Burundi

Start: 2006
Phase: Started in 2006 in 3 provinces – gradually expanded to national scale in April 2010
Coverage Estimate: 100%
Feasibility: Good with some caveats
Supported by: MOF/MOH; WB; EC; CTB/BTC; Cordaid; GAVI; Bilateral partners

Description:

Burundi was the second country in Africa after Rwanda that rolled out PBF countrywide in 2010. After pilots were conducted in 11 of the 17 provinces in Burundi since 2005 by CORDAID and other partners, PBF was scaled up to the national level in 2010. This was the beginning of a phase of strong national ownership characterized by the integration of PBF into the national health policy, a mix of PBF and free health care indicators for children under 5 and pregnant women. Currently, 50% of the PBF budget is financed by the State through a budget line dedicated to PBF and the national PBF Unit mobilizes the remaining external resources from several partners. Several studies showed favorable results.

External monitoring missions for the implementation of the PBF (the MOH, World Bank, EU, different bilateral cooperation’s) were conducted in 2012 and in 2014. After the deterioration of the political context, these missions discontinued after 2014. The gaps and weaknesses identified in the scaling up and for which corrective actions are necessary remained unanswered. Problems in the design remain such as the rigidity of the user fee setting, the absence of quality improvement bonuses and the absence of the PBF equity indicators as well as that public and private providers are not treated equally.

Reference:

Bonfrer, I., Soeters, R., Van de Poel, E., Basenya, O., Longin, G., van de Looij, F. (2014). Introduction of Performance-based financing in Burundi associated with improvements in care and quality. Health Affairs.

Bonfrer, I, Van de Poel E, Van Doorslaer, E The effects of performance incentives on the utilization and quality of maternal and child care in Burundi. Social Science & Medicine 123 (2014) 96-104.

Falisse, JB, Ndayishimiye, J, Kamenyero, V, Bossuyt, M Performance-based financing in the context of selective free health-care: an evaluation of its effects on the use of primary health-care services in Burundi using routine data. Health Policy and Planning 2014; 1–10

Bertone, M. P. and B. Meessen (2010). “Splitting Functions in a Local Health System: Early Lessons From Bubanza and Ngozi Projects in Burundi.” The Hague, Cordaid.

Falisse, J.-B., B. Meessen, et al. (2012). “Community participation and voice mechanisms under performance-based financing schemes in Burundi.” Tropical Medicine and International Health (in press)((in print)).

Nimpagaritse, M. and M. P. Bertone (2011). “The sudden removal of user fees: the perspective of a frontline manager in Burundi.” Health Policy and Planning 26 (Supplement 2): 63-71.

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