of the nursing staff. It’s no longer a secret, because of the low salaries of doctors, some of them prefer to leave public healthcare structures to work in the private sector or even abroad where the grass is still green. This is not without consequences for the care of patients.
Promising recommendations
At the end of the three days of the above-mentioned dialogue, recommendations were made to the State so that it could improve the health sector. First, it is better to increase the proportion of the state budget allocated to health to reach at least 15% of the national budget. The introduction of new taxes to finance health is also mentioned. It is also necessary to establish compulsory, contributory and equitable health insurance. It is necessary to establish a medical assistance fund to improve equity in access to care.
In addition to this, it is necessary to put in place mechanisms to motivate and retain health personnel. The list of recommendations is not exhaustive.
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