Strengthening health care structures in Burundi

Context

Burundi has a population density of 437 people per square kilometre and is experiencing continuously high population growth. This is putting increasing pressure on the country’s natural and economic resources. In 2018, the average birth rate was 5.5 children per woman – one of the highest birth rates in the world. Barely 23 per cent of the population use modern methods of contraception and family planning. The school and health care systems are struggling to cope with the population growth.

More than half of the population is younger than 18. Gender-based violence against women and girls is widespread. Socio-cultural factors prevent Burundi from taking a positive approach to topics such as sex education and family planning. In view of this situation, the Burundian Government has expressed its intention to curtail population growth and to promote sexual and reproductive health, and has declared both issues to be national priorities. It also aims to promote respect for the associated rights.

Objective

The quality of the services available relating to sexual and reproductive health and rights (SRHR) has been improved in the provinces of Mwaro, Muramvya and Gitega.

Approach

The project is guided by the country’s National Development Plan and supports the implementation of the strategic plan of the National Programme for Reproductive Health. It operates in the provinces of Mwaro, Muramvya and Gitega and comprises two fields of action:

• Strengthening the capacities of health districts and health centres to implement tailored quality management
  The project plans and implements a quality competition in which health centres can participate. Quality assistants of the health districts support the health centres in using their resources to achieve improved quality. Personnel in the health centres play a central role in the change process. The staff members use questionnaires to evaluate the quality of their own services, particularly those relating to family planning, sexually transmitted diseases, sexual violence and sex education, including sex education for adolescents and young adults. They work together to develop an improvement plan and to monitor the implementation of this plan. A jury will select the winners of this competition. The overall process is being supported by project experts. The intention is to transfer methods and guidelines from the quality competition to the health districts.
• Creating awareness of SRHR among young people through networks that encompass civil society, various sectors (educational institutions, municipalities, churches/communities, state family centres) and religious faiths
  The project supports a total of 29 networks that have been established within the areas served by the health centres. Alongside the health centres and municipalities, schools, family centres, non-governmental organisations and religious leaders are represented in these networks. Thanks to the work of these networks, young and vulnerable people in particular are being educated on the issues of SRHR, family planning, sexually transmitted diseases, and sexual and gender-based violence. An association for young single mothers was also founded, through which they can provide support for one another and, as equals, can help to educate other young women and girls. In addition, the project supports dialogue between religious leaders, as well as dialogue with the health centres.

Results

Since 2013 the number of people using modern contraceptives in the three provinces in the project area has risen from 59,738 in 2015 to 64,991 in 2017 (sources: PNSR, 2016; PNSR, 2018).

So far, 68 health centres have participated voluntarily in the quality competition. These centres have, for instance, improved their waiting rooms and reduced waiting periods. They have paid increasing attention to confidentiality standards (particularly for young people). Hygiene in the centres has also been improved. The issue of family planning has been incorporated into medical treatment, nutritional advice and vaccinations. Better skills among quality assistants have strengthened the implementation of the quality management approach by the districts.

Since the start of the project, 29 local networks have been created that work on educating on SRHR issues in particular for young people. Over 230 stakeholders are active in these networks, including municipalities, health centres, youth groups, churches and 114 schools. The work of these networks has reached out to 82,152 young people. Dialogue on demographic issues has also been initiated between religious leaders and health care personnel. Information events on reproductive health have been held for the first time at 30 denominational schools.